Abortion After Roe, Johanna Schoen, University of North Carolina Press, 2015
As Congress prepares for another round of hearings about the alleged misdeeds of Planned Parenthood Federation of America clinics, it's impossible not to see the ongoing witch hunt for what it is: an assault on women's reproductive autonomy. That the anticipated questioning will likely reveal nothing damning is irrelevant. Indeed, the goal of the year in and year out attempts to shutter the nation's premier provider of reproductive health care is simply to taint Planned Parenthood and make the general public leery about utilizing the services its health centers offer.
The congressional attack on Planned Parenthood follows an agenda that abortion opponents began crafting more than 40 years ago. In fact, efforts to reverse the Supreme Court's decision in Roe v. Wade have utilized a slew of tactics, including legislation to restrict abortion access, sit-ins, acid attacks, kidnappings and the well-documented harassment of doctors and their escorts, security officers and office staff. And then there's murder - the killing of eight people to date, all assassinated because of their association with abortion.
When anti-choice activists began referencing an abortion Holocaust, the language stuck.
Johanna Schoen's new book, Abortion After Roe, zeroes in on these anti-choice tactics, with particular attention to the language and strategies used by anti-abortion forces against clinics, clinicians and patients. It's a depressing read, made even more disturbing by revelations about infighting and political disagreements within pro-choice circles. In fact, there's a great deal of dirty linen here, and while it is important for reproductive justice activists to know and discuss this history, the book is likely to feed the frenzy of those who are hell-bent on limiting women's reproductive choices.
That this is not Schoen's intent - she is overtly pro-choice - matters little.
But let's start with the anti-abortion movement. Almost immediately after Roe, the number of physicians willing to terminate unwanted pregnancies went from 1,550 in 1973 to 2,734 in 1979. By 1982, the number had increased to 2,908.
As availability ramped up, and as more and more women opted to end unwanted pregnancies, those who opposed abortion knew that they needed to sully providers and those who relied on them. Their first opportunity came in April 1974, 15 months after the legalization of abortion, when Dr. Kenneth Edelin, a Boston ob-gyn, was convicted of manslaughter for performing a hysterotomy, a then-common second trimester abortion method that is similar to a Caesarian delivery. Schoen writes that Edelin was charged because the prosecutor successfully argued that he had killed a live baby - not, as he contended, aborted a nonviable fetus.
Although the guilty verdict was overturned on appeal, the trial taught anti-choice activists valuable lessons about using the words "baby" and "murder" rather than "fetus" and "choice."
They subsequently learned about the power of images. Shortly after the Edelin trial ended, John and Barbara Willke, early leaders of the National Right to Life Committee, began to wave photos of fetal parts before audiences to enhance their argument that it was immoral to use fetal tissue for medical studies - never mentioning that research using fetal tissue had been instrumental in the development of vaccines for diseases like polio. Their goal was to increase revulsion toward abortion. The graphic depictions supplemented written copy that quoted scientists referring to the fetus "as a specimen rather than a charming infant-to-be," a strategy, Schoen reports, that elicited disgust, at least among those who already opposed abortion.
Battle lines were drawn when the rescue movement began to bring hundreds of protesters to clinic doors, blocking entryways.
In addition, they hauled out the specter of Nazi medical experimentation as if Dr. Mengele and modern-day abortionists were one and the same. Not surprisingly, when anti-choice activists began referencing an abortion Holocaust, the language stuck. As one Catholic bishop told his flock, "If there is a more unspeakable crime than abortion itself, it is using victims of abortion as living human guinea pigs." It's an argument that has been trucked out repeatedly over the past four decades - and continues to be an anti-choice charm.
Meanwhile, back in the 1970s, Schoen notes that while anti-choice forces were digging in for a protracted battle over the efficacy of abortion, pro-choice forces were struggling to find terra firma on which to build clinics. But how to do this? For feminists eager to develop collectively run, women-centered care, free of male doctors and male management, this required quick acquisition of the many skills necessary to run a sustainable business. Doctors, on the other hand, had to learn the most effective abortion techniques and then establish clinics that followed a more typical medical model. Differences over standards of care arose. So did questions. As Schoen notes:
Did professionalism and adherence to medical standards necessarily imply hierarchy and delivery of abortion care through a traditional model? Or could alternative clinics deliver care that was considered professional? Did the collection of data and presentation of medical research surrounding abortion care reinforce medical hierarchies in which physician researchers created information for other physician researchers? Or might such information be accessible and useful to all?
The debate eventually led to the creation of the National Abortion Federation (NAF) in 1975, but Schoen reports that the group never represented more than a small percentage of providers and clinics. "From the very start," she writes, "NAF was plagued by profound disagreements about the best ways to deliver abortion care." For example, should doctors be paid by the number of procedures performed or by fixed salary? Should clinics be for-profit or nonprofit? Can clinics be feminist if they employ male physicians?
Still, by 1978, NAF released "Standards for Quality Abortion Care," a manual "which articulated expectations of professionalism and safety for all NAF members to meet." According to Schoen, that year's annual conference included hands-on workshops covering medical research and practice, dealing with media and prescribing contraception, among other topics.
It seemed as though providers were finally hitting their stride - and then the Chicago Sun-Times ran a series of articles at the end of 1978 that exposed four subpar abortion clinics and detailed the shoddy treatment patients received. On top of this, almost simultaneously, Bernard Nathanson, a physician who opened one of New York City's first clinics, did an about-face and declared himself opposed to abortion. His 1979 book, Aborting America, had gravitas and was widely publicized. Unfortunately, he was not an anomaly; other former clinicians also switched sides and immediately became anti-choice darlings and media stars.
Then, when Ronald Reagan sailed into the White House a year later, anti-choice forces got an even bigger boost. Not only did he profess support for overturning Roe, but he appointed several outspoken anti-abortionists to key government posts. Battle lines were further drawn when the rescue movement began to bring hundreds of protesters to clinic doors, blocking entryways and making it difficult for health centers to function.
Abortion After Roe emphasizes how much is at stake if Roe is overturned or clinics are defunded.
Clinics were under siege, and providers looked to NAF for leadership to help them cope with the "rescues" and the burgeoning menace and violence the "antis" were orchestrating. They were sorely disappointed. According to Schoen, "discussions about the personal and emotional impact that the virulent anti-abortion activism had on abortion providers, clinic staff, and their families was noticeably absent." Worse, clinics found themselves on incredibly shaky ground, not only having to shoulder the cost of increased security, but also having to formulate strategies to protect themselves and each other.
So what to do? Schoen notes that a number of clinic administrators and owners called a weekend-long meeting in November 1989 to talk about the many topics neglected by NAF. Calling themselves the November Gang, they addressed the rescues as well as the growing stigma surrounding abortion that had been fueled by Nathanson and the blockaders. Together, they decided to focus less on those outside the clinic - boisterous and sometimes dangerous protesters they had no control over - and more on what was going on inside their buildings. Additionally, they worked to develop better pre- and post-surgical counseling to make sure that each patient was confident about her decision and knew what to expect.
The November Gang eventually created the National Coalition of Abortion Providers, later reconstituted as the Abortion Care Network, to lobby Congress and statehouses about abortion legislation and help providers develop best practices for reproductive health care.
Needless to say, they have their work cut out for them. "Good women have abortions," their materials declare. And of course they do.
Nonetheless, as Schoen reminds us, the big picture remains grim for supporters of reproductive justice. The number of abortion providers has fallen precipitously in the last decade and a host of barriers to access - from the refusal of insurance plans to cover abortion, to mandated waiting periods between counseling and surgery, and unnecessary regulatory demands on clinics - have been imposed throughout the country.
That said, the endless assault against Planned Parenthood clinics may have awakened a once lethargic giant. To wit: A recent conference call initiated by the Planned Parenthood Federation of America to discuss how to fight back included an astounding 30,000 organizational supporters. What's more, their conclusions were clear: Whether it's writing, calling, tweeting or emailing lawmakers, doing clinic defense or organizing an action to promote reproductive justice, there is something everyone can do to support Planned Parenthood and bolster the right to abortion.
Abortion After Roe emphasizes how much is at stake if Roe is overturned or clinics are defunded. Thankfully, this message has caught fire, not only galvanizing support for Planned Parenthood, but also providing pro-choice forces with a platform from which to push for real reproductive justice. It's been a long time coming.