Book Club: Living in the Crosshairs

CrosshairsLiving in the Crosshairs is an important and terrifying book that was published last year by Oxford University Press. Its authors are David S. Cohen, a law professor at Drexel University who also sits on the boards of the Women’s Law Project and the Abortion Care Network, and Krysten Connon, who graduated from Drexel Law School in 2012, and is now an attorney in Philadelphia. In it, they look at targeted harassment of abortion providers. This is different from the protests we may think of outside abortion clinics, which are aimed at the clinic, or the women seeking abortions, or the issue in general. Targeted threats and attacks are aimed at individuals who work in the clinics. They are personal.

The title comes from a story of one provider’s dealings with the legal authorities. He describes one protest at the clinic where he works, where:

… a new sign displayed Paul’s picture in crosshairs. “I was just shocked that that was legal. I just can’t see how that’s fair.” Paul contacted the FBI about the targeted protest, particularly in light of the sign with the crosshairs. “They said it’s perfectly legal. The protesters could do that, and they could do worse.”

This incident shows the way abortion providers are targeted, literally and figuratively, by anti-abortion activists, and is a representative example of the stories told by the people interviewed for this report. In all, 87 providers were contacted, and 82 of them agreed to be interviewed at length. The authors included doctors, administrators, and other medical and non-medical staff who work where abortions are performed. Non-medical staff are also targets; as the authors point out, of eight providers murdered by anti-abortion killers, four were doctors; the others included two receptionists, a security guard, and a volunteer escort. And more recently, we’ve seen in Colorado Springs that people unrelated to a clinic can also be killed in anti-abortion violence. The danger is great; almost all of those interviewed chose to use false names, and to have details that could identify them changed as well.

The murders are the most serious kind of anti-abortion violence, but far from the only one.

According to the most recent statistics available from the National Abortion Federation, from 2010 to 2013 there were 9 attempted or successful bombings and arsons; 66 acts of vandalism; 425 incidents of trespassing; 8 clinic invasions; 2 anthrax/bioterrorism threats; 14 incidents of assault and battery; 12 death threats; 18 bomb threats; 26 acts of burglary; and 34 incidents of stalking.

The authors make a strong case for calling threats and violence aimed at abortion providers domestic terrorism, a term that is, of course, a political hot potato. In 2009, when the Department of Homeland Security included “anti-abortion extremism” in two draft reports on domestic terrorism, they received protests from members of Congress concerned that right-wing groups were singled out, and from members of anti-abortion groups who were afraid their freedom of speech would be curtailed. As a result, DHS removed these phrases from the finished reports that came out in May, not long before Dr. George Tiller was murdered.

Terrorism can be defined as action taken to provoke fear in order to make political change. Yet of the 82 interviewees in this book, only one left the field permanently and one left for a year and then returned. But the atmosphere of terror is taking its toll: Fewer people now perform abortions, and some medical schools and even ob/gyn residency programs no longer teach how to do them.

Medical facilities providing abortion services have decreased by almost 40% since 1982, 89% of counties in the United States have no abortion provider, and only 14% of obstetrician-gynecologists perform the procedure.

The Atlantic had an article on this serious problem earlier this year. As it is, there are only four doctors in the country who can perform abortions after 24 weeks, a procedure that can be necessary to save a woman’s life. The right to abortion is not guaranteed, and access is becoming more and more difficult.

One provider, who ran a residency program housed in both a public and a Catholic hospital, faced political opposition from the county supervisors who were overseeing the program at the time. When they removed the abortion clinic used as an outside placement for residents’ training from the list of approved placements, he notified the state accreditation agency since the program would no longer conform to their requirements. This began a series of investigations and attempts to have him fired or to lose his hospital privileges, initiated by the board of supervisors. Anti-abortion groups, he learned, were involved in hiring his replacement when he eventually left his job. He sued, and received a settlement.

Using investigations and legal proceedings to harass providers is just one tactic used by anti-abortion groups. While I read, I was amazed by the amount of time abortion opponents gave to the fight. They find out as much as they can about providers once they are identified. They protest at providers’ homes, at other places they work, at their children’s schools, and at their parents’ jobs or residences — even if in a different state. One provider was physically assaulted at the Supreme Court itself. One protester went to the priest at a provider’s church to tell him what her job was; the priest told her he would see that she was denied communion as long as continued working as a provider. These abortion opponents spend a great deal of time doing research — especially in the days before the Internet — or they spend money having others do the research for them. And there’s a lot of money behind the anti-abortion forces.

Abortion providers’ lives are profoundly affected by being targeted. Some go to work in disguise, some wear bulletproof vests or even carry guns. Many take extra precautions, from choosing where to live, to driving different routes to and from work every day, or using different cars, or having someone else drive them, all in the best tradition of John le Carré. Some suffer symptoms of post-traumatic stress. They become well acquainted with local police and prosecutors, preferably before trouble begins. Police departments vary in their responsiveness — in one instance, an officer laughed at a provider who was being followed and asked what she expected, given what she did — while others are helpful and rigorous.

Yet providers find support when they least expect it. When some have been picketed at home, and their neighbors were sent leaflets telling them their neighbor is a murderer, their neighbors have rallied to support the provider, even in conservative neighborhoods. When a protester followed one provider into her mother’s nursing home, a nurse quickly intervened, then came back and talked to her mother:

As soon as things began to calm down a little bit, the nurse said to my mother, “I want you to know that your daughter saved my life. And I am so glad that I was able to do something to help you.” Then the nurse looked at me, and she said, “I know you probably don’t recognize me, but I’ll never forget you helped me.” She said, “I came for an abortion, and I was really conflicted.”

When she recited that back to my mother, she said, “When she advised me to do what was best for me and hugged me, I knew that this is where I wanted to be.”

That provider didn’t even remember what decision the nurse had made, and the nurse didn’t say. The whole point was that her needs were dealt with respectfully and unconditionally.

The authors have organized the book to progress from stories of harassment, with analysis of the tactics used; to the providers’ reactions and ways of protecting themselves; to interactions with law enforcement and the legal system; to proposed remedies to the weaknesses in current laws; and it ends with stories of why providers keep doing their jobs.

Providers continue the work for different reasons, but usually because of the patients. Some remember working before Roe v. Wade, when women often died or suffered serious harm from illegal abortions. One remembered her own illegal abortion, from which she almost died. Some are dedicated politically to the need for safe places for abortions to be done, while for others, it is more personal. But all share a common dedication to the work.

This is not an easy book to read; I could manage only a few stories at a sitting. For most of us, as the authors point out, all of this information is new. Unless you are a provider or close to a provider, there would be no reason for you to know. But the book makes a strong case that more people must know about the reality faced by those who provide a common and legal health service, so that we can see how necessary it is to make changes to our laws and their enforcement. I would strongly recommend this book to anyone with an interest in women’s health and well-being.