Friday, January 25, 2008

All Dressed Up...and No One Left To Terrorize

Don't look now, but the front lines of the abortion battle are shifting. The decades-long face-down between insanely brave Planned Parenthood clinic workers (who accepted bodyguards and stalkers and phone harassment and the possibility that they'd be blown up at their desks or taken out by a sniper while sitting at their dinner tables as just another part of the job) and earnestly sincere raving crazies who drive around town with gruesome and bloody pictures taped all over their cars and derive their greatest satisfaction in life from howling public "murder" accusations at women who are, far more often than not, simply trying to see a doctor for a yeast infection -- well, that little piece of urban guerilla warfare, which has been ravaging lives and careers for decades in an American small town or suburb near you, is finally heading into a new phase of engagement.

And this new round looks like it may find the screeching mob of would-be fetus rescuers all dressed up -- with nowhere left to go, and nobody left to terrorize. may not.

Christian fundamentalist trolls are fond of insisting that they're nothing at all like the Muslim fundamentalists. After all, they declare proudly, heads drawn back and chins jutting forward in quivering self-righteousness, they don't engage in acts of terrorism. Which is beyond crazy. I mean, just imagine what those same denial-mongers would have to say if radical Islamic terrorists had pulled off a 30-year campaign of violence against US and Canadian medical clinics that ended up with this kind of casualty list:

7 murders, including three doctors, two clinic employees, a security guard, and an escort
17 attempted murders
383 death threats
153 incidents of assault and battery
3 kidnappings
41 bombings
173 arsons
91 attempted bombings or arsons
619 bomb threats
655 bioterror attacks (all hoaxes), 554 of which were committed by one man
1630 incidents of trespassing
1264 incidents of vandalism
100 attacks with butyric acid stink bombs
One-third of all abortion clinics in 1981 were gone by 2005.

If Islamic jihadists had done even a tenth this much damage, every last Muslim in America would be doing stress-position calisthenics in a concentration camp somewhere in the Nevada desert right now. But since this impressive achievement in domestic terrorism was almost entirely accomplished by white Christian men -- well, y'see, it's Not Terrorism when we do it. And, as we all know by now, it's especially Not Terrorism when the targets aren't white, Christian, or male.

But, while most of the country was looking the other way, the entire abortion battlefield quietly, slowly, and irrevocably changed. Over the past seven years, medical technology has been gradually shifting the supply lines through which abortion is delivered. The change crept in so silently that, for a long time, very few people noticed. But suddenly, according to an article this week in the Washington Post, that one subtle change -- in the form of mifepristone, aka RU-486 -- is starting to make a fundamental difference in the way abortion happens -- and is talked about -- in this country.

According to the Post's Rob Stein:

At a time when the overall number of abortions has been steadily declining, a new survey reported that RU-486-induced abortions have been rising by 22 percent a year and now account for 14 percent of the total - and more than 1 in 5 of early abortions performed by the ninth week of pregnancy.

It's not the actual numbers that are interesting here; it's the trendline. RU-486 has been available in the US since 2000; and its use has been increasing at a slow but steady rate ever since. What's new is that it's finally approaching critical mass, gaining acceptance with the vast numbers of doctors who've wanted to offer their patients the option of a safe early abortion, but simply couldn't take on the daunting social, financial, or physical risks of performing the operation themselves. Increasingly, year by year, drug has allowed more and more of these doctors and their patients to do a complete end-run around the crazies at the clinic door. And this has gone on long enough now that it's starting to change the way we approach the whole issue, on several fronts.

First, it's already putting more abortion providers back in service. For 20 years, the number of doctors and clinics offering abortion was in free fall: every year, it seemed, more of them succumbed to anti-choice harassment and pressure and closed their doors. Old doctors retired; young ones were discouraged from learning the procedure; clinic directors balked at the PR and security problems and the insurance premiums. But, according to the Guttmacher Institute, the rate of decline suddenly flattened from 8% to 2% in 2001, as doctors started adding RU-486 to their practices -- and that rate has held steady ever since. We're still losing abortion providers, but most of those losses are being offset by the growing number of doctors offering drug-induced medical abortion. Even better news: those doctors are now everywhere, including states where the last surgical abortion provider was run out years ago.

Second, it's changing the way women experience abortion. Medical abortion gives women the dignity of going through the process in the privacy and comfort of their own homes, rather than having to hunt down a clinic, get themselves there, and face down the hysterical, pleading mob massed around the clinic doors both before and after enduring a painful and invasive surgery. Also: most late abortions are necessary only because women are forced to wait too long while they arrange the funding, access, or logistics for an expensive, often too-far-away surgical abortion. Mifepristone greatly reduces the expense and hassle -- and, with it, the unnecessary delays that lead to most later-term abortions.

Third, unlike most drugs, RU-486 is dispensed directly by doctors -- which also cuts out of the loop moralizing pharmacists who see women's most essential life decisions as a sort of moral gym equipment on which to freely exercise their underdeveloped consciences, and score some extra Jesus Points in the process. (A lot of these same people can't be trusted to hand out birth control pills or Plan B, either -- and if the pharmacy profession can't get these people to fulfill the terms of their licenses, RU-486 is the precedent from which to argue that we should seriously consider putting these other controversial items back into the hands of doctors as well.)

Fourth: As medical abortion becomes the norm, it would seem to leave that howling pitchfork-and-torch-bearing mob at the clinic door all dressed up for battle -- with absolutely nowhere to go. Unfortunately (as we'll see) that doesn't necessarily mean that the battle will be over any time soon. But it does make staying with the current tactics a lot more complicated.

Assuming every woman who went through the doors at a Planned Parenthood clinic was there for an abortion was always the same flavor of stupid as assuming that that everyone who goes into Safeway must be buying beer. Even so: as RU-486 becomes The Way It's Done, those women aren't easy pickings any more. You can't just hang out in front of the clinic on Tuesdays and Thursdays and assume everyone coming up the sidewalk is a slutty, bamboozled, innocent, callous-hearted baby-killing bitch who just doesn't understand that it's a baaayyybbeee, that she has Options, and how much Jesus loves her.

That era, as I said, is coming to an end. Increasingly, those women are bypassing the clinic entirely. Instead, they're showing up for regular appointments, on all days of the week, at doctors' offices all over town. Which makes it hard on the berzerkers: after all, there's no legitimate way of knowing which doctors are in the abortion business now, or why any individual woman is seeing any given doctor on any given day. Our culture has strong, long-standing customs protecting discussions between doctors and patients; and as abortion increasingly slips behind that shady wall, that decision is finally ending up exactly where we've always argued it should be -- as a private matter between a woman and her doctor.

Over the long haul, making early pregnancy termination a common piece of most doctors' everyday medical practice will be the final step in normalizing abortion, removing its stigma, and ensuring that it will eventually be accepted as an unquestioned and relatively uncontroversial right.

* * *

When that happens, the question becomes: will the anti-choice terrorists respect that wall -- or will they try to go over it, get around it, or simply blow it up?

The most plausible answer is: all of the above.

What's likely to happen -- because it's what usually happens when radical groups are driven to the fringes -- is that the moderate members who make up the bulk of the movement let go and move on, leaving a much smaller fanatical core to carry on. Without that moderate influence to provide a constant, tempering reality check, the craziness level heats up and becomes concentrated. The remaining True Believers have wrapped up their lives and careers and (in some sad cases) their entire reason for being in the fight. For these professional warriors, losing control of the battlefield -- in this case, losing control of women, and the presumed male prerogative to control women's fertility -- may prove to be a fate too shattering to contemplate.

When this kind of defeat and isolation happens, we're usually wise to expect trouble. As abortion moves from the public battlefield to the privacy of homes and offices over the next decade or so, the sheer frustration over losing so much ground could very well drive an angry remnant of fanatics toward a final frenzy of unprecedented and spectacular terrorist violence.

Before that happens, though, they're likely to try to join the battle on new fronts. In particular, we should expect full frontal assaults on our cultural and legal assumptions about medical privacy. They'll probably never give up on Planned Parenthood as the all-time all-star Personification of Absolute Evil in their perfervid little cosmological drama -- conservatives can do without God, but they can't get through the day without a devil; and they're loathe to give up on one they've become so familiar with. But when abortion vanishes behind a wall of privacy, we can expect to see newly focused attempts to breach the wall of doctor-patient confidentiality, using every means at hand.

They're already at it, as those who've been following the exploits of former Kansas attorney general Phil Kline can tell you. (Kline used his office to harass the state's abortion doctors, requiring them to give up their case records to state review -- a step that would have outed tens of thousands of women who'd had abortions.) This is a preview of what doctors will be in for: escalating attempts to use the law (or simple spying) to discover their treatment choices, open their files, and put their patients' data on public record. We'll see increased use of medical oversight and disciplinary boards to harass doctors and compile lists of women who've had abortions. To the degree this succeeds, it will set terrible precedents that will jeopardize everybody's right to the confidentiality of their own medical records.

And, with those lists in hand, they will -- for the first time -- probably start going directly after women. The anti-choice movement has always assumed that women are weak vessels, at best lacking moral agency and at worst overwhelmed by pregnancy and easily gulled by manipulative men into making bad choices. Leaving aside what this worldview says about their own psychosexual kinks, it was a galling, insulting, sexist assumption from the get-go. But for the most part, it did keep them from directing the brunt of their punitive rage toward us. (The fastest way to shut up the "abortion is murder!" rant is to say: "Fine. When do we start sending women to the gas chamber for it?" It's always fun to listen to the necks snap as moral absolutists make that abrupt warp-speed U-turn into moral relativists. "'s not really what I meant....")

But in medical abortion, the agent of termination is not surgical instruments in the hands of the doctor in an office, but drugs in the hands of the patient at home. That fact literally puts the event far more directly under women's control -- a shift that may finally force them to fully reckon with the fact that women are ultimately the responsible moral agents in every abortion decision. And if they do make this leap, we can expect it to get very nasty indeed as the personal becomes political on a whole new level. Our increased privacy will be met with overwhelming publicity: websites, public flyers, picketing in front of our houses, harassing phone calls to employers and family members. The more private the choice becomes, the harder they will fight back by trying to make it as public as possible.

When the frustration builds to the point where violence comes, it will likely be on that same front as well. In the past, anti-abortion terrorists bombed clinics because "that's where the babies die," and shot doctors because they were "the real murderers." In the future, that same logic may lead them to bring the gasoline and bombs to the new "abortion chambers" -- that is, our own private homes --a nd direct their rage at the new "murderers," now recognized as women themselves.

From there, it's easy to step off into truly frightening images culled from The Handmaid's Tale. That's one possible outcome to be aware of; but it's far from the most likely one. More likely, public revulsion at these outrageous privacy invasions and violent tactics will be their undoing -- putting the anti-choice movement in such bad odor that it will lose all of its credibility, and most of its cultural support. We'll know we're getting close when the conventional wisdom accepts that "anti-abortionists" are out to do to our families what they did to Terry Schiavo's; that "pro-life" is exactly equivalent with "pro- snooping- in- your- family's- business"; that "saving babies" is usually a self-righteous bully's excuse for harassing and assaulting women; and that "anti-abortion violence" is, precisely, the modern definition of "domestic terrorism."

RU-486 is, still slowly, shifting the public conversation about abortion. As that new discussion opens up and grows louder, it will also change the ways in which pro- and anti-choice people interact. And -- if we watch for it -- it may give us our last, best chance to return the entire subject to the private sphere, where it ought to be, once and for all.