The Medical Establishment Shied Away From Abortion. Now Roe Is on the Line.

This Saturday marks the 49th, and quite possibly the last, anniversary of Roe v. Wade, the 1973 Supreme Court ruling that legalized abortion in every state. Roe’s precarious future can be attributed to various factors: the tenacity of the anti-abortion movement, the addition of three conservative justices to the court during Donald Trump’s presidency, the opportunities that pro-choice advocates may have missed. But if, as is widely expected, the Supreme Court upholds a Mississippi statute that bans most abortions after 15 weeks of pregnancy and overturns or guts Roe later this year, I will be thinking about something else: not the legal precedent, but the role that lawlessness and terrorism — and the medical community’s response to it — played in hastening Roe’s demise.

The act of terrorism that particularly haunts me took place on Oct. 23, 1998. That evening, an obstetrician-gynecologist named Barnett Slepian was standing in the kitchen of his home in Amherst, N.Y., a suburb of Buffalo, when a sniper’s bullet struck him in the back. He collapsed to the floor and, within a few hours, was pronounced dead. At the time, Dr. Slepian was one of three abortion providers in the Greater Buffalo area. One of the others was my father, Shalom Press, an obstetric gynecologist who performed abortions on certain days in his private practice.

The grief that visited the family of Dr. Slepian, who was survived by his wife, Lynne, and four sons, could just as easily have engulfed my family. This feeling was magnified a few days after the sniper attack, when the Amherst police called my father to inform him that The Hamilton Spectator,a newspaper in Ontario, had received an anonymous warning that he was “next on the list.” Several packages filled with anti-abortion literature had been delivered to the same paper. One of them contained a photograph of Dr. Slepian with an “X” drawn over his face.

Although the murder of Dr. Slepian came as a shock, it was not exactly a surprise. Five years earlier, David Gunn, an abortion provider in Pensacola, Fla., was shot dead by a man who lingered outside the clinic and reportedly screamed, “Don’t kill any more babies!” before opening fire. A few months later, an anti-abortion zealot named Rachelle Shannon attempted to murder George Tiller, an abortion provider in Wichita, Kan. (Dr. Tiller survived, only to be shot again, this time fatally, by another anti-abortion extremist in 2009.)

Flowers left by mourners line the front door of Dr. Barnett Slepian’s Amherst, N.Y., office in 1998 in the days following his murder.Credit… Michael J. Okoniewski for The New York Times

Dr. Slepian’s murder was part of a string of sniper attacks targeting abortion providers in their homes. In Buffalo, as elsewhere, the lethal violence was preceded by years of protests and blockades that turned the places where abortions were performed into battlegrounds. At my father’s office, women were routinely screamed at and harassed, to the point that some would come through the doors in tears. There were threatening phone calls and acts of vandalism. On several occasions, protesters invaded the office and once even chained themselves together with bicycle locks. Demonstrators at my father’s office and in front of my parents’ home accused my father of being a “baby killer.”

This violence and harassment did not stop every doctor who believed women should have access to abortion from continuing to serve as a provider. In my father’s case, it had the opposite effect, deepening his commitment and resolve.

But it did help to isolate abortion from mainstream medicine, in part by dissuading countless physicians from incorporating the procedure into their medical practices, as my father did at his office. Had a critical mass of doctors adopted this approach, the crisis in abortion care that exists today, where many women in the South and the Midwest are forced to travel more than 100 miles to find a clinic,might not have reached such an acute stage. Abortion might have become a more routine part of reproductive health care, with more OB-GYNs seeing it as part of their professional responsibility. By 2017, just 1 percent of abortions were performed in private offices, owing in part to the fact that doing so carries risks that most physicians, including many who are sympathetic to abortion rights, generally prefer to avoid.

My father got a sense of this when, at one point, he joined a group practice near downtown Buffalo. As far as he knew, the doctors in the group were pro-choice. Some even performed abortions in city hospitals on occasion. But they didn’t do them at the practice.

That individual physicians might wish to avoid turning themselves — and, potentially, their patients, co-workers and families — into targets of wrath and violence is understandable. Less understandable is the failure of the mainstream medical community, and an array of powerful institutions within it, to respond to the hostility and violence directed at clinics and abortion providers by affirming support for them. Hospital officials could have stepped forward to assert that they, too, would help ensure that abortion services remained available, particularly in states and communities where clinics were under siege. Medical school deans could have announced that they would redouble their commitment to providing training in abortion to residents at teaching hospitals.

Taking such steps would have demanded courage. Little such courage was shown. By 2017, the percentage of all abortions done in hospitals had dwindled to 3 percent, and many teaching hospitals impose restrictions on performing abortions that are more stringent than the legal requirements in their states.Although the reasons for this vary, the desire to avoid the stigma associated with abortion, and the risk of provoking abortion opponents, looms large, according to Lori Freedman, a medical sociologist who has studied the phenomenon. “Some hospital administrators are afraid the hospital will become targeted by anti-abortion forces for doing procedures at all,” she said. “Some have had such experiences already.”

Residents and medical students affiliated with the group Medical Students for Choice have pushed for more comprehensive abortion education. But at many universities and residency programs, in-house abortion services do not exist and residents must go to an outside facility such as a local Planned Parenthood clinic to receive training in the procedure.

To be sure, the relationship between mainstream medicine and abortion was ambivalent even before such concerns became widespread. As the sociologist Carole Joffe has noted, most of the nation’s leading medical organizations failed to issue any significant guidelines on abortion immediatelyafter Roe was decided. That reticence reflected the conflicted feelings many doctors had about a procedure that some linked to infamous back-alley “butchers,” and that others associated with feminists who were claiming authority over their bodies in ways that made many male doctors uncomfortable. (Notably, although the American Medical Association asserted in a 1970 resolution that the principles of medical ethics “do not prohibit a physician from preforming an abortion,” the document stated that abortion procedures should be determined by the “sound clinical judgment” of medical professionals, not “mere acquiescence to the patient’s demand.”) Some doctors also believed that abortion was morally wrong.

In subsequent decades, professional associations such as the American College of Obstetricians and Gynecologists “danced around the issue” of abortion for fear of alienating members who might not support abortion rights, said Doug Laube, an abortion provider who served as ACOG’s president from 2006-2007. Though the organization is formally pro-choice, Dr. Laube told me that during his tenure as president he observed that the stigma associated with abortion made ACOG reluctant to “advocate for abortion services as regular, normal medical care.”

There has been some recent progress on this front, most notably an amicus brief submitted to the Supreme Court by dozens of medical organizations, including ACOG and the A.M.A., in Dobbs v. Jackson Women’s Health Organization, the case that could lead to Roe’s reversal later this year. The brief affirms that the restrictive Mississippi abortion law under review in the case is “fundamentally at odds with the provision of safe and effective health care.” Meanwhile, a new generation of abortion providers, many of them women motivated by a sense of social justice, has begun to emerge, in a field that includes family medicine doctors as well as OB-GYNs.

But even if Roe somehow survives the Dobbs case, the provision of abortion already has been transformed in ways that have left millions of women, particularly poor women and women of color, without access to services. The failure to embed abortion in mainstream medicine has made it easier for abortion opponents to target clinics with so-called TRAP (targeted regulation of abortion providers) laws that impose increasingly onerous rules and regulations on them. A wave of restrictive state measures has been enacted in recent years. It has also set the stage for laws like S.B. 8, the Texas statute enacted last year that encourages private citizens to sue anyone who performs or “abets” abortions, including medical practitioners.

Although S.B. 8 has provoked its share of outrage, in a post-Roe world such vigilantism may become normalized, just as harassment outside of clinics has been normalized, and just as the murder of abortion providers and clinic staff has been largely forgotten. Though it rarely garners much attention anymore, this violence has by no means ceased. On New Year’s Eve, a Planned Parenthood clinic in Knoxville, Tenn., was burned down. The arson appears to be part of an ominous trend. According to the National Abortion Federation, which tracks such data, the number of death threats and threats of harm reported by abortion providers more than doubled in 2020, compared to the previous year. Reports of vandalism and stalking also rose.

Melissa Fowler, the group’s chief program officer, attributed the escalation to the fact that anti-abortion extremists have felt emboldened. She expressed particular alarm about reports of protesters showing up outside clinics, openly carrying guns, menacing and frightening patients and staff. “We wouldn’t tolerate this in any other medical field,” she said. “If people saw it on their way to the dentist, it would be deemed unacceptable.”

The passivity and silence of the medical establishment, of medical school deans and hospital officials, and of too many (privately) pro-choice physicians, is not the only reason such intimidation fails to elicit outrage, or even to be noticed, when it happens outside an abortion clinic. But it is definitely part of the reason. Thanks to their acquiescence, terrorism, intimidation and violence have won.

Eyal Press is a journalist and author whose most recent book is “Dirty Work: Essential Jobs and the Hidden Toll of Inequality in America.”

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