By the time American women reach the age of 45, about one in three will have had an abortion. Despite its prevalence, the abortion experience is still relegated to the private realm, while the abortion issue continues to generate a storm of protest in the public sphere. To understand this paradox, one must consider the history of abortion, as well as the ideology and tactics of the pro-choice and pro-life movements. The fiercely polarized debate over abortion raises many difficult questions about privacy: Should abortion have been constitutionally and rhetorically grounded in the right to privacy? Can a minor have an abortion without parental consent? If a married woman seeks to terminate a pregnancy, must she notify her husband? Is the right to privacy meaningless if abortion services are inaccessible? How do abortion clinics protect patient confidentiality, and can these medical records be subpoenaed? Should anti-abortion activists be able to broadcast the identities of abortion providers and patients, and what impact does this have? How do women manage the stigma of abortion? Will the abortion pill someday enable women to end unwanted pregnancies in the privacy of their own homes, and could this depoliticize the issue? Finally, how will the recent changes to the Supreme Court shape abortion policies and practices in the twenty-first century?
During the first half of the twentieth century, abortions were illegal, secretive, and heavily stigmatized, but American women still found ways to get them. Working behind closed doors, some doctors sympathetically aided female patients who were desperate to terminate unwanted pregnancies. In the 1950s and 1960s, women of privilege were sometimes able to get approval from hospital committees for “therapeutic” abortions, while poor women and women of color were more likely to have to rely on self-induced or back-alley abortions, which were painful, life-threatening, and even more covert. In public discourse, this subject was taboo. The Sheri Finkbine case was the first to shine the national spotlight on abortion. During her pregnancy in 1962, Finkbine had been given thalidomide, a tranquilizer that was later discovered to produce severe birth defects. When she went public with her story in order to warn others about the dangers of this drug, the hospital where she was planning to go canceled her scheduled abortion, and she was forced to travel to Sweden for the procedure. Two years later, a German measles outbreak in the United States resulted in the births of over 20,000 congenitally abnormal babies. Awareness of this situation drove thousands of women to terminate their pregnancies, and it also prompted scrutiny of the restrictive abortion laws by both the medical community and the public.
The 1960s brought technological advances in birth control, a sexual revolution, and a climate that was ripe for social protest. During this decade, the second wave of the feminist movement was instrumental in mobilizing support for abortion rights since the abortion issue fit well with the feminist battle cry at the time: “The Personal Is Political.” In the late 1960s, the National Abortion Rights Action League (NARAL) appeared on the political scene, and in Chicago activists created the legendary underground abortion network known as “Jane.”
The Roe v. Wade, 410 U.S. 113 (1973) decision, which legalized abortion in 1973, was in many ways a response to this changing social climate and to state-level efforts to reform abortion laws. Some states, like New York, had already lifted their bans on abortion. The case of Roe v. Wade involved a challenge to a Texas law, which made abortion a criminal act unless a woman’s life was in danger. The Supreme Court determined that the inferred right to privacy in the Constitution was “broad enough to encompass a woman’s decision whether or not to terminate her pregnancy.” Previously, the Court had used a similar rationale to strike down statutes prohibiting married couples’ use of birth control (Griswold v. Connecticut, 381 U.S. 479, 1965) and criminalizing the distribution of contraceptives to unmarried people (Eisenstadt v. Baird, 405 U.S. 438, 1972). In Roe, the Court used a “strict scrutiny” standard, which provides the highest level of constitutional protection for Americans’ most fundamental rights. However, the right to privacy for women’s decisions about pregnancy was not absolute: the Roe decision stipulated that a state could claim a “compelling” interest in preserving life once the fetus is capable of surviving outside the womb.
Framing abortion as a personal privacy issue for women has been advantageous for the pro-choice movement. Signs at pro-choice rallies boldly proclaim these messages: “Keep Your Laws Off My Body” and “U.S. Out of My Uterus.” Perhaps even more resonant are the slogans that underscore the individual’s right to freedom, like “My Body, My Choice.” The notion of self-determination is fundamental to the American value system. In contrast, radical feminist claims for “abortion on demand” have never been palatable for mainstream audiences. Feminist scholars and legal analysts have debated the efficacy of grounding reproductive rights in privacy as opposed to other possibilities such as the right to health care, the right to equal protection, or the right to consent to bodily intrusion by a fetus. For example, philosophy professor and founder of the National Network of Abortion Funds, Marlene Gerber Fried, sees the rhetoric about abortion as a “private choice” as limited, isolating, and ironically counter to the feminist claim that the personal is political.
The pro-life movement comes at this issue from an entirely different perspective. In this view, the right to privacy pales in comparison with the right to life. Scholars like Kristin Luker, author of Abortion and the Politics of Motherhood, explain that competing world-views are at the heart of the conflict over abortion. For pro-life activists, abortion not only represents the destruction of human life, but it also symbolizes a decline in traditional family values. The legalization of abortion galvanized the pro-life opposition, as movement successes often do, and it fueled a new era of clashes in judicial, political, and social arenas. Organizations
like the National Right to Life Committee and Operation Rescue (now called Operation Save America) emerged as fierce challengers. According to the National Abortion Federation, which tracks legislative initiatives, 500 bills that would further restrict abortion services were introduced in Congress in 2005, and 26 were signed into law. The pro-life movement’s tenacity in pursuing restrictive legislation and its tactical ingenuity have often forced the pro-choice movement into a defensive posture.
The legal precedent that was set in Roe has endured for over three decades, but in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992), the Court introduced a new standard that allows states to place restrictions on abortion prior to fetal viability, provided that these do not constitute an “undue burden” to the woman. As part of this decision, parental consent laws and waiting periods were allowed, but requiring a woman to inform her husband was considered a substantial obstacle and was therefore deemed unconstitutional.
According to a 2005 Gallup Poll, 64 percent of Americans said they would be in favor of a law requiring that the husband of a married woman be notified if the woman decided to have an abortion. An even higher percentage favored parental consent laws for minors. Opponents stress that most teens do involve a parent or other trusted adult in the decision to terminate an unwanted pregnancy, and that minors are allowed to make other confidential decisions about medical care. For example, all 50 states grant minors the authority to approve the diagnosis and treatment of sexually transmitted diseases. Currently, 34 states have some type of parental involvement stipulation regarding the decision to terminate a pregnancy. In Arkansas, for example, the minor must bring her parent or guardian, or provide that person’s notarized signature as an indication of consent, to the clinic. Some states allow minors to obtain a judicial bypass in recognition of the fact that some teens may be victims of incest or subject to abuse if parents were to find out about the pregnancy. There is evidence that parental consent laws increase the likelihood of second-trimester procedures, but these laws may also lower rates of sexual activity, pregnancy, and abortion for young women.
Poor and rural women’s access to abortion has also been curtailed. With the cost of a first-trimester surgical abortion averaging around $400, the cost of this procedure is prohibitive for many women. In addition, 87 percent of U.S. counties lack even a single abortion provider. In states like Wyoming, women must drive hundreds of miles or travel to neighboring states for abortion services. Waiting periods can be particularly taxing for women who have to travel out of state. Although there has been a drop in the number of abortions in recent years, there is an insufficient geographic distribution of abortion providers. In large cities, the situation may be different, In Detroit, for example, abortion clinic owners compete for patients. Some try to gain a competitive edge by offering a more private, spa-like atmosphere, complete with amenities like aromatherapy candles and relaxing music.
This example contrasts dramatically with the emotionally charged battleground outside many abortion clinics. The front lines of the abortion wars have been chronicled extensively. In some places, pro-life activists assemble in peaceable prayer vigils or offer sidewalk counseling and resources to women who are conflicted about their decision. In other places, women must run what they describe as an intimidating gauntlet of protestors, where they are subjected to gruesome photographs of bloodied fetal parts, pleas of “Don’t kill your baby!” and even threats like “God will punish you!” Members of Operation Save America, who participate in blockades do so in an impassioned effort to compel women to turn away from what the protesters see as the horrors of abortion. Although some women are able to deflect anti-abortion accusations with hostility, others feel shaken, invaded, or tearful. To offset this emotionally taxing journey, clinic workers may try to create a safe space inside the clinic. This can be done with sympathetic reassurances or with security measures like bulletproof glass. While some women feel more at ease with these safeguards to protect their privacy, others perceive the lock-down system as prisonlike and frightening.
Security systems are used to protect clinic workers and patients from sieges, bombings, arson, anthrax, stalking, and violence. Many equate these acts perpetrated by the radical fringe of the anti-abortion movement with terrorism, although those who have murdered abortion doctors see themselves as protecting the lives of unborn babies. Two important victories for the pro-choice movement in this regard came in 1994. The first was the Freedom of Access to Clinic Entrances Act, which makes it a federal offense for any person to threaten, attempt to sabotage, or engage in destructive acts against clinics, or to use violent behavior directed at clinic personnel with the purpose of blocking reproductive health services. The second was Madsen v. Women’s Health Center, in which the Supreme Court ruled that a 36-foot buffer zone protecting clinic entrances and a ban on disruptive noise do not curtail the protestors’ rights to free speech: “The First Amendment does not demand that patients at a medical facility undertake Herculean efforts to escape the cacophony of political protests.”
In addition to protesting against those seeking abortions, anti-abortion activists have tried to increase the emotional costs for abortion providers. Protestors have picketed outside providers’ homes, tracked them with binoculars and cameras, and posted identifying information about them and their families. In 1995 the American Coalition of Life Activists (ACLA) distributed wanted posters for a dozen abortion providers who they charged were “Guilty of Crimes Against Humanity.” In 1997 Neal Horsley’s compendium Nuremberg Files website made headlines because the names of abortion providers who had been murdered were struck out, making it look very much like a hit list. Unlike handing out leaflets, posting information on the Internet can reach millions of people in a matter of seconds. Such activities affect the privacy rights that help protect abortion providers from harassment and danger. At the state and local levels, laws, ordinances, and injunctions have been sought to restrict these kinds of activities. The Driver’s Privacy Protection Act of 1994 made it more difficult to obtain personal information based on names and license plates. The Ninth U.S. Circuit Court of Appeals in San Francisco ruled in Planned Parenthood v. ACLA that the wanted posters were disseminated to intimidate doctors and constituted a “true threat” of violence. The plaintiffs were awarded $109 million in damages.
Anti-abortion activists also have made attempts to uncloak patient privacy. Although it is difficult to estimate the extent to which these strategies are used, there have been reports of women who have received abortions being tracked down by phone calls, finding anti-abortion literature on their doorsteps, and having their family members or acquaintances informed of their abortion decision. In 2001 a woman in Illinois was taken from an abortion clinic to a hospital for the repair of a cervical tear. As she was wheeled out to the ambulance, a protestor took her picture and uploaded it to the Missionaries to the Unborn website, along with information that had been obtained about her hospitalization, age, medical history, family, and hometown. The patient sued the hospital for failing to protect her medical records, as well as the anti-abortion activists for “publicly humiliating her.” In 2002 a website called abortioncams.com was launched, with the explicit goal of shaming “homicidal mothers” and deterring them from entering abortion clinics. Anti-abortion activists have claimed that women going to clinics are using public streets, and that the activists’ “journalistic” right to take pictures is protected by the First Amendment. Opponents counter that women going to a clinic to obtain abortions is not a newsworthy event, and that having their pictures taken is emotionally distressing to the women.
To help protect patient privacy, some clinics enlist volunteers to escort patients. Women’s faces can also be shielded from protestors with umbrellas, or clients can be encouraged to use private entrances. Yellow-page advertisements for abortion providers almost always mention confidentiality. Although the procedures for protecting privacy vary, options of one-on-one counseling, official notices of privacy practices relating to medical records, and forms to indicate preferences regarding follow-up contact may be available. Particularly in smaller communities, a woman might worry about her car being seen in the clinic parking lot or her name being called out in the waiting room. In larger clinics, women may feel they are “herded like cattle” into an open recovery area, or there may be only a thin curtain preventing a woman from being exposed as she undergoes a pelvic exam or reacts with an emotional display. Like providers, patients need privacy to protect them from possible retaliation. Privacy may also enable them to make decisions free from the influence of others and to avoid being judged for their choices.
The question of whether abortion is morally right or wrong continues to be debated, and the public is sharply divided. According to a 2006 Gallup Poll, 53 percent of Americans consider themselves to be pro-choice, while 42 percent consider themselves to be pro-life. A strong, consistent, majority have supported a woman’s right to an abortion under dire circumstances—in cases where the mother’s life is in danger, when conception occurred during rape, or if genetic tests confirm fetal abnormality—but fewer are supportive of abortion under any conditions.
Consequently, women confide with great trepidation, often testing the waters before revealing information. Abortion is usually a closely guarded secret because it is still stigmatized and associated with sexual irresponsibility, although certainly some women do not adopt that point of view. In Stigma: Notes on the Management of Spoiled Identity,sociologist Erving Goffman explains that individuals can manage stigma by dividing up their social world, which entails sharing the discrediting information with a relatively small group while concealing it from everyone else. A woman who has an abortion may also try to pretend that everything is okay because she does not want to burden others with the knowledge. Ultimately, this code of silence isolates women from their support networks and renders women who have had abortions invisible in our society. In 2002 approximately 1.29 million abortions were performed in the United States, but personal stories were available infrequently because the abortion experience is so very private.
The abortion pill has the potential to make the abortion experience even more private. Emergency contraception, also referred to as Plan B or the morning-after pill, prevents implantation. It is effective for 72 hours after contraceptive failure or unprotected sex. RU-486, which can be used within 49 days of conception, was approved by the FDA in 2000. At the present time, this “medical abortion” typically involves multiple trips to a clinic. In the first visit, a woman takes mifepristone to block progesterone, without which the lining of the uterus breaks down, ending the pregnancy. This is followed by misoprostol, which causes the uterus to contract and empty. In the final visit, the clinician uses a blood test or an ultrasound to ensure that the abortion is complete. The reviews of this procedure are mixed. Some women feel that it is less invasive, more natural, more like a miscarriage, more humane, relatively easy, not terribly painful, and more private. Others report considerable bleeding, cramping, nausea, and pain from passing the embryo. They also express worries about expelling the material outside of a controlled clinical setting. The drugs may also suppress the immune system and make women more vulnerable to infections. Clinic workers have speculated about the potential of medical abortion to diffuse anti-abortion demonstrations.
Before he took office, President George W. Bush boldly stated, “I do not like abortions. I will do everything in my power to restrict abortions.” Bush’s former attorney general, John Ashcroft, in an effort to defend the federal “partial-birth” abortion ban, sought sensitive medical records of more than a thousand women who had received abortion care. His attorneys argued that “individuals no longer possess a reasonable expectation their histories will remain completely confidential.” Bush’s long-awaited opportunity to nominate justices to the Supreme Court finally came in 2005. The appointments of Chief Justice John Roberts and Judge Samuel Alito have been accompanied by a surge in anti-abortion initiatives. In March 2006 Republican Governor Mike Rounds of South Dakota signed a restrictive abortion ban, which is intended to be a direct challenge to Roe v. Wade. As pro-choice organizations mobilize supporters to prevent this law from taking effect, similar abortion bans are pending in at least 10 other states. According to a poll taken by the Pew Research Center in 2005, only 32 percent of Americans would like to see Roe v. Wade overturned. But in an ABC News-Washington Post poll that same year, 42 percent said they want to make abortion harder to get. At this historic moment, Justice Harry A. Blackmun’s words in the dissenting opinion in Webster v. Reproductive Health Services (1989) appear even more prophetic: “Women of this Nation still retain the liberty to control their destinies. But the signs are evident and very ominous, and a chill wind blows.”
During the first half of the twentieth century, abortions were illegal, secretive, and heavily stigmatized, but American women still found ways to get them. Working behind closed doors, some doctors sympathetically aided female patients who were desperate to terminate unwanted pregnancies. In the 1950s and 1960s, women of privilege were sometimes able to get approval from hospital committees for “therapeutic” abortions, while poor women and women of color were more likely to have to rely on self-induced or back-alley abortions, which were painful, life-threatening, and even more covert. In public discourse, this subject was taboo. The Sheri Finkbine case was the first to shine the national spotlight on abortion. During her pregnancy in 1962, Finkbine had been given thalidomide, a tranquilizer that was later discovered to produce severe birth defects. When she went public with her story in order to warn others about the dangers of this drug, the hospital where she was planning to go canceled her scheduled abortion, and she was forced to travel to Sweden for the procedure. Two years later, a German measles outbreak in the United States resulted in the births of over 20,000 congenitally abnormal babies. Awareness of this situation drove thousands of women to terminate their pregnancies, and it also prompted scrutiny of the restrictive abortion laws by both the medical community and the public.
The 1960s brought technological advances in birth control, a sexual revolution, and a climate that was ripe for social protest. During this decade, the second wave of the feminist movement was instrumental in mobilizing support for abortion rights since the abortion issue fit well with the feminist battle cry at the time: “The Personal Is Political.” In the late 1960s, the National Abortion Rights Action League (NARAL) appeared on the political scene, and in Chicago activists created the legendary underground abortion network known as “Jane.”
The Roe v. Wade, 410 U.S. 113 (1973) decision, which legalized abortion in 1973, was in many ways a response to this changing social climate and to state-level efforts to reform abortion laws. Some states, like New York, had already lifted their bans on abortion. The case of Roe v. Wade involved a challenge to a Texas law, which made abortion a criminal act unless a woman’s life was in danger. The Supreme Court determined that the inferred right to privacy in the Constitution was “broad enough to encompass a woman’s decision whether or not to terminate her pregnancy.” Previously, the Court had used a similar rationale to strike down statutes prohibiting married couples’ use of birth control (Griswold v. Connecticut, 381 U.S. 479, 1965) and criminalizing the distribution of contraceptives to unmarried people (Eisenstadt v. Baird, 405 U.S. 438, 1972). In Roe, the Court used a “strict scrutiny” standard, which provides the highest level of constitutional protection for Americans’ most fundamental rights. However, the right to privacy for women’s decisions about pregnancy was not absolute: the Roe decision stipulated that a state could claim a “compelling” interest in preserving life once the fetus is capable of surviving outside the womb.
Framing abortion as a personal privacy issue for women has been advantageous for the pro-choice movement. Signs at pro-choice rallies boldly proclaim these messages: “Keep Your Laws Off My Body” and “U.S. Out of My Uterus.” Perhaps even more resonant are the slogans that underscore the individual’s right to freedom, like “My Body, My Choice.” The notion of self-determination is fundamental to the American value system. In contrast, radical feminist claims for “abortion on demand” have never been palatable for mainstream audiences. Feminist scholars and legal analysts have debated the efficacy of grounding reproductive rights in privacy as opposed to other possibilities such as the right to health care, the right to equal protection, or the right to consent to bodily intrusion by a fetus. For example, philosophy professor and founder of the National Network of Abortion Funds, Marlene Gerber Fried, sees the rhetoric about abortion as a “private choice” as limited, isolating, and ironically counter to the feminist claim that the personal is political.
The pro-life movement comes at this issue from an entirely different perspective. In this view, the right to privacy pales in comparison with the right to life. Scholars like Kristin Luker, author of Abortion and the Politics of Motherhood, explain that competing world-views are at the heart of the conflict over abortion. For pro-life activists, abortion not only represents the destruction of human life, but it also symbolizes a decline in traditional family values. The legalization of abortion galvanized the pro-life opposition, as movement successes often do, and it fueled a new era of clashes in judicial, political, and social arenas. Organizations
like the National Right to Life Committee and Operation Rescue (now called Operation Save America) emerged as fierce challengers. According to the National Abortion Federation, which tracks legislative initiatives, 500 bills that would further restrict abortion services were introduced in Congress in 2005, and 26 were signed into law. The pro-life movement’s tenacity in pursuing restrictive legislation and its tactical ingenuity have often forced the pro-choice movement into a defensive posture.
The legal precedent that was set in Roe has endured for over three decades, but in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992), the Court introduced a new standard that allows states to place restrictions on abortion prior to fetal viability, provided that these do not constitute an “undue burden” to the woman. As part of this decision, parental consent laws and waiting periods were allowed, but requiring a woman to inform her husband was considered a substantial obstacle and was therefore deemed unconstitutional.
According to a 2005 Gallup Poll, 64 percent of Americans said they would be in favor of a law requiring that the husband of a married woman be notified if the woman decided to have an abortion. An even higher percentage favored parental consent laws for minors. Opponents stress that most teens do involve a parent or other trusted adult in the decision to terminate an unwanted pregnancy, and that minors are allowed to make other confidential decisions about medical care. For example, all 50 states grant minors the authority to approve the diagnosis and treatment of sexually transmitted diseases. Currently, 34 states have some type of parental involvement stipulation regarding the decision to terminate a pregnancy. In Arkansas, for example, the minor must bring her parent or guardian, or provide that person’s notarized signature as an indication of consent, to the clinic. Some states allow minors to obtain a judicial bypass in recognition of the fact that some teens may be victims of incest or subject to abuse if parents were to find out about the pregnancy. There is evidence that parental consent laws increase the likelihood of second-trimester procedures, but these laws may also lower rates of sexual activity, pregnancy, and abortion for young women.
Poor and rural women’s access to abortion has also been curtailed. With the cost of a first-trimester surgical abortion averaging around $400, the cost of this procedure is prohibitive for many women. In addition, 87 percent of U.S. counties lack even a single abortion provider. In states like Wyoming, women must drive hundreds of miles or travel to neighboring states for abortion services. Waiting periods can be particularly taxing for women who have to travel out of state. Although there has been a drop in the number of abortions in recent years, there is an insufficient geographic distribution of abortion providers. In large cities, the situation may be different, In Detroit, for example, abortion clinic owners compete for patients. Some try to gain a competitive edge by offering a more private, spa-like atmosphere, complete with amenities like aromatherapy candles and relaxing music.
This example contrasts dramatically with the emotionally charged battleground outside many abortion clinics. The front lines of the abortion wars have been chronicled extensively. In some places, pro-life activists assemble in peaceable prayer vigils or offer sidewalk counseling and resources to women who are conflicted about their decision. In other places, women must run what they describe as an intimidating gauntlet of protestors, where they are subjected to gruesome photographs of bloodied fetal parts, pleas of “Don’t kill your baby!” and even threats like “God will punish you!” Members of Operation Save America, who participate in blockades do so in an impassioned effort to compel women to turn away from what the protesters see as the horrors of abortion. Although some women are able to deflect anti-abortion accusations with hostility, others feel shaken, invaded, or tearful. To offset this emotionally taxing journey, clinic workers may try to create a safe space inside the clinic. This can be done with sympathetic reassurances or with security measures like bulletproof glass. While some women feel more at ease with these safeguards to protect their privacy, others perceive the lock-down system as prisonlike and frightening.
Security systems are used to protect clinic workers and patients from sieges, bombings, arson, anthrax, stalking, and violence. Many equate these acts perpetrated by the radical fringe of the anti-abortion movement with terrorism, although those who have murdered abortion doctors see themselves as protecting the lives of unborn babies. Two important victories for the pro-choice movement in this regard came in 1994. The first was the Freedom of Access to Clinic Entrances Act, which makes it a federal offense for any person to threaten, attempt to sabotage, or engage in destructive acts against clinics, or to use violent behavior directed at clinic personnel with the purpose of blocking reproductive health services. The second was Madsen v. Women’s Health Center, in which the Supreme Court ruled that a 36-foot buffer zone protecting clinic entrances and a ban on disruptive noise do not curtail the protestors’ rights to free speech: “The First Amendment does not demand that patients at a medical facility undertake Herculean efforts to escape the cacophony of political protests.”
In addition to protesting against those seeking abortions, anti-abortion activists have tried to increase the emotional costs for abortion providers. Protestors have picketed outside providers’ homes, tracked them with binoculars and cameras, and posted identifying information about them and their families. In 1995 the American Coalition of Life Activists (ACLA) distributed wanted posters for a dozen abortion providers who they charged were “Guilty of Crimes Against Humanity.” In 1997 Neal Horsley’s compendium Nuremberg Files website made headlines because the names of abortion providers who had been murdered were struck out, making it look very much like a hit list. Unlike handing out leaflets, posting information on the Internet can reach millions of people in a matter of seconds. Such activities affect the privacy rights that help protect abortion providers from harassment and danger. At the state and local levels, laws, ordinances, and injunctions have been sought to restrict these kinds of activities. The Driver’s Privacy Protection Act of 1994 made it more difficult to obtain personal information based on names and license plates. The Ninth U.S. Circuit Court of Appeals in San Francisco ruled in Planned Parenthood v. ACLA that the wanted posters were disseminated to intimidate doctors and constituted a “true threat” of violence. The plaintiffs were awarded $109 million in damages.
Anti-abortion activists also have made attempts to uncloak patient privacy. Although it is difficult to estimate the extent to which these strategies are used, there have been reports of women who have received abortions being tracked down by phone calls, finding anti-abortion literature on their doorsteps, and having their family members or acquaintances informed of their abortion decision. In 2001 a woman in Illinois was taken from an abortion clinic to a hospital for the repair of a cervical tear. As she was wheeled out to the ambulance, a protestor took her picture and uploaded it to the Missionaries to the Unborn website, along with information that had been obtained about her hospitalization, age, medical history, family, and hometown. The patient sued the hospital for failing to protect her medical records, as well as the anti-abortion activists for “publicly humiliating her.” In 2002 a website called abortioncams.com was launched, with the explicit goal of shaming “homicidal mothers” and deterring them from entering abortion clinics. Anti-abortion activists have claimed that women going to clinics are using public streets, and that the activists’ “journalistic” right to take pictures is protected by the First Amendment. Opponents counter that women going to a clinic to obtain abortions is not a newsworthy event, and that having their pictures taken is emotionally distressing to the women.
To help protect patient privacy, some clinics enlist volunteers to escort patients. Women’s faces can also be shielded from protestors with umbrellas, or clients can be encouraged to use private entrances. Yellow-page advertisements for abortion providers almost always mention confidentiality. Although the procedures for protecting privacy vary, options of one-on-one counseling, official notices of privacy practices relating to medical records, and forms to indicate preferences regarding follow-up contact may be available. Particularly in smaller communities, a woman might worry about her car being seen in the clinic parking lot or her name being called out in the waiting room. In larger clinics, women may feel they are “herded like cattle” into an open recovery area, or there may be only a thin curtain preventing a woman from being exposed as she undergoes a pelvic exam or reacts with an emotional display. Like providers, patients need privacy to protect them from possible retaliation. Privacy may also enable them to make decisions free from the influence of others and to avoid being judged for their choices.
The question of whether abortion is morally right or wrong continues to be debated, and the public is sharply divided. According to a 2006 Gallup Poll, 53 percent of Americans consider themselves to be pro-choice, while 42 percent consider themselves to be pro-life. A strong, consistent, majority have supported a woman’s right to an abortion under dire circumstances—in cases where the mother’s life is in danger, when conception occurred during rape, or if genetic tests confirm fetal abnormality—but fewer are supportive of abortion under any conditions.
Consequently, women confide with great trepidation, often testing the waters before revealing information. Abortion is usually a closely guarded secret because it is still stigmatized and associated with sexual irresponsibility, although certainly some women do not adopt that point of view. In Stigma: Notes on the Management of Spoiled Identity,sociologist Erving Goffman explains that individuals can manage stigma by dividing up their social world, which entails sharing the discrediting information with a relatively small group while concealing it from everyone else. A woman who has an abortion may also try to pretend that everything is okay because she does not want to burden others with the knowledge. Ultimately, this code of silence isolates women from their support networks and renders women who have had abortions invisible in our society. In 2002 approximately 1.29 million abortions were performed in the United States, but personal stories were available infrequently because the abortion experience is so very private.
The abortion pill has the potential to make the abortion experience even more private. Emergency contraception, also referred to as Plan B or the morning-after pill, prevents implantation. It is effective for 72 hours after contraceptive failure or unprotected sex. RU-486, which can be used within 49 days of conception, was approved by the FDA in 2000. At the present time, this “medical abortion” typically involves multiple trips to a clinic. In the first visit, a woman takes mifepristone to block progesterone, without which the lining of the uterus breaks down, ending the pregnancy. This is followed by misoprostol, which causes the uterus to contract and empty. In the final visit, the clinician uses a blood test or an ultrasound to ensure that the abortion is complete. The reviews of this procedure are mixed. Some women feel that it is less invasive, more natural, more like a miscarriage, more humane, relatively easy, not terribly painful, and more private. Others report considerable bleeding, cramping, nausea, and pain from passing the embryo. They also express worries about expelling the material outside of a controlled clinical setting. The drugs may also suppress the immune system and make women more vulnerable to infections. Clinic workers have speculated about the potential of medical abortion to diffuse anti-abortion demonstrations.
Before he took office, President George W. Bush boldly stated, “I do not like abortions. I will do everything in my power to restrict abortions.” Bush’s former attorney general, John Ashcroft, in an effort to defend the federal “partial-birth” abortion ban, sought sensitive medical records of more than a thousand women who had received abortion care. His attorneys argued that “individuals no longer possess a reasonable expectation their histories will remain completely confidential.” Bush’s long-awaited opportunity to nominate justices to the Supreme Court finally came in 2005. The appointments of Chief Justice John Roberts and Judge Samuel Alito have been accompanied by a surge in anti-abortion initiatives. In March 2006 Republican Governor Mike Rounds of South Dakota signed a restrictive abortion ban, which is intended to be a direct challenge to Roe v. Wade. As pro-choice organizations mobilize supporters to prevent this law from taking effect, similar abortion bans are pending in at least 10 other states. According to a poll taken by the Pew Research Center in 2005, only 32 percent of Americans would like to see Roe v. Wade overturned. But in an ABC News-Washington Post poll that same year, 42 percent said they want to make abortion harder to get. At this historic moment, Justice Harry A. Blackmun’s words in the dissenting opinion in Webster v. Reproductive Health Services (1989) appear even more prophetic: “Women of this Nation still retain the liberty to control their destinies. But the signs are evident and very ominous, and a chill wind blows.”
