On Sunday, May 31, 2009, I was just finishing up my final day as a teaching doctor in ob-gyn and family planning at Washington Hospital Center, in Washington, D.C., when text messages began flooding my cell phone. Dr. George Tiller, one of the abortion movement’s bravest practitioners and an outspoken advocate for the rights of women—a man we in the abortion rights community sometimes called “St. George”—had been shot, point-blank, in the forehead.
Dr. Tiller was, as I am, a Christian, and at the moment of his assassination he had been standing in the vestibule of his home church, Reformation Lutheran, in Wichita, Kansas, handing out bulletins for the day’s services. It was Pentecost—a joyous thanksgiving to God for the gift of the Holy Spirit—and the service had already commenced, with the choir singing an African song, and the senior pastor accompanying on drums. At a few minutes after ten in the morning, Scott Roeder, an anti-abortion extremist who used the online handle ServantofMessiah, entered the vestibule with a handgun, approached Dr. Tiller, and pulled the trigger. He then ran into the parking lot and threatened the churchgoers who happened to be lingering there, before fleeing the scene in a powder-blue Taurus. In the entrance to the church, one usher attempted CPR on Dr. Tiller, while another rushed into the sanctuary, found Jeanne Tiller, and escorted her down the aisle to the spot where her husband of forty-five years lay sprawled on his back in a pool of blood. Parishioners recollected later that they could hear her scream.
In 2006, as an eager first-year Family Planning fellow, I began attending meetings of the National Abortion Federation (or the NAF, as it is known), a professional association for abortion providers that establishes clinical standards of care, offers continuing education for practitioners, does clinic security assessments, and, through an anonymous donor, helps to subsidize abortion procedures and travel costs for poor women. At my very first meeting, I had been seated across the table from Dr. Tiller during an educational panel. His work and his bravery were legendary, and I was awestruck. He was one of three doctors in the country who continued to perform third-trimester abortions despite the vitriolic political outcry against the procedure and legislative attempts to criminalize doctors who performed them. He was a veteran, quite literally, of the abortion wars and wore his wounds with pride. His clinic, Women’s Health Care Services, in Wichita, had been bombed twenty-three years earlier, and in 1993, a terrorist named Rachelle Shannon had shot Dr. Tiller in both his arms. In a gesture of defiance and outrage, Dr. Tiller had returned to the clinic the very next day, his arms bandaged from his wounds, and proceeded, as usual, to perform abortions. With fondness and reverence, abortion rights advocates regarded Dr. Tiller as more than a movement leader: he was a guru, a teacher, a saint. Even opponents, in awe of his toughness and righteousness, acknowledged that he was a warrior. But all his experience, and all the admiration in the world, couldn’t keep him safe. So constantly bombarded was Dr. Tiller with threats on his life that he had been forced to turn his clinic into a fortress—bulletproof glass, floodlights, security cameras, and armed guards. It was hard to believe, as I regarded Dr. Tiller across a conference table that day in 2006, with his benign midwestern features and his cleft chin, that this mild person could be the object of so much fury. This guy was shot for doing what you think you want to do! I had thought to myself. Are you sure about this?
At the break, I approached him. “Dr. Tiller,” I began, “I just want to let you know what a fan I am and how much—”
Tiller cut me off. “Hold on a second,” he said. “Please call me George. There’s no need to see yourself as any different. In this work, we are all the same, standing up for women and what we know to be right.” To this day, I do not know exactly what he meant when he called me “different.” Was Dr. Tiller referring to my relative inexperience—I was a newbie in this hardened crew—or to my race, and the fact that male African American abortion doctors are as rare as snow in July, or so I thought at the time. (In fact, there have always been black providers, working in the shadows, pre-Roe, to avoid the double stigma of race and abortion.) When I recall that conversation now, what I remember most is his generosity and his inclusiveness, the fact that he welcomed me as a fellow traveler, without even knowing my name. Over the years we became friendly, greeting each other at meetings, united as only comrades in the trenches can be, and in the Tuscaloosa clinic where I work, a letter from him hangs on the wall. “Abortion is a matter of the heart,” it says. “For until one understands the heart of a woman, nothing else about abortion makes sense at all.” Below it, his signature: George Tiller.
That Sunday, as my phone filled with messages and calls, my mood sank from exuberant to desolate—an emotional pivot I had not felt since twenty years earlier, upon receiving the news of the death of my mother. The sadness and loss I felt were deeply personal. But something even more powerful colored my grief as well. Instead of terror, or personal anxiety, I felt a hardening of my resolve, a refusal to be intimidated, and a tranquility, if I can call it that, about what I had come to see as my calling. Dr. Tiller’s death made things simpler for me, and clearer: I would do what I knew to be right, and I would not succumb to fear.
At his trial, Scott Roeder pleaded not guilty on the basis of justifiable homicide. In his eyes, Tiller was a murderer. And in his opinion, Tiller deserved to die. A jury rejected that claim. Roeder was sentenced to life in prison with no chance of parole for fifty years. The jury saw Roeder, rightly, for what he was: a terrorist. He is also a fanatic. I have heard fanaticism defined as a doubling down of effort behind a misbegotten aim. If that is true, then conscientious resolve is fanaticism’s antidote: a doubling down of effort behind a clear aim, despite the risk.
• • •
One of the things that infuriates me the most about the abortion wars, as they’re called, is the way that the antis have shrouded their case in the language of God. With phrases like “pro-life” and “culture of life,” the antis seized the moral high ground nearly forty years ago, and they retain it to this day, because abortion rights activists, the people who have been fighting for the rights of women, have never mounted a significant religious or moral counterargument. Never mind that every great justice cause, from abolition to same-sex marriage, has been waged in religious terms, in order to influence or inspire the souls of the passive or the undecided. Believing themselves too high-brow, or too rationalistic, or too scientifically minded to stoop to this level, pro-choice advocates have ignored the evidence and the history. Presuming that religion is a corrupting and divisive force, progressive and humanist people have failed to offer a moral, spiritual, ethical, or religious case for abortion rights and so have ceded those arguments to their opponents. Meanwhile, the tactics that the antis have used, for decades, have been so explicitly un-Christian (and I’m not just talking about the murder, arson, bombings, and other terrorist acts that have stained the anti-abortion movement since its inception) that it seems to me a wonder that any faithful Christian would want any part of them.
If you take anti-abortion rhetoric at face value, without knowing much about the Bible, you might assume that the antis have Scripture on their side. That’s how dominant and pervasive their righteous rhetoric has become. But they do not. The Bible does not contain the word “abortion” anywhere in it. As an inspired document, the Bible is full of guidance for me about justice and love. But as a historical document, the Bible is a ruthless, unsparing record of the historic misogyny of the early Jewish and Christian people. The Bible was codified in centuries when women were only slightly more valuable than goats or sheep. Wives were property, bought and paid for with cash, like farm animals and household goods. Menstruation, the physiological event that occurs monthly in women of child-bearing age, was seen as defiling, a contamination: the Bible offers many rules concerning the separation of women from their communities and families during their menstrual periods and the purification rituals required of them in the aftermath. The Bible offers many picayune rules, similarly, about the conditions under which a woman might have sex—which is, to say, never, except with her only husband, who might have more than one wife—and the instances in which she might be executed (stoned!) for violating these rules. In the world of the Bible, bearing many children was a woman’s most important job; infertility was seen as a reason for everlasting shame and humiliation—and even separation from God. Even in that ancient cultural context, however, abortion is never mentioned. The only time the Hebrew Bible alludes to something like abortion is in the Book of Exodus, which poses the following hypothetical: If two men are fighting, and one man accidentally hurts the other man’s pregnant wife, and if as a result of that fracas the wife loses the pregnancy, the aggressor must pay the husband a fine. (In the event that the aggressor accidentally kills the man’s wife, he then must himself be killed.) The death of a fetus is regarded as a loss but not a capital crime. Throughout Jewish scripture, a fetus becomes human when—and only when—its head emerges from the birth canal. The New Testament values marriage, sexual purity, and asceticism. But it doesn’t talk about abortion at all.
When I was growing up in fundamentalist churches in the South, the subject of abortion was never preached from the pulpit. Pastors preached fire-and-brimstone sermons against sexual promiscuity and sexual infidelity. It was common, in the churches of my childhood, to cast women in the role of temptress. As far back as the Garden of Eden, the woman beguiled the man and led him into the Fall, while the man—I remember finding this unfair, even as a child—could abrogate his responsibility. She tempted me, the man could say. All I did was eat. In the culture in which I grew up, this was the underlying understanding, that because of their sexuality, women had evil powers and were not very emotionally stable, and the double standard was baked into our understanding of sex: any person might fail to live up to God’s expectations regarding purity and fidelity, but the girls were the ones charged with guarding God’s line, and they were the ones punished when lust or dominance or impatience or boredom were victorious.
Yet even though the religious culture in which I grew up was misogynistic and regarded women’s sexuality as shameful, abortion was not something we concerned ourselves with. Until the 1980s, abortion was seen as a political, legalistic issue and not a religious one. Indeed, for most conservative churchgoers in the South, all politics were seen as corrupting, desecrating influences. The Christian ideal was to separate from the world, to immerse oneself in the Bible, and to leave politics to the heathens. This was true even in many black churches during the civil rights movement. There were many churches in Birmingham, but, given the number, not as many of my neighbors as you would think participated in the civil rights campaigns. In fact, people in the black community down south frequently joke that if half the folks who claimed to have marched with Dr. King had actually done so, the movement would have been over a lot sooner! “Render therefore unto Caesar the things that are Caesar’s,” my mother’s friends said to one another, by which they meant, keep your head down, mind your business, and let other people worry about politics. Even when, as a teenager, I found Jesus, the emphasis in the prosperity gospel I learned from Pastor Mike was on self-improvement and achievement—on the glories and abundance made available to every individual through God. All the churches and the church people I knew well were, like their conservative brothers and sisters throughout the nation, explicitly and intentionally apolitical.
In the years before Roe, Republicans—not Democrats—were the most outspoken advocates for abortion rights. Family planning and population control were Republican issues—rooted both in the small-government and individual-rights priorities of the right-wing establishment and also in some cases the more insidious attempts of white elites to curb reproduction among browner Americans. In 1970, New York’s governor Nelson Rockefeller signed a bill legalizing abortion in New York. Two years later, his older brother, John D. Rockefeller III, working as an appointee of President Richard Nixon, called for improved access to contraception and liberalization of abortion laws. George Herbert Walker Bush was a long-standing supporter of Planned Parenthood, having sponsored and supported Title X, public funding of contraception for indigent women—right up until 1980, when he was being considered as vice president to run on the Republican ticket alongside Ronald Reagan. The right to safe and legal abortion appealed to Republicans because it went along with certain cherished conservative ideals: freedom from government intervention in personal decision making, and freedom to pursue the American Dream—giving each individual the opportunity to design his or her own future.
Not that I paid attention to any of this. I was a child. And then, as a teenager, I was knocking on doors, handing out tracts promising salvation through God. For Christians, the 1980 election changed everything. In the late seventies, a small but powerful alliance of Protestants, Catholics, and political strategists intent on putting Ronald Reagan in the White House came up with a cynical plan. By framing abortion as the most important threat in a broad secular assault on “family values”—and using rhetoric of the “sanctity of life” lifted directly from the Roman Catholic catechism—a group of what were essentially lobbyists found they could mobilize conservative voters throughout the Bible Belt, millions of citizens who had previously been politically passive and who regarded the polls as profane. The public face of this alliance was an organization called the Moral Majority, led by a fundamentalist Christian pastor from Virginia named Jerry Falwell, who conflated religion and politics by preaching that abortion was murder, and that the moral duty of a good and faithful Christian was to declare him- or herself to be “pro-life.” It was, perhaps, the most successful marketing campaign ever launched in the political sphere, creating legions of single-issue voters who would stand in line at the polls in any weather to elect pro-life candidates.
Anti-abortion politics became, in an instant, part of a sweeping “traditional” worldview, focused, first and foremost, on overturning Roe. But it wasn’t just Roe: the Moral Majority and their allies hated homosexuality, single parenthood, pornography, feminism, and legions of other secular ills. The antis reached back into their Bibles and discovered there “proof” for their anti-abortion beliefs, most notably a previously obscure verse from the Book of Jeremiah, which seemed to say “a person” existed in utero even before conception, even before the union of sperm and egg. Before I formed you in the womb, I knew you; before you were born, I set you apart. This understanding of conception is a religious understanding. But it was promulgated widely as secular truth.
Almost overnight, pulling the lever for the Republican candidate became the “Christian” way to signal a vote for “life,” and for the way the God of the Bible said he wanted things to be. Millions of Christians flocked to the polls, electing Ronald Reagan in a landslide—their secondary (but no less explicit) motive to put a pro-life president in the White House who would appoint Supreme Court Justices who would overturn Roe. Women—and especially poor women, who disproportionately use abortion clinics—were the collateral damage of this political campaign, painted as heedless, heartless killers lacking in conscience, personal responsibility, and heart. “Abortion on demand now takes the lives of up to one and a half million unborn children a year,” Ronald Reagan said in 1983 on the brink of being reelected, overwhelmingly, for a second term. “Human life legislation ending this tragedy will someday pass the Congress, and you and I must never rest until it does.” And for the next dozen years, Republicans could count on mobilizing these conservative voters simply by raising the possibility that their “family values” were under attack.
Even in my most fundamentalist moments, this was no Christianity that I recognized as mine, starting with the fact that nearly every mother I knew was a single mother, including and most important my own, which argued for a broader definition of family values. More, the God I learned about from Pastor Mike was one of hope and transcendence—of pure joy. My God was ambitious for me. I knew for sure that He didn’t care if I was poor, or black, or born into hardship. He didn’t want me to be anything other than what I was, and He wanted to love me so that I would thrive and prosper, both materially and spiritually. At the time I admit I took the Word literally, in that I believed as a youth that, through Jesus, Mike could cast out demons and heal the sick, and I emulated the chastity of Jesus as much as I could. As a college student at Berea I embraced the rigidity of my Christian brothers and sisters, and held sexual purity up as the ultimate ideal. But even in college, I would have chafed against the absolutist views that the so-called religious right were promoting as Truth.
My inclination to feel on the “outside” of this sweeping conservative Christian movement had to do, of course, with the environment in which I was raised. The anti-abortion movement was launched and promulgated largely by whites, triggering in me a nausea and a primal loathing that I believe is the reasonable response of someone who grew up among folks who carried with them in their bodies memories of lynchings and the terrorism of the Ku Klux Klan. Many of my neighbors and relatives endured the real trauma of this violence, and I repudiated it viscerally. “My brother was cut up by white men and fed to the hogs,” my grandfather used to tell me, “because no one ever found his body.” The assaults on abortion clinics that started in the late seventies and continue to this day are nothing short of terrorist acts, targeting powerless people—women in need and the people who have decided in good conscience to help them—incited and enabled by the hateful language and culture that the antis have cultivated. There have been more than two hundred arson attacks and bombings of abortion clinics since the Supreme Court ruled in Roe. More than six hundred letters bogusly purporting to contain anthrax were sent to clinics between 1998 and 2002. Eleven people, including four doctors, have been assassinated for their affiliation with this work, which is legal. And most of these crimes were committed in the name of God.
In the early nineties, while I was still a medical resident buried in labor and delivery rooms in Cincinnati, Ohio, thousands of abortion protesters laid siege to all three abortion clinics in Wichita, Kansas. Under the direction of a guerrilla anti-abortion outfit called Operation Rescue, in an initiative they called the Summer of Mercy, the protesters took particular aim at Dr. Tiller’s clinic. Every day for six weeks, starting at seven in the morning, the protesters descended on Women’s Health Care Services and would shout prayers, sing hymns, and yell at patients. “Don’t murder your baby!” they would scream. Holding signs that said, BABIES KILLED HERE!, they would swarm the clinic doorways and then sit, for hours, reading Scripture aloud, barring any entrance or exit from the clinic itself. At one point, clinic staff were blockaded inside, unable to leave for thirty-six hours. Protesters chained themselves to the fence outside of Tiller’s clinic, swooned, crawled, and lay on the ground. Police on horseback arrived to control the scene, and the protesters shimmied under the horses, forcing officers to drag them away. During the Wichita protest, two thousand seven hundred people were arrested and all three clinics in the city had to be temporarily closed.
The violence prompted by the Summer of Mercy led to new federal legislation, called the Freedom of Access to Clinic Entrances Act, which prohibits protesters from barring women from entering and leaving clinics. And it also led to ramped-up protection for patients and clinic workers, with abortion rights organizations enlisting thousands of orange-vested volunteers to escort women safely through clinic doors. These measures have helped, and the volume on clinic protests has quieted somewhat since its peak. But in my career as an abortion provider, I have worked in eleven clinics, and I have never, ever—not once—entered my workplace without being verbally assaulted and harassed by people who see it as their God-given role to interfere with me and my work, and to question my Christian faith and the judgment of my patients. I had my very first experience doing a perp walk even before I was, in any official capacity, an abortion doctor. It was when I interviewed for the reproductive-health fellowship at the University of Michigan. To get to the administrative offices of the Planned Parenthood clinic in Ann Arbor, I had to drive past protesters who lined the driveway, quietly holding signs that said, PLANNED PARENTHOOD KILLS BABIES! This was a rude awakening, coming from Hawaii, one of the first states in the country to legalize abortion. Because this behavior was so foreign to me, I was more unsettled by these tame protesters than I might have been. (I realized this later after I saw far worse.) Once I took up residency in Ann Arbor, I drove past these protesters as a matter of course. Usually, I entered the clinic by the back door, which provided me with more safety and security. Sometimes, however, I entered by the front. This was safe for me, too, at the time. For one thing, I was not yet visible in the reproductive-justice movement. And for another, I am black. Due to the color of my skin, none of the protesters lining the front walk ever assumed I was the doctor who provided abortions. They assumed, instead, that I was the irresponsible boyfriend who had gotten someone pregnant. I would joke to my friends: “I’m never the doctor, just another ‘baby daddy’—a prolific one, since I’m at the clinic every week!” Worse: the protesters assumed that I was probably forcing a woman to have an abortion against her will. One of them once called through the fence, “Sir! Sir! Don’t make your wife kill your baby!”
Inside the clinics, we try, morbidly, to joke about our protesters. They are regulars and have become so familiar to us that we know them by their first names; the earnest intensity with which they carry out their mission—taking photos of everyone who enters and exits the clinic, including the kid who delivers the spicy chicken wings in Montgomery—would be humorous if their stakeouts weren’t so rooted in hate and tinged with the implication of violence. The person who owns and runs that clinic in Montgomery, June Ayers, sets the tone by being fierce to the bone and, at the same time, keeping her spirits light. Her staff and the patients benefit, equally, from her natural generosity and warmth.
My policy, in general, is not to interact with protesters—not to give them power by showing my fury. What would I gain? For eighteen months, I worked at Family Planning Associates in Chicago, where there was a regular protester named Brian. He would show up every day that I was on the schedule, sometimes as early as six thirty in the morning, sometimes in the freezing, subzero weather. He would stand outside the gate, smoking a cigarette in five feet of snow, and when I walked to the clinic door from my car, he would yell the same thing, every day. “You filthy Negro abortionist!” he’d say. I’d usually keep my head down and try to avoid trouble, believing that these irrational protesters are not worth a minute of my time or an ounce of my energy. But one day, my tolerance spent, I walked up to Brian and looked him in the face.
“What is it about my reality that bothers you more?” I asked him. “Is it that I’m a ‘Negro,’ as you call it? Or is it that I provide abortions?”
“It’s that you do abortions,” he answered quickly.
“Then why refer to my race at all?”
“Oh,” said Brian. “I just throw that in.”
I had to laugh. Here was a man for whom there was one thing worse than being black—and that was providing abortion care to women who needed it.
I try, if I can, to see the humanity even in the people who hate me for what I do. At the Jackson Women’s Health Organization, also known as the Pink House, there is a regular protester named Esther. Because we are in the South, even committed adversaries address each other formally and respectfully. In keeping with our southern gentility, we refer to her as “Miss Esther.” She is an older white woman, slightly obese, with a thick Mississippi accent. She likes to yell at me through the wrought iron fence behind which she stands and advise me that I’m going to hell. I don’t usually engage with her, but, again, one day I did. “I don’t think you’re interested in talking with me,” I told her. “I think you’re interested in talking at me.” I told her what I believed, that Scripture does not forbid abortion. She told me I wasn’t reading Scripture right.
“There is no ‘right’ interpretation of Scripture,” I answered. Then Miss Esther said she hoped I didn’t think she was being mean, and she prayed that I would one day start to practice “legitimate” medicine. I thanked her for her time.
• • •
Not every encounter is as civil. In the early months of February 2016, I received my first explicit death threat. It was lunchtime. I was eating takeout at my desk, not thinking about anything much. I had recently learned that people who were not your “friends” on Facebook could send you messages that would be cached in a separate folder, and I was browsing through that folder, just curious about who might have contacted me. And there, I found a message that was about three weeks old. “I know who you are,” it said. “I know where you live. If you think killing babies is acceptable, you are DEAD wrong. You’re on my radar now. I’ll be watching you.” The poster had obviously concocted a Facebook page expressly for the purpose of threatening my life, and I remember thinking, clear as day, This is a death threat. And then, my second thought: Why am I not terrified? I contacted Facebook and the chief of security at the National Abortion Federation, who contacted local law enforcement and the FBI. The incident was disconcerting, but I tried to shrug it off. That three weeks had transpired between the writing of the post and my finding it comforted me. So far, I have decided not to hire a security detail or to buy a bulletproof vest, feeling that if I get to the point where I’m more worried about my life than I am about the rights of women, I will stop doing abortions altogether.
The truth is that progress by abortion rights activists only stimulates the antis’ taste for confrontation. One Sunday in June 2016, the very day before the Supreme Court ruled in favor of the Texas-based clinic Whole Woman’s Health, asserting that by restricting access to abortion clinics, the TRAP laws passed by the state of Texas constituted an “undue burden” on women seeking legal abortion care, a group of picketers showed up to “pray,” as they call it, at the front door of my home in Birmingham. I do not know how they got my address. Fortunately, I was not at home that day. In anticipation of the court’s decision, I was already on my way to Washington, D.C. But in front of my home, on the quiet city block where I live, with a progressive church just down the street and a four-star restaurant in pitching distance, the antis set up camp and stayed there all day. They counted rosaries and got on their knees. And they held posters aloft. One of them said, WILLIE PARKER DOES THIS TO CHILDREN, before a photoshopped, bloody image of a disarticulated fetus that looked like carnage from a war movie.
Everybody who loves me worries about my safety “all the time,” as my youngest brother, Steve, puts it. Earnestine always wants a text from me when I’m traveling, constant assurance that I’m safe and sound. Many others—friends, lovers, employers, colleagues—have begged me to take more aggressive safety precautions, and it is a deep frustration to them that I refuse. I don’t take their concern lightly, but I believe you don’t negotiate with terrorists; you don’t give in to fear. Instead, I deflect their concern with a joke: I don’t need a vest, I say. My best protection is my everyday self. I can walk around in plain sight because no one on earth expects a large, bald black man in sweats and a baseball cap to be a doctor at all, let alone one of the last abortion doctors in the South. But the serious answer to their concern is this: I’ve right-sized the risk in my mind. I try to confront real risk, and deal with that, and not the hypothetical risk. I take what reasonable precautions I can without upending my life. I never give my mailing address or my e-mail to strangers. And when I arrive at work, I park my car in a different space each time: it seems prudent not to advertise the make and model of my car.
There’s another, philosophical element to my risk-benefit analysis. All my lifelong heroes have been accosted, or beaten, or assaulted for their righteous stands on human rights, specifically civil rights, and I see the work my peers and I do as similar to theirs. When the work you do is threatening, revolutionary, or life-altering for people, there’s really no point, for me at least, in being clandestine about it. I understood that in undertaking this work, I would be in the public eye and therefore in harm’s way, and so before I started performing abortions full-time, I considered all the risks, even the hypothetical ones, in order to gain a psychic comfort level: I might get shot at, accosted at the lunch counter, or threatened on the phone, or have my house burned or my car bombed. Having turned each one of these possibilities over carefully in my mind, I was able to find a space of tranquility. The fact is, you might wake up one morning and get electrocuted by your coffee grinder. You might get hit by a bus while crossing the street. There’s risk with everything, and it’s a given that we’re all going to die. As the gospel says, “No one knows the day or the hour.” So the only thing about which you have any choice is how you will live. And I’ve chosen to live according to my principles and by trying to make a difference. I don’t equivocate at all on the importance of the work I do being an abortion provider. And that leaves me very satisfied.
Dr. King said it. And Malcolm X said it. There are fates worse than death. A life with no purpose would for me not be a life worth living. I have no desire to die prematurely, but I am more intent on avoiding a death of spirit than I am avoiding harm for my decision to respect women and honor women, to help them achieve their goals and preserve their dignity.
At the same time, I’m only human. So even though I’m confident about my calling—I’m right with myself, morally, and I have adjusted to living under a unique kind of stress—I experience an involuntary shiver each morning when I arrive at work, turn off the key, and glimpse David or Brian or Doug, three different men defending the same patriarchal system in three different states, across the parking lot and see the bloody posters and the telephoto lenses, and hear harsh white male voices bellowing at me. I have been told that I come across as cool, even monkish in my demeanor, but I am not a martyr or a saint. The bare-bones truth is that I am outraged on a daily basis that I have to live with this threat, that the implication of violence has been normalized. Even more outrageous to me is that the women I serve face threats far worse than this.
The threat of violence surrounding the practice of abortion care is so relentless and so unnerving that even well-meaning doctors are persuaded not to undertake the risk. One of my colleagues, a doctor named Diane Horvath-Cosper, a young physician and new mother who works as an abortion provider in Washington, D.C., was shocked to find on an anti-abortion website a photograph of herself and her one-year-old daughter with a clear message that implied she was being watched by anti-abortion forces. And when she began to speak out about abortion rights, and the dangers that abortion providers face, her bosses forbade her from doing so—they did not want to draw additional, undue attention to their hospital’s abortion practice. So Diane, who is brave and committed, filed a civil rights complaint and called Physicians for Reproductive Health, a physician-led advocacy organization whose board I now chair, to see if they might help her get some support and guidance, and now she regularly speaks out about the anti-abortion activists who made implied threats against her one-year-old child. But Dr. Horvath-Cosper is the exception, not the rule. More physicians retreat from this stress than embrace it.
Increasingly, ob-gyn residency programs in the United States are beginning to offer abortion care as a component of graduate medical education. Of the residents who are trained, the vast majority choose not to perform abortions as a matter of course—preferring to refer their patients to someone like me rather than live in the shadow of constant unpleasantness and risk. The terrorism of the antis in the name of Christ has thus had the desired effect. Decades of shootings and bombings and shouting and protesting has meant that the number of doctors willing to perform abortions has dwindled. In 1981 there were 2,900 abortion providers and only 1,720 in 2011, a 41 percent decline, and the number of doctors willing to admit that they do abortions is even smaller. This is the state of things, even though the American College of Obstetricians and Gynecologists, the professional organization representing us, supports access to safe abortion, and the overwhelming number of ob-gyns are pro-choice.
• • •
The truth is, no one wants their kids to go to school or church and be taunted and called names for the work they do. My friend Gloria Gray, who owns and runs the abortion clinic in Tuscaloosa, Alabama, was raised in the church—“You didn’t go anywhere if you didn’t go to church,” she told me—and finds that as she has gotten older, her world has grown increasingly small: few of her old friends and neighbors speak to her anymore. Very few people want to live as I do, a bachelor, a vagrant—a conscious choice that I have made in order not to bear the responsibility of putting others in harm’s way. I chose not to buy the house next door to my brother Fred when it became available—because what if his house burned when they bombed mine? Or what if a so-called Christian with a gun mistook him for me? He is taller than I am, but in many ways we look the same.
We know, from experience during the dark ages before Roe, that women intent on terminating their pregnancies will find a way. According to the Guttmacher Institute, there were more than a million self-induced and illegal abortions a year during the fifties and sixties—approximately the same number of legal abortions as the present day. But death and injury rates were much, much higher. Complications from abortion was listed as the official cause of death for 2,700 women in 1930, a number that is likely to be conservative, since many physicians and coroners lied to protect the reputations of family members. In addition, many women received ghastly injuries from self-inflicted or amateurish abortions. Coat hangers, knitting needles, or bicycle pumps were inserted into their uteri, resulting in puncture wounds, hemorrhages, infections, and embolism. The rate of death from illegal abortion decreased in the decades pre-Roe—not because fewer women were seeking to terminate their pregnancies, but because of the widespread use of effective antibiotics. Women will seek abortion whether it’s safe and legal or not—even at the risk of their own lives.
As legitimate abortion doctors are impelled to hide, and top-notch physicians are dissuaded from undertaking this work, the number of quacks and predators will increase. In 2010, the FBI raided the West Philadelphia abortion clinic of a doctor named Kermit Gosnell, whose illegal practices and unsanitary facilities led to innumerable hospitalizations as well as to the death of one woman, named Karnamaya Mongar, who received an overdose of an opioid analgesic. The conditions the FBI found in Gosnell’s clinic were appalling. There were blood and urine stains everywhere, and semiconscious patients lay on dirty recliners under bloody blankets. A flea-ridden cat roamed the clinic freely, leaving feces on the floor. Fetal remains were stored in milk jugs and cat food containers. According to testimony at his trial, Gosnell regularly performed abortions after twenty-four weeks, beyond the legal limit in Pennsylvania, and his employees told authorities that babies born alive had been killed when Gosnell snipped their spinal cords with a pair of scissors.
Gosnell charged 25 to 40 percent less than the Planned Parenthood clinic less than three miles away, and some of the women who sought his care did so, they said, because they had nowhere else to go. They either could not afford the $500 fee that their Medicaid would not pay (thanks to the Hyde Amendment), or they had delayed their decision until it was too late, and Gosnell would do abortions at any stage. Gosnell made himself indispensable because he was the last, awful resort for young girls who couldn’t get permission from their parents and for people too poor to pay a legitimate doctor. At age seventy-two, Gosnell received a life sentence without a possibility of parole.
Gosnell is what happens when abortion becomes too difficult to procure, and when the occupation itself—abortion provider—is something too socially disreputable for any young, idealistic doctor to undertake. There is no excuse for Kermit Gosnell, who was a criminal and an inhumane predator of women. But he is a boon to the anti-abortion forces, because his heinous misdeeds tarnish all of us who do take this work seriously and do it skillfully and well.
Doctors like Gosnell are able to emerge because the culture of intimidation scares the good, brave physicians away. In the aftermath of Dr. Tiller’s death, abortion providers collectively got very, very nervous. They were forced, very reasonably, to search their souls—for in the face of that cold-blooded murder, the risk they undertook every day was revealed incontrovertible. Is it worth it? people wondered. Do I dare to continue? The community of abortion providers, usually very tight-knit, grew silent, and I became concerned that the silence was enabling an echo chamber of fear. So, in an effort to calm and encourage my colleagues, hoping to share with them the soul lesson I had received from the story of the Good Samaritan and some of the tranquility I felt, I posted a letter on a LISTSERV of the Family Planning Fellowship. Fear and courage “are often framed as polar opposites, but in fact I experience them as complimentary,” I wrote. Fear—the fear of the priest and the Levite—is rational, healthy, and self-preserving. Courage, on the other hand, “has to be chosen and taken. We often take the fear and leave the courage, when we should do the converse: leave the fear and take the courage.” Seeking to console, I shared with my colleagues an e-mail Dr. Tiller himself had written and distributed widely some eight years before.
He wrote: “Being involved in a philosophical Armageddon, such as slavery or abortion, adds dimension to one’s existence, crystallizes the vital priorities, and adds clarity to the purpose of being. The idea is to be in the purpose and neither live entirely for the purpose or die daily for the purpose.”
In my note to my colleagues, I called on my spiritual mentor, Dr. King, to help me magnify Tiller’s own words. Harm to anyone you know on the basis of the thing you hold in common is reason for pause, I explained. But for me, Dr. Tiller’s execution served as a stand-up call, not a wake-up call. When Dr. King alluded to death threats during the Montgomery bus boycott, he described incessant calls to his home. “Nigger,” one of the callers said, “we are tired of you and your mess now. And if you aren’t out of town in three days, we’re going to blow your brains out and blow up your house!” Dr. King had a newborn baby at home in those days, and he recalled that, in the moment of crisis, the voice of God was as audible for him as it ever was. It said, “Stand up for righteousness, stand up for justice, stand up for truth. And lo I will be with you, even unto the end of the world.” That response seemed relevant in the fight before us.
I’ll never know what those who disagreed with me think. They didn’t share their responses. But I do know that I received many personal expressions of thanks to my missive. Fellow providers told me, in private, that they were less afraid and less intimidated after I put the incident into perspective for them. More, I think the fellowship of brave—there is no other way to describe them—abortion providers simply appreciated my articulation of the calculus we must take into account. The question all of us faced after Dr. Tiller’s death was this: How do we move forward now, understanding that the risk of death is real? It must be the same feeling that soldiers have as they go into battle. They know that in the conflict people will die, and that by going on the front lines the risk is direct. How do you put that into perspective? I was able to speak the truth in a way that did not defy logic, but instead put fear in its place. Fear is a rational response to such an event, and looked at that way, as the other side of courage, it can be empowering.
In recent years, a new generation of physicians and other health-care providers has stepped forward, people who prioritize abortion access and training above their concerns about safety and risk. Not so long ago, the only doctors who provided abortions were the ones who lived through the years pre-Roe and saw firsthand the disastrous consequences of illegal abortion. As a result, the abortion doctors were an aging breed, and no one was stepping in to replace them. Fortunately, this is changing. Thanks to the same Family Planning Fellowship under which I trained, there are now literally hundreds of doctors with the expertise to do surgical abortion up to twenty-four weeks. Also, the Ryan Program, named in honor of the noted gynecologist and medical educator Dr. Kenneth Ryan and launched at the University of California, San Francisco, in 1999, provides funds and support to any ob-gyn residency program that wants to incorporate abortion care in its regular training—with the goal of making abortion an integrated part of women’s health and not a separate professional track. In 1993, the American College of Obstetrics and Physicians changed its guidelines and reaffirmed its position to consider abortion a core competency in women’s health; as a consequence, medical students are beginning to insist that the ob-gyn residencies to which they apply offer abortion training. Family practice doctors, nurse practitioners, nurses—all are beginning to demand that abortion training be more widely available to them and not contained only within the ob-gyn specialty. All these are efforts to normalize and destigmatize the practice of abortion care so that being a person who provides abortions is as unremarkable as any professional choice.