Surprising firsthand accounts from the front lines of abortion provision reveal the persistent cultural, political, and economic hurdles to access
In an America where abortion has been legal for over thirty-five years, the procedure can be surprisingly inaccessible: even in cases of rape, imminent threat to the mother’s life, or complicated miscarriage and even with a willing doctor.
How did the post-Roe v. Wade world come to resemble pre-Roe so closely? While “abortion wars” may immediately bring to mind the very real threat of antiabortion violence, sociologist Carole Joffe shows how a pervasive stigma operates less dramatically but just as effectively to maintain cultural, political, and economic barriers to access.
After thirty years embedded in reproductive-health research, Joffe relays compelling testimony from doctors, health-care workers, and patients as they struggle against these barriers that shame women and marginalize physicians, even within the medical community. Real-life stories include those of poverty-stricken rape victims scrambling and sometimes failing to cover the cost of abortions that should be covered by Medicaid; a doctor having to beg her superior for permission to perform in-hospital a medical abortion too dangerous to handle at a clinic; and a woman whose miscarriage is causing septic shock refused care and bundled off to another hospital.
Along with these portraits, however, Dispatches from the Abortion Wars also offers hope for real change, pointing the way to a more compassionate standard of women’s health care-one that responds to the needs of the individual and trusts women to make their own moral choices.
“In this brilliant and gripping report from inside the trenches of a high-stakes culture war, Carole Joffe takes us into the lives of the brave and committed doctors and activists who work against extraordinary odds—and sometimes give their lives—to preserve our precious right to choose. This is a must-read book for us all.” —Arlie Hochschild, author of The Commercialization of Intimate Life
“Carole Joffe has given us a rare and privileged look into the beleaguered world of abortion providers. I found their determination inspiring—and Joffe’s level-headed perspective deeply clarifying.” —Barbara Ehrenreich, author of Nickel and Dimed
“For anyone wishing to understand the full complexity of ‘the abortion wars’ in our time-at every level, from national politics and culture to the personal struggles and triumphs of clinicians and patients-this lucidly written book is a must.” —Rosalind Petchesky, Distinguished Professor of Political Science, Hunter College and the Graduate Center, City University of New York
“A clear-eyed and sobering account of just how successful a small number of antiabortion extremists have been in denying abortion care to American women. Most enlightening and moving are Joffe’s portraits of abortion providers and their patients whose stories allow the reader to see the cruelty and misogyny at the heart of the antiabortionists’ attempts to impose ‘one size fits all’ rules.” —Suzanne T Poppema, MD, author of Why I Am an Abortion Doctor and chair, Physicians for Reproductive Choice and Health
“With an insider’s eye and a searing intellect, Carole Joffe tells the true story of life on the front lines of abortion care.” —Maureen Paul MD, MPH, Mt. Sinai School of Medicine
“No one knows more about reproductive rights in the United States than Carole Joffe. This indispensable book shows how, more than a quarter century after Roe v. Wade, abortion access is being eroded from many different directions. Its portrayal of the human toll of the abortion wars is both harrowing and galvanizing.” —Michelle Goldberg, author of The Means of Reproduction
Review: Feminist Review - February 17, 2010
“…Dispatches from the Abortion Wars is often riveting. Joffe’s insights into popular culture, alongside her analysis of the recent barrage of ballot initiatives, are spot on in explaining the growth of negative attitudes about abortion.”
Review: Sacramento News and Review - February 11, 2010
“Joffe’s book reveals the stigma associated with abortion, toward women and physicians—even in cases of rape or threat to a mother’s life. It’s a discussion that shouldn’t be avoided, even in a post-Roe v. Wade world.”
Review: Slate - February 1, 2010
“Abortion providers already have plenty of reason to worry about their safety, as sociologist Carole Joffe details in her instructive and memorable new book, Dispatches. They didn't need this boost for the vigilantes.”
Review by: Michelle Goldberg, The American Prospect - January 28, 2010
"In her new book Dispatches from the Abortion Wars , the sociologist Carole Joffe makes the human costs of Hyde agonizingly clear."
Review: Booklist - January 1, 2010
"This scholarly yet clear and well-paced reportage from the front will stir as it encourages debate."
From the Preface
Clich? though it may be, there really are abortion wars raging in the United States, wars fought on numerous fronts. The front that most resembles conventional warfare involves attacks on those who provide abortions. Since the 1973 Roe v. Wade decision legalizing abortion, eight members of the abortion-providing community have been murdered, and numerous others have been stalked at their homes and churches as well as at their workplaces. Children of some providers are harassed at their schools. Antiabortion fanatics continue to this day to firebomb and vandalize clinics. Staff and patients at these clinics are subjected to constant picketing and often ear-splitting verbal harassment delivered through megaphones. As in other wars, opponents of abortion engage in intelligencegathering by videotaping those who enter abortion-providing facilities and photographing the license plates in the clinics’ parking lots.
But there are many other important fronts in the abortion wars. To an extraordinary degree, abortion dominates our national politics, often serving as the decisive issue in parties’ choice of candidates, in the nomination of judges at all levels of the judiciary, in the selection of political appointees to serve in federal agencies. Most strikingly, during the two presidential terms of George W. Bush, an individual’s stance on abortion was typically used to determine his or her fitness to serve in positions that had absolutely nothing to do with that issue--for example, a position on a drug advisory panel. The abortion wars have also had an impact on U.S. foreign policy, determining in some instances how much foreign aid a particular country will receive. At recent United Nations conferences, the U.S. delegation’s fanatical opposition not only to abortion but to contraception drew scorn from other nations and often left the United States isolated.
State legislatures have also been extremely consequential terrains in the abortion wars, as hundreds of regulations attempting to restrict abortion care in various ways are introduced each year. At the local level, the abortion wars are reflected in how a particular community responds to the presence, or potential presence, of an abortion-providing facility. Whether a landlord will rent or sell a suitable building, whether contractors agree to work on it, whether vendors such as cleaning services will agree to do business with a clinic--all these factors, which typically are not issues in other areas of health care, can determine whether abortion care can survive in a particular place.
The abortion wars have had a dramatic impact on popular culture as well. Several television shows in the 1970s portrayed women choosing abortions in a sympathetic light, which unleashed a flood of complaints to the networks and advertisers by irate opponents of abortion. Ever since, both television and Hollywood have notably avoided a repetition of that mistake.
Finally, American medical culture is an often overlooked but extremely important front in the abortion wars. For various reasons, which I elaborate further in the following chapters, American medicine has supported the concept of legal abortion but has been much more ambivalent about those who actually perform the procedure. This ambivalence has resulted in a chronic shortage of providers. Abortion politics has also led to policies at some hospitals that put women’s health at unacceptable risk.
In writing this book about the abortion wars, I am not claiming to provide a balanced account, as do many other social scientists and journalists who address the abortion issue. Rather, I see myself as a war correspondent, embedded with troops on one side of the conflict (the troops in this instance being the abortion-providing community). I also do not aspire to change the minds of those who are convinced that abortion is immoral. My goal instead is to show the costs of these wars. They are costly, obviously, for those seeking abortions and those providing them. But I believe these wars have also proved costly for American society as a whole, causing a degradation of our political culture. The abortion wars have not only brought an unprecedented level of violence and terrorism to healthcare institutions; they have also led to a culture of lies about science and medicine at the highest levels of government. I have come to understand the abortion wars as a brilliant distraction that drains energies and resources away from other social needs, including the adequate provision of services that would allow people to have the intimate and family lives they wish for.
In both the subtitle of this book and several times thus far in this preface, I have used the words fanaticism, fanatics, and fanatical. I do not use such provocative words lightly. People who kill and terrorize those they disagree with on abortion, I believe, merit the designation fanatics, because they view ending abortion as justifying any means. I believe that charges of fanaticism are also fairly applied to those figures in political and religious circles who legitimate such violence (for example, a sitting U.S. senator who has called for the death penalty for abortion providers, or a priest who has called the murder of providers “justifiable homicide”). I see fanaticism at work in the numerous efforts to equate the value of a woman’s life with that of an embryo: for example, the official Republican Party platform, which does not permit abortion even in cases of a threat to a woman’s life. I similarly view as fanatics those who have taken it upon themselves to redefine many forms of contraception as abortion and who are now seeking to withhold birth control from the vast majority of Americans, who do not share their views.
However, I do not believe that most of the individuals who oppose abortion should be considered fanatics. There is no question that most Americans who consider themselves “pro-life” disavow the terrorist acts of the most violent wing of the antiabortion movement. Many of those opposed to abortion, moreover, favor exceptions in cases of threats to the life of the woman and pregnancies that result from rape or incest. Given that at least occasional use of birth control is nearly universal among heterosexually active Americans, we can safely assume that a strong majority of abortion opponents do not embrace the more recent campaign against contraception. In numerical terms, therefore, those who can reasonably be labeled fanatics make up a very small portion of the universe of abortion opponents. My argument is that the violent actions and extremist political positions of the most fanatical sector of the antiabortion movement, however, have had significant consequences.
In a country where systematic political violence is rare (and never before aimed at a particular group of health-care professionals), the attacks on abortion providers have inevitably had a searing impact on Americans’ consciousness. For medical institutions, the legacy of this violence (which, after a period of quiescence, reemerged in 2009 with the brutal assassination of Dr. George Tiller) contributes to a reluctance by administrators to incorporate abortion care and a reluctance on the part of some clinicians otherwise drawn to this work to perform abortions. For American society more generally, the violence and endless protesting at clinics have marked abortion as something highly controversial and have therefore added to its stigmatization. Similarly, the absolutism that would ban all abortions sometimes leads centrist politicians to make costly compromises on how abortion is regulated. Many restrictions that appear reasonable impose cruel barriers for many of the most vulnerable women. Others, such as the requirement that doctors lie to their patients about disproved links between abortion and breast cancer or suicide, may not appear reasonable to the public once people learn of them, but these regulations serve to reinforce the idea that abortion is always embroiled in contentiousness.
In short, the most fanatical elements of the antiabortion movement have established the contours of the abortion wars. These true believers have sought to eliminate from public conversation about abortion what I believe the issue most cries out for: a recognition of nuance. But with the black-and-white view of the world that is characteristic of fanaticism, they have refused to acknowledge the shades of gray that are inevitably present in matters pertaining to sexuality, reproduction, and abortion. Ironically, the wars against abortion waged by fanatics are counterproductive, leading to more unintended pregnancies and therefore more abortions.
What are my credentials as an abortion war correspondent? I am a sociologist with broad interests in reproductive health and reproductive politics. In particular, I have focused on those who make up the workforce in abortion facilities and other reproductive health settings. For the past thirty years or so I have interviewed and observed at clinics where abortions (and usually other reproductive health services) are offered. I have watched young doctors and other clinicians being trained to perform these procedures. I have attended numerous conferences where providers gather to discuss their work lives. Conveniently, the development of a number of Listservs within the abortion-providing community in the past decade has enabled me to transcend the limitations of geography and remain engaged in regular conversation with providers throughout the country.
My observations of the abortion issue over such a long period have allowed me to witness an important transformation in both the strategy and the rhetoric of the antiabortion movement. In the period immediately after Roe, women getting abortions were a prime focus of the movement’s wrath, demonized as “murderers,” “sluts,” and, interestingly, “lesbians” (I recall a group of protesters taunting abortion patients outside a Philadelphia clinic in the late 1970s with this accusation). But this antiwoman discourse could not last, for the simple reason that too many women, including some within antiabortion circles, were getting abortions. Women who sought abortions became reframed as victims: “Abortion hurts women” is today one of the leading messages of the antiabortion movement. And providers, those doing the “hurting,” became the prime villains in the abortion drama of opponents.
I report on this war from the perspective of these embattled providers of abortion. By provider, I mean not only the clinicians who perform abortions but also the clinic directors and managers who have the challenging task of administering the freestanding clinics where most abortions in the United States take place. Very often, as we will see, it is they who suffer from physical attacks, who deal with the police when surrounded by aggressive protesters or when suspicious packages arrive, who deal with lawyers when state legislators pass yet another restriction, who plead with the plumber to come fix the frozen pipes even though the plumber’s fellow church members have urged him not to provide service to the “baby-killers.” As such, clinic directors and staff members are important combatants in the abortion wars.
This book was started during the presidency of George W. Bush, an unusually harsh and dispiriting time for those who work in the field of reproductive health, including abortion care. It is being completed in the first months of the presidency of Barack Obama. Like virtually all the providers and advocates whom you will meet in this book, I am heartened by the election of Barack Obama and eagerly look forward to his presidency. I am hopeful that with this change of administration, some lessening of the abortion wars may be posxvi sible. Specifically, I hope that opponents of abortion will come to agree with supporters that the root problem that must be addressed is that nearly half of all pregnancies in the United States are unintended. When the problem is framed this way, then solutions are at least partly found in improved contraceptive access and in factually accurate and in-depth sex education--options that were decisively repudiated by the Bush administration. But even if this hoped-for progress on reducing unwanted pregnancies occurs, some abortions will always be needed, and our new president clearly understands that.
These promising possibilities of the Obama presidency notwithstanding, I have no illusions that the abortion wars will be “over” simply because of the outcome of the 2008 election. Antiabortion forces received a setback in that election, but the movement, including its most violent wing, is hardly going away, as the murder of Dr. Tiller made tragically clear. Most important, the day-to-day events in abortion clinics--the trenches from which most of my dispatches will be sent--are affected as much by local events as by national ones. In places where antiabortion sentiment remains strong, provision will remain very challenging. The stigma that I believe explains so much about the place of abortion in American culture runs deep, and will change only slowly. Nevertheless, I hope the following pages reveal that in the abortion wars, women who seek abortions and the men and women who provide them are themselves resourceful and committed combatants.
1 The Stigma of Abortion
2 ìYou Need a Community with Youî: Becoming an Abortion Provider
3 The Clinics: Ground Zero in the Abortion Wars
4 Regulating Abortion
5 Hospital-Based Abortions: Chaos, Cruelty, and Some Accommodation
6 Abortion Patients and the ìTwo Americasî of Reproductive Health
7 ìEvery Woman Is Differentî: What Good Abortion Care Looks Like
8 What Kind of America Do We Want?
Afterword: ìAbortion Is a Perfectly Proper Nounî
Postscript The Legacy of George Tiller
Carole Joffe's appearance on GRITtv