ST. LOUIS -- They still come, their faces set, and position themselves on the reception room couches to look at the wall and wait. They come with young men beside them, or sad bustling women who might be mothers or aunts, or they come by themselves and murmur their names to the receptionist and watch the door that opens when a patient is about to be admitted inside. On Saturday the picketers are on the sidewalk and call up to the clinic director by name, B.J., you have blood on your hands, but the cars pull around them and into the parking lot and the women still come. When she wakes in the morning, B.J. Isaacson-Jones considers sometimes the things she heard the weekend before, the particular cries of the people carrying picket signs, and then she attends to her own family and dresses for work.
She says nothing has changed. She says the numbers are undiminished. The measurable data at Reproductive Health Services show no drop, no dip beyond the momentary confusion a year ago this month when some women appeared to believe the United States Supreme Court had just permitted the state of Missouri to outlaw abortion. Last July 3 Isaacson-Jones stood in her office, the chairs pushed aside to make room for the television cameras and reporters who had crowded in to focus on her face as she learned the news of the verdict; a network crew had placed a television beside Isaacson-Jones's desk, and she obliged them with sober profile shots as the first reporters could be seen descending the Supreme Court steps with the printed ruling in their hands.
"The Webster decision," they called it, or Webster v. Reproductive Health Services, and when Isaacson-Jones had finished her statement to the press, she and some clinic workers went into another room and closed the door behind them and wept.
The news was not as bad as it might have been, for the director of an American abortion clinic, but it appeared to be very grim. The justices had upheld Roe v. Wade, but they had done so in language suggesting that states might now begin removing piece by piece the constitutional protections approved 16 years earlier by a majority of the court. "We were in a state of shock," says Isaacson-Jones. "We really were."
A narrow conference table runs nearly the full length of her office, and Isaacson-Jones has placed upon it her lunch, a salad she pushes at absently with her fork. She does not eat. She says again that nothing has changed. She says anger and resolve seem to hold her quite fiercely now, that she does not think she or the women she works with will ever be quite the same people they were before last July, but that the Missouri abortion law challenged by Reproductive Health Services and upheld by the U.S. Supreme Court has had no discernible effect on the women who come to what is still the state's busiest abortion clinic.
She says that since last July Reproductive Health Services has in fact opened an adoption agency as well, a separate facility off the same office building hallway, and that in late 1989, as every working state legislature in the country grappled with what had come to be known as "post-Webster legislation," the agency's director called Isaacson-Jones to tell her the first Adoption Associates baby was about to be handed in the office to new adoptive parents.
"I went in and I picked her up," Isaacson-Jones says, "and it was really rough. That's a baby. And she's soft, and she was going to be loved, and she smelled good -- "
Isaacson-Jones lifts from her desk a framed photograph of the baby, bundled in pink, resting against Isaacson-Jones's chest. "It took me several days to process the experience," she says. "I came back in here, and I had to sit down and wonder if what I had been doing with abortion was right."
Law of Confusion It was a messy law to begin with, a kind of statutory collection basket for any idea that might ultimately lead the Supreme Court to overturn Roe v. Wade. The law's principal authors, two Missouri lobbyists and a private attorney who had defended abortion clinic blockaders, had drafted their language while thinking about both the Missouri legislature and the new Supreme Court; in 1985, when the first versions of the Missouri House and Senate bills began to circulate, then-President Reagan had made it clear that as aging justices retired he intended to replace them with judges who shared his opposition to nationwide legal abortion.
The Missouri legislature, for its part, was so reliably antiabortion that the Planned Parenthood lobbyist in the state capital referred to her frail group of legislative supporters as the Kamikaze Squad. Wide majorities approved both the state House and Senate versions of the 1986 abortion bill, and nearly everybody who watched the votes understood that this was a law intended as much for Washington as for Missouri. Its opening language was deliberately provocative, the phrasing an echo of more than a decade of Right to Life missives: "The general assembly of this state finds that (1) The life of each human being begins at conception; (2) Unborn children have protectable interests in life, health, and well-being... ."
None of this language actually prohibited or curtailed anything, though. And the rest of the law contained restrictions of such variety and complexity that by the time the case reached the Supreme Court last year, the last stop in a three-year constitutional challenge by Reproductive Health Services and Planned Parenthood, the office of Missouri Attorney General William L. Webster had already backed off in appellate arguments on many of the original provisions. The original law required that all abortions beyond 15 weeks be performed in hospitals rather than clinics; the state gave up on that. The original law prohibited any public employee from "encouraging or counseling a woman to have an abortion not necessary to save her life"; state attorneys gave up on that too, and were explaining by last year that the law was meant only to prevent the funding of new programs planning such encouragement.
The law did require "viability testing" by the time the case reached the Supreme Court, and it did declare that no abortion could take place in a public hospital unless the pregnancy was physically endangering the mother's life. A majority of the justices upheld these provisions, and incorporated into their lengthy separate opinions were passages read in every state capital as an invitation for further restrictions. Send us your laws, the justices appeared to be saying, and we'll reconsider the concept of "abortion rights." And amid the nationwide turmoil that followed, from massive demonstrations to local elections suddenly polarized by the abortion question, a single elegant irony has hovered here in the state where the law was passed: It does almost nothing, this law, to the practice of abortion in Missouri.
The case has had its effect on Missouri legislators, who immediately began statehouse maneuverings over their own post-Webster bills. It has had its effect on activists, who declare from both sides of the abortion debate that their rosters have swelled to unprecedented numbers. It has set off a controversial statewide initiative campaign that is now in its frantic final week of signature-gathering; if enough voter names are collected by Thursday, a measure rescinding the new abortion law and prohibiting further state abortion restrictions will be placed on the November ballot, a prospect so loaded that abortion rights supporters themselves have been fighting bitterly and publicly about whether the petitions should be circulated at all.
Judith Widdicombe, the nurse and abortion rights organizer who founded Reproductive Health Services, is in the midst of that battle, fending off criticism from colleagues that her signature-gathering campaign is perilously ill-timed. Samuel Lee, the lobbyist who helped draft the Missouri law and urge it through the state legislature, has split with his own antiabortion allies over arguments about how tough new restrictive legislation ought to be. Andrew Puzder, the St. Louis attorney who wrote the "life of each human being begins at conception" passage, is experimenting with new legislative language -- he likes the idea of requiring judicial review, with consideration of both the woman's rights and the rights of what the law would call her unborn child, for every abortion request -- and savoring the commotion his last effort helped inspire.
"I think as far as getting people to think about this issue, and getting the court to turn around, it was immensely successful," Puzder says. "Beyond my wildest dreams."
But in the places where actual women come for actual abortions, almost no one in Missouri believes the law has changed much of anything for either patients or their physicians. At Reproductive Health Services, which provides just under half the state's 17,500 abortions a year, the numbers of women obtaining abortions this January and May increased slightly from last year's totals for those months -- and abortion opponents do not dispute the clinic's figures. "I do think there are significant impacts to Webster," says attorney Mario Mandina, Kansas City president of a statewide group called Lawyers for Life, "but most pro-lifers feel the Webster case has not stopped one abortion in Missouri."
Planned Parenthood, the only organization besides Reproductive Health Services that provides abortions to large numbers of women in Missouri, recorded a 20 percent drop last summer in women consulting its Kansas City clinic; the clinic director rented billboards and put up massive signs reading "STILL A CHOICE," and the numbers returned to their pre-Webster levels. Two lawyers with a point to prove filed some guerrilla cases that were promptly tossed out by the presiding judges: One attorney argued that the fetuses of jailed pregnant women were now Missouri citizens suffering involuntary detention; and another argued that his client, a convicted drunk driver facing additional penalties for being under 21 when he was arrested, had legally begun his life at conception and thus was nine months older than his driver's license said he was.
A state college administrator wrote a much-circulated memorandum advising his staff members that no campus employee could give abortion information to a student seeking advice, but he amended it afterward to say he had misunderstood the directives of the law. Two St. Louis judges cited the "unborn children have protectable interests" language when they acquitted protesters charged with abortion clinic trespass, but a Missouri appellate court later rejected that reasoning; the appellate court ruled, in an issue probably destined for the state Supreme Court, that abortion protesters could not legally defy trespass laws by arguing that they were saving human lives.
And the Missouri physicians who still do abortions followed accounts like the story of Maralee and Kevin Dinsdale, a western Missouri couple whose dismal experience last fall seemed to offer tangible evidence that the new restrictions were having at least some direct effect. Maralee Dinsdale is a 33-year-old schoolteacher from the town of Carrollton; during the summer of the Webster ruling, she was pregnant with what she and her husband hoped would be a second child. They had been trying for three years to have a baby, but Dinsdale had miscarried once and had lost a second pregnancy when the fetus died before birth.
In her 20th week of pregnancy, Dinsdale had a sonogram and was told, after a distraught nurse hurried out of the room to bring in the doctor, that her fetus was developing without a brain. Anencephaly is the medical term for this condition; it is always fatal to newborn infants, and the Dinsdales' doctor offered to end Maralee Dinsdale's pregnancy by inducing labor immediately. But when he contacted the two hospitals where he has privileges, each turned him down: By their definition the doctor was describing an abortion, the administrators said, and by their definition the hospitals they run (one is municipally owned, and one directed by a publicly elected board) are public facilities. The Dinsdales were proposing an abortion performed by a private physician and paid for by private funds, but the new state law appeared to have closed off the only hospitals where their doctor could do his work.
Maralee Dinsdale finally obtained her abortion at a Kansas clinic, and the Webster decision, it might be argued, had forced her across the state line. Neither she nor her husband had actively joined the abortion debate before last year, but Maralee Dinsdale was so angry about being barred from her doctor's hospitals that she traveled to Washington this spring to testify before Congress. "I am pro-choice, period, no matter what," she says. "I don't know if I started out that way. But it's nobody's business. The politician, or the sister-in-law, or the doctor, or whatever -- when they say, 'Yes, you have to have the baby,' then they're done. And that's when they walk away."
Dinsdale has learned since last fall that other pregnant women have been sent over to Kansas too, that she and her husband were not the only Missouri couple to leave the state after public hospitals cut off access. A University of Missouri obstetrician says the state-funded campus hospital in Columbia used to provide several dozen abortions a year to women with severely malformed fetuses, and that the law now requires him to tell these patients they must have their abortions somewhere else. Adele Hughey, the director of the Kansas clinic that handled Dinsdale's abortion, says her facility has since last summer accommodated a small but still unprecedented number of patients like this, Missouri women who discovered grave fetal problems past the gestational point when private clinics in their region would offer them abortions. "Fewer than 10," Hughey says. "In previous years, maybe we've had one a year."
The Realities But even that statistic is murkier than it sounds, complicated by medical and geographical realities that have parallels in many states besides Missouri. The main western Missouri metropolitan area is Kansas City, which spills across the Kansas border; driving to Hughey's abortion clinic in Kansas requires a car ride quicker for some Missouri residents than the drive to the Planned Parenthood clinic on the Missouri side of town. And nothing in the new Missouri law constrains private hospitals from providing abortions themselves. Of the few remaining Kansas City doctors who will do abortions on the Missouri side of the border, at least one says he would have considered helping Maralee Dinsdale in a private hospital if she had been referred to him instead of to a clinic across the state line.
That doctor is not exactly clamoring for public recognition, though; the community of Missouri physicians who will acknowledge performing even occasional abortions is extremely small. There simply are not many places to get an abortion in this state, and that was true before the law clamped down on public hospitals. Private hospitals sometimes turn away all abortion patients, or admit them only in early pregnancy. The city of St. Louis has never allowed elective abortions on the public hospital premises. In Kansas City, where Truman Medical Center had once been the state's only public hospital providing significant numbers of abortions, internal policies had already curtailed the abortion service; by the time of the Webster ruling Truman had dropped from 600 to fewer than 50 abortions per year, and the room that had once served as the hospital's main abortion facility was being used as a changing area for other surgical patients.
"The women of Missouri," Adele Hughey says, "already had a bad deal." Which is not to say the women of Kansas have a dramatically better deal, from Hughey's perspective; driving across state lines is old news by now for women in many parts of the country, particularly in rural areas where the drives sometimes traverse 300 miles of abortion-hostile territory. Reproductive Health Services itself advertises in the yellow pages of Illinois, Arkansas, Kentucky and Indiana, and there are northern Mississippi women who will circumvent both Tennessee and Kentucky to reach B.J. Isaacson-Jones's clinic in St. Louis.
Isaacson-Jones takes no comfort in that, and neither is she particularly relieved by Missouri's declaration that the newly mandated "viability testing" seems simply to mean the same kind of pre-abortion medical examinations all reputable physicians perform anyway. The abortion law itself may be very small business, here in the state that started the past year's ruckus, but it is plain to both sides that next year's efforts will set more ambitious goals. "The bottom line," says Judith Widdicombe, defending the petition drive to place the abortion issue on the ballot this fall, "is that without the initiative -- or if we do it and it loses -- we will not have legal abortion in Missouri in 1991. Ninety-eight percent of all abortions will be gone."
Many of Widdicombe's own usual allies think she is probably wrong about that, and they also object both to the wording of the ballot measure and to the prospect of offering it to Missouri voters this fall. "To move right now to a statewide vote, when we really didn't have the grass-roots organization in place, we felt was an unnecessary risk," says Laura Cohen, coordinator for the Missouri branch of the National Abortion Rights Action League. "If it loses, you can forget this issue for a long time in this state."
Certainly the prospect of new legislation is a real one, Cohen says; last year's bills, some so strict they would effectively prohibit abortion, were blocked by committee heads in what everyone understood was a maneuver that would survive only one legislative session. But NARAL and other Missouri abortion rights groups are so set in their opposition to the petition drive that Cohen indicates they may offer only lukewarm support even if the initiative reaches the November ballot. "I'm not saying we would stay neutral," she says. "I'm saying we would just not become actively involved in supporting it."
Missouri's abortion opponents have watched with some satisfaction as this increasingly acrid argument plays itself out in the local press. "It's been very painful," says B.J. Isaacson-Jones, who adds diplomatically that she thinks a voter initiative is a good idea, but that she doubts the state will completely prohibit elective abortion next year. "I think the public perception has changed," she says. "This high visibility Webster gave us -- we exploited it. We used it every way we could. We have shown them what Reproductive Health Services is all about."
The clinic's new adoption agency has proved rather a success, Isaacson-Jones says: Sixteen babies have been placed in adoptive homes since last summer. She says the Webster decision had nothing to do with the agency's opening, that she had for some time been studying similar facilities run by two abortion clinics in Utah and Texas. But politics and public appearances and protest marches have made this an emotional year for Isaacson-Jones, and she describes a bewildering kind of epiphany in her private moment with the Adoption Associates baby in the small pink blanket.
"I spent a lot of time for two days, and some time for a couple of weeks, walking through the clinic, talking to women, listening to the stories of women," Isaacson-Jones says. "In the real world, not all women want to give up their babies. I was confident, based on my relationship with the social worker, that this baby's mother made the best choice for herself." The word is deliberate, weighted as it has become with the rhetoric of the abortion debate, and Isaacson-Jones uses it again: "She made the choice."
And as she has talked about adoption over the last few months, about the services that might help women who are trying to bear their babies or avoid unwanted pregnancy in the first place, one of the people Isaacson-Jones has talked to is Andrew Puzder, the attorney who helped write the law that Reproductive Health Services challenged in court. Their conversations have been tentative, a search for issues that might find common support from both sides of the abortion debate, and each now speaks of the other with something that sounds like genuine respect.
"We knew when we extended the invitation what it must be like for Andy to walk into Reproductive Health Services," Isaacson-Jones says. "I'm not a black-and-white thinker. I never thought he was right, wrong, good or bad. I thought the differences between our sides were just that, differences. But I have come to know him, a little, as a human being."