TIME: Almanac 1993/TIME Almanac 1993.iso/time/050492/05049921.000

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                                                                                COVER STORIES, Page 26

ABORTION

The Future Is Already Here


No matter what happens to Roe v. Wade, the doctors who perform
abortions and their patients face formidable obstacles

By RICHARD LACAYO -- Reported by Julie Johnson/Washington,
Priscilla Painton/New York and Elizabeth Taylor/Sioux Falls


    Just because abortion is legal in Illinois doesn't mean
that Sheela Paine can easily get one. At the age of 30, she
already has five children. Last week she was in the 19th week
of a pregnancy she couldn't afford; her husband is unemployed
and the family lives on welfare. She also couldn't afford the
reduced $425 price of a second-trimester abortion at the clinic
near her home in East St. Louis. During her last pregnancy Paine
tried to induce miscarriage by taking quinine pills. She ruled
out a cheap illegal abortion because a girlfriend bled to death
after getting one. "I know other girls who've done different
things," she says. "Jumped off the top of dressers or provoked
their boyfriends to jump on them." But the prospect of trying to
support yet another child made her sick with worry. "My hair
started coming out," she says. After many anxious days, she
finally got an abortion last week after she was able to borrow
the money.

    Abortions are still legal in Texas too. But that doesn't
mean doctors can easily perform them. Four years ago, Dr.
Curtis Boyd's Dallas clinic came under siege for weeks by
antiabortion demonstrators. One day one of the protesters began
asking after Boyd's children by name. "How's Kyle?" the man
would inquire. "Has he had any accidents?" Then came the
handwritten death threat in his mailbox. Boyd moved his family
out of town for a while, and on Christmas Eve his clinic was
torched. Boyd is back in business today, but with a sharper
sense of the odds against him. "You have a President of the
United States who says abortion should be illegal," he says.
"You have religious leaders saying that doctors who perform this
service should go to hell. You have antiabortion groups that
harass medical staff. What professionals would continue to do
a service that subjected them to this kind of abuse?"

    This is how matters stand now, in what may be the last
days for a woman's constitutionally protected right to abortion
in America. The Supreme Court is widely expected to uphold the
Pennsylvania law that would require a woman seeking an abortion
to notify her husband and wait 24 hours after hearing a
state-prepared presentation about adoption and child-support
alternatives, among other things. By okaying the law, or most
parts of it, the court would invite other states to introduce
new restrictions of their own. Next year the nine Justices may
entirely reverse Roe v. Wade, the 1973 Supreme Court decision
that guaranteed abortion rights; states would then have the
option of banning abortion outright.

    But for all the attention paid last week to the arguments
before the Justices in Washington and the outcry of the
demonstrators in Buffalo, that is not where the issue is really
being decided. At this moment, abortion is not available in 83%
of America's counties, home to nearly a third of American women
of childbearing age. For reasons of professional pride, or fear,
or economic pressure, doctors have backed away from the
procedure even where it remains available.

    The reality in most American communities is that two
decades of moral and religious reflection, legal maneuvering and
political assaults have combined to do precisely what
conservatives promised when Roe was handed down: roll back the
Supreme Court ruling until it is no longer the law of the land.
Now, in the noisy streets and legislatures and the bare chambers
of the individual conscience, that most fundamental question --
Who decides whether a woman can have an abortion? -- must itself
be redecided. With that, America is entering new moral and
political territory, rough and uncharted, but lit by the
phosphor of righteous certainties. And as the combatants square
off with their irreconcilable notions of life and liberty, the
middle ground, what there is of it, promises to become scorched
earth.


    THE WAR OF IMAGES

    The National Abortion Rights Action League is distributing
a map of America these days that offers its vision of the
future. If Roe is overturned, naral predicts that just seven
states, mostly along both coasts, can be counted on to keep
abortion easily available. Across the broad middle of America,
an area stretching from Idaho and Nevada east to Kentucky and
Tennessee, the group foresees a nearly unbroken regime of tough
new obstacles and outright prohibitions. Though opponents of
abortion say the other side is overstating the threat as a way
to mobilize supporters, they are quietly confident of roughly
the same outcome. "At the end of this decade we will probably
have a patchwork of state laws," says Gary Bauer, president of
the conservative Family Research Council and formerly the
domestic policy adviser in the Reagan White House. "But legal
or illegal, it will be much more likely that abortion will be
seen as a matter of shame and something to be avoided."

    To reinforce the shame and remind women of the options,
antiabortion groups are undertaking a war of images. Last month
the Arthur S. DeMoss Foundation, a Pennsylvania-based group that
contributes to conservative causes, began an ad campaign on
cable stations to promote the idea that adoption is the solution
to unwanted pregnancies. Michael Bailey, an Indiana
advertising-promotions executive, declared himself a
congressional candidate in his district's Republican primary,
largely in order to run a series of antiabortion ads on
television. The 30-second spots graphically depict what he says
are aborted fetuses; under federal regulations, local television
stations have no power to censor political ads. "I always have
believed that if television stations ever aired pictures of
aborted babies, it would begin to change many people's minds
about the issue," Bailey explains. "People would focus on the
evidence of abortion -- which is the aborted baby -- rather than
this ill-conceived idea of women's choice. Choice is no choice
to babies."

    The predicament of women trying to get abortions is harder
to distill into a single wrenching image. There are 1.6 million
abortions carried out in the U.S. each year, representing
almost a fourth of all pregnancies. It is estimated that more
than 46% of American women will have had one by the time they
are 45. But while there are about 2,500 places around the
country that provide abortions -- down from a high of 2,908 ten
years ago -- they are mostly clustered around cities, leaving
broad areas of the country unserved. A single clinic serves 24
counties in northern Minnesota. Just one doctor provides
abortions in South Dakota.

    For a glimpse of the future, look at Mississippi. Three of
the state's four clinics are clustered around the capital and
largest city, Jackson. But their survival is threatened by a new
law that would require clinics to have advance transfer
agreements with hospitals to care for patients who may suffer
complications -- a provision designed to capitalize on the
resistance among many hospitals to associate themselves with
anything as controversial as abortion.

    A law requiring a 24-hour waiting period will go into
effect if the Supreme Court upholds that provision in the
Pennsylvania law. Though it sounds benign enough, it can
confound poor women who already have to travel long distances
to find a clinic, only to discover they must also scrape
together the price of overnight accommodations. Often by the
time they get the money together, they have advanced into the
second trimester, when the cost is higher. (Only 12 states --
Mississippi is not one of them -- routinely provide Medicaid
financing for abortion.) Nancy Rogers owns one of the clinics
near Jackson. Two years ago, when she went to the capital to
argue against the bill before a state legislator, she got a
sense of what she was up against. "His exact words were, `I have
no sympathy for anyone who cannot afford a motel room.' "

    There's one other clinic in Mississippi, but lately it has
not been open for business. When Dr. Joseph Booker first moved
to the coastal town of Gulfport to set up a gynecology practice
in 1988, local officials granted him every permit he needed to
start business. But when he purchased a small commercial
building last year and made plans to relocate his Gulf Coast
Women's Clinic, he got a different reception. In January, when
he applied for a permit for interior reconstruction, Harrison
County code administrator Ben Clark told Booker he had learned
that abortion was part of Booker's practice. The permit was
denied.

    Soon after, the Harrison County board of supervisors
passed an ordinance prohibiting the operation of an abortion
clinic within 500 ft. of a church, school, kindergarten or
funeral home. There are two churches close by Booker's building.
Four of the five hospitals in the Gulfport-Biloxi region have
denied Booker admitting rights that would guarantee his patients
a bed in the event of complications. For good measure, the
local power company has refused to provide electricity to his
unfinished clinic until he secures the building permit he cannot
get.

    Since the electronic security alarm has been rendered
useless, the site has been vandalized four times in recent
months. For now Booker is referring women seeking abortions to
Jackson, 160 miles north. But he remains determined to revive
his practice in Gulfport. "Nobody's going to tell me how to
practice medicine or scare me out of practicing it," he says.
His lawyer, John Jones, is challenging the 500-ft. ordinance in
court but knows it won't be easy. "Every time we jump through
a hoop," he says, "they create another hoop."


    TARGETING DOCTORS

    Discouraging the doctors who provide abortion has become
one of the characteristic tactics of the most militant
antiabortion groups. In Buffalo, the same Rev. Robert Schenck
who pushed a fetus in front of abortion-rights demonstrators
last week has promised to stand outside restaurants frequented
by doctors from abortion clinics, holding banners announcing
that abortionists eat here. Other leaders are threatening to
picket the schools attended by the doctors' children.

    Death threats, obstruction and broken windows have taken
their toll, but the medical profession has tiptoed away from
abortion for less dramatic reasons as well. Though physician
surveys show that a large majority of gynecologists and
obstetricians are pro-choice, many doctors are inclined to see
abortion as routine work that's poorly paid by their standards.
Partly from a desire to keep abortion within reach of poor
women, Planned Parenthood, which operates 900 clinics around the
country, has succeeded in keeping prices low at their
facilities. That in turn has put competitive pressure on
everyone else, keeping the average price for a first-trimester
abortion at just $251, not much of an increase over the $196
price of twenty years ago. At a Planned Parenthood clinic in New
York City, a physician earns up to $125,000 annually for a
four-day week, perhaps half what he or she might make in private
practice.

    Hospitals have also been withdrawing from the abortion
business. In the years after Roe was handed down, more than half
of all abortions were performed in hospitals. By 1988, 86% were
done in neighborhood clinics and an additional 4% in the
offices of individual doctors. Some hospitals shy away from the
procedure because of opposition from potential donors or members
of their governing boards. At the same time, because abortion
is a relatively simple procedure that doesn't require general
anesthesia or the costly equipment of a hospital operating room,
groups like Planned Parenthood encouraged the move to clinics
as a way to keep abortion cheap and accessible.

    But clinics tend to be small outposts that offer easy
targets for the sit-ins, arson and bombings that a large,
well-guarded hospital is better suited to resist. And as the
work has fallen largely to clinic doctors who specialize in
abortion, it has dropped off the list of skills that a woman's
regular physician can be expected to have. A new study by Dr.
H. Trent Mackay of the University of California at Davis shows
that last year just 12% of the nation's obstetrics-gynecology
residency programs made training in first-trimester abortions
a routine part of their program. Only 7% did so in the case of
second-trimester abortion training. Compare that with 1985, when
nearly a fourth of all such programs routinely taught abortion
procedure for both trimesters.

    So it's no surprise that many clinics must go far afield
to find a doctor who is willing and able to perform abortions.
The Allentown Women's Center in Pennsylvania can offer them in
large part because one day each week Dr. Amy Cousins makes the
120-mile drive from New York City. On two other days she treks
200 miles north to provide the same service in Binghamton, N.Y.,
where the antiabortion group Operation Rescue has its
headquarters. "I can't get anybody to cover for me," she says.
"So I don't go on vacation."

    As older physicians retire, the medical profession is also
losing its institutional memory of the days before Roe. A
generation raised in the era of safe and legal abortion is less
likely to produce doctors ready to go to the barricades at the
first sign of women being forced to undergo illegal -- and
dangerous -- abortions. "I have personally taken care of women
with red rubber catheters hanging out of their uterus and a
temperature of 107 degrees," says Dr. David Grimes, 45, of the
University of Southern California School of Medicine. "Once a
physician has watched that happening, he or she will never be
willing to watch the laws go back."


    THE RISING BARRIERS

    But what if the laws do "go back"? If Roe is eventually
overturned, the first result is likely to be a wide-scale
confused impression that the loss of the constitutional right
means abortion will instantly become illegal in every state.
"Women will see the big headlines, and some are going to lose
the message," says Dr. Michael Burnhill, professor of clinical
obstetrics and gynecology at the University of Medicine and
Dentistry of New Jersey. "They are going to be confused as to
whether they can get an abortion at all."

    In some places they won't be able to. naral predicts that
13 states will ban abortion outright, though typically with
exceptions for the so-called hard cases: when the life of the
mother is at risk, the fetus is seriously deformed or the
pregnancy resulted from rape or incest. Other states are likely
to be satisfied with a raft of new restrictions, such as 24-hour
waiting periods and laws requiring clinics to be equipped as
hospitals, which would drive up prices. Parental notification
laws, already in place in 18 states, will be even more widely
adopted, posing problems for many girls under 18, who at present
account for 11% of all abortions.

    Such obstacles are hardly insurmountable. But they are
likely to make it take longer for women to afford and arrange
an abortion, which makes the procedure more dangerous. They also
have the effect of sending a message. To abortion opponents, the
message is that abortion on demand is immoral, and so should be
illegal. But abortion-rights advocates see a different subtext.
Instituting a waiting period suggests that women seeking
abortions do so blithely and without reflection -- a notion
belied by the experience of women who have endured the private,
wrenching process of deciding to terminate a pregnancy. Experts
calculate that 93% of married women who have abortions talk to
their husbands about it. The others may have good reason not to.
"If husband notification is upheld," says Jean Hunt, head of the
Elizabeth Blackwell Health Center for Women in Philadelphia, "it
will be almost impossible to provide services for women who live
in fear of their husbands."

    The idea of parental notification has a logic to it in
communities where high school girls cannot receive aspirin from
a school nurse without a parent's approval. But again, abortion
rights advocates argue that a girl who does not want to tell her
parents she is pregnant may have profound reasons for her
silence, and no new law is likely to overcome that immediate
fear.

    Some extreme opponents of abortion would go well beyond
waiting periods and notification laws. Though they refrain from
pressing for such an outcome, they would impose criminal
penalties, including prison time, for women who seek abortion
-- not just for the doctors who perform them. But many
pro-lifers, while they equate abortion with murder, are
reluctant to treat women as killers, in part because throwing
young women in jail would alienate too many Americans. Press
them on the inconsistency, and they often reply that women who
seek abortions are themselves victims of exploitation, economic
desperation or misinformation.

    No matter what penalties are imposed, past experience
suggests that when women are sufficiently desperate, they will
terminate their pregnancies by any means available. That is what
worries abortion-rights advocates, as they recall the years just
before Roe, when there may have been as many as 1.2 million
illegal abortions annually in the U.S. States that keep abortion
available in the future are likely to become magnets for women
from nonabortion states. In the 2 1/2 years preceding Roe,
nearly 350,000 women traveled for that reason to New York, which
was at the time one of the few states in which abortion was
legal. Referral agencies popped up overnight to charge the
out-of-staters as much as $100 for the names of abortion
doctors. As prices climbed as high as $1,000, abortion became
a hustler's game. "There were doctors who were literally
becoming millionaires," says Dr. Irving Rust, the medical
director of a Planned Parenthood clinic in the South Bronx.
"Anytime you have a situation where supply and demand is the
main dynamic, it brings out the worst."

    Pro-choice groups are preparing for the day when they will
have to provide an abortion underground, with networks to help
women get to states where abortion is available. Some are urging
more radical solutions. Carol Downer, director of the
Federation of Feminist Women's Health Centers, based in Los
Angeles, travels widely to talk to women's groups about
"menstrual extraction," a home-abortion procedure she
co-developed in the early 1970s. A suction technique similar to
the vacuum-aspiration process that is now the most common form
of first-trimester abortion, it requires a 50-mL syringe
attached to a flexible plastic tube, which withdraws the
contents of the uterus and deposits them into a closed
container.

    The premise behind menstrual extraction is that a home
abortion provided by concerned friends is better than one
carried out in some surgical speakeasy. Downer insists that
women without medical training can learn to perform menstrual
extraction on other women safely. A cooperative doctor may still
be needed to obtain the equipment, some of which can be
purchased legally only by physicians or clinics. "It will take
some thinking and determination and motivation to put [the
kit] together," she says.

    Many doctors and abortion-rights groups consider her
message irresponsible and menstrual extraction far too risky to
contemplate. They stress the danger of infection, sterility or
even deadly sepsis in the event of a puncture in the uterus. If
menstrual extraction is attempted more than six weeks after a
woman's last period, it can also lead to severe complications,
including cramps, bleeding and blood clots.

    Downer's critics also fear that poor women and teenagers
-- the ones most likely to have trouble getting to states where
abortion is legal -- are the ones least likely to master the
procedures for performing an abortion safely. It is small
comfort that hospital emergency rooms would be obliged to treat
any woman who developed complications. "Abortion is minor
surgery," says Barbara Radford, the head of the National
Abortion Federation, an association of abortion providers. "But
you need backup, you need proper equipment, you need proper
medication."

    So long as women can get to any state where abortion is
legal, menstrual extraction is unlikely to become a real
alternative to physician-provided abortions. But the very fact
that it's under discussion once more is a sign of the ways in
which America is bracing itself for a partial return to the
past. In the two decades since Roe was handed down, a generation
has grown up that knows nothing of the days of illicit abortions
conducted on kitchen tables, or in doctor's offices at night
with the blinds drawn.

    For the same two decades, while pro-lifers have waved
pictures of the developfetus, there were no more new images of
women victimized by illegal abortions. In the years to come,
those pictures, and the desolate realities they represent, are
sure to reappear. It was harsh experience that led to the
climate of opinion that welcomed Roe. Will it take harsh
experience again to sort out the national will on abortion once
and for all?