Now that the Food and Drug Administration has again delayed over-the-counter sale of the morning-after pill Plan B, new lobbying efforts are underway to make the drug widely available. This report, published in May 30, provides useful background on how the personal ideology of Bush appointees is adversely affecting the health and welfare of women.

Late last October Dr. W. David Hager, a prominent obstetrician-gynecologist and Bush Administration appointee to the Advisory Committee for Reproductive Health Drugs in the Food and Drug Administration (FDA), took to the pulpit as the featured speaker at a morning service. He stood in the campus chapel at Asbury College, a small evangelical Christian school nestled among picturesque horse farms in the small town of Wilmore in Kentucky’s bluegrass region. Hager is an Asburian nabob; his elderly father is a past president of the college, and Hager himself currently sits on his alma mater’s board of trustees. Even the school’s administrative building, Hager Hall, bears the family name.

That day, a mostly friendly audience of 1,500 students and faculty packed into the seats in front of him. With the autumn sunlight streaming through the stained-glass windows, Hager opened his Bible to the Old Testament Book of Ezekiel and looked out into the audience. “I want to share with you some information about how…God has called me to stand in the gap,” he declared. “Not only for others, but regarding ethical and moral issues in our country.”

For Hager, those moral and ethical issues all appear to revolve around sex: In both his medical practice and his advisory role at the FDA, his ardent evangelical piety anchors his staunch opposition to emergency contraception, abortion and premarital sex. Through his six books–which include such titles as Stress and the Woman’s Body and As Jesus Cared for Women, self-help tomes that interweave syrupy Christian spirituality with paternalistic advice on women’s health and relationships–he has established himself as a leading conservative Christian voice on women’s health and sexuality.

And because of his warm relationship with the Bush Administration, Hager has had the opportunity to see his ideas influence federal policy. In December 2003 the FDA advisory committee of which he is a member was asked to consider whether emergency contraception, known as Plan B, should be made available over the counter. Over Hager’s dissent, the committee voted overwhelmingly to approve the change. But the FDA rejected its recommendation, a highly unusual and controversial decision in which Hager, The Nation has learned, played a key role. Hager’s reappointment to the committee, which does not require Congressional approval, is expected this June, but Bush’s nomination of Dr. Lester Crawford as FDA director has been bogged down in controversy over the issue of emergency contraception. Crawford was acting director throughout the Plan B debacle, and Senate Democrats, led by Hillary Clinton and Patty Murray, are holding up his nomination until the agency revisits its decision about going over the counter with the pill.

When Hager’s nomination to the FDA was announced in the fall of 2002, his conservative Christian beliefs drew sharp criticism from Democrats and prochoice groups. David Limbaugh, the lesser light in the Limbaugh family and author of Persecution: How Liberals Are Waging Political War Against Christianity, said the left had subjected Hager to an “anti-Christian litmus test.” Hager’s valor in the face of this “religious profiling” earned him the praise and lasting support of evangelical Christians, including such luminaries as Charles Colson, Dr. James Dobson and Franklin Graham, son of the Rev. Billy Graham.

Back at Asbury, Hager cast himself as a victim of religious persecution in his sermon. “You see…there is a war going on in this country,” he said gravely. “And I’m not speaking about the war in Iraq. It’s a war being waged against Christians, particularly evangelical Christians. It wasn’t my scientific record that came under scrutiny [at the FDA]. It was my faith…. By making myself available, God has used me to stand in the breach…. Just as he has used me, he can use you.”

Up on the dais, several men seated behind Hager nodded solemnly in agreement. But out in the audience, Linda Carruth Davis–co-author with Hager of Stress and the Woman’s Body, and, more saliently, his former wife of thirty-two years–was enraged. “It was the most disgusting thing I’ve ever heard,” she recalled months later, through clenched teeth.

According to Davis, Hager’s public moralizing on sexual matters clashed with his deplorable treatment of her during their marriage. Davis alleges that between 1995 and their divorce in 2002, Hager repeatedly sodomized her without her consent. Several sources on and off the record confirmed that she had told them it was the sexual and emotional abuse within their marriage that eventually forced her out. “I probably wouldn’t have objected so much, or felt it was so abusive if he had just wanted normal [vaginal] sex all the time,” she explained to me. “But it was the painful, invasive, totally nonconsensual nature of the [anal] sex that was so horrible.”

Not once during the uproar over Hager’s FDA appointment did any reporter solicit the opinion of the woman now known as Linda Davis–she remarried in November 2002 to James Davis, a Methodist minister, and relocated to southern Georgia–on her husband’s record, even though she contributed to much of his self-help work in the Christian arena (she remains a religious and political conservative). She intermittently thought of telling her story but refrained, she says, out of respect for her adult children. It was Hager’s sermon at Asbury last October that finally changed her mind. Davis was there to hear her middle son give a vocal performance; she was prepared to hear her ex-husband inveigh against secular liberals, but she was shocked to hear him speak about their divorce when he took to the pulpit.

“In early 2002,” Hager told the churchgoers that day, “my world fell apart…. After thirty-two years of marriage, I was suddenly alone in a new home that we had built as our dream home. Time spent ‘doing God’s will’ had kept me from spending the time I needed to nourish my marriage.” Hager noted with pride that in his darkest hour, Focus on the Family estimated that 50 million people worldwide were praying for him.

Linda Davis quietly fumed in her chair. “He had the gall to stand under the banner of holiness of the Lord and lie, by the sin of omission,” she told me. “It’s what he didn‘t say–it’s the impression he left.”

David Hager is not the fringe character and fundamentalist faith healer that some of his critics have made him out to be. In fact, he is a well-credentialed doctor. In Kentucky Hager has long been recognized as a leading Ob-Gyn at Lexington’s Central Baptist Hospital and a faculty member at the University of Kentucky’s medical school. And in the 1990s several magazines, including Modern Healthcare and Good Housekeeping, counted him among the best doctors for women in the nation.

Yet while Hager doesn’t advocate the substitution of conservative Christianity for medicine, his religious ideology underlies an all-encompassing paternalism in his approach to his women patients. “Even though I was trained as a medical specialist,” Hager explained in the preface to As Jesus Cared for Women, “it wasn’t until I began to see how Jesus treated women that I understood how I, as a doctor, should treat them.” To underscore this revelation, Hager recounted case after case in which he acted as confidant, spiritual adviser and even father figure to his grateful patients. As laid out in his writings, Hager’s worldview is not informed by a sense of inherent equality between men and women. Instead, men are expected to act as benevolent authority figures for the women in their lives. (In one of his books, he refers to a man who raped his wife as “selfish” and “sinful.”) But to model gender relations on the one Jesus had with his followers is to leave women dangerously exposed in the event that the men in their lives don’t meet the high standard set by God Himself–trapped in a permanent state of dependence hoping to be treated well.

In tandem with his medical career, Hager has been an aggressive advocate for the political agenda of the Christian right. A member of Focus on the Family’s Physician Resource Council and the Christian Medical and Dental Society, Hager assisted the Concerned Women for America in submitting a “Citizen’s Petition” to the FDA in August 2002 to halt distribution and marketing of the abortion pill, RU-486. It was this record of conservative activism that ignited a firestorm when the Bush Administration first floated his name for chairman of the FDA’s advisory committee in the fall of 2002. In the end, the FDA found a way to dodge the controversy: It issued a stealth announcement of Hager’s appointment to the panel (to be one of eleven members, not chairman) on Christmas Eve. Liberals were furious that they weren’t able to block his appointment. For many months afterward, an outraged chain letter alerting women to the appointment of a man with religious views “far outside the mainstream” snaked its way around the Internet, lending the whole episode the air of urban legend.

Back in Lexington, where the couple continued to live, Linda Hager, as she was still known at the time, was sinking into a deep depression, she says. Though her marriage had been dead for nearly a decade, she could not see her way clear to divorce; she had no money of her own and few marketable skills. But life with David Hager had grown unbearable. As his public profile increased, so did the tension in their home, which she says periodically triggered episodes of abuse. “I would be asleep,” she recalls, “and since [the sodomy] was painful and threatening, I woke up. Sometimes I acquiesced once he had started, just to make it go faster, and sometimes I tried to push him off…. I would [confront] David later, and he would say, ‘You asked me to do that,’ and I would say, ‘No, I never asked for it.'”

I first heard of Davis’s experience in 2004 through a friend of hers. After a few telephone conversations, she agreed to have me fly down to see her in her modest parsonage in Georgia, to tell me her story on the record. With her mod reading glasses, stylish bob and clever outfits, Davis, 55, is a handsome woman with a sharp wit. She spoke with me over two days in January.

Linda Davis (née Carruth) first met David Hager on the campus of Asbury College in 1967. “On the very first date he sat me down and told me he was going to marry me,” Davis remembers. “I was so overwhelmed by this aggressive approach of ‘I see you and I want you’ that I was completely seduced by it.”

Davis, a former beauty queen, was a disengaged student eager to get married and start a family. A Hager-Carruth marriage promised prestige and wealth for the couple; her father was a famous Methodist evangelist, and his father was then president of Asbury. “On the surface, it just looked so good,” she remembers. The couple married in 1970, while Hager completed medical school at the University of Kentucky.

“I don’t think I was married even a full year before I realized that I had made a horrible mistake,” Davis says. By her account, Hager was demanding and controlling, and the couple shared little emotional intimacy. “But,” she says, “the people around me said, ‘Well, you’ve made your bed, and now you have to lie in it.'” So Davis commenced with family making and bore three sons: Philip, in 1973; Neal, in 1977; and Jonathan, in 1979.

Sometime between the births of Neal and Jonathan, Hager embarked on an affair with a Bible-study classmate who was a friend of Davis’s. A close friend of Davis’s remembers her calling long distance when she found out: “She was angry and distraught, like any woman with two children would be. But she was committed to working it out.”

Sex was always a source of conflict in the marriage. Though it wasn’t emotionally satisfying for her, Davis says she soon learned that sex could “buy” peace with Hager after a long day of arguing, or insure his forgiveness after she spent too much money. “Sex was coinage; it was a commodity,” she said. Sometimes Hager would blithely shift from vaginal to anal sex. Davis protested. “He would say, ‘Oh, I didn’t mean to have anal sex with you; I can’t feel the difference,'” Davis recalls incredulously. “And I would say, ‘Well then, you’re in the wrong business.'”

By the 1980s, according to Davis, Hager was pressuring her to let him videotape and photograph them having sex. She consented, and eventually she even let Hager pay her for sex that she wouldn’t have otherwise engaged in–for example, $2,000 for oral sex, “though that didn’t happen very often because I hated doing it so much. So though it was more painful, I would let him sodomize me, and he would leave a check on the dresser,” Davis admitted to me with some embarrassment. This exchange took place almost weekly for several years.

Money was an explosive issue in their household. Hager kept an iron grip on the family purse strings. Initially the couple’s single checking account was in Hager’s name only, which meant that Davis had to appeal to her husband for cash, she says. Eventually he relented and opened a dual account. Davis recalls that Hager would return home every evening and make a beeline for his office to balance the checkbook, often angrily summoning her to account for the money she’d spent that day. Brenda Bartella Peterson, Davis’s friend of twenty-five years and her neighbor at the time, witnessed Hager berate his wife in their kitchen after one such episode. For her part, Davis set out to subvert Hager’s financial dominance with profligate spending on credit cards opened in her own name. “I was not willing to face reality about money,” she admits. “I thought, ‘Well, money can’t buy happiness, but it buys the kind of misery you can learn to live with.'”

These financial atmospherics undoubtedly figured into Linda’s willingness to accept payment for sex. But eventually her conscience caught up with her. “Finally…I said, ‘You know, David, this is like being a prostitute. I just can’t do this anymore; I don’t think it’s healthy for our relationship,'” she recalls.

By 1995, according to Davis’s account, Hager’s treatment of his wife had moved beyond morally reprehensible to potentially felonious. It was a uniquely stressful year for Davis. Her mother, dying of cancer, had moved in with the family and was in need of constant care. At the same time, Davis was suffering from a seemingly inexplicable exhaustion during the day. She began exhibiting a series of strange behaviors, like falling asleep in such curious places as the mall and her closet. Occasionally she would–as she describes it–“zone out” in midsentence in a conversation, and her legs would buckle. Eventually, Davis was diagnosed as having narcolepsy, a neurological disorder that affects the brain’s ability to regulate normal sleep-wake cycles.

For Davis, the diagnosis spelled relief, and a physician placed her on several medications to attain “sleep hygiene,” or a consistent sleep pattern. But Davis says it was after the diagnosis that the period of the most severe abuse began. For the next seven years Hager sodomized Davis without her consent while she slept roughly once a month until their divorce in 2002, she claims. “My sense is that he saw [my narcolepsy] as an opportunity,” Davis surmises. Sometimes she fought Hager off and he would quit for a while, only to circle back later that same night; at other times, “the most expedient thing was to try and somehow get it [over with]. In order to keep any peace, I had to maintain the illusion of being available to him.” At still other moments, she says, she attempted to avoid Hager’s predatory advances in various ways–for example, by sleeping in other rooms in the house, or by struggling to stay awake until Hager was in a deep sleep himself. But, she says, nothing worked. One of Davis’s lifelong confidantes remembers when Davis first told her about the abuse. “[Linda] was very angry and shaken,” she recalled.

As Hager began fielding calls from the White House personnel office in 2001, the stress in the household–and, with it, the abuse–hit an all-time high, according to Davis. She says she confronted her husband on numerous occasions: “[I said to him,] ‘Every time you do this, I hate your guts. And it blows a bridge out between us that takes weeks, if not months, to heal.'” She says that Hager would, in rare instances, admit what he had done and apologize, but typically would deny it altogether.

For a while, fears of poverty, isolation and damnation were enough to keep Davis from seeking a divorce. She says that she had never cheated on Hager, but after reuniting with a high school sweetheart (not her current husband) in the chaotic aftermath of September 11, she had a brief affair. En route to their first, and only, rendezvous, she prayed aloud. “I said to the Lord, ‘All right. I do not want to die without having sex with someone I love,'” she remembers. “‘I want to know what that’s like, Lord. I know that it’s a sin, and I know this is adultery. But I have to know what it’s like.'”

Davis was sure that God would strike her dead on her way home that weekend. But when nothing happened, she took it as a good sign. Back in Lexington, she walked through her front door and made a decision right there on the spot. “I said, ‘David, I want a divorce.'”

Marital rape is a foreign concept to many women with stories like this one. Indeed, Linda Davis had never heard the term until midway through her divorce. In Kentucky a person is guilty of rape in the first degree when he engages in sexual intercourse with another person by “forcible compulsion”; or when the victim is incapable of consent because she is physically helpless. The same standards apply to the crime of sodomy in the first degree (equivalent to rape, and distinct from consensual sodomy). Both are felonies.

In sexual assault cases, the outcome hinges on the issue of consent. A high-level domestic violence prosecutor in Kentucky confirmed that a scenario such as this one, in which Davis was in a deep sleep from the narcolepsy, could meet the “physically helpless” standard required for a first-degree offense. A prosecutor could also argue that Hager engaged in sodomy with Davis by means of forcible compulsion, even though the alleged encounters did not involve violence. According to the Kentucky Supreme Court’s decision in 1992 in Yarnell v. Commonwealth, a climate of abuse involving “constant emotional, verbal, and physical duress” is tantamount to forcible compulsion. In that case, the victims submitted to the sex acts to avoid a loss of financial security, as well as to maintain peace in the household.

Historically, the legal system has long been indifferent to the crime of marital sexual assault; as recently as twelve years ago in some states, it was legal for a man to force his wife physically into sex, or commence having sex without her consent–actions that could land a stranger in jail. Until 2000 the Kentucky Penal Code still contained archaic procedural obstacles for prosecuting marital rape, including a requirement that it be reported within one year of the offense. (No other felony–including “stranger rape”–contains a statute of limitations.) Even today, marital sexual assault is a notoriously difficult crime to prosecute. Women like Davis often have strong financial incentives to stay with their spouses; those who speak out frequently face an uphill battle to convince people that their husbands, who may be well liked and respected, are capable of something this ugly at home. Also, because marriages play out over many years, some sex is consensual, while other sex is not–a fact that may complicate matters for a jury in a criminal proceeding.

Linda Davis chose not to bring allegations of marital rape into her divorce proceedings; her foremost desires at the time were a fair settlement and minimal disruption for her sons. Nonetheless, she informed her lawyer of the abuse. Natalie Wilson, a divorce attorney in Lexington, asked Linda to draw up a working chronology of her marriage to Hager. “[It] included references to what I would call the sexual abuse,” Wilson explained. “I had no reason not to believe her…. It was an explanation for some of the things that went on in the marriage, and it explained her reluctance to share that information with her sons–which had resulted in her sons’ being very angry about the fact that she was insisting on the divorce.”

As it turned out, when the dust settled after their divorce, nearly everyone in the Hagers’ Christian and medical circles in Lexington had sided with Hager, who told people that his wife was mentally unstable and had moved in with another man (she moved in with friends).

Davis had only told a handful of people about the abuse throughout her marriage, but several of her longtime confidantes confirmed for this article that she had told them of the abuse at the time it was occurring. Wilson, the attorney, spoke to me on the record, as did Brenda Bartella Peterson, Davis’s close friend of twenty-five years. Several others close to Davis spoke to me off the record. Two refused to speak to me and denounced Davis for going public, but they did not contest her claims. Many attempts to interview nearly a dozen of Hager’s friends and supporters in Lexington and around the country were unsuccessful.

As for David Hager, after repeated attempts to interview him for this story, we finally spoke for nearly half an hour in early April. That conversation was off the record. “My official comment is that I decline to comment,” he said.

As disturbing as they are on their own, Linda Davis’s allegations take on even more gravity in light of Hager’s public role as a custodian of women’s health. Some may argue that this is just a personal matter between a man and his former wife–a simple case of “he said, she said” with no public implications. That might be so–if there were no allegations of criminal conduct, if the alleged conduct did not bear any relevance to the public responsibilities of the person in question, and if the allegations themselves were not credible and independently corroborated. But given that this case fails all of those tests, the public has a right to call on Dr. David Hager to answer Linda Davis’s charges before he is entrusted with another term. After all, few women would knowingly choose a sexual abuser as their gynecologist, and fewer still would likely be comfortable with the idea of letting one serve as a federal adviser on women’s health issues.

(Lest inappropriate analogies be drawn between the Hager accusations and the politics of personal destruction that nearly brought down the presidency of Bill Clinton, it ought to be remembered that President Clinton’s sexual relationship with Monica Lewinsky was never alleged to be criminal and did not affect his ability to fulfill his obligations to the nation. This, of course, did not stop the religious right from calling for his head. “The topic of private vs. public behavior has emerged as perhaps the central moral issue raised by Bill Clinton’s ‘improper relationship,'” wrote evangelist and Hager ally Franklin Graham at the time. “But the God of the Bible says that what one does in private does matter. There needs to be no clash between personal conduct and public appearance.”)

Hager’s FDA assignment is an object lesson in the potential influence of a single appointment to a federal advisory committee that in turn affects thousands, even millions, of lives. Witness the behind-the-scenes machinations that set the stage for the FDA’s ruling against Plan B, a decision that the American College of Obstetricians and Gynecologists called a “dark stain on the reputation of an evidence-based agency like the FDA.”

On December 16, 2003, twenty-seven of the FDA’s advisers on women’s health and nonprescription drugs gathered in Gaithersburg, Maryland, to evaluate the safety and efficacy of emergency contraception for over-the-counter use. (The Plan B pill, which drastically reduces the risk of pregnancy when used within seventy-two hours after intercourse, has long been available by prescription only; its advocates say its greater availability could significantly reduce the nation’s abortion rate.) After a long day of highly technical deliberation, the advisers voted 23 to 4 to drop the prescription-only status of emergency contraception. “I’ve been on this committee…for almost four years, and I would take this to be the safest product that we have seen brought before us,” announced Dr. Julie Johnson, a professor at the University of Florida’s Colleges of Pharmacy and Medicine.

But on May 6, 2004, the FDA rejected the advice of its own experts and refused to approve the sale of Plan B over the counter. In his letter to Barr Laboratories, Steven Galson, acting director of the FDA’s Center for Drug Evaluation and Research, claimed that Barr had not provided adequate data showing just how young adolescent women would actually use the drug.

That issue was never voted on by the committee. It was, however, broached by Hager at the meeting; he mentioned his concern for these “younger adolescents” several times.

In his private practice back in Kentucky, Hager doesn’t prescribe emergency contraception, because he believes it is an abortifacient, and, not surprisingly, his was one of the four votes against widening its availability. But rather than voice his ethical opposition to the product, Hager emphasized his concern about adolescents, which other committee members have since called a “political fig leaf.” According to Dr. James Trussell, who voted in favor of Plan B, the FDA had at hand six studies examining whether teens as young as 15 would increase their “risky” behavior if they knew they had a backup emergency contraceptive–and none of the studies showed any evidence for that contention.

In his sermon at Asbury College last fall, Hager proudly recounted his role in the Plan B decision. “After two days of hearings,” he said, “the committees voted to approve this over-the-counter sale by 23 to 4. I was asked to write a minority opinion that was sent to the commissioner of the FDA…. Now the opinion I wrote was not from an evangelical Christian perspective…. But I argued it from a scientific perspective, and God took that information, and He used it through this minority report to influence the decision.” [Emphasis added.]

None of the four panel members I spoke with for this article were aware of Hager’s “minority opinion.” An FDA spokeswoman told me that “the FDA did not ask for a minority opinion from this advisory committee,” though she was unable to say whether any individual within the agency had requested such a document from Hager. This past January the FDA missed a deadline to respond to a new application from Barr Laboratories, and any forward motion on making Plan B more widely available has completely stalled.

Meanwhile, David Hager’s stock has been rising among conservatives. Though his term on the FDA panel is set to expire on June 30, observers on both sides of the political divide anticipate his reappointment. In March I spoke with Janice Shaw Crouse, executive director and senior fellow at the Beverly LaHaye Institute, the research arm of Concerned Women for America. She is one of Hager’s staunchest advocates in Washington (some credit her with engineering his FDA appointment); Crouse sits alongside Hager on Asbury College’s board of trustees. In May, when informed of the allegations against him, she declined to revise her earlier statement. “I would not be at all surprised to see Dr. Hager elevated to a higher position or to another very influential position when it comes to women’s care,” she told me. “Because he has shown that he does care about women regardless of…the [religious] issues that people want to try to raise…. When people try to discredit him, he continues on. He hasn’t caved in, and he hasn’t waffled. He has been a gentleman. He is a person of character and integrity, and I think people admire that.”