Abortion, legal since 1973, still shapes, divides doctors

On the 30th anniversary of the Supreme Court decision that legalized it, physicians recount what role abortion has played in their medical practices.

By Tanya Albert, amednews staff. Jan. 27, 2003.

There are few, if any, medical procedures that generate as much controversy as abortion.

Physicians who agree to perform them can find themselves the target of protestors' words and sometimes violent actions.

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As America enters the fourth decade of legalized abortion, picketing at clinics continues, but some more violent acts declined, according to a new study from the Alan Guttmacher Institute, "Trends in Abortion in the United States, 1973-2003."

In 1985 and 2000, 80% of nonhospital facilities that provide abortions reported picketing, but the percentage of facilities that received bomb threats dropped in the 15-year span, the study shows. For example, 15% of facilities received bomb threats in 2000; 48% did in 1985.

Protests continue at 80% of abortion clinics.

But 30 years after the Roe v. Wade decision, issued Jan 18, 1973, the number of physician offices, clinics and hospitals where abortions are performed is declining. Between 1996 and 2000, the number dropped 11%, with 1,819 abortion providers in 2000, according to the study.

Here are the stories of four physicians whose professional lives have, to varying degrees, been shaped by the legalization of abortion.

The things he saw

When North Carolina obstetrician-gynecologist Takey Crist, MD, was an intern and resident in the second half of the 1960s, he saw firsthand the desperate measures women were taking to terminate their pregnancies.

One young woman arrived at the hospital after fraying a lamp cord and holding the live wire to her belly. Another woman was treated after her uterus became severely infected from an unsterile "back-alley" abortion. She underwent a hysterectomy, and the infection temporarily shut down her kidneys before she recovered.

Paint brushes, coat hangers and pills such as quinine tablets also have all been commonly tried methods of ending pregnancies.

Bomb threats were reported by 15% of abortion clinics in 2000, down from 48% in 1985.

The experience shaped Dr. Crist's career, spurring him to open a clinic in North Carolina in 1973 that offered human sexuality classes, counseling, obstetrics and gynecology, adoptions and abortion services.

"If a woman who is pregnant does not want a pregnancy, I don't care who you are -- the law, a clergy member -- you are not going to stop her from ending that pregnancy," said Dr. Crist, who practices in Jacksonville, N.C., and is the only abortion provider within 50 miles.

His commitment to providing women with a safe way to end a pregnancy is what helped him endure protests outside of his office and his home that escalated in the late 1980s and early 1990s.

The harassment has eased over the past several years, but Dr. Crist is concerned and saddened that obstetricians in training can opt out of learning how to end a pregnancy.

"Learning about terminating a pregnancy is part of women's health," said Dr. Crist, 65, who has no plans of retiring anytime soon. "If I'm in training for thoracic surgery, I can't say I don't want to treat certain people and not learn a procedure."

On the front lines

Family physician George Tiller, MD, was outside his Wichita, Kan., office on a summer day in August 1993 when he was shot in the arms by an anti-abortion protester who he thought was handing him a pamphlet.

He survived the attack, and the woman who pulled the trigger of the .25-caliber gun went to prison.

Dr. Tiller -- whose office was bombed in 1986 -- was under federal marshal protection for several years after the shooting.

From 1996 to 2000, the number of U.S. facilities performing abortions dropped 11%.

Dr. Tiller has provided abortion services since 1973 and specializes in second-trimester elective and second- and third-trimester therapeutic abortion care. He still faces protesters outside of his office nearly every day. But, he said, support from his wife of 39 years as well as others in the community has helped him through times when he's feared for his safety.

"Although there have been some hardships, I have had more expressions of love," said Dr. Tiller, a board member of Physicians for Reproductive Choice and Health.

He said he had learned the importance of a woman controlling her own pregnancy.

Early in his practice, he was surprised by the strong physician-patient relationship that formed between him and women who came to him for abortions. They often returned, bringing their husbands, boyfriends and children to receive care at the family practice.

Dr. Tiller said he hoped women would be more active and make reproductive freedom their No. 1 priority: "Abortion is simply a matter of survival for women."

A change of opinion

In 1969, Bernard N. Nathanson, MD, an ob-gyn, was a co-founder of the National Assn. for the Repeal of Abortion Laws. The group distributed pamphlets, picketed and lobbied state legislators in New York to legalize abortion. When it was legalized, he served as the director of a center in New York that provided abortions.

But by 1978, Dr. Nathanson concluded that he could no longer perform abortions. He now believes that it takes a baby's life.

"It wasn't an epiphany on the road to Damascus that culminated in 1978," Dr. Nathanson said. "It was a gradual decision between 1974 and 1978."

During that time, technology improved, and through fetal monitoring and ultrasound, Dr. Nathanson said he had a window into the womb. Prior to that, he said, there was an imbalance to his thinking. The pregnant woman was the obvious patient.

But the technology allowed him to see the fetus, he said, and that allowed him to strike a balance in his thinking. "I discovered that the developing baby was no different than any of us," he said.

Dr. Nathanson has since earned a graduate degree in bioethics. He wrote the book The Hand of God, A Journey from Death to Life by the Abortion Doctor Who Changed His Mind and travels around the world to speak out against abortion.

"If abortion clinics closed tomorrow, we would not go back to the back-alley abortion days," Dr. Nathanson said. He predicts that there would be a flourishing black market for medical abortion pills.

"We're not going to wipe out abortion," he said. "All we can do is set moral standards."

The next generation

New York City obstetrician-gynecologist Anne R. Davis, MD, MPH, finished her residency at the University of Washington School of Medicine in Seattle about five years ago, knowing she wanted to protect a woman's right to choose.

She learned about abortions during her residency and now provides the service for patients.

Dr. Davis has not encountered the protests or violence that some other physicians have during the course of their careers. But she's well aware of the ongoing abortion debate, and she does her part to remain active in education and research.

An active member of the Physicians for Reproductive Choice and Health's board, Dr. Davis testifies before state legislatures, works with medical students, does research about contraception and abortion, and lectures about medical abortion.

"The fewer people we have," she said, "the less service we are going to be able to provide."

Dr. Davis hopes that as more health professionals are educated about medical abortion -- which became available in the United States when the Food and Drug Administration approved mifepristone in 2000 -- women will see better access to abortion providers.