This woman has run an abortion clinic in the Deep South for more than two decades. FRONTLINE agreed, because of security concerns and as a condition of filming, not to identify her or the state in which her clinic is located. In this interview, she expresses her weariness after years of struggling to keep her clinic open and her feeling that abortion clinics in the South are being "triaged" and that not enough people are fighting to help poor women access abortion. She also talks about the effects of state-mandated clinic regulations. "They're not about providing safe abortion care," she says. "That's not what these regs are about. They're about restricting access or closing down clinics." And she is critical of what she sees as a "disconnect between the pre-born and the post-born" in the pro-life movement. "It seems that so many of these groups, so many of the hardliners, when they say, 'I'm pro-life,' they mean, 'I support the pregnancy in utero,' in the uterus. But I see so little sustenance and support for women and children, particularly poor women and children. Those are the ones that are castigated and blamed." This is the edited transcript of an interview conducted on July 20, 2005.
[Talk about the effects of Roe v. Wade.]
Well, most of us realize that Roe v. Wade happened in 1973. And I think there were basically perhaps two states, California and New York, that provided abortion care almost immediately or even just before Roe. Then the rest of the country worked really hard to make abortion care available to women, because I think many of the folks at that time that worked so hard to have Roe become a reality saw the consequences of illegal abortion for women and realized that it was a relatively simple, easy procedure. And so abortion clinics started opening up across the country. What this did was, it segregated abortion care from mainstream medical care. And that was good, and that was bad.
There were some very positive things that occurred. Free-standing abortion clinics were the first outpatient surgical treatment centers, and then they became the model for all others to follow. … Also economically, abortion clinics had done a remarkable job of maintaining the price of health care while providing quality service.
So in many ways, abortion clinics have been wonderful models of the provision of health care with very limited resources. The problem is that we broke from the whole health care society, the health care system, and it's created all sorts of difficulties and problems. For example, one of the issues is that if women need hospital-based care, they have an increasingly difficult time of getting hospital-based abortion care. And so women's health suffers. …
Describe for me the early days of providing abortion care. …
I think that very probably in the mid- to later '70s that there was this sense of idealism -- that we were saving women's lives; that we were giving women choice; that women were having the opportunity to make decisions about when they could have a child and raise a child. They were making decisions about their life.
And all of that I think was very empowering, and to some extent still is. But the landscape has changed dramatically over those years, and I do think that young people take the concept of abortion being available for granted and have no sense of what the possibilities may be for women, for families and for basically health and welfare for all of us.
[What does it mean that abortion clinics are not incorporated into hospitals?]
There's no doubt that as abortion providers, particularly in the Deep South, we feel very, very isolated. We should have access to all of the finest medical facilities. The whole [state] charity hospital system should be assisting us in the provision of quality abortion care.
But that hasn't happened. That's not going to happen. Right now that's illegal, and so we end up being very isolated and dealing with very sick women, women who desperately need abortion care and have no place else to turn. …
Tell me when you came here and why you came. What brought you here?
I was in Florida, and I was working for the Youth Employment and Training Program as a manpower counselor, and the women we saw were between the ages of 16 and 21. We had two years to get them off of public assistance into a work program. Most of these women already had at least one child, if not two. And one of the things that I saw happen, if they became pregnant again, is that it shattered all of their goals for self-sufficiency for them and for their family.
And so I definitely saw the impact of unintended pregnancies on women and their families. And at the time, I was doing volunteer pregnancy testing for a clinic, and the woman there knew that there were no services in this Deep South part of the country, and so she asked me if I wanted to come and open a clinic, an abortion clinic. And I looked at the demographics. And I saw the women, and I knew what was going on. So I decided to come and to open a clinic.
Tell me about that decision and how it impacted you. Why is that hard to talk about?
This is all about the women. And the women I knew, looking at the demographics, I knew that women of privilege could go to all sorts of big cities like Dallas or Atlanta or even New York City [and] receive safe abortion care. I knew that there was this whole group of women that were stuck and poor and had no access to abortion care.
We heard stories of what was going on in this part of the country. Historically, you will find information about a woman called the Red Rubber Catheter Lady. She would travel at least 200 miles coming out of Arkansas, … and for $200, she would insert a catheter in a woman's uterus, a pregnant woman's uterus, and leave her. And the reason that you could find the documentation for this is that these women would end up in emergency rooms bleeding and septic, with a red rubber catheter still hanging out of their uterus.
So I made the decision. I thought seriously about it. And it is true -- I prayed about it, and I said: "If I'm intended to go and to do this, show me. Please just show me that I'm supposed to do this." And I went into the bathroom, and on the stall was, "If men got pregnant, abortion would be a sacrament." And for me, that was the decision to go, to come. …
When we first opened, the first day we opened, we had six patients and over 1,000 protesters. And it was daunting, to say the least. I was young; I had just turned 30, and I certainly believed that women had the right, but I had no idea -- I guess I was naive -- had no idea it would draw such a firestorm. …
Do you remember any conversations you had with anybody at that time?
No, I don't remember. I can tell you the part of what I remember is that there was, along with 1,000 protesters, there was a mock funeral. There was a little casket, and there was actually, as I recall, a state senator railing. And a large part of the protesters were part of that as well.
[How long has the clinic been open?]
This is our silver jubilee, 25 years in June. Twenty-five years last month.
So looking back, … did you ever imagine you'd be doing it this long?
I expected that things would change and things would get better. I believed that as more women had abortions and as suddenly it becomes everybody's sister, mother or daughter, that it would change the sentiment of the country.
And to some extent, I think that's happened. But I think what's happened now is this horrible veil of hypocrisy that's occurred that's made it just incredibly difficult, because we still know that people with means and privilege can receive abortion care, but really, still poor women cannot. …
Talk to me about the women who don't make it to your clinic. …
What I say about women who can't make their way to find safe abortion care is that generally, they fly under all the radar. They're voiceless and faceless women. They're not the folks that are being lobbied for, and it's very hard to track them or understand what's happening to them.
I think that the only real way to see that are as a result of the consequences of lack of care. And you have to look at the human indicators, which are things like infant mortality and teen pregnancy, the dropout rates. There's just a whole list of things that go on where you can see that women being denied access are affected across the board in terms of basic health and welfare for their family and themselves. …
Already, if you look at the demographics in terms of infant mortality, … we're seeing the consequences of [high infant mortality rates].
… What I would really like folks to start talking about is women and children and taking care of them.
And let's look at the consequences of lack of access to reproductive health care from sex education, sexuality education to contraception to abortion and the impact that it has on society. These are the same legislators that are saying that if you have more than four children, then you no longer will be covered by welfare.
So what is a woman supposed to do? Really, I don't know. This is getting back to the issue [of] how did this all happen? Why is this all so controversial?
I think part of it is there is this issue of whether … women are allowed to be sexually active or not, and I don't know that we've ever settled that in our society, and I'm not sure why. Theologians perhaps could speak to that whole issue, but that's incredibly difficult.
And it affects the health of women and children. I think that we've decided that it's all right for men to be sexually active, at least now, with all of the commercials for Viagra and the rest. We know that having an erection for four hours requires medical attention. I mean, everybody knows that in their home. Our children hear that every day now, practically. But do we ever talk about contraception for women on TV? I mean, a little bit. …
The money that was invested [in Viagra] was amazing. Could we even take a little bit of that money and try to help poor women and their babies? Wouldn't that be nice? I mean, what are the consequences of this? When you really look at it like that, for me, it makes no sense. I don't understand. I really don't. …
Basically, part of what I'm saying is there still appears to be a double standard. I don't know if that's the case, but it certainly appears that way to me. And it seems that in the 21st century now, at least we should realize the consequences in terms of the suffering and health and welfare issues that continue to generate this by this hypocritical stand.
[So what are women's choices?]
We end up in a society that at this point in time doesn't feel that complete sexual education is a good thing, and so young women and men are not necessarily taught completely about their bodies in school. And we've tried many times in [our state] and in other states to implement sex education in the public school systems.
But the response has been in teaching sex education, you're teaching kids how to do it, how to have sex, and so consequently it's promoting promiscuity. So we've erred on the side of abstinence, which has increased pregnancy rates. And so we're not teaching kids how to protect their body, how to take care of their body, how their body works.
And then we have issues of contraception availability for poor women. It's a struggle and a nightmare. Everybody thinks there are so many choices for women, and yet still only one choice for a man, for men: the condom. That's it. But women have more choices. But still, they're difficult to access and not 100 percent.
So we end up with women having no education, no contraception. And what are they supposed to do? Abstinence seems to be the answer. But then that makes no sense at all to me, because like I said previously, men are sexually active. Who are they sexually active with? So again, it's an incredible double standard. And women and children are suffering.
[What is it like being an abortion provider in the South?]
But also, there's another really big issue that's going on right now that is very uncomfortable. I think that we're being triaged. I think that basically the folks that are supportive of abortion rights are saying: "We can't save everybody, so let's just let Mississippi … go. We're not going to be able to save those women, and let's concentrate on who we can save." And that's frightening. Certainly it's frightening because we're here. We're being triaged, cast out, if you will.
But yet again, these women, the neediest of the needy, are being deserted. And when we have the most major spokespeople in the country backing away from the abortion issue, then there's no one left. Who's speaking for these women now? Where are the policy-makers? Where are the brave women senators that will step out and protect and help these women? They're not on their horizon any longer.
[What are the pro-choice activist groups doing?]
Well, I do think that everyone -- all of the women's groups, all of the abortion rights groups -- have been tattered and torn over the six years under the Bush administration. And I do think that there has been the triage there, that the decision was made that we don't have the resources to cover every single state. … There's not a NARAL [Pro-Choice America] affiliate in Mississippi. I don't know that there ever has been. NOW has a minor presence here.
But I still think that when you get in Washington or New York, which is where most of these groups are, the air becomes rarefied. And sometimes those groups, they lose touch with really what's happening. And I think that part of that has happened.
I think now everybody's working on the spin and the best way to say things and correctness. And I think that now we're no longer proactive; we're reactive. We're reacting to what's happened. And so I think people are, for a variety of reasons -- partially because of resources, partially because of politics -- I think people are making choices to go places where it's safe and they think they can win. And that's not in Mississippi. …
[Do you see pregnant women from Mississippi coming to your clinic?]
… We're seeing increasing numbers of Mississippi women traveling to us. … We have a state law that women have to come in 24 hours in advance and sit in person and receive the state-mandated information. So this requires that women come into [the clinic] at least twice, and they are traveling long, long distances.
I think what happened, particularly with this 24-hour law, is that everyone thought, what's wrong with giving women some information and letting them think about it? And that seems perfectly OK until you start looking at issues of distance and yet again poverty and realizing that often the things that stop women are transportation. That's a huge issue for women.
And so the long distances without public transportation are incredibly difficult for rural and poor women. And then you have issues, those day-to-day, mundane, nasty issues, which are child care, trying to get child care for two days, trying to get a day off from work, and on and on. So there are incredible roadblocks for women now.
It's funny, because a lot of people think that it's just so sad, so tragic when women have an abortion. But you know what is even more tragic is when women can't access an abortion. The women that we see here that really suffer in this clinic are the women who are too far for us and that have no recourse. That's the really sad case.
When women come who are too far along for an abortion, what's the reason that they're coming in so late?
… The reason that women delay seeking abortion care is many-faceted. Sometimes it's that they don't have access to transportation. At this point in time it's helping the poorer women pay for abortion care, and so it's incredibly difficult for a woman to come up with the money. One of the worst cases is if a woman cannot afford abortion care, then she has to have a baby. I mean, there are good reasons to be a mom, but because you can't afford abortion is not one of them.
But there are many reasons women delay. Sometimes they have regular periods and continue on having regular periods in the pregnancy. Often I think denial plays a big part of it. Women keep on thinking and praying about getting their period, and it doesn't happen. Younger women have to tell their parents about it, and it's incredibly difficult for them to get up the nerve to do that. We know that the 24-hour laws are delaying women seeking abortion care. Women are having terminations later because of these state-mandated 24-hour laws. …
Let's talk about clinic regulations. … The state is saying that they're doing this to provide better abortion care for women. … Talk about that a little bit.
But there's more just before that, too, because over the years in [our state], the legislature has tried to outlaw abortion completely, and the legislature was priding itself on attempting to send up the case that would challenge and overturn Roe.
And for years we were in those battles. And often the courts would turn them back. But there was this incredible drive to overturn Roe directly. And even in [our state], we had fights going on between hard-core fundamentalists that didn't want any exceptions, including rape and incest, to abortion and then others that were trying to be more helpful in terms of getting a passage of a law that would outlaw all abortion and would include exceptions.
So there was this tremendous battle, tremendous energy. Somewhere along the way those folks that are opposed to abortion, the provision of abortion care, realized that they didn't have to outlaw it to make it unavailable. All they had to do was start regulating it to the extent that ultimately restricted women's access.
And so this whole movement has occurred where it's almost a death by a thousand cuts. Each little law that's passed, each little regulation that passed on the surface may not seem like that much. And, you know, even with the 24-hour law, it looks good. What's wrong with giving women information and letting them take 24 hours to think about it, until you realize all of the devastation that can cause? And few folks follow that to the natural conclusion.
So that was one example. The other is having the states now start regulating and licensing abortion clinics. Up until two years ago, we were not regulated by the state in the sense that they gave us an abortion clinic license. And now they do that. That whole process has been a tremendous battle and has required lots of lawyers. It first started out with a huge pile of regulations that, basically, was akin to the ambulatory surgical treatment centers, and so much of it was not even applicable to us. …
A first-trimester abortion doesn't need an ambulatory surgical treatment center. But the irony for me is that if [my state] was really interested in ensuring safe abortion care, they would open up their hospitals and at least provide abortion and care for women whose health is being threatened by the pregnancy. We've had many cases of very high-risk women that are on Medicaid [for whom] abortion care should be provided by the state, and the state refuses to do it. They could open up their health units to do at least pregnancy testing and even the first state-mandated 24-hour information so that women wouldn't have to travel such long distances twice, and they'd be getting the accurate information that the state requires. But the state's done none of that. …
They're not about providing safe abortion care. That's not what these regs are about. They're about restricting access or closing down clinics. And there are an awful lot of policy-makers that will come right out and tell you that. …
Two-thirds of the country supports Roe v. Wade, yet all of this is happening without any public outcry. Why?
I think part of the problem with public perception, what's happening right now, is that people really are uninformed and unaware. And then on top of that, it's incredibly hard to put yourself in a poor woman's shoes and to realize what she has to face every day. Most people don't give that much thought. …
In [my state], when they passed the 24-hour law, the state believed that women were not being told what they were doing and they were not being shown all the information. The state believed that if women just saw the pregnancy, the fetus developing, that it would stop all abortions. And it didn't.
Women do know what they're doing, and women are intelligent, independent, moral agents capable of making these decisions. They must have the right to decide when to have a baby and when to become a mother. They must. …
… At the current time, we are a licensed abortion clinic. This is the second year that we've been licensed. Initially, the regs were incredibly difficult and impossible, and [we've been] working with our lawyers and working with the state, I think, for a process of about five years; I'm not sure. We managed to move more towards something that had some significance and was meaningful -- I'm not sure how much significance and meaning.
But one of the issues that occurred was the state wanted us to keep the medical records on the premises for at least five years, and for us that's impossible. And what we were using at the time was a business that does hospital records, keeps all the hospital records for everyone, and we've never had a problem with retrieving a record. So it seemed to make perfect sense to keep us lean and using the charts that we needed to follow up women in abortion care. Really for us, within three months after the procedure, the record can go to storage. We're sure that … in that length of time, everything should be fine, or we should know about it at that point in time. So there's absolutely no way we could keep five years' worth of records in this clinic.
But we ended up compromising and coming up with one year. But in doing that, that even was difficult for us. We had to install a whole new filling system, and although it wasn't huge, it was to the cost of $8,000. And in some ways I think it actually hinders us and makes it more difficult, because now we have this body of files that aren't necessary. …
What has the state come in to inspect you for?
… First of all, there were four different inspections which occurred. And one was public health; one was the fire marshal and the state themselves; and I think there's one other that I'm forgetting. But basically, they were coming in to inspect the bathrooms. They decided that we needed drains in the bathrooms, so we installed drains.
They were looking at how we handled our trash, where we were throwing our trash and making sure that we were following biohazard requirements. And they'd come in, and they'd look at our records. They'd make sure that we're storing them on site for at least one year. And you pull records.
One of the issues that we fought over is they wanted to come in and inspect us with no notice. And the problem with that, of course, is that when we're seeing women, it's not acceptable to have a public health official come in and be with women while they're receiving abortion care.
So that was one of the things that we've fought, and now it's been agreed that they have to give us some notice. …
They did come in and measure hallways. They also have the recliners-in-recovery requirement, which says there has to be 2.5 feet on three sides of the recliner, whereas before we had a little table with tea and cookies for the women. And so one of the contentions [was] that we need to remove the tea and cookies from the women in order to assure that they have better abortion care, which made no sense at all.
But it's been ongoing. It continues. And all the regulators are a little bit different. The fire marshal folks don't want anything near the ceiling; the public health folks don't want anything on the floor. So there are all these issues. …
[How do you feel about the fact that they do this?]
Well, I just think it's ironic that the state … is trying to tell us about the safety of the provision of abortion care when they've done so few. We are the experts, and they could learn a great deal from us and integrate it into the public health system if they really cared about the safety and quality of abortion. …
One of the things that we're looking at is the lack of training for abortion providers. … From your perspective, what has it meant to you that there are so few doctors that you can call upon?
There are so many issues with access to care in the Deep South, but one that's I think probably universal throughout the country is that there is so little abortion training for doctors at this point in time in all of the medical schools. And again, if the interest of public health was safe abortion care, you would think that all of the medical schools in [my state] would be offering training in abortion care. And there is none. So abortion care training is not provided in this state. And I think now at this point historically, the numbers are down. And potentially that's the chill of politics, but I'm not really sure.
So how does it affect you personally? …
Finding doctors who are willing to risk everything. basically. at this point in time to provide abortion care is difficult. First of all, so few doctors are trained. It's not considered a part of standard medical care. …
The procedure itself, first-trimester abortion, is just simple. It is minor surgery. Regardless of what you think of abortion, regardless of the moral consequences, the one thing that is absolutely true is a first-trimester abortion is very safe and very easy to perform. So you have this paradox of the very simple procedure, this very safe procedure no one's being trained in, and such a level of harassment around doctors providing abortion care that it makes it really difficult to find physicians that are brave enough and willing to provide care.
… You've got to now have a doctor who does the state-mandated counseling. You have to have physicians to do this work for you. How does that affect you? …
The whole state 24-hour law -- the requirement is that they sit in person individually and talk with the doctor and receive state-mandated material -- that doctor has to be a [state] doctor, which is insane, because you would think that a Texas doctor is very capable of reading a state-mandated script and giving this information to women. You would think that the Mississippi doctor would be very capable of this. But according to state law, … it has to be a [state] doctor that's providing this state-mandated information. …
Many states are implementing this. They start with lesser examples. Generally, most states right now don't have you sitting down in person and talking to a doctor in person, and some states even allow you to call on the telephone and receive some information. But it's just going to get worse if we don't start really showing what these laws are about and what they're doing to people. I think states in the North will continue to work to regulate and restrict abortion care, and they'll use a women's right to know act as a way to begin that process. …
One of the ironies which has occurred with the Bush administration is the fact that now crisis pregnancy centers are very in vogue, or at least they're receiving a great deal of resources either through the federal government or through the state government. For example, in Mississippi, crisis pregnancy centers there are receiving funding for license plates that say, "Choose life."
When you buy a license plate, a specialty license plate, a large portion of that money goes to crisis pregnancy centers. It's my understanding, too, apparently, that there's a lot of money for ultrasound machines that are being provided for crisis pregnancy centers.
There are some real problems with crisis pregnancy centers. Having never been in one, OK, I can't be completely sure what's going on, but I do know that we've seen many women who have gone to crisis pregnancy centers coming in very fearful of an abortion and being given a great deal of misinformation and guilted and fearful as a result of going in and visiting a center. And that's not right. That's just not right. At the very least, women deserve the information.
And again, let the crisis pregnancy center start doing these state-mandated sessions. Let's let them get some doctors in there and do that for the state requirement and utilize the booklets that the state has provided. What's wrong with that? That would certainly be a way to help women.
Right now it seems that the crisis pregnancy centers want to help women have babies, but really offer no real alternatives for women to raise these babies and have no resources truly available to them for the long term.
And again, a woman with children already, some baby clothes and formula and even a stroller isn't going to help for that long. That's just not what's required to raise a child. The whole thing that is really problematic for me is the disconnect between the pre-born and the post-born. I just don't understand that. It seems that so many of these groups, so many of the hardliners, when they say, "I'm pro-life," they mean "I support the pregnancy in utero," in the uterus. But I see so little sustenance and support for women and children, particularly poor women and children. Those are the ones that are castigated and blamed.
They say they offer women the choice of adoption. …
One of the things that we do in training our counselors that work here is have adoption agencies particularly -- we utilize Volunteers of America. They come in and do in-services for us, talk with our staff about adoption and what's available to women, making sure that we have all the information that we need and because we want women to make a decision that's best for them.
And if a woman is ambivalent, often what we do is we ask her to take some time and give her information about adoption, including some phone numbers to call so that she can talk with folks about that alternative. And so the irony is that we do provide adoption referrals on a regular basis. But as best I know, no adoption services provide referrals to us when they see women who may actually indeed be seeking abortion care.
I don't think crisis pregnancy centers offer any abortion referrals at all. And so where's the choice there? …
[Your state prohibits anyone who receives state money from funding abortion or referring anyone for an abortion. Has the state legislated around poor women?]
In [my state], the state law says no public monies may be used for or to assist in the provision of abortion care, and that's been used as a gag rule. So the state does not refer for abortion services.
Through the health units, there are no referrals there. And the state also provides no monies for abortion services, although they will provide all resources for prenatal care. So what the state has done is basically subjected a class of women, poor women, to forced maternity on behalf of the state.
And they can do it because they can get away with it. These are voiceless and faceless women. They don't have representation in the legislature or really in Congress. No one's speaking on their behalf. And in that example, to some extent, it is like the pre-Roe days. …
It's almost as if abortion isn't legal in this country for poor women. …
Abortion is not a fundamental right for many, many women, particularly for poor women and rural women. There's no doubt about it that it is as though abortion is illegal.
Another part of it, though, that I think really ties into it is whether or not abortion is considered moral. And this is such an area of gray that people -- really good, intelligent people -- shy away from it, because they just don't want to deal with it. Personally, I believe that abortion is a very moral decision, and it requires strength and courage, and that women deserve the best possible care. If they don't get that care, if the state jeopardizes them receiving quality abortion care, then the state should be held accountable for the consequence.
Is that happening?
The state is not being held accountable at all. And so far, the actual consequences of restricting abortion care through regulations that seem benign hasn't come to the surface yet. Women are being hurt, women are suffering, families are suffering, and no one's speaking out. … Women are having babies and sometimes in horrible situations, sometimes very ill, children that are already ill. They have situations where they truly cannot support another child.
[Some people say Americans only pay attention to abortion when the issue comes before the Supreme Court.]
One of the most difficult things about providing care out in the hinterland is that it does seem that people are very unaware of what's going on and how women are suffering. I do think that with the Supreme Court issues at this point in time, the appointment of a new justice on the horizon, potentially it can change things dramatically if abortion is addressed in that arena. But there's so much at stake that the concept of triage, I think, comes into play.
And I don't know if it would be for the best if Roe was overturned in the sense of mobilizing people. I mean, I don't know if it actually would mobilize people to any great degree. I do know that for me, the problem is that if Roe was overturned, I know women would suffer.
If Roe was overturned, there would be no abortion services in this part of the country, and I don't know what poor women would -- well, I know what poor women would do if Roe was overturned. They would go back to aborting themselves, or they would go back to the Red Rubber Catheter Lady who inserts a catheter in a pregnant uterus and leaves the woman. And it's so senseless, because this is basic human health care.
Women are human beings, and they deserve basic human health care. Sometimes I do fantasize about Roe being overturned, because then I think that there would be this real threat, this real enemy. Many young women that take all these rights for granted would suddenly realize what they've lost and the consequences of that. And right now it seems like we're all asleep a little bit or trying to find common ground and not actually addressing the issues of women being hurt by regulation and then consequently restriction. …
With all this talk about Roe being overturned and all of that, I certainly have questions [as to] whether or not President Bush or the right really want Roe to be overturned, because I do think that there would be an outcry. And right now, as long as Bush continues to just barely regulate it, and everything flies below the radar, and still insidious and never encroaching, but never an all-out attack or criminalizing abortion, I think that most women and men are asleep. I don't think they realize what's going on. And in that respect, I think that the assault on abortion rights is very clever; it's very smart. And we are losing. …
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