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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.
The arrest in France of James Kopp, the accused assassin of Buffalo obstetrician Barnett Slepian, could not have come at a more awkward time for the Bush Administration. Bush inaugurates himself by blocking aid to international family planning agencies and by nominating antiabortion fanatics to run the Justice Department. Then fugitive Kopp surfaces to remind the American public of where
these bottom-line commitments lead.
In 1994 Bill Clinton's Justice Department initiated a grand jury inquiry into
abortion-clinic violence. But FBI agents grumbled that Justice was
wasting their time, and the grand jury folded its tent in January of
1996 after finding no evidence of a national conspiracy. Five years
later, it's clear that Kopp--accused in three nonfatal shootings in
Canada and the United States in addition to the murder of Dr.
Slepian--had a lot of help, the kind of help for which "conspiracy"
is the operative legal term.
So far, investigators have
arrested two antiabortion felons in Brooklyn--Dennis Malvasi,
convicted of a 1987 clinic bombing in Manhattan, and Loretta Marra,
who blockaded clinics with Kopp. They sent Kopp money and stayed in
touch with him through a Yahoo drop box. The circle is almost
certainly wider--and transnational. For the past year Kopp lived in
Ireland, bunking in hostels and mingling with the fundamentalist
breakaway Catholic sect founded by excommunicated Archbishop Marcel
Lefebvre. Kopp managed to acquire at least two separate Irish
identities and passports for himself and a blank Irish passport and
birth certificates for his New York friends, and someone in Ireland
vouched for his references for an employment agency--all of which
makes it obvious that his was not a solo act. Ireland's right-to-life
leaders deny any connection to the assassin, and it's entirely
possible that his support network was American. In the last
half-decade US antiabortion campaigners have moved on Ireland in a
big way, introducing a militancy previously unknown
Speculation necessarily swirls around the followers
of the Rev. Patrick Mahoney of the Washington-based Christian Defense
Coalition. In March 1999 Mahoney led a brigade of forty Americans to
Dublin, where they occupied the offices of the Irish Family Planning
Association and taught their Irish counterparts all-American
blockade-and-intimidation techniques. Indeed, only a day before
Kopp's arrest, Mahoney was slapped with an Irish court injunction
prohibiting him from further harassing the IFPA. Mahoney had tolerant
words in 1997 after Slepian's shooting, and responded to Kopp's
arrest by warning the Bush Administration not to "harass and
intimidate the pro-life movement."
It can't escape notice
that the Kopp conspiracy began to unravel just as the Court of
Appeals for the Ninth Circuit overturned a jury verdict and
injunction on the Nuremberg Files website, which displays
photos of abortion providers and a list with a strike through the
names of assassinated physicians. On March 28 the Ninth Circuit
unanimously found, in the words of presiding Judge Alex Kozinski,
that if the website's rhetoric "merely encouraged unrelated
terrorists," it is protected by the First Amendment.
Michelman of NARAL called the ruling "a major setback for a woman's
right to choice," and along with Planned Parenthood vowed to pursue
the case to the Supreme Court. To me, Kopp's overdue arrest suggests
a different conclusion. There can be no doubt that the Nuremberg
Files website contributed to a climate of fear--that the website
is the theory and James Kopp's rifle is the practice. Yet the
emerging facts of Kopp's flight make it clear that keeping The
Nuremberg Files off the Internet would not have saved Dr. Slepian
or brought the shooter to justice. The important thing is to
investigate real antichoice gangsterism, real shootings, real escape
routes. The important thing is to insist on the continuity between
Kopp and the "respectable" antiabortion agenda of the White House.
Bush and Ashcroft have been assiduously working to accomplish by
executive order what Kopp attempted with a gun: diminishing the
availability of abortion and thus undermining a civil right. This,
and the climate of fear generated by clinic violence, must be fought
with politics, not censorship. And the recent rise of police
surveillance aimed at antiglobalization protesters only makes more
clear the danger of prosecuting an inflammatory publication as if it
were the hand that smashed the windowpane or pulled the
Kopp's arrest is full of ironies. The most
antichoice Attorney General in US history is now stuck prosecuting an
antichoice assassin; an Administration wild about the death penalty
must forgo capital punishment to secure Kopp's extradition because
France opposes it. It would be a final, and tragic, irony if
prochoice advocates permit antiabortion thugs like Mahoney to play
the martyr--drawing attention away from the very violence they have
A woman two months pregnant goes to see her Ob-Gyn for prenatal care. As required by law, her doctor informs her that her condition places her at greater risk for a wide range of medical problems: hypertension and diabetes if she is overweight; complications of surgery if, like one in four women, she has a Caesarean section; permanent weight gain with its attendant problems, including heart disease; urinary tract infections and prolapsed uterus if she has had multiple pregnancies; postpartum depression or psychosis, leading in rare cases to suicide or infanticide; not to mention excruciating childbirth pain, stretch marks and death. There are ominous social possibilities, too, the doctor continues, reading from his state-supplied script: increased vulnerability to domestic violence; being or becoming a single mother, with all the struggles and poverty that entails; job and housing discrimination; the curtailment of education and professional training; and lowered income for life.
No state legislature would compel doctors to confront patients with the statistical risks of childbearing, serious though they are; a doctor who did so on his own would strike many as intrusive, offensive and out of his mind. Should a woman seek abortion, however, anti-choicers are pushing state laws requiring that she be informed of a risk most experts do not believe exists: a link between abortion and breast cancer. Like the supposedly widespread psychological trauma of abortion, which even anti-choice Surgeon General Dr. C. Everett Koop was unable to find evidence of, the abortion-breast cancer connection is being aggressively promoted by the anti-choice movement. (Even Mother Jones, always quick to take feminists down a peg, leapt on this bandwagon, with an April/May 1995 piece entitled "Abortion's Risk.")
"It's yet another example of efforts to encumber this legal choice and make it more difficult and painful for women," says Dr. Wendy Chavkin, professor of public health and clinical obstetrics and gynecology at New York's Columbia Presbyterian Hospital, and editor in chief of the Journal of the American Medical Women's Association. It's also an attempt by anti-choicers to reframe their opposition to abortion as concern for women's health, something not usually high on their list. These are, after all, the same people who fight health exceptions to "partial birth" abortion bans and who have successfully prevented poor women from receiving medically necessary abortions with Medicaid funds.
Nonetheless, such is the power of the anti-choice movement that laws have been passed in Montana and Mississippi, and bills are pending in fifteen other states, mandating a breast cancer warning (and in some cases, a waiting period for it to sink in). Along with laws come lawsuits: In Fargo, North Dakota, the Red River Women's Clinic is being sued for failing to give such a warning; a 19-year-old Pennsylvania woman is suing a New Jersey clinic for her abortion two years ago, which left her, she claims, with an overwhelming fear of contracting breast cancer. In ferociously anti-choice Louisiana, a new law permits women to sue for damages--including damages to the fetus!--up to ten years after their abortion. Given today's high rates of breast cancer, a deluge of litigation is in the making.
Does abortion cause breast cancer? Some studies have appeared to suggest a connection: Dr. Janet Daling, for example, an epidemiologist who says she is pro-choice, compared the abortion histories of 1,800 women with and without breast cancer and found that, among those who had been pregnant at least once, the risk of breast cancer was 50 percent higher for those who had abortions--but her cancer-free sample was obtained through telephone interviews with women chosen at random from the phone book. Not everyone has a phone, of course, which raises questions about the comparability of the samples, and besides, how many women would volunteer information about their abortion history to a voice on the phone? Like other studies showing a link, this one was marred by "recall bias": Cancer patients are more likely to volunteer negative information about themselves than healthy people. They are looking for an explanation for a disease--and one many feel must somehow be their fault. Demographic studies, which are free from recall bias, produce different results: Lindefors Harris, analyzing the national medical database of Swedish women in 1989, found that women did deny their abortions, that breast cancer patients were less likely to do so--and that women who had had abortions were less likely to get breast cancer. The largest study to date, of 1.5 million Danish women, found no correlation.
"The supposed link between breast cancer and abortion is motivated by politics, not medicine," says Dr. David Grimes, clinical professor of obstetrics and gynecology at the University of North Carolina. "The weight of the evidence at this time indicates no association. To force this on women is just cruel." Indeed, the National Cancer Institute, the American Cancer Society and the World Health Organization, none of which have an ax to grind, reject the notion. The standard medical textbook, Diseases of the Breast, concurs. The main figure advocating the link is Dr. Joel Brind, professor of biology and endocrinology at Baruch College, who has done no original research on this issue but is a tireless anti-choice propagandist--plug "abortion breast cancer" into a search engine and the top half dozen sites are his.
Abortion is just about the only medical procedure in which doctors and patients are hemmed about by lawmakers. No other operation has legally mandated waiting periods, although many are dangerous, life-altering and irreversible; with no other operation are doctors legally required to give specific information--certainly not information that the vast preponderance of medical opinion believes to be false or at best unproven. Good medical practice calls for discussion of the pros and cons of particular courses of treatment, not burdening the patient's choice with unsubstantiated fears. Will we ever see a law requiring doctors to tell pregnant patients that abortion is statistically safer than carrying to term--which it is? Sure, the day state lawmakers put a waiting period on Viagra prescriptions, to let male patients really consider whether an erection is worth a heart attack.
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