Even so, some question whether reproductive care is "medically necessary," the sine qua non of insurance reimbursement. "About 60 percent of women access healthcare through these services," responds Alice Berger at Planned Parenthood of New York City in an "Is the Pope Catholic?" tone. Furthermore, she says, it's ultimately quite costly for the insurance companies if women don't get the services. "The sequelae are unintended pregnancy, STDs, later-term abortions, cancer that's not detected early enough--very serious stuff that translates into big dollars," Berger says.

Yet the majority of commercial plans do not provide reversible family-planning methods in their benefits, which means millions of women are paying out of pocket for diaphragms, the pill and condoms. In fact, women spend 68 percent more on healthcare per year than men do--this, while symmetrically making around 70 cents to the male dollar. And then there's the fact that just five weeks after the erection-helper Viagra became available, nearly half of the 270,000 very expensive prescriptions sold were paid for by some form of insurance. Meanwhile, although Congress forbids abortions in military hospitals even if the servicewoman pays for the procedure out of pocket, the Washington Feminist Faxnet reported in early October that the Pentagon earmarked $50 million to bankroll Viagra for US troops and military retirees. Is potency a medical necessity? I guess God knows, because according to Brian Mulligan at the Catholic Healthcare Network, even the Vatican supports Viagra.

One bright spot in the bleak landscape: A proposed merger in Kingston, New York, between a Catholic and a secular hospital fell apart, largely due to community-based resistance to the threatened loss of reproductive services. Citizens held rallies, wrote hundreds of letters to the editor, signed petitions and decorated the town with lawn signs that read "people of all faiths use our hospital!" Lois Uttley, director of the MergerWatch project, which coordinated community efforts, was thrilled with the victory. But it drove home the lesson that advocates of reproductive freedom, who are accustomed to focusing on legal rights, now have to fight in new arenas. "New York is a pro-choice state--on paper," says Uttley, who, in alliance with the California Women's Law Center, was awarded a Ford Foundation grant to expand her community organizing efforts nationally. "But we have four regions in this state where access is in peril right now. We can no longer focus purely on legislation."

After Dr. Barnett Slepian, an OB-GYN who performed abortions, was slain in his Buffalo-area home by a sniper with a high-powered rifle, representatives from various reproductive rights organizations tossed around the scary facts and figures. Two-thirds of all OB-GYNs who perform abortions are over the age of 65 and will soon be retiring; in 84 percent of US counties, there are already no providers. The precedent has been set to treat abortion and related services as unseemly and therefore marginalized to easily targeted women's clinics. Doctors who perform abortions are picked out of their crowd of peers and terrorized. An OB-GYN at the Cleveland Clinic told me that while he is personally pro-choice, he wouldn't have a public profile as such, because he believes that the atmosphere in his community (medical and otherwise) would not defend a doctor who supported reproductive freedom. "I am counting on others to take the risk," says the doctor, who asked not to be identified. "And I fear that I am part of the problem by not standing by this procedure that I want to have available, but won't do myself."

As abortion opponents focus on providers, so must abortion rights supporters. "Most of the people in med school now were born at or around the time of Roe v. Wade," says Kiersta Kurtz-Burke, a student at Tulane who is also the national coordinator for the Southeast region of Medical Students for Choice. Besides pushing medical schools to include training in the very simple abortion procedure, MSC also raises historical consciousness by screening the Dorothy Fadiman documentary When Abortion Was Illegal and bringing in older doctors to recount tales of the days when fifty women might be in the septic ward due to botched illegal abortions. MSC also tries to bridge the fact that most medical students are pro-choice and yet few want to take on what they see as a harrowing life as a provider. "Providing abortions can be integrated as a small part of your family practice," says Kurtz-Burke. "You might have a regular patient who at some point doesn't want to be pregnant." In the next couple of years, the first waves of some 5,000 doctors belonging to MSC will be setting up family and OB-GYN practices across the country. Meanwhile, doctors aren't the only hope for women needing abortions. The National Abortion Federation reports that in New York, which has no "physician only" law, physician assistants (PAs) are providing abortions. Vermont has a long history of PAs doing abortions with as good an outcome, if not better, as those performed by doctors. Nurse practitioners can also be trained in the procedure in Vermont, and just a few months ago, the first modern midwife was trained in surgical abortion. With nonsurgical "medical" abortion on the not-so-distant horizon (RU 486 is due here in late 1999), even more midlevel healthcare providers will be able to terminate an unwanted pregnancy.

Feminists of the second wave declared that women would never be free unless they could control their own bodies, a fierce belief that became law in 1973. But Congress doesn't have to ban abortions if the American Medical Association treats the procedure as beyond the bounds of medical training. The Catholic Church doesn't have to bother swaying the opinion of the majority of Americans who believe in a woman's right to choose if it owns the hospital they go to. Strategies for attaining reproductive human rights have changed with the times, shifting away from a focus on legislation and the courts and toward community organizing and consciousness raising. But after all the years of feminist struggle, we face a grim and familiar reality: Women are getting screwed.

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