Long before Merle Hoffman found her niche as a provider of reproductive health care, she sought to be extraordinary. The question was how she would do it.
Her first brush with fame came as a pre-teen concert pianist, a vocation she ultimately found isolating. A brief stint as a career counselor when she was barely out of high school was followed by a job as a medical assistant in Queens, New York.
It was there, serendipitously, that Hoffman made her first foray into the field that would subsequently define her public persona.
Hoffman's boss, Dr. Martin Gold, was a well-established - and married - internist, 28 years her senior, and suave. "Dr. Gold was the sage, the counselor, the healer," she writes in "Intimate Wars." At the end of every workday, the pair would talk, first about their patients and then about politics, philosophy and the arts. Although Hoffman credits Gold with being a good listener, she acknowledges that she was a receptive audience for his stories, whether about his wartime medical service or his residency at Manhattan's Bellevue Hospital. She found Gold's descriptions of women who were admitted because of self-induced abortions horrifying, she writes, and she never forgot the desperation he detailed.
By the late 1960s, Gold and Hoffman had become romantically entangled, and she was enrolled in college. But despite the swirl of campus activism, she remained aloof, consumed by her classes, her work and her relationship with Gold.
Gold, however, was fully grounded in the era's shifting political mores, and when New York state legalized abortion in 1970, he saw the shift as a sound business opportunity. As the cofounder of the Health Insurance Plan of Greater New York (HIP), the first not-for-profit health maintenance organization (HMO) on the east coast, Gold and a colleague approached HIP's board of directors and proposed to offer abortion services for their subscribers. According to Hoffman, some members of the board bristled at the suggestion but agreed to a compromise: HIP would establish a separate, ambulatory medical office where abortion would be offered. A year later, in 1971, Flushing Women's Medical Center - later renamed Choices Women's Medical Center - opened its doors. "Having left my childhood behind, and longing for a great stage to act upon, I was ready to throw myself into creating new worlds," Hoffman writes in "Intimate Wars." "Now was the time - this was my hour."
At that point, she continues, "feminism was in the air." Nonetheless, Flushing Women's Medical Center was not established on feminist principles. Still, as Hoffman immersed herself in the Center, her conversations with patients taught her about the huge role forced pregnancy plays in women's oppression.
In addition, her hands-on training included lessons in dealing with urban bureaucrats. "After a few months, the New York City Department of Health, which had jurisdiction over all abortion providers in the City, sent in surveyors to review our facilities and practices. Our clinic was relatively small," Hoffman reports. "We were only seeing five or six patients per week and charging $77 per procedure, but with so many patients traveling from out of state to have abortions, New York took extra care to inspect every single facility. Flushing Women's was sterile and safe, but the inspectors took note of our meager 600 square feet of space. I watched their faces tighten when they noticed the cots in the hallways."
The inspection resulted in the City shuttering the Center; four months later, it re-opened in larger quarters with Hoffman at the helm. "I was in charge of a staff that included a front desk receptionist, two counselors, two doctors who worked on a case-by-case basis, and three part-time RNs and LPNs. To many of these employees I was the symbol of a radically changed world. I was young, I was a woman, and I had no medical training. By the age of 26, I was hiring and firing physicians," she writes.
Not surprisingly, problems ensued, and Hoffman reports ongoing power struggles between male doctors and female staff. Less expected were conflicts with employees who assumed that the clinic would be collectively run since it was woman-headed. These tensions led Hoffman to develop what she calls "a collective autocracy ... I listened to everyone's opinions with respect and interest and promoted a good deal of feedback, but I stopped treating my staff as a surrogate family. I kept myself separate."
This enabled Hoffman to become better attuned to the patronizing attitudes of doctors toward their female patients. What's more, she became aware that "the metaphoric role of physicians as surrogate fathers and deities resulted in them communicating in a kind of code, a language that only the members of the brotherhood spoke and understood."
Hoffman responded by creating a Patient's Bill of Rights, giving consumers the power to question their physicians. They were further empowered to have all procedures explained to them before being asked to consent to treatment.
Although Hoffman's consciousness continued to develop throughout the early 1970s, she writes that it was not until the 1976 passage of the Hyde Amendment - which cut off Medicaid coverage for abortion - that she became overtly political. Enraged by the Act, she not only assailed the Amendment's racist and classist underpinnings, she also addressed the misogyny at the core of anti-abortion rhetoric and organizing.
And she brought people together, organizing a daylong conference on women's health for politicians, HIP physicians, students and medical consumers. Speakers included New York City's then-mayor, Abraham Beame, writer Barbara Ehrenreich and Congresswoman Bella Abzug. The event, Hoffman writes, was successful in educating the attendees and boosted HIP's reputation as a pro-woman business.
Eager to keep this momentum going, HIP hired a publicist for Hoffman, and it wasn't long before she was a nationally known pro-choice spokeswoman. She became prominent in the National Association of Abortion Facilities, and her involvement with NARAL Pro-Choice America and the now-defunct New York Pro-Choice Coalition led to her participation in televised debates with the Rev. Jerry Falwell and members of Operation Rescue. She also took to the streets, demonstrating against the Catholic Church and religious fundamentalists.
Decades later, she's still going strong. Hoffman continues to direct Choices and, as publisher of On the Issues Magazine, has consistently fostered debate - ruffling more than a few feathers along the way. In fact, some in the feminist community have distanced themselves from her, arguing that it is impossible to be both feminist and capitalist. Other activists feel that Hoffman's belief in meeting violence with violence is anathema to feminist doctrine. Hoffman finds such arguments naive, and as someone who proudly purchased a 20-gauge shotgun shortly after the 1993 murder of abortion provider Dr. David Gunn, asserts that it is essential to fight back when threatened.
Clearly, Hoffman's style isn't for everyone. At the same time, it's impossible to read "Intimate Wars" and not be moved by her determination and passion. Indeed, Hoffman's commitment to women's health, and her reflections on her own missteps and the missteps of the pro-choice movement, are honest and heartfelt. From her decision to adopt a child to her love affairs, this is the story of one woman's quest to live fully. Opinionated, fierce, bold and brash, "Intimate Wars" chronicles Hoffman's efforts to improve women's lives and influence history. She deserves our gratitude.