As an abortion provider, I long ago "opted out of the war", as Peg Johnston in her cogent essay, labeled it. Because of the continued stigmatizing efforts of the far right, opting out is ever more difficult. However, Carole Joffe sees reason for hope in her new book.
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Abortion
Can we ever win the abortion wars?
As jury selection continues in the Wichita, Kan., trial of Scott Roeder -- whose alleged murder of late-term abortion provider Dr. George Tiller was lauded by the extreme antiabortion group Army of God -- the title of sociologist and reproductive rights historian Carol Joffe's new book becomes all the more chillingly apt. In "Dispatches From the Abortion Wars," Joffe shows that the battles over abortion rights in the United States are being "fought on numerous fronts": not only with guns, bombs and fire, and not only in foreign relations, national politics and state legislatures.
Antiabortion forces, Joffe writes, also deploy the psychological weapon of antiabortion stigma, a potent contaminant of conscience and community that has led to, among other things, "a chronic shortage of [abortion] providers" and even antiabortion hospital practices "that put women's health at unacceptable risk." (One Onion-esque example: a woman whose deep-vein thrombosis made her too sick for a clinic abortion. She was cleared for a hospital procedure only after much negotiation; there, her OB tried to persuade her to continue her high-risk pregnancy by making her take a tour of the newborn nursery.) Even when we win, we lose, Joffe argues, observing that even preposterous doomed-to-fail "fetal personhood" initiatives, simply by dint of being out in the cultural ether, "reinforce the idea that abortion is a contentious and stigmatizing issue." And all of this is an important thing to remember, today especially, the 37th anniversary of Roe v. Wade.
Joffe makes clear that her target is not your average private citizen who votes, or even campaigns, "pro-life." It's the antiabortion (and -contraception) movement's fanatic fringe, whose "violent actions and extremist political positions ... have had significant consequences [and] have established the contours of the abortion wars" -- at very least, by making the less-loony hard-liners appear reasonable by contrast. Her argument, based on hundreds of interviews with providers and patients -- not to mention 30 years of reproductive health research -- is unapologetically one-sided.
"I see myself as a war correspondent, embedded with troops on one side of the conflict," she writes. Her goal? "To show the costs of these wars. They are costly, obviously, for those seeking abortions and those providing them. But I believe these wars have also proved costly for American society as a whole, causing a degradation of our political culture. The abortion wars have not only brought an unprecedented level of violence and terrorism to health care institutions; they have also led to a culture of lies about science and medicine at the highest levels of government. I have come to understand the abortion wars as a brilliant distraction that drains energies and resources away from other social needs, including the adequate provision of services that would allow people to have the intimate and family lives they wish for."
Ironically, of course, the abortion wars are "counterproductive, leading to more unintended pregnancies and therefore more abortions," Joffe notes. The savvier fanatics can't not know that. Maybe, then, that draining distraction was the objective all along. So, in that sense, have we already lost? Salon talked to Joffe about strategies on both sides of the conflict, and about where she does in fact find hope for peace.
You describe one young doctor who's afraid to "come out" to senior colleagues as having had abortion training and another relocating to the South who asks colleagues how to "discreetly" get in touch with other providers. How pervasive is antiabortion sentiment in the medical community?
What my research has suggested is that most medical professionals are not against abortion. They are against controversy. Even those who want to provide abortions find that they can't because even their pro-choice colleagues or potential partners "don't want to get involved." They also wind up marginalized or even ostracized by peers who succumb to pressure by local antiabortion groups.
One of my great regrets about this book is that it was in production too late to include the Krispy Kreme controversy, where they announced last Jan. 20 that in honor of Obama's inauguration they'd give every customer a "free doughnut of choice." The American Life League, one of the real wingnut groups, went crazy, issuing a press release saying Krispy Kreme was endorsing Obama's support for abortion rights. Krispy Kreme had to immediately issue their own press release saying, "We didn't mean that at all -- just come in and get a doughnut."
In other words, we live in a culture where potential controversy lurks around every corner. This will inevitably have an impact on health professionals who are sympathetic to the need for abortion but therefore not interested in providing it. Even when they are, it's hard. I think my most poignant example is the doctor who wondered whom it was "safe" to tell that she'd had abortion training. It's like a classic coming-out story. This is not normal. This shouldn't be. Again and again the stigma helps reinforce the idea that abortion care is different from any other part of medicine. If you're training to be a cardiologist you don't have to worry if you blurt that to someone by mistake.
Never mind the fact that they could get shot. You write that before Roe, it was sheer illegality that kept doctors from identifying themselves to one another. Now, it's stigma, and threats to personal safety. What other comparisons can you make between the pre-Roe era and now?
Yes, one major similarity is that culture of secrecy, though now it's for different reasons. Many providers today are marginalized just as they were before Roe [i.e., pre-Roe, those who performed abortions out of "medical necessity," whether strictly conforming to the legal definition or not]. But as before Roe, when it becomes known who does abortions, your colleagues who normally ignore you, when they have a patient with serious medical issues [requiring abortion], guess who they call: the doctors they don't invite to their cocktail parties. There's both this distance from and dependency on abortion providers that's so striking. I remember the very first time I spoke with George Tiller in 1998, before he'd become so controversial. I asked him about the reactions of his colleagues, and he said to me that some are realizing that the world is not as black-and-white as they'd thought. These were his colleagues in Wichita who thought of themselves as strongly antiabortion until they had a patient with [a baby who had] anencephaly at 26 weeks pregnant. Then they realized they did need Dr. Tiller's services.
There is also the continued difficulty -- even cruelty -- faced by women trying to get medically necessary abortions in hospitals, which I really had not been fully aware of. In the book, I compare the experiences of two doctors who had to beg medical officials for a patient to get an abortion. In the first case, the OB had reason to hesitate, given that it was the 1960s and he was afraid he'd get caught. But the second was in 2007, and all the doctor wanted was what should have been routine approval for a patient in a very serious condition. Even though abortion is legal its provision is not something that can be taken for granted, even in a hospital. You have to beg people.
One difference, though, is the change in strategy of the antiabortion movement -- at least since the period right after Roe. Then, women who got abortions were demonized as "sluts" and, bizarrely, given that we didn't have much advanced fertility technology then, "lesbians." But that couldn't last, in part because so many women, including those who were ostensibly anti-choice, were getting abortions. Now the focus is on women as victims. "Abortion hurts women" is one of the big messages, and now the providers are the villains.
Why does abortion occupy such a polarizing place in America, as opposed to, say, in European democracies?
This comes up again and again, and I don't think there's one answer. It's not that there's no antiabortion sentiment in Europe. It's just that it hasn't developed into this huge movement against women and providers. One big difference is that there's no equivalent elsewhere of the theocratic elements that control so much of our culture right now. And those countries for whatever reason do not seem to have the sexual schizophrenia we do here, where we have thongs for girls but "Our Bodies, Our Selves" banned from libraries. We are a society deeply conflicted about sexuality, especially female sexuality.
Also, where you have national healthcare you can get birth control when you want it, and abortions are often delivered through the same system as other services so you can't actually surround a clinic the way you can here. But more to the point, abortion is part of a healthcare system. And what happens? The rates of unintended pregnancy and abortion are much lower. It's a model that's staring us right in the face.
Historically speaking, the abortion issue took on a life of its own here when the then-new right realized that opposition to the first federally funded childcare bill in 1971 had galvanized a major political force. But childcare itself didn't have good staying power because of the number of women entering the labor force who needed childcare themselves. So the passage of Roe v. Wade turned out to serve as the perfect "battering ram" -- I love that image, from the political scientist Rosalind Petchesky -- for a whole range of right-wing issues.
There's much discussion right now about how essential it is for abortion to be covered by health insurance. But you say many women don't use the coverage they have. Why?
It's back to the stigma. They don't want the paper trail. They may not want their husbands or partners or parents to somehow find out. They're worried their employers will find out ... At the same time, I interviewed a woman who had a $17,000 hospital bill relating to a late-term abortion and was not sure her insurance company would pay. She was still negotiating. At the saddest moment in her life she and her husband were facing financial disaster. Among all abortions these constitute a relatively small number, but not as small as we think. One hundred and fifty thousand abortions take place after 20 weeks. These women will also face enormous difficulties if their insurance is taken away.
What will it take to normalize abortion within the larger healthcare setting? Is that even possible?
The healthcare reform discussions have shown us exactly how not to normalize it. I am heartbroken about how abortion has only been further stigmatized by what we've seen over the last few months. What it would take, first of all, is a healthcare bill that paid for contraception -- we don't even know if that's going to be a fight -- and to have the Hyde Amendment repealed so that poor women can have access to the full range of reproductive care, and to have medical schools routinely teach abortion. Which, actually, they are doing a better job of now than they were a number of years ago.
OK, so that's something. Any other cause for cautious hope?
Well, when Dr. Tiller was murdered, I had to go back through the manuscript and write about him in the past. Obviously, that dampened some of my optimism. But I do find cause for optimism in the dogged determination of the provider community, even when -- as in the case of Tiller's staff, whom I've interviewed since the book came out -- who always had to order their pizza without giving a name and then go pick it up because the place wouldn't even deliver to them. These are people who in the middle of all the craziness found an imam to come instruct them in the details of burial of ashes [the clinic cremates fetal remains] so that they could fully serve their Muslim patients. I know it sounds schmaltzy, but when there are people like this in the field, I can't not be optimistic. Just as a powerful abortion rights movement has begun to emerge within American medicine, social movements create other social movements. The very virulence and aggression of the antiabortion movement in many ways makes the provider community that much stronger.
There's also the example of the Jennifer Boulanger, a clinic director in Allentown who decided to go public -- she was on Rachel Maddow -- about threats she'd received, and she actually began to get unanticipated support from people in the area who were outraged. Even a local Lutheran pastor developed an informal network that meets periodically to talk about how to bring peace to the community. The message is, "Let us disagree, but peacefully." That's really the hope. That what I call the "civilians" in the abortion wars will come forward and stand together to stop the bullies.
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