In 2011, an acquaintance named Susan Yanow approached me with an idea. Susan lives in Boston and is a fierce abortion rights activist, a one-person wrecking crew for patriarchy. She conceived a project that, in the manner of medical-residency program admissions, matches abortion doctors with the clinics nationwide most desperate for skilled help. If an abortion clinic in an embattled state is struggling to stay open because local physicians, fearing physical harm and the negative fallout of stigma and shame on their families, refuse to work there, then Yanow will send them a willing and capable doctor from out of state. The result is a small band of warriors, perhaps as many as a hundred, who regularly fly in to the most dangerous states—in the South, the Midwest, and the Great Plains, where their lives and reputations are in peril—perform abortions, and then fly out. Most of these doctors are women, and they split their time between the clinics and their practices in ob-gyn or family medicine. But a few, like me, are full-time “circuit providers.” They are always on the road. They log sometimes as many as one thousand miles a week. These are the indefatigable special forces of the abortion rights movement, living out of anonymous hotels, sometimes wearing masks to protect their identities and bulletproof vests to preserve their lives. Operation Save America, the twenty-first-century iteration of Operation Rescue, which organized the Summer of Mercy in Wichita and whose founder, Randall Terry, implied after the assassination of Dr. Tiller that he deserved what he got, tracks these practitioners and exposes them when it can. One famous circuit provider, whom I won’t name for obvious reasons, always traveled wearing a Three Stooges mask. Operation Rescue found her out and posted her photo, her name, as well as that of her elderly mother, on its website. Susan wondered if I might want to join this small army of traveling doctors to serve the women for whom getting a safe and legal abortion was nearly impossible. I was intrigued.
At the time, I was living in Washington, D.C. In 2009, I had left my job as the director of Family Planning at Washington Hospital Center to become the medical director of five busy Planned Parenthood clinics in metro D.C. But I was in transition again, putting together a schedule as an independent contractor, working in abortion clinics in Washington and Philadelphia. I had been at Planned Parenthood for two and a half years, doing abortions for women on a daily basis and providing the medical leadership for the clinics. But my appetite for advocacy was growing. I had a long-standing interest in public health. In clinical work you can improve lives on an individual level; a public-health approach aims for system-wide change, and in the years immediately following my training at Harvard, I spent three years working for the California Department of Health Services, studying the data on domestic violence, maternal mortality, black infant health, and teen pregnancy. The professional question that tantalized me was this: How do we improve health prospects for women by attacking behaviors, perceptions, and, yes, laws?
Planned Parenthood had given me opportunities to speak out. I traveled with the organization’s president, Cecile Richards, when she made calls on the Hill, and when President Obama was trying to pass his health-care law, Planned Parenthood tapped me to protest the Stupak-Pitts Amendment, which restricted the provision of abortion care for women receiving government insurance. (Despite our advocacy, the amendment passed.) I was grateful for these opportunities to advocate, but I found that my connection with Planned Parenthood constrained me as well, for there were times when my mission and my employer’s were not precisely aligned. In 2010, for example, the far-right television personality Glenn Beck began traveling the country in what he called a “civil rights” campaign—“We are on the side of individual freedoms and liberties,” he said, “and, dammit, we will reclaim the civil rights movement!”—appropriating the legacy and the rhetoric of Dr. King to further an anti-feminist, anti-gay, anti-abortion agenda. He was even traveling in cahoots with Alveda King, a niece of Dr. King, who worked for Priests for Life as an agent of the black genocide movement. Beck’s campaign was odious to me, especially the irreverent appropriation of civil rights language and iconography. When he made his station stop in the District of Columbia, I wanted to meet him with a full-throated rebuttal. But at Planned Parenthood headquarters, strategists had decided that their optimal play was to keep temperatures low and to meet Beck with silence. Sensing their reticence to engage on this issue but personally convinced this pernicious and disrespectful ploy had to be addressed in an urban center with a large African American population, I expressed my intent to speak out as a black man and physician on behalf of my community. As a compromise, I proposed that I speak my mind outside my Planned Parenthood affiliation. They accepted.
Not every unit in an army can fight every battle, and I decried Beck’s hypocrisies under my own banner. Don’t misunderstand. I am a loyal Planned Parenthood partisan and will fight with and for them at every opportunity. But the incident helped me see that if advocacy was to become a greater part of my mission, I had better be unfettered by organizational obligations—and so I continue to join with Planned Parenthood as an ally. By detaching myself from my full-time job, I could continue to do what I loved—engage with patients on a personal level and provide them with expert care—while also standing up for what I believed. I could also work more seamlessly with a number of strong organizations doing necessary justice work on reproductive, race, and gender-equality issues. And so I went out on my own, took charge of my own health insurance, retirement plan, and also my time. I worked in clinics four, five, and sometimes six days a week, but always preserved one day for activism, to meet with other activist organizations, to strategize, to write, or to speak in public. I increased my contact with the advocacy group Physicians for Reproductive Health, and regularly led young doctors on visits to the Hill, where, dressed in our white coats, we would meet with congressional staff, drop off fact sheets, and tell our patients’ stories. I sometimes felt hokey walking around the nation’s capital in a lab coat, but I was comfortable, too. From my days as a proselytizing Christian, I had long ago developed the thick skin needed for knocking on doors. When I looked around the well-waxed hallways, I saw Americans of every color, dressed in the uniforms of their profession—military or law enforcement officers, the winner of the Miss Agribusiness competition wearing her sash—pressing upon their representatives the importance of their cause.
Susan’s mission dovetailed nicely with my expanding vision of my life as a symbiotic combination of clinical work and advocacy, and I filled out forms she sent me that would match me with a clinic with the greatest need. But when her system connected me with Jackson Women’s Health clinic in Mississippi—the only abortion clinic in the entire state, which at the time retained just one doctor who flew in a couple days a week from his home in Charlotte, North Carolina, and who wore a Halloween mask as he drove from the airport to downtown Jackson, my first reaction was “No.” And my second reaction was more emphatic: “Hell, no.”
At the time, my mind was set. I was nearly fifty, after all. Since Hawaii, I had spent most of my professional life in the North, in liberal, urban communities. I had come to enjoy all the advantages these environments provided me. For one thing, it was not anomalous in Washington or Philadelphia to be an African American abortion provider, although as a male member of that professional group, I would always be somewhat of a unicorn. In Washington, it was easy enough to move around inconspicuously, to make friends, and to live among people who shared my commitment to broad-mindedness. And my chosen occupation did not exclude me from any social circle (or any friendship or any romantic attachment, for that matter). In the hubbub of Washington, D.C., what I missed of the South as a loss of a common language, an agreed-upon sense of gentility and manners, was more than compensated for by an openness about almost everything. In Washington, I could be looser and more frank about who I was and what I did every day. I could say the word “abortion” without raising eyebrows. I could talk about what I believed. The Northeast left me satisfied. As I liked to say back then, Alabama was a better place to be from than to be in.
Also, Mississippi had a serious public-relations problem, in my mind. I knew too well, having been raised in the South, how historic disagreements around politics and principle there can fester and then erupt, suddenly, into violence—sometimes lethal violence. And Mississippi had long been the symbolic epicenter of racial violence. I had seen Mississippi Burning at least five times, but even before I saw the movie I knew, of course, about the terrible deaths of James Chaney, Michael Schwerner, and Andrew Goodman, the middle of the night traffic stop by the Ku Klux Klan—the gunshots, the terrible lynching. While attending medical school in Iowa, I frequently traveled by car from Birmingham to Iowa City, driving a route that took me through the northeast corner of Mississippi, through rural counties with names like Prentiss, Lee, and Alcorn, and as I logged the miles, the images of those assassinated young men haunted me. The countryside abutting those stretches of highway seemed to be populated by the overworked, starving ghosts of my people, and I always told friends that I didn’t like to drive through Mississippi: the trees were too tall and the nights too dark. As a black man, I had a primal, visceral fear of the entire state. Emigrating there as an African American abortion provider was inconceivable to me.
Then I thought better of my instinctive negativity. “If I’m going to say no to this, I better know what I’m turning down,” I said to myself, and in August 2011, I flew to Jackson from Washington, D.C., to check out Mississippi’s last open abortion clinic. I boarded the plane with some anxiety, fearful that I was going back in time, to a place where white men wore skinny ties and their hair slicked back, and people like me were called “colored” or “Negro.” I was afraid, to be frank, that by looking at me, people could see through my skin and discern who I was and what I did all day. Instead, what I found was a plane disproportionately full of black people, just regular folks, traveling home. And when I arrived in Jackson, I was bowled over—smitten—almost immediately. Waiting for me at the small airport, by the curb, was Shannon Brewer, the clinic’s administrator. Young, African American, and whip smart, Shannon reminded me of Earnestine. Our connection was immediate. Shannon was warm but serious. She had worked her way up through every function of the clinic; she had never been to college but had washed glassware and instruments, counseled patients and held their hands in the procedure room. Now she was running the place: in charge of patient appointments and paperwork, the doctors’ schedules, and the budget. Chatting all the while, Shannon drove me to the clinic, a stand-alone sandstone building on a hipster block of Jackson, which the owner, Diane Derzis, had, in a blatant gesture of defiance against conformity and social conservatism, painted Pepto-Bismol pink. There, Shannon introduced me to Miss Betty, an older woman who did the counseling. Miss Betty’s manner was open and endearing; she was like the cool aunt you wish you had. She had grown up in Mississippi during the civil rights era, and in the 1980s had helped launch Jesse Jackson’s presidential campaign. As she matured, Miss Betty had shifted the focus of her activism from civil rights to reproductive rights, and she approached this work with the calm, assertive confidence of a person with a calling. What struck me was that everyone I met in connection with the clinic was a woman. And almost everyone was black.
The city of Jackson was also not what I expected at all. It was in the midst of a progressive renaissance. The clinic was within walking distance of a health food store and a pub that served artisanal beer. I never ate there but, right down the street, was a revamped old service station that was now a very popular and creatively named barbecue joint called Pigs & Pint. Once a flash point for racial conflict in the country, the city now has a black mayor. And the manners and customs of the people I met down there—well, they reminded me of family, of people I already knew. Shannon and Miss Betty told me about the women who came to Jackson Women’s Health seeking care—women living in the Delta, in abject poverty, sometimes driving for four or five hours on country roads to get there. Mississippi has some of the highest rates of teen pregnancy in the country, as well as some of the highest infant and maternal mortality rates. Nationally, the poverty rate is about 14 percent, but in Mississippi, it’s 23. And among black people in Mississippi, it’s 36. These stories, these data points, reinforced my sense of belonging to this world. This was a place, and people, I already knew, down deep in my bones. And then Shannon and Miss Betty told me about their political activism. At that time, the Mississippi state legislature was considering a proposed “fetal personhood” ballot measure, like the bill pending in Colorado at that time. But the employees of this clinic, together with a coalition of other reproductive health activists, infertility specialists, advocates for victims of rape, and community organizers among women of color had organized a countermovement called Wake Up, Mississippi, a campaign to articulate the vast and devastating impact on women that the passage of such a bill would have. And the bill failed. These were health-care workers who were also civil rights activists, and they buttressed my present sense of calling. I saw that without this clinic, kept open by these people, the women of Mississippi would have no options. When Diane Derzis drove up from her summer home in Mobile to meet me, I was bowled over. Charismatic, defiant, and super-smart, Diane had been trained as a lawyer and worked for years as a lobbyist in the area of reproductive rights. She owned clinics in Jackson, Birmingham, and Virginia—committed to the rights of women and to fighting like hell for their right to abortion care.
I flew back to Washington, feeling totally engaged and energized—understanding my vocation in a whole new way. In Washington, in Philadelphia, there were more than enough abortion providers. The emotional dynamics and inner conflicts around abortion in these urban hubs might be the same for the women who needed them, and the medical procedure was, of course, identical. But as in Hawaii, open clinics and qualified doctors were everywhere, and patients who had made the inner journey of deciding to have an abortion and then moved heaven and earth to be able to schedule an appointment were not at risk of having that procedure canceled or rescheduled arbitrarily because the one provider willing to work in their state had car trouble or was home sick with the flu. In Washington, D.C., if an abortion provider doesn’t show up for work, a woman can still get her abortion—most likely on the same day. In Mississippi, if the single doctor on the schedule in the only clinic in the state has a family emergency or a sore throat, then every woman sitting in the waiting room that day is out of luck; forced to reorganize her life again to come back another time. I saw how much I could contribute in Mississippi. I called Susan and told her yes, I would travel back and forth. I understood that by committing to a schedule of regular trips outside my safe zones, I was taking on more risk. I understood that as a black abortion provider in the South, I was making myself easy to see, easy to notice, easy to target—that I was essentially leaping from the frying pan and into the fire.
• • •
Working as an abortion provider in the South allowed me to see with my own eyes what I had long suspected. It wasn’t just the provincial white legislators who were to blame for the raft of new laws restricting access to abortion, especially for women who live in Bible Belt states. It was whole flanks of the left (among them passionate abortion rights supporters) who found it easy to look away from the plight of their sisters or who were able to rationalize the new laws as, in some way, “reasonable.” Partially, this was the result of a misbegotten political strategy.
In 2005, hoping to find common ground with those same social conservatives who elected George W. Bush, Democrats recalibrated their position on abortion. Instead of waging a righteous war on behalf of women and their constitutional rights to liberty and privacy, Democrats began to concede that abortion was a “difficult,” even “tragic” choice. In so doing, they threw Eve under the bus—again—turning reasonable adult women who sought abortion into victims, awash in their own sad luck and bad judgment. Even Hillary Rodham Clinton turned back progress and contributed to this very public devaluing of women’s choices. “We can all recognize that abortion in many ways represents a sad, even tragic choice to many, many women,” she told an audience in 2005. (She has since revised her rhetoric, pushing back against the laws designed to erode women’s choice: “Everything I have seen,” she said during her 2016 campaign for president, “has convinced me that life is freer, fairer, healthier, safer, and far more humane when women are empowered to make their own reproductive health decisions.”)
Imagining that they were building “common ground” with social conservatives, Democrats began to talk about “a third way,” using language that cast abortion as morally difficult and the women who sought them as agonized, fretful, and full of pain. “Abortion is bad, and the ideal number of abortions is zero,” wrote the pro-choice columnist Will Saletan in a New York Times op-ed. This strategy completely ignored the historical facts: as long as women have been getting pregnant, they have searched for ways to become un-pregnant, and for thousands of years, the methods they found were harmful to their health, causing infection, illness, and even death. And as a political maneuver, it backfired in incalculable ways, for all of a sudden a bipartisan moral consensus seemed to be emerging: if abortion is bad, then the women seeking abortion must also be bad, and new laws must be enacted to protect them from themselves.
The plight of women in Mississippi was also intensified by the ability of the nation’s progressives and elites to look away from them, to disassociate themselves from their southern sisters or to regard them as beyond help. Before I took my trip down there, I too was guilty of believing that there was something “backward” about the state that justifies disengagement. Just as groups of people like to subordinate other groups of people to themselves and so obliterate their humanity, whole regions have been dehumanized as well. And Mississippi is the bottom of the bottom. Even people who hold ideals about equity and justice can find themselves thinking that the problems in Mississippi are too intransigent, so impossible to solve that no right-minded, forward-thinking person could ever hope to interact with them and find any success. And so the people of Mississippi become isolated in their suffering, cut off from a larger political and social world. This disdain for places like Mississippi is what allows its own non-democratic state government to persist. In a state that’s 55 percent black, nearly every legislator in the state assembly is white.
Who enables the desperate isolation of the women of Mississippi? In part, it’s liberal women with children who themselves became enraptured with the sonogram images they saw at the obstetrician’s office and who wept when they heard the fetal heartbeat. Especially when I travel in upscale, liberal circles I see a fetishization of motherhood and children that I don’t quite understand, a universe away from the hardscrabble world in which I grew up. This sacralization of motherhood in every sector of the privileged classes enables a widespread social conservatism that, at base, diminishes women’s liberty: a consensus that motherhood is a woman’s most important role. When a society tacitly agrees that a morally neutral, biological process—procreation—is “miraculous,” then any intervention in that process can be seen as desecrating, and any choice against motherhood will be met with widespread disapproval. (In the churches I come from, a “miracle” is God’s intervention in the natural order of things—an ability, say, to turn a flask of water into wine or one loaf of bread into many. The way I see it, through a doctor’s eyes, there is perhaps nothing on earth less miraculous or more ordinary than the animal process of human procreation, which was happening long before the Bible was written and will continue long after today’s newborns are dead.) But among the elites, the same people who write checks to Planned Parenthood, the whole enterprise of parenthood has taken on a hothouse aspect, which allows a blurry consensus about the “sanctity of life” to flourish—instead of a clear-eyed definition of what “life” really is. Mommy blogs, conversations about “having it all” and “helicopter parenting”—all contribute to a cultural neurosis around motherhood that obscures what ought to be a value-free choice. A cultish preference for motherhood is so embedded in culture that even well-meaning women reflexively judge one another for their reproductive choices. Now a “broad-minded” woman may be heard to disapprove out loud of her sister-in-law’s abortion (“She could afford another baby!”), or to privately judge her friend’s decision not to have children as “selfish.” The truth is that there is no intrinsic moral value to becoming a mother or not becoming one. A woman who pursues a pregnancy is merely prioritizing her life around motherhood. And a woman who has an abortion is prioritizing her life around not wanting to become a mother or around devoting herself and her resources to the children she already has. Homo sapiens will continue to reproduce and evolve, with or without any individual woman’s participation in that process.
But in Bible Belt states, the antis seized this widespread cultural reverence for motherhood as an opening. If a culture presumes that motherhood is, a priori, always a higher moral or even religious good, then people don’t automatically revolt when laws are enacted that essentially force women into becoming mothers. Liberals may hear about laws enacted elsewhere, in states where they are not likely to live, that require counseling and waiting periods, widened hallways and hospital admitting privileges, and shrug: None of these seem, on the face of it, so bad. Shouldn’t women be protected after all? But this is paternalism and complacency, a turning away from truth. As the late-night comedian and political commentator John Oliver puts it, “Abortion cannot be theoretically legal.” It will not matter that abortion is the law of the land if fewer and fewer brick-and-mortar abortion clinics exist—shut down for lack of compliance to a million new arbitrary rules and restrictions. Increasingly, limited or no access to abortion is a reality. Eighty-nine percent of U.S. counties have no abortion provider at all; nearly 40 percent of American women of reproductive age live in these counties. That means on average, a woman has to drive thirty miles to a clinic, more than fifty if she lives in a rural area—and more if she seeks an abortion after twenty weeks.
From the relative safety of the blue states, voters who support abortion rights can be insulated from the devastating impact some of the new laws make on women’s lives. As governor of Indiana, Vice President Mike Pence signed into law a bill that bans abortion on the basis of a diagnosed fetal disability, and requires abortion providers to advise patients about perinatal hospice, in the event of a lethal fetal anomaly. Perinatal hospice is not an established medical protocol but a bundle of services invented by anti-abortion forces. What the antis want is for nonviable fetuses to live inside the uterus until they die of natural causes, which increases the risk of harm to the health of the mother, because every pregnancy becomes more potentially dangerous as it progresses to term. This same Indiana law is the one that requires a miscarried or aborted fetus to be buried or cremated—even against a woman’s wishes. In Alabama, a 2014 law requires a minor who wants an abortion without her parents’ permission to go to court, where the state can appoint a lawyer for the fetus. The judge in charge can delay or adjourn the case indefinitely, in effect causing the girl to “time out” of the legal abortion period, which in Alabama is twenty weeks post-fertilization. In recent years, three states—Arizona, Arkansas, and South Dakota—passed laws requiring abortion providers to tell women who choose medication abortion that they can “reverse” the procedure by taking high doses of progesterone. This is, simply put, not true.
I implore all American women to examine their biases about abortion, to search their souls for the terrible double standard that defines this debate. Do you privately think that the poor women and women of color who live in regions far away are beyond your help or are, in some way, “not like” you? Do you perpetuate a bias by thinking that limiting access to abortion is okay for other (poor, black and Latina, or red state) women, as long as your private physician will prescribe the abortion pill for you if you need it, and as long as abortion clinics stay open in your state? Or are you secretly squeamish about abortion rights now that you’ve seen the sonogram images of your precious and beloved children in utero? Do you find yourself agreeing, a little, that life might begin at conception, that abortion is tragic? Do you think that if the women sitting in the chairs in the clinic only knew how gratifying motherhood is, they might reconsider?
Life is a process. Your life is a process. As a free human being, you are allowed to change your mind, to find yourself in different circumstances, to make mistakes. You are allowed to want your own future. What I see is this: The women who enter abortion clinic waiting rooms in states like Alabama and Mississippi are in possession of a resourcefulness and a resiliency that is impossible to see from the provinces in Los Angeles or Chicago or New York, and a pragmatic ability to reconcile what they understand about God with the very real circumstances of their lives. These women are no different from any women, anywhere. They are wise and intelligent. They are more likely to have their hopes and dreams stifled, but they want the same things that anyone wants—namely, a feeling of control over the rest of their lives.
Working in the South brought this point home. When it comes to protecting the right to safe and legal abortion, all women are sisters. A legal threat to abortion access for a poor, African American woman is a legal threat to a white woman, too. A statewide ban on twenty-week abortions affects every woman, no matter what her income or where her kids go to school. It may be easy to look away from the plights of women like those who come to the clinics where I work, but if lawmakers succeed in stripping away the rights of poor women to obtain abortions, they will also be quietly but inexorably stripping away all women’s rights. Solidarity is the best defense.
I have seen this solidarity at work, especially in recovery rooms. After abortions, women are frequently volatile, awash with relief or tearful at the end of a long inner journey. Frequently I have seen two women, virtual strangers, black and white, holding hands across their bed rails, one woman in the midst of her emotional turbulence and the other one helping her through it.