Constant harassment and intimidation at abortion clinics continue to limit the ability of abortion providers to do their jobs and of women to obtain abortions in a safe and respectful space. Laws such as the Freedom of Access to Clinic Entrances Act (FACE) are meant to stop the often violent harassment that anti-abortion protesters use outside of abortion clinics. However, local and federal law enforcement can be lax in investigating threats: the report notes that the police often do not understand the provisions of FACE, or are unwilling to interfere with what they perceive as “the expected cost of providing abortion.”

Increasingly, anti-abortion groups are using litigation as a strategy to further harass abortion providers and burden law enforcement and the judicial system. For example, an anti-abortion group in Allentown, Pennsylvania sued the city after their protesters were arrested for “trespass, impeding access, racist and sexual taunting, and residential picketing” outside of a women’s clinic. The city eventually settled after a lengthy case, paying $10,000 to each of the 13 protestors. Experiences such as these have made law enforcement officials reluctant to interfere with protests outside clinics for fear of the legal repercussions. In this case, the Allentown City Solicitor told the clinic director that the city could no longer respond to any complaints at the clinic “unless there is a threat to life or person,” effectively admitting to the city’s almost complete inability to enforce the law with regards to abortion protestors.

As seen with Dr. Tiller’s murder, which occurred while he was attending church with his family, this type of violent persecution is not restricted to the healthcare facilities where abortions are performed. Many abortion providers must take certain precautions, such as holding unlisted phone numbers, listing property in a spouse’s name, and wearing bulletproof vests while traveling to and from work. Anti-abortion protestors also use the internet to further harass both providers and women seeking abortions – a group in Texas used car registry information to send out a mass email identifying by name women who entered a Planned Parenthood clinic.

The many dangers involved in providing abortions take their toll on doctors, staff, and the women themselves. Physicians in particular are driven away from performing abortions due to the significant financial expense required to secure their clinic and workers, the social stigma they and their families face, and the risk of physical harm. The number of abortion providers is shrinking, and is likely to only get worse in the future as abortion providers age and retire — the majority of current providers are over 50 years old. Few medical students are given the opportunity to observe or learn how to provide abortions, as most doctors today never saw an abortion performed during medical school, and half of OB-GYN training programs fail to provide routine instruction in abortions. This shortage means that despite the fact that one in three American women will have an abortion in her lifetime, nearly a quarter of women seeking abortions have to travel 50 miles or more to find a clinic.

Even more disturbing, it has become close to impossible to find doctors who will perform abortions after a woman is 24 weeks into pregnancy. Following Dr. Tiller’s murder, Warren Hern is one of only a few doctors to openly acknowledge that he provides late-term abortions. In a recent article, he describes the precautions, including bulletproof glass and protection from US marshals, that he and his staff members must take to protect themselves and the women they provide abortions for. Dr. Tern describes the anti-abortion movement as “a violent terrorist movement, [with] a fascist ideology,” that publicly deplores acts of violence while continuing to push for “cold-blooded, brutal political assassination[s]” such as that of Dr. Tiller.

Despite the danger, Dr. Hern continues to provide abortions at his clinic because he sees it as the most important work he can do in medicine. However, the unrelenting harassment of anti-abortion protestors threatens the reproductive rights of women seeking abortions and the safety of medical professionals that provide them. Violations of these rights by anti-abortion groups must be taken more seriously by law enforcement and local and federal government. Otherwise, acts of violence against abortion providers such as Dr. Tiller will only continue.

The ban, included in Nicaragua’s revised Penal Code, allows no exceptions, even in the case of maternal health, incest, or rape. Previously, therapeutic abortion (performed if the life or health of the woman is at risk because of the pregnancy) was legal but highly restricted – it was only permissible if three medical practitioners deemed it necessary and a family member agreed. Now, however, medical practitioners can even be arrested for treating a pregnant woman with a condition such as HIV/AIDS or cancer, because the treatment may cause injury or death to the fetus. Health care workers can also be prosecuted if a fetus is accidentally injured or harmed during birth. The threat of these harsh legal consequences may simply keep medical professionals from seeing pregnant women at all, to avoid prosecution in the event of unintentional fetal injury or death. Even women who have miscarriages fear being arrested, as it can be nearly impossible to determine whether an abortion was spontaneous (a miscarriage) or intentional.

Women and girls who are raped or victims of incest are also included under the abortion ban. Most reported rape cases in Nicaragua involve victims under the age of 18, and 87% of rape or incest victims who get pregnant are between 10 and 14 years old. In the report, a local NGO described supporting a nine-year-old victim of incest and rape through pregnancy, because no other legal options were available. Young women and girls who have not reached physical maturity have higher rates of pregnancy complications and are particularly endangered by this abortion ban.

The ban was enacted primarily due to pressure from the Catholic Church and other Christian groups; no health or human rights-based assessment of the law’s impact was carried out prior to its passage. Numerous Nicaraguan medical groups oppose the law, including the Nicaraguan Society of General Medical Practitioners, and the ban is in violation of the Nicaraguan Obstetric Rules and Protocols created by the Ministry of Health. Despite this, the National Assembly voted to revoke therapeutic abortion in October of 2006, seemingly “with full knowledge of the severe pain and suffering that necessarily follows from the denial of essential medical services to pregnant women and girls.”

The UN Committee Against Torture, the UN Committee on Economic, Social and Cultural Rights, the UN Human Rights Committee, and the Inter-American Convention on Human Rights (which Nicaragua is a party to) have all strongly objected to Nicaragua’s abortion ban. The Nicaraguan Constitution itself states that “every person enjoys state protection and recognition of the inherent rights of the human person, the unrestricted respect, promotion and protection of human rights…” However, in enacting an absolute ban on all abortions, the Nicaraguan government has seriously harmed efforts to improve the health of women and girls in the country and failed to meet its obligations to protect the human rights of all citizens.

The recent murder of Dr. George Tiller, a prominent Kansas abortion provider, is a tragedy whose consequences will reverberate far beyond the immediate devastation of his friends, family and patients. Dr. Tiller was a true hero, an activist who dedicated his life to women’s reproductive rights, and now the most recent in a line of martyrs murdered for ensuring the safety of women around the country.

Thirty-six years after abortion became legal, the United States faces a dearth of providers: only 12% of counties have doctors who provide this service, the vast majority of whom are in metropolitan areas. This unfortunate statistic is in part the result of the coordinated attacks on abortion providers that have persisted over the decades. Since 1977, there have been 8 murders and 17 attempted murders of physicians. There have been 41 reported bombings of clinics, hundreds of cases of arson and invasions, and thousands of reported cases of vandalism and trespassing. Every one of these acts serves to deter practitioners from providing abortions services, in effect hindering the possibility for Americans to access safe, legal procedures.

As doctors, women, and concerned members of our communities, we refuse to stand silent as our mentors are murdered. We write this letter in solidarity with Dr. Tiller and the many brave defenders of women’s rights who devote their careers to providing women with safe reproductive options. We implore the medical community to join us to demand that our communities stand up to the domestic terrorism that continues to attack our profession, and insist that these criminals and their handlers be brought to justice. Only in this way can we assure that Dr. Tiller’s legacy is preserved for women around the country.

AuTumn Davidson, MD
Kenneth Barron, MD
Gabrielle Burger, MD
Tiffany Forti, MD, MPH
Tara Kumaraswami, MD
Monica Lucero, MD, MPH
Jennifer Scanlon, MD

See also: Responses: The murder of Dr. Tiller

(originally posted June 2, 2009)

From Nancy Northrop, President of the Center for Reproductive Rights,

I am deeply saddened by the tragic news of Dr. Tiller’s murder. Dr. Tiller has long been a stalwart and fearless defender of women’s fundamental health and rights, providing abortions despite decades of relentless and vicious attacks on his clinic, family and private life. His death is a devastating loss to the reproductive rights movement and to women across this country. We send our condolences to his family and friends.

Others on the web react to the event:

NY Times: Abortion Doctor Shot to Death in Kansas Church

The American Prospect: Why Clinic Violence is Obama’s Problem

The Huffington Post: Rachel Maddow interviews Dr. Susan Wicklund, abortion provider and friend of Dr. Tiller

The Lede: Doctor Was Target of O’Reilly’s Rhetoric

Salon: Sure, killing a doctor’s wrong — but don’t overreact!

Protesters seek legalization of abortion in Brazil

It may be hard to imagine a 9-year-old, all of 79 pounds and four feet tall, 15 weeks pregnant with twins. Now compound that image with the girl’s story– sexually abused repeatedly, allegedly by her stepfather, since the age of 6. While the alleged rape should be enough to raise media attention, it is the tense controversy over reproductive rights in the predominantly Catholic country that is making headlines after the medical team who performed the legal abortion, as well as the girl’s mother, were summarily excommunicated by the Church.

Brazilian Minister of Health Jose Gomes Temporao declared, “It is legitimate for the church to have its dogmas, but theses dogmas must not be imposed on society as a whole.” Archbishop Jose Cardoso Sobrinho of the coastal city of Recife countered in a TIME interview, “They took the life of an innocent… Taking that life cannot be ignored.”

The case highlights both the great intersection between religion and health in Brazil and also the critical feature of abortion-access and abuse in the country. Unwanted pregnancy and clandestine abortions are, sadly, a constant in the nation, in which abortion is only permissible in the case of rape or endangerment to the life of the mother. In fact, a new report by Brazil’s IPAS, a non-governmental organization, indicates that each year more than 1 million women undergo illegal abortions in Brazil. Moreover, the head of the Latin America’s most prominent women’s health clinic, Pérola Byington Hospital in São Paolo, Dr. Jefferson Drezett, estimates that 1 in 3 pregnancies in the country is unwanted. In the Pérola Byington Hospital, which specializes in treating victims of sexual violence, 13 out of 47 abortions performed in the past year involved girls under the age of 18.

In a country where, according to IPAS, 250,000 women a year are treated by doctors for traumas due to botched abortions, it is alarming that the reproductive health of women is subject to religious scrutiny and criminalization. Until Brazil can separate religious doctrine from medical treatment, victimized women like the abused 9-year-old may still have to endure a situation in which dogma is placed above their reproductive rights.

Open your perspective:

New York Times: Abuse in Brazil