Clinic Owners Face Down Danger to Make Reproductive Freedom A Reality

Abortion is one of the safest medical procedures in the country; ironically, those professionals and staff who make sure that abortion is safe may find their own safety compromised.

Since it began tracking anti-abortion violence in 1977, the National Abortion Federation has tabulated more than 156, 961 incidents of violence and disruption at clinics.

Who are the people who keep open the doors of these facilities and welcome patients, despite the difficulties? These two profiles portray different generations and experiences: one of an abortion provider who began her career the day after Roe v. Wade was decided in 1973, and the other of a woman who was only five at that time, but has now taken up the mantle of providing services to women.

– The Editors

Susan Hill – 37 Years of Courage by Mary Lou Greenberg

Susan Hill insists she’s not brave. Yet she’s voluntarily lived in a war zone most of her life and refuses to retreat.

As founder, president and CEO of the National Women’s Health Organization (NWHO), a network of abortion clinics in the midwest and south, she has gone through 16 arsons and fire bombings and been vandalized hundreds of times. She and her staff have been picketed, protested, stalked, and assaulted – verbally and physically – too many times to count. One of her doctors, David Gunn, was murdered by an anti-abortion protestor on March 10, 1993, the first of eight abortion doctors and staff to be assassinated in this war.

Despite all this and more, Hill says, “I have never doubted for one minute that I am doing the right thing.”

It seems a far cry from Hill’s upbringing. She was the daughter of a Hall of Fame football player and went to a Southern Baptist women’s college. She got married at 21 to a professional baseball player.

The south was “not a hotbed of women’s issues,” she says. As a social worker, though, she had what she describes as a wake-up call. She saw women with serious injuries who ended up in the hospital after illegal abortions. It was, she says, an indication that “things weren’t what they should be.”

Hill remembers vividly the day that a doctor friend called her up and asked if she had the radio on. Newscasters were announcing the Roe v. Wade decision. The doctor said that he wanted to open what would be the first abortion clinic in Florida and asked if she wanted to work for him. She said she’d have to talk to her husband, and when she raised it that evening, he encouraged her.

Two weeks later the clinic opened. “We hadn’t even advertised,” she says. But word of mouth brought women to Orlando from all over the Southeast.

The first woman she assisted was a young teenager with cerebral palsy who had been raped by her uncle. “That was 37 years ago,” Hill says, “and I will never forget her face. Over the years I have carried her face with me and haven’t needed anything else to be strong.”

Two years later Hill decided to establish clinics of her own in small cities in the south where women didn’t have easy access to abortion. From this, the National Women’s Health Organization grew to a network that numbered 11 clinics at one time, and today is made up of four — in Jackson, Mississippi; Fort Wayne, Indiana; Columbus, Georgia; and Raleigh, North Carolina.

“I wanted to go to places no one else wanted to go,” she says. Restrictions passed over the years have made it increasingly hard for patients to access these services.

When women drive hours to get to one of her clinics; when they persist in fighting through obstacles like waiting periods, parental consent and other restrictive laws; when they walk to the door after being accosted by vicious protestors – well, “that’s bravery,” Hill says. “The women teach us every day.”

For herself and the clinic staff, it’s more dangerous now to provide abortion, Hill says. But they understand the need.

“Staff don’t have to stay here, but they do, despite the threats and hardship,” says Hill. She recalls doing interviews for employees for a new clinic in Jackson, where services were needed desperately, on a day of horrific violence at clinics in Boston in December 1994. An armed gunman burst into two different clinics and killed two young women staff members, Leanne Nichols and Shannon Lowney. Hill told the women being interviewed about the killings, and later wondered if any of those she’d hired would show up for work the next week. Most did – and one-half of all those hired that day are still with the Jackson clinic, Hill says.

These women, Hill says, know about the struggles of women. “They’d grown up on the Mississippi Delta and knew about life,” she says. They know, she says, the importance of giving women this choice.

One of the worst things to happen over the years, says Hill, was passage of the Hyde Amendment in 1976, cutting off federal Medicaid funds for abortion. Today, she still sees the effects of the Hyde Amendment. Women without funds are forced to have abortions later in pregnancy because they delay until they can raise the money.

Hill recalls that she spoke to Dr. George Tiller just two weeks before he was gunned down and killed in the vestibule of his church in Wichita, Kansas on May 31, 2009. Hill referred patients to Dr. Tiller, as many providers did, because Dr. Tiller specialized in especially difficult cases of women in the second and third trimesters whose lives or health were at risk in the pregnancy.

She asked him on that occasion why he, one of the most targeted providers in the country, continued. “Who would take care of the women?” he asked, by way of answering.

As for Hill, she answers the same question by quoting the words of a patient in North Dakota. The woman filled out a comment form after her abortion. It said simply: I left with dignity I didn’t have when I came in. “That’s why I do this,” Hill says.

“Women have got to have the right to make this decision,” Hill adds. “They [the anti-abortion forces] have done these things to frighten us, to make us stop, but they won’t succeed,” she says.

Editor’s Note: Sadly, Susan Hill died of breast cancer on January 30, 2010, little more than a week after she was interviewed for this article.

Mary Lou Greenberg is an activist in New York City who writes for Revolution Newspaper.

Amy Hagstrom Miller: Picking Up The Reins by Eleanor J. Bader

According to the New York-based Guttmacher Institute, between 1982 and 2008 the number of abortion providers in the U.S. fell by 37 percent, forcing people in 87 percent of the country to travel a significant distance-–in many cases between 50 and 100 miles—to end unwanted pregnancies. Worse, 57 percent of doctors who perform abortions are presently over the age of 50.

At the same time, there are pockets of good news: Medical Students for Choice, a group formed to train the next generation of caregivers, has evolved into a network of more than 10,000 physicians dedicated to teaching North American interns and residents about the latest abortion techniques and contraceptive options. In addition, during the last decade numerous feminist entrepreneurs have stepped up, opening new clinics or purchasing established ones to ensure continuity of care to the adolescents and adult women who rely on their services.

Forty-two year old Amy Hagstrom Miller, owner of five Whole Woman’s Health centers in Texas and Maryland, is one of them. The mother of two began her career in the abortion field in 1989, an idealistic 21-year-old eager to test her progressive, woman-centered philosophy in the real world. Her job was to answer phones at a Twin Cities Planned Parenthood and she recalls frequent blockades and protests by Operation Rescue in the years before passage of the Freedom of Access to Clinic Entrances Act (FACE). Despite the mayhem, Hagstrom Miller found the work fulfilling. “I was especially interested in the identity questions (that) women examine when they have an unplanned pregnancy,” she says. “It’s the big stuff, — religion, family, life and death — and the decision about what to do forces the woman to think about what she wants from her life. I wanted to help these women with their ethical conundrums and use the conversations to help decrease the stigma about abortion.”

Listening to patients and helping them deconstruct the guilt and shame that too often accompanies them into the clinic form the core of Hagstrom Miller”s beliefs about patient-centered care. While life has moved her from Minnesota to Austin, Texas, her commitment is as ironclad today as it was two decades ago. “Each day I have a palpable sense of doing something that matters,” she says.
Each day I have a palpable sense of doing something that matters

Hagstrom Miller never planned to become a business owner. Then, in late 2000, she got a phone call from a clinic in Austin asking her to lend her administrative skills to a facility there. She accepted. “After working in the facility for 18 months, the physician who owned it said he wanted to retire and I was able to buy it from him,” she explains.

But it wasn’t easy. The purchase required Hagstrom Miller to beg and borrow, but in January 2003 the papers giving her ownership were signed. Five months later, in May 2003, she purchased a second Austin clinic and subsequently consolidated the two into one large reproductive health practice. After that, she purchased two health centers in Baltimore, and by 2009 also owned clinics in Beaumont, Fort Worth, and McAllen, Texas.

Now, 55 to 60 Whole Woman staff and approximately 12 physicians treat more than 10,000 women a year. About 30 percent of the patients are seen for non-pregnancy related concerns.

Her work, Hagstrom Miller says, is more mission than job. “At Whole Woman we don’t worship the doctor, we worship the patient. We greet each patient warmly and give her the sense that we’re specifically waiting for her. We also try to offer her the things she’ll need—a fleece blanket since recovery rooms are typically cold and a cup of herbal tea to reduce post-operative nausea—before she has to ask for them.”

The Whole Woman website further explains the centers’ ethos: “It is our philosophy that each woman must be at the center of her own healthcare decisions, and that treating each woman holistically—honoring her head and her heart as well as her body—will better serve women and improve women’s health and happiness in our communities.”

That said, it’s often challenging to run a chain of clinics. Disruptions are constant, whether unscheduled inspections or dealing with state bureaucracies. She nearly went bankrupt in Maryland, she says, while waiting more than nine months for the state, which allows Medicaid payments for abortion, to actually reimburse the clinic. Equally frustrating, the center in Beaumont had to argue with an inspector who alleged that the facility had no right to dispense the morning-after pill because it is not a pharmacy. “She didn’t have a leg to stand on, but fighting with her over this issue took a lot of my time and was exhausting,” says Hagstrom Miller.

And then there are the protesters. While the Whole Woman owner says that she tries to pay them little mind, she and her doctors have been followed and their home addresses have been published, making the threats hard to dismiss. Still, she doesn’t feel like she’s at war. “The first generation of clinic owners saw themselves as outside the medical mainstream. For me, and for Whole Woman, abortion is just one part of women’s reproductive lives. I’m not on the frontlines. I simply want to see abortion normalized as a routine part of women’s lives.”

Eleanor J. Bader is a freelance writer, teacher, and activist. She writes for The Brooklyn Rail, The L Magazine, RHRealitycheck.org, and other progressive and feminist publications.