The Abortion Distortion

Photo: Hannah Whitaker

Most New Yorkers hadn’t heard of Bart Stupak before he attached his devastating anti-abortion amendment to the House’s health-care-reform bill three weeks ago. We know a lot more about him now, of course: that he lives in a Christian rooming house on C Street; that he’s a former state trooper. He has become a symbol of legislative zealotry, living proof that the fight over the right to choose will always attract a more impassioned opposition than defense. (As Harrison Hickman, a former pollster for NARAL, put it to me: “If you believe that choosing the wrong side of the issue means spending eternal life in Hades, of course you’re going to be more focused on it.”) Just a week after the vote, when I reached the Michigan Democrat as he was driving across his district, he seemed dumbfounded that anyone found his brinkmanship surprising. “I said to anyone who’d listen: ‘Do you want health care, or do you want to fight out abortion?’ ” says Stupak. He points out that he’d nearly managed to bring down a rule about abortion funding earlier in the summer, this time in a bill about spending in the District of Columbia. “I said, ‘Look, that was a shot across your bow,’ ” he recalls. “ ‘I was being polite to you. That was a warning.’ And the leadership just blew us off.”

Until it realized it couldn’t, of course. And the results sent chills through the pro-choice world, dampening what was otherwise an impressive victory for Democrats on the issue of universal health care. If Stupak’s amendment holds, then any health-insurance plan that’s either listed on the government-run exchange or accepts federal subsidies—which would likely be almost all of them—would not be allowed to cover abortions. (The Senate bill is better thus far, but what the legislation will ultimately be, assuming it passes at all, is anyone’s guess.) Four days after the vote, Kate Michelman, the former head of NARAL, and Frances Kissling, the former head of Catholics for Choice, warned of an ominous new landscape in a Times op-ed: “The House Democrats reinforced the principle that a minority view on the morality of abortion can determine reproductive-health policy for American women.”

But is that actually right? Was Stupak’s truly the minority view?

According to a Gallup poll from July, 60 percent of Americans think abortion should be either illegal or “legal only in a few circumstances.” Only seventeen states pay for the procedure for poor women beyond the standards of the 1977 Hyde Amendment—meaning if the woman’s life is in danger or she’s been the victim of rape or incest. Just two months before the health-care bill’s passage in the House, a Rasmussen poll found that 48 percent of the public didn’t want abortion covered in any government-subsidized health plan, while just 13 percent did. (Thirty-two percent believed in a “neutral” approach—though what on Earth that means is hard to say.)

“I knew even some pro-choice people would vote with us,” says Stupak. “This wasn’t like opposing RU-486 or parental consent.”

To really understand the House vote on abortion, one ought not look just at Bart Stupak. As the Democratic co-chair of the pro-life caucus in Congress, he was bound to have strong feelings on the subject. More representative, perhaps, of the kind of supporter he attracted in Congress was David Obey—chairman of the Appropriations Committee and, with some exceptions, a committed Wisconsin progressive. He votes for expanding money to Pell Grants, Head Start, and stem-cell research. He was an outspoken opponent of the Iraq War and voted against a Republican-proposed ban on gay adoptions in the District of Columbia. It just so happens that he takes the pro-life doctrine of his faith quite seriously. “I agree with my church,” he wrote in a national Catholic weekly in 2004, “that abortion in most cases is wrong.”

“Because there’s a Democratic majority in Congress and the president is pro-choice,” says Nancy Keenan, the current director of NARAL, “it sometimes gets lost how truly numerically challenged we are.” That’s especially true for people in New York City, where access to abortion is plentiful and unconstrained. But it’s a very ambivalent pro-choice nation we live in. The idea that a bunch of pro-life rogue wingnuts have hijacked the agenda and thwarted the national will is a convenient, but fanciful, belief. Even with an 81-person margin in the House, and even with a passionately committed female, pro-choice Speaker, it was the Democrats who managed to pass a bill that, arguably, would restrict access to abortion more aggressively than any state measure or legal case since the Supreme Court decided Roe v. Wade.

From the moment abortion was legalized nationally in 1973, the American public wasn’t especially comfortable with it. As Jeffrey Rosen, the legal scholar at George Washington University, wrote in The Atlantic three years ago, Roe v. Wade was one of the few Supreme Court decisions that was out of step with mainstream public opinion. Patricia Schroeder, the Denver Democrat who was first elected to the House in 1972, remembers that practically every bill she saw in the beginning of her tenure had an anti-abortion rider attached to it, forcing the same ten or so women down to the House floor. “And we’d get very angry,” she recalls, “because there would be very few congressmen joining us. They’d say, ‘We really don’t like having to vote on this all the time,’ and we’d say, ‘Um, we’re not the ones bringing you down here.’ ” Within a decade, says Elizabeth Nash, an analyst at the Guttmacher Institute, states had made significant headway in trimming the law’s scope, with 27 passing measures that required 24-hour waiting periods, mandatory counseling, or both (now law in 34 states), and 25 passing measures that required parental notice or consent (ditto).

Photo: Hannah Whitaker

And going strictly by the numbers, it may not look like public opinion on abortion has changed very much over the years. In April 1975, according to Gallup, 21 percent of Americans thought abortion should be legal under all circumstances and 22 percent thought it should be illegal under all circumstances. In the early nineties, there was a brief spell where a full third of Americans believed abortion should always be legal. That started to slide midway through the Clinton years, and by May of this year, we were almost exactly where we started in 1975: 22 percent saying always legal and 23 saying always illegal.

But that downward trajectory could continue. If forced to choose, Americans today are far more eager to label themselves “pro-life” than they were a dozen years ago. The youngest generation of voters—those between the ages of 18 and 29, and therefore most likely to need an abortion—is the most pro-life to come along since the generation born during the Great Depression, according to Michael D. Hais and Morley Winograd, authors of Millennial Makeover, who got granular data on the subject from Pew Research Center. Crisis Pregnancy Centers, dedicated to persuading women to continue their pregnancies, now outnumber the country’s abortion providers, who themselves are a rapidly aging group (two-thirds are over 50, according to a National Abortion Federation study from 2002). In the wake of the murder of Dr. George Tiller this year, the Senate couldn’t even pass a resolution condemning violence against abortion providers.

Abortion counselors will also tell you that the stigma attached to the procedure is worse than it’s been in years. “When I started as a patient advocate in Ohio in 1996,” says Jeannie Ludlow, a professor at Eastern Illinois University who has written a great deal about abortion, “what I mostly saw were women who were thinking about abortion in individual ways—this is what’s going on in my life, this is what I’m thinking I should do. But by the time I left in 2008, our patients would be saying all that and ‘Oh, and I know I’m going to feel bad for the rest of my life,’ even if they seemed perfectly sure of their choice.”

One could say, in a sense, that the pro-choice movement has always had the harder job. The choice argument is an analytical one, grounded in theories of privacy and the rights of the mother; the pro-life side has the case with instant visceral and emotional appeal: This is life we’re talking about. Things were also bound to get worse when the national tide turned Democratic; whenever a pro-choice person occupies the White House, those who fret about the issue stop giving money to NARAL and the pro-life side reasserts itself (indeed, says Cecile Richards, the head of Planned Parenthood, protests at her clinics are up, up, up).

But these explanations alone can’t fully account for the shift in tide. Rather, it’s a confluence of things—starting, I’d argue, with technological advances. Generally, science is the friend of progressive political causes. Not this one. As fetal ultrasound technology improved during the nineties, abortion providers, conditioned to reassure patients that the fetus was merely tissue, found it much harder to do so once their patients were staring at images that looked so lifelike. Banking on the emotional power of seeing a beating heart on a television screen—many in the pro-life movement refer to sonograms as “God’s window”—organizations like Focus on the Family began to use this technology to their advantage, sending ultrasound machines to Crisis Pregnancy Centers in an initiative taglined “Revealing Life to Save Life.”

Perhaps just as important, the pro-life movement got very shrewd about its politics, realizing that it had a highly conflicted electorate on its hands. As William Saletan shows with depressing cogency in Bearing Right: How Conservatives Won the Abortion War, the pro-choice movement was never going to win its case on the basis of women’s rights. Men, especially southern white men, didn’t care. The most persuasive argument it had was an old American standby: The government has no right meddling in your business. It didn’t take long for the pro-life movement to use this argument to its own advantage, realizing that if the public didn’t like the government making decisions about abortions, it could force pro-choice legislators to admit that the public wouldn’t like the government funding them either. They were right. Soon, pro-choice candidates were running away from public funding and toward parental consent—another constraint the public overwhelmingly prefers, as well as 24-hour waiting periods—and a more libertarian Supreme Court upheld these restrictions in landmark cases in 1989 and 1992.

Yet that still wasn’t the worst of it. Until the mid-nineties, the political debate over abortion remained mostly in the theoretical realm, with the role of government at its center. Had it stayed there, it’s possible we’d be in a different place today. But in late 1995, a Florida Republican congressman named Charles Canady had a stroke of insight that would shift it to the realm of both the metaphysical and brutally physical, which is precisely where the pro-life movement wanted it all along. On the floor of the House, he introduced a bill that would ban so-called “partial-birth abortions,” a second-trimester surgical method previously known as intact dilation and extraction. The procedure was extremely upsetting to behold. In it, the fetus—or is it a baby?—is removed from the uterus and stabbed in the back of the head with surgical scissors. It’s a revolting image, one to which the public was ritualistically subjected on the evening news as the debate raged on the House and Senate floors. Defending it was a pro-choice person’s nightmare. Pat Moynihan compared it to infanticide. Clinton still vetoed the ban in 1996, but it was eventually signed into law in 2003 and withstood a Supreme Court challenge in 2007. More important, women were spooked. “A lot of our patients started asking whether or not the fetus felt pain after that, even if they were early along in their pregnancy,” says Albert George Thomas, who until two years ago had spent eighteen years as the head of the family-planning clinic at Mount Sinai. He adds that many women also came into his clinic expressing confusion about the size of the fetus they were aborting. Some were terrified that it was huge, even those who were coming in at six weeks. At that stage, it’s the size of a lentil.

The woman is 28 years old and ten-and-a-half-weeks pregnant. She wears false eyelashes, blue eyeliner, and a striped shirt of black and gray. The condition is: I can sit in on her counseling session if I do not know her name.

“I can see that you are stressed,” starts Claire Keyes, her counselor.

“Yeah,” the woman responds. “Always look stressed.”

Keyes was particularly interested in counseling this woman because of the constellation of adjectives she’d checked off on her intake form: selfish, uncertain, guilty. If you listened only to pro-life cant, you’d think that women were unconflicted—cavalier, even—about their abortions, using them fungibly with birth control. Keyes can tell you this is seldom the case, especially in such a Catholic city as Pittsburgh, and especially among African-Americans, like this woman, who on national surveys are less inclined than whites to identify themselves as pro-choice.

“I see you’re going to school,” says Keyes. “Is it harder doing that or working?”

“Going to school.”

“Because …?”

“Because I got to cram in homework; sometimes I don’t do it,” says the woman. “I got three kids: 13, 11, and 8. And I got to deal with them, and the household, and phone calls from school, ’cause they’re cutting out. So it’s just like … a whole lot of … everything.” She reaches for a tissue. “Basically, I go to school, and as soon as I come home, I go straight to sleep.”

Not all abortion clinics drill down and do this kind of work. But the Allegheny Reproductive Health Center in Pittsburgh, from which Keyes stepped down as director in January but still works as a counselor, has a national reputation for being psychologically oriented. If there’s any place where the complexity and ambivalence surrounding abortion plays out, it’s here.

Keyes opens the woman’s folder. “The first thing I saw in your chart,” she says, “is you’re not sure about your decision. What do you want to tell me about that?”

“I don’t know,” says the woman. “In a sense, I got too much going on, and I can’t afford to take on another child. But in a sense, I feel pressure from my boyfriend, because he don’t want the kids … so it’s like, I want to. I’m not into the whole abortion thing. I did it before”—twice, according to her chart, once last year at this very clinic—“and I really didn’t like it. I think some things happen for a reason.”

The youngest generation of voters—those most likely to need an abortion—is the most pro-life to come along since the generation born during the Great Depression.

Keyes knows that most women refer to the developing lives inside of them as “babies,” rather than fetuses, whether they’re conflicted about their abortions or not. She knows that occasionally women want to keep sonograms of the fetuses they’ve aborted and even ask to see their reassembled remains once the procedure’s through. (This is standard medical procedure, in order to make sure all the parts have been removed.) While many of her clinic patients are at peace with their decision, others are not, and she’s got piles of loose-leaf binders containing pink hearts inscribed with messages to husbands, boyfriends, parents, God (“A lot are to God”), and the never-born that express those feelings of uncertainty—like this one, written in the bubble handwriting of a teen who had accompanied her friend: To the unborn child, Know that your mom made the choice to keep you in heaven and this was not easy for us. (I was her support.) At the end of each counseling session, Keyes offers women a basket of stones from which to choose and make a wish. In early 2008, she built a small sanctuary in her clinic so that women and their partners could “say a final good-bye or a prayer, or just to sit quietly and not think anything at all.”

Keyes gestures toward the waiting room, where the patient’s boyfriend is sitting. “Is he an important part of your life?”

The woman hesitates. “I guess. For now.”

“He doesn’t have kids?”

“He’s got kids. He just don’t want any more.”

Keyes pauses. “I don’t feel you in this decision, and that makes me sad.” She thinks. “If you had to name a percentage—pick a number—what percentage of your decision to be here today is yours?”

The woman stares into space. “Basically, 99 percent of it is him.” She looks listlessly at Keyes. “So. Get it done and over with.”

Keyes gently returns her look. “We have a saying around here: We don’t do abortions for boyfriends.”

The woman is silent for several long, drawn-out seconds. Then, she offers something. “But see, that’s where it comes down to my percent. I have three kids already. So, he leaves, and now I have four children and no dads.”

“Oh,” says Keyes. You can see that she is processing this, trying to figure out whether one percent truly means one percent. “Okay. So let’s just say you had the abortion done here today. What happens when you wake up tomorrow?”

“I’ll feel bad. But I wouldn’t be, like, angry. The way I see it, whatever happens, better that way, because if it don’t work out between us, at least I don’t have any strings attached.”

“So if he disappeared tomorrow, would you say”—Keyes snaps her fingers—“ ‘I should have continued that pregnancy?’ ”


Keyes reaches for a pen. “Okay. You’re going to have to tell me what to write here.”

“I’m gonna do it. Get it over and done with.”

Keyes sucks in her breath, uncertain again. “That’s not a reason.”

The woman reaches for another tissue. “It’s for the best, and best interest of me, and my life.”

A few minutes later, we leave the room. Keyes is shaking. I start to ask her a question, but she cuts me off. “Do I feel good about signing this? Shit, no.” She wipes her eyes. “And I could deny her. We do deny women abortions.”

Well, look, I say. You told her she has trouble acting for herself. That was valuable.

Keyes brushes it off. “She was here a year ago. She might have heard the same thing from the counselor then. In fact, let’s look.” She starts flipping the pages of her chart. “Oh my God.”


“I was her counselor.”

She covers the woman’s name, and together we peer at Keyes’s old notes: Certain of her decision … not prepared for a fourth child … may have a fourth later … gave her a stone.

After surveying a raft of studies dating back to 1989, the American Psychological Association concluded last year that there was no evidence to suggest that an abortion causes mental-health problems in adult women. Indeed, clinic workers will tell you that most patients experience relief when the procedure is over, believing they were doing what’s best. But that doesn’t mean women approach abortion without anxiety or conflict. And if you want to hear honest talk about the realities of abortion, go speak with those abortion counselors and providers. Even the most radically pro-choice will tell you that the political discourse they hear about the subject, with its easy dichotomies and bumper-sticker boilerplate, has little correspondence to the messy, intricate stories of her patients. They hear about peace and guilt, relief and sin. And it is they who will acknowledge, whether we like it or not, that the rhetoric and imagery of the pro-life movement can touch on some basic emotional truths. Peg Johnston, who manages Access for Women in upstate New York, remembers the first time her patients unconsciously began to co-opt the language of the protesters outside. “And it wasn’t that these protesters were brainwashing them,” she says. “It’s that they were tapping into things we all have some discomfort about.”

This is quite a brave confession for Johnston—or any pro-choice person—to make. It means making oneself vulnerable to opportunist pro-life activists, who’ll happily take those words about uncertainty or moral qualms and repurpose them for their own ends. Back in the late eighties, Charlotte Taft, who first pioneered the practice of writing notes on hearts in her Dallas clinic, mentioned to a journalist that women knew “abortion is a kind of killing,” and poor Kate Michelman, at NARAL, was forced to go on the defensive for days. Last year, Lisa Harris, a Michigan doctor, wrote an incredibly powerful essay for Reproductive Health Matters, trying to come to terms with the goriness of second-trimester abortions while simultaneously recognizing their validity: “What do we do when caught between pro-choice discourse that, while it reflects our values, does not accurately reflect the full extent of our experience of abortion and in fact contradicts an enormous part of it, and the anti-abortion discourse and imagery that may actually be more closely aligned to our experience but is based in values we do not share?” Following the publication of her essay, the pro-life movement went nuts, calling her a hypocrite, semantic gymnast, and Dr. Mengele.

But Harris raises a very real and terrible dilemma for those of us who are pro-choice: Engage these questions and you play into the hands of the pro-life movement; refuse to engage in them and you risk living in a political vacuum. Nancy Keenan, the current president of NARAL, knows this. Last year, at an event commemorating the 35th anniversary of Roe v. Wade, she told her audience: “Our reluctance to address the moral complexity of this debate is no longer serving our cause or our country well.” Michelman knew it too. Twenty years ago, on Face the Nation, she said practically the same thing.

The trouble is, both Keenan and Michelman are soldiers; their primary job is to defend abortion rights. Even clinic workers weren’t always comfortable talking about moral complexity. “In the beginning,” recalls Johnston, “we were so afraid of Roe being overturned we didn’t want to do anything to jeopardize legal abortions. So things like the reality of abortion—all those posters showing bloody fetal tissue—we freaked out at it, and if people used to ask ‘Am I going to regret this?’ or ‘Is God going to punish me?’ the questions would stop some of us cold.” But sustained exposure to the worries of women making this decision, day after day, year after year, has a way of changing things, and in the past decade, some of the most emotionally honest pro-choice materials—workbooks, DVDs, websites—and conversation have come from people who’ve been at patients’ sides.

Particularly the academic literature. In “The Things We Cannot Say,” published last year in Women’s Studies Quarterly, Jeannie Ludlow describes the experience of seeing repeat-abortion patients—“I love you guys, but I hope I never see you again!” says one as she leaves the clinic—and dares the pro-choice movement to own up to the fact that it’s these women, much more so than rape and incest victims, whom they’re defending: average, fallible people who on occasion screw up their birth control. And then there was Harris, who wrote about performing an abortion on a woman who was 23 weeks along and then immediately running to deliver a premature baby … of 23 to 24 weeks. “I thought to myself how bizarre it was that I could have legally dismembered this fetus-now-newborn if it were inside its mother’s uterus,” she writes, “but that the same kind of violence against it now would be illegal, and unspeakable.” Later she notes, “Currently, the violence and, frankly, the gruesomeness of abortion is owned only by those who would like to see abortion (at any time in pregnancy) disappear.”

The girl, a high-school sophomore from a small rural town, is curled up in a ball in her seat, her giant sweatshirt pulled down low over her gym shorts. Her mother, trim and erect and clearly stunned, can barely squeak out her question: “It’s too late for her to have an abortion now, right?”

“Well,” says Keyes, looking at the daughter, “you can’t have one at this clinic. There’s one hospital in Pittsburgh where they do it, but it’s often hard to get an appointment.” She looks at the patient’s folder. Her sonogram says she’s 21-weeks pregnant, which means the fetus—or baby—is nearly a foot long. “Oh. You live in West Virginia. Why does life have to be so complicated?” She closes it. “There are a few other places you can go, if you still decide that an abortion is what’s appropriate for you. One would be D.C. There’s also Cleveland. New York. And Philadelphia.”

As a political matter, it has always been safest to discuss second-trimester abortions in the context of a looming tragedy: women whose lives are endangered by the pregnancy, women who discover terrible fetal anomalies. But they’re not the only women who get them. Some are extremely poor and only scrape together the money for the procedure when it’s nearly too late. Some are drug addicts or mentally unstable. And some, like this patient, are 15 years old. Adolescents have an amazing capacity for denial. And when girls are this young, their periods are so irregular and their birth-control literacy is so poor they often have no idea they’re pregnant until the baby starts to kick.

Keyes turns to the daughter. “Is there anything you want to ask me?”

The girl is catatonic. Then: “Are they positive? I went to the thing in July”—by which she means her local health department, in order to get birth-control pills—“and when I had a pregnancy test, I wasn’t pregnant.”

Keyes stands up to get a pregnancy calculator wheel. “When in July?”

“The beginning.”

“Okay. Fourth of July, we’ll call it.” She spins the wheel and turns it upside-down to show the girl. “If you got pregnant on the Fourth of July, that puts you at 21 weeks. So you were pregnant either right when you went for your pills, or right before, or right after. Which means it didn’t show up.”

The girl is impassive. Her mother is holding her head in her hand. “So if we can’t do it at the hospital here, the closest place to us would be where? Cleveland?”

Keyes consults some literature and determines that it is. One clinic goes to 22 weeks, the other to 24. “Here’s one thing I’d advise,” she says. “Make the appointment, because that way, at least you’re on the books. People don’t do this procedure every day, and it takes three days.”

At this, the girl’s mother shoots straight up in her chair. “Three days?” You can almost read her thought: I will never be able to take that kind of time off.

“You have dilators inserted one day. The next you have more. And the third day is the procedure itself.” Keyes adds that it would save her and her daughter time if they hang around the clinic until the doctor is free, so that he can read aloud the statement they’re required by Ohio state law to hear. The mother nods and asks Keyes to go get him. “So anything after 24 weeks,” she asks, “and she can’t get an abortion?”

Keyes shakes her head. “There’s someone in Colorado, but other than that, no. Doctor Tiller is gone.”

This girl could have given up her baby for adoption. For all I know, that’s the path she chose, though it didn’t look like she was headed in that direction. It was certainly an easier option for me to stomach, if I were to be honest about this. This girl was halfway through her pregnancy. She was in her fifth month.

But the truth is, there were no good outcomes in this situation. Carrying the baby to term during her sophomore year would have been horribly difficult, nothing like the movie Juno would have you believe. Terminating at five months tests the moral limits of even the most obdurately pro-choice. And yet that’s still not what’s most depressing here. What’s most depressing is to think that in the coming years, this girl may effectively have no choice at all.

NARAL’s Nancy Keenan likes to say that abortion’s biggest defenders right now are a “menopausal militia”—a rueful, inspired little joke. These baby-boomers, whose young adulthoods were defined by the fight over the right to choose, will soon be numerically overtaken by a generation of twentysomethings who is more pro-life than any but our senior citizens. As GOP strategists Christopher Blunt and Fred Steeper have pointed out, this group came of age during the partial-birth debate and was the first to grow up with pictures of sonograms on their refrigerators. The major development in reproductive technology during their lifetimes wasn’t something that prevented pregnancies but something that created them: IVF. These kids have no idea—none—what it was like to live in a world without abortion rights. (“This generation’s knowledge of Roe is like, ‘Roe vs. what?’ ” says Keenan.) And they feel much more strongly about personal responsibility than the generations preceding them: Didn’t use birth control? The burden’s on you.

Given this demographic shift, plus the Stupak Amendment, plus the unavoidable fact that abortion’s essential nature is unchanging—it will always involve some brutal nexus of the heart and the mind—it’s hard for a pro-choice person like myself to see how the ball rolls forward. Perhaps Obama will help. This is, after all, a president who went to Notre Dame, a school with a 167-year history of Roman Catholic orthodoxy, and dared to give a speech about abortion. But what he said was hardly his usual optimistic, paradigm-shifting oratory. All it was was a sober recitation of the problem, one that all-too-painfully explained why public opinion on the subject hasn’t budged in 36 years. “I do not suggest that the debate surrounding abortion can or should go away,” he told his audience. “No matter how much we may want to fudge it—indeed, while we know that the views of most Americans on the subject are complex and even contradictory—the fact is that at some level, the views of the two camps are irreconcilable.”

The Abortion Distortion