The Washington PostDemocracy Dies in Darkness

Roe at 40: ‘It’s never been this frightening before.’

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PITTSBURGH — On a cold morning before dawn, one of the nation’s oldest abortion clinics is getting ready for its newest patients.

Nurses lay out sterilized equipment. An assistant pulls warm blankets from the dryer. A counselor gives directions to a woman who is lost. By sunrise, patients begin arriving. One gets off a city bus with her brother. A 36-year-old mother comes with a friend.

Outside, protester Nathanael Provan holds a sign emblazoned with a single word: LIFE. “Your baby is beautiful,” he tells a patient entering the clinic.

“I already have four beautiful babies at home,” Chantelle Johnson, 25, snaps.

It’s been almost 40 years since since the Supreme Court legalized abortion on Jan. 22, 1973, galvanizing people on both sides. Abortion clinics sprang up across the country. The National Right to Life Committee was founded. Opponents and proponents girded for an epic conflict.

But today, the battle is a slog of legislative fights and piecemeal regulations. Here, in a city where the battle over abortion was frequently and sometimes violently joined, combatants on both sides agree: They are dead-tired of the struggle over this clinic’s existence.

Claire Keyes, the longtime director of the Allegheny Reproductive Health Center, recalls thinking that the Supreme Court had settled the abortion argument, once and for all. “When I came into the clinic for the first time, the feeling that we had was this sense of giddiness,” she said. “Women had gained the right to control their own destiny.”

Helen Cindrich, who runs the state’s oldest anti-abortion group, remembers being confident that the public would soon turn against the procedure.

“We used to think that if people knew what life before birth was, it would all be over,” she said. “We thought that when they heard about partial-birth abortion, nobody would ever go for that.”

Keyes and Cindrich are part of the first generation of activists to devote their entire careers to the fight over legal abortion. Neither expected, when they took up the cause, that they would be fighting many of the same battles four decades later.

Enthusiasm was palpable

Claire Keyes began her career before the Roe decision, working as a volunteer to help Pittsburgh women get abortions in New York, where the procedure was legal. After the 1973 Supreme Court ruling, she was hired as a counselor in a newly opened Pittsburgh clinic. She remembers the enthusiasm was palpable.

“The physicians who were so eager to work at the clinic had the same feeling,” she said. “That is something that is so remote from the current situation. By the time that there were physicians who were being murdered, it wasn’t something that doctors were eager to do.”

In 1978, she became the director of the Allegheny center, a job she held until 2008. Three doctors worked at the clinic.

“I initially thought I would just provide abortions to women who really needed them,” said Robert Thompson, a doctor who has worked at the clinic for more than three decades. “I realized soon that was a very naive way to think about this. All the women who showed up at the clinic, in some way, needed this. Who was I to be the arbiter?”

Thompson, who estimated that he has performed about 50,000 abortions, says he never expected to end up at the center of a heated national debate — or to have protesters picket his private practice, where he does not perform abortions, or to have his wife draw the curtains at night because of safety concerns.

“We were just coasting along,” he said. “None of us saw this coming.”

Legal challenges

In 1972, shortly after Helen Cindrich left her job to become a stay-at-home mother, she saw a woman on a television talk show describing her pregnancy as a “parasite.” She called the Catholic Diocese of Pittsburgh to say how upset she was. They referred her to a group of “seven ladies” who were meeting on the issue, she recalled.

Soon she was making cookies for the group’s booth at the local mall; two weeks later, she was running her own booth, handing out anti-abortion literature along with free pens and pins. Eventually, she became executive director of People Concerned for the Unborn Child, the oldest anti-abortion group in the state.

Pennsylvania, meanwhile, was moving to the forefront of states attempting to impose abortion restrictions. It barred Medicaid, the state-federal health program for the poor, from paying for elective abortions. After the law was upheld by the Supreme Court, several states passed similar laws.

And that was just the start. Over the next several years, Pennsylvania sent more abortion-related laws to the Supreme Court than any other state, creating a legal foundation for states to impose an array of abortion restrictions.

Cindrich assumed that such legal challenges meant clinics like Allegheny did not have much time: Some law, or some change in public opinion, would force them out of business.

In 1977, she participated in her first sit-in — at Allegheny.

A dozen or so women “just went up and sat down on the 12th floor” of a downtown office building, ignoring police warnings that they would be arrested. “So we went to jail that day,” she said.

The next year, Cindrich was arrested at Allegheny again. She began going to the annual March for Life in Washington, picketing abortion-rights supporters such as Jimmy Carter and Bill Clinton, and praying outside clinics.

Protests intensify

By the late 1980s, the protests were intensifying. Allegheny, a frequent target, eventually got evicted.

The violence escalated at the clinic’s new location. A firebomb caused $5,000 in damage. Several hundred protesters would turn out at the clinic on a regular basis. Some jammed a Chevrolet Chevette into the clinic’s door. Police had to cut the car in half to remove the two protesters inside.

“Our tactic was going limp,” said Keith Tucci, a young evangelical pastor who was executive director of Operation Rescue in the early 1990s. “We were pro-life potatoes. We would lay in front of the doors.”

“The City of Pittsburgh was having to deal with something that had never occurred on this scale,” said Keyes. “There wasn’t anywhere for them to turn. The media were a constant presence.”

“It was a horrible, horrible time in my life,” she said.

Over time, abortion opponents’ tactics changed. People with full-time jobs didn’t have the time to spend in jail, Tucci said.

More importantly, potent legal challenges were emerging. The Pennsylvania Abortion Control Act, signed into law by Gov. Robert Casey (D) in November 1989, included several new restrictions. For example, women were required to notify their husbands before the procedure, and doctors had to tell women about possible hazards.

Planned Parenthood of Southeastern Pennsylvania challenged the law as a violation of the guarantee of legal abortion under Roe v. Wade.

Abortion opponents hoped the Supreme Court would use Planned Parenthood v. Casey to dismantle Roe. It had recently ruled in favor of a Missouri law that allowed the state to prohibit abortions in publicly funded hospitals.

The court, which handed down its ruling in 1992, didn’t overturn Roe. But it did uphold most of the Pennsylvania restrictions. The court created a new “undue burden” standard, saying that states could restrict abortion as long as those regulations were not “too severe” or lacked “legitimate, rational justification.”

Anti-abortion groups now had a playbook on how to restrict abortion. “Our legal analysts thought we could start moving the boundaries of Roe, testing how far you can go within the Supreme Court ruling,” said Charmaine Yoest, president of Americans United for Life, which provides state legislators with model abortion restrictions.

“There was this relief that Casey didn’t overturn Roe, but if you go back and read the decision, you see the Court essentially invited additional abortion restrictions,” said Elizabeth Nash, state manager for the nonprofit Guttmacher Institute, which tracks reproductive health issues and supports abortion rights. “In a lot of ways, Casey gutted Roe.”

Last year, states passed 92 abortion restrictions, more than three times the number in any year since Guttmacher started keeping count in 1985.

Future of abortion rights

As the 40th anniversary of Roe approaches, Keyes is fearful about the future of abortion rights — and the clinic.

“It’s never been this frightening before,” she said. “I don’t know if we’re going to make it.”

A Pennsylvania law passed in 2011 requires surgical abortion clinics to become certified as ambulatory surgical centers and meet other rules.

Eight of Pennsylvania’s 22 surgical abortion providers failed to gain approval under the new law. They can offer medical abortions, using a prescription drug, but not perform surgical procedures. To comply with the regulations, abortion clinics will need to install hospital-grade elevators and have a set number of parking spaces.

“Sometimes I think the regulations are what will actually get us, more than what we saw in the early years,” said Thompson, one of the clinic’s three doctors. He’s in his late 60s and isn’t sure who will take his place when he retires.

Pennsylvania had 50 providers of abortion care in 2008, an 11 percent decrease since 2005, according to the Guttmacher Institute.

With other clinics closing and the facility she spent three decades directing in jeopardy, Keyes now finds it difficult to find the optimism she has held for decades.

‘It’s reassuring’

These days, Cindrich is getting ready to come to Washington Jan. 25 for the March for Life. She would rather travel to Greece or the small town in Ireland where her mother was born, but until her successor turns up, she's focused squarely on advancing her movement's cause.

"I figure somebody, one day, is going to walk into here and take over," she said. "I'll know when it's time."

Meanwhile, she's making preparations for the trip to Washington: About 120 buses will be going, and she has to figure out which movies they'll watch on the four-hour trip. Even though this is her 38th March for Life, she's excited.

“It’s reassuring,” she said, “To spend the day with 100,000 other people who feel the same way that I do.”