In many respects, the recent meeting in Chicago of the National Abortion Federation (NAF), the major professional association of abortion providers in North America, looked like any other medical gathering. Participants wearing name tags attended workshops, engaged in lively debate about medical innovations in their field, examined the exhibits set up by vendors and greeted old friends and colleagues.
But in other ways this was not a typical medical conference. Security was tight, with guards checking registration badges and conferring on walkie-talkies. Along with presentations on "Vaginal Ultrasound Assessment" and "Monitoring Chorionic Gonadotropin Levels After Mifepristone Abortion" were sessions on "Ensuring the Rights of Minors: Making Your Judicial Bypass Work" and "Understanding FACE (Freedom of Access to Clinic Entrances) and How to Invoke Its Protection." One of the keynote speakers was an FBI agent who played a key role in the apprehension of James Kopp, the fugitive accused of murdering Dr. Barnett Slepian, an abortion provider in Buffalo, New York, in 1998, and of wounding several other physicians.
While NAF meetings always display this surreal combination of conventional medical components and vivid reminders that abortion is the most politicized--and besieged--branch of medicine in the country, this year the atmosphere was especially tense. The fact that the reliably prochoice Clinton-Gore team is gone, replaced by an Administration that is deeply, and cleverly, hostile to abortion, seemed to hover over every conversation. As abortion providers well know, even if Roe v. Wade is not overturned, abortion access can be eviscerated by its enemies. Here are just some of the Bush Administration's initial steps in that direction:
§ As Attorney General, John Ashcroft, one of the most fanatically antiabortion senators in history, is charged with protecting the safety of abortion providers and patients. Despite repeated assertions at his confirmation hearings that he accepts Roe as "settled law," no one expects him to continue with the forceful and active steps that his predecessor, Janet Reno, took to combat antiabortion terrorism. Ashcroft will also play a key role in judicial appointments. While public attention has inevitably focused on the Supreme Court, judges appointed to lower federal courts have an enormous impact on abortion provision, ruling in such diverse areas as waiting periods, legislatively mandated scripted counseling for abortion patients, interpretations of permissible buffer zones outside clinics (areas that may be kept free of protesters) and on any revisitation of "partial birth" abortion bans.
§ Secretary of Health and Human Services Tommy Thompson sent chills down the NAF community's collective spine when he announced at his confirmation hearings that he would call for a "review" of the FDA's approval last fall of the "abortion pill," RU-486 (mifepristone). Also, antiabortion Congressmen have introduced the Patient Health and Safety Act (PHSA), a bill that seeks to restrict distribution of the drug by prohibiting anyone other than physicians who provide surgical abortions from dispensing it, thereby thwarting its promise to improve access in underserved areas. Thompson's threatened "review" would likely do the same.
For now, Thompson appears to be holding off on such a review. The Administration has not yet named an FDA commissioner, most likely because of the hot-button politics of mifepristone approval. And it is not clear whether the PHSA will pass the Senate. But uncertainty over the fate of this drug is hampering the campaign to disseminate it. Prospective abortion pill providers face a host of other challenges as well: arranging malpractice insurance and managed care reimbursement, conforming to legal requirements (parental notification, waiting periods, etc.). As a result, nearly all those currently offering the drug are surgical providers.
§ The Unborn Victims of Violence Act, passed by the House on April 26, makes it a federal crime to injure or kill the fetus of a pregnant woman. Even though the act specifically exempts abortion, the prochoice community widely views it as a crucial first step in a campaign by abortion opponents to secure the status of "personhood" for the fetus (and indeed, embryos and blastocysts). As one lawyer at the NAF meeting told me, "Fertilized cells will have the same legal status as a woman, and eventually this will threaten various forms of birth control as well as abortion." George W. Bush has voiced his eagerness to sign the bill into law.
And what of the Supreme Court? Amid the rumors of the possible retirement of one or more Justices this summer, the stakes are high for abortion providers--and for Bush as well. Given the public's split on the issue, Bush risks alienating a sizable number of voters no matter what he does. (Despite people's discomfort with abortion, polls show that a majority wants to see Roe stand.) One likely scenario is that Bush will nominate a "stealth" antichoicer--one with no paper trail on abortion--and then try to prevent an abortion case from reaching the Court before the 2004 election.
How can the abortion rights movement respond? Lucinda Finley, a law professor at SUNY, Buffalo, says, "The movement must convince senators to announce that they will not confirm someone who is unwilling to state his or her position on Roe." The Feminist Majority urges a filibuster against any nominee not committed to preserving Roe (see www.million4Roe.com). Whether prochoicers have such political capital remains to be seen. The recent abortion rights march in Washington, whose timing unfortunately conflicted with Earth Day and Quebec demonstrations as well as the NAF meeting itself, attracted a disappointing turnout and almost no media attention.
As the rest of the movement awaits the Court showdown, abortion providers continue to endure countless hassles just to open the doors of their clinics each day. Many states have imposed TRAP--"targeted restrictions against abortion providers"--laws consisting of cumbersome rules, directed only at abortion facilities, regulating such matters as door width and air flow. Even those in states without TRAP laws face constant battles with landlords who try to evict them, vendors under pressure not to service them and frequent threats of violence. The community of providers, which has shown an extraordinary ability to carry on its work with humor and bravery even in such unacceptable circumstances, is gearing up for a long fight.