Defending clinics in Kentucky

A FRIEND recently sent me a link for a blog about a clinic defense in my hometown of Louisville, Ky. It reminded me of how the national statistics often don't really tell the story of how far we have gone back since Roe v. Wade, the 1973 Supreme Court decision that made abortion legal.

NARAL ranks Kentucky 46th in its 2009 Report Card on Women's Reproductive Rights, with a grade of F. The situation in the seven states bordering Kentucky isn't much better, with only two states--West Virginia and Illinois--considered pro-choice. Indiana, Ohio, Missouri and Virginia also get F grades, and Tennessee a D+.

Nationally, only 13 percent of counties offer abortion services; in Kentucky, only two of 120 counties have abortion clinics--Louisville Metro (Jefferson) and Lexington Metro (Lafayette). The clinic in Lexington only operates on a part-time basis. Just one clinic remains open in Louisville. According to Guttmacher Institute, 77 percent of Kentucky's women live in those other 118 counties. Six other metropolitan areas have no abortion provider.

A group of very courageous young women began gathering every Saturday morning outside of the EMW Surgical Center in Louisville to counter right-wing protesters who chase patients down from the moment they step out of their cars to they reach the clinic door.

One woman who takes part in clinic defense described the scene at the clinic:

Kentucky Right to Life and the Catholic Church have a strong presence...Operation Rescue has made some appearances, as have other well-known groups. These out-of-town groups are often brought in and sponsored by the Cards for Life, the University of Louisville's pro-life student group...

Some small groups hold signs and sing songs while the Catholics line the sidewalk and pray the rosary. Occasionally, we get a lone soapbox preacher that preaches over the rosary...These more passive protesters decorate the sidewalk near the clinic door, where the whole scene comes to a head.

A whole different brand of aggression exists down the sidewalk and across the street. This is where the protesters, who we refer to as "chasers," meet and accost clients and their support people often before they are even out of the car.

Chasers are known for pushing their way to clients and grabbing hold of them, stopping in the middle of the sidewalk to impede progress toward the clinic, shaming, guilting, judging and even telling small children that "mommy is a murderer," all while forcing pamphlets at people and showing them pictures and fetus figurines.

The clinic defense has grown over time, with volunteer escorts--male and female--turning out every day the clinic is open as a protective barrier between clients and the protesters.

EMW Surgical Center is a full-time, full-service women's clinic, providing a wide array of obstetrician/gynecologist (OB/GYN) services. As a result of attacks by anti-abortion forces over more than two decades, very few women's health facilities are still open across the state, and only two offer abortion services.

KENTUCKY HAS some of the most repressive anti-choice laws on the books, many of which are unconstitutional and unenforceable.

These include: a mandatory 24-hour waiting period with biased counseling, including enlarged color photographs of fetuses; a ban on abortion counseling or referrals for sexual assault and rape victims; an insurance prohibition for abortion not just for public, but also for private insurers; prohibition of public funding for abortion; parental consent; and TRAP--targeted regulation of abortion providers and a post-viability restriction.

Kentucky also has two additional laws that have been declared unconstitutional--an abortion ban after 12 weeks and spousal notification. The ban on public funding unduly puts a burden on low-income women. Even women who have a private insurance plan must purchase a separate rider for abortion.

Kentucky bans Medicaid from paying for abortions. There is supposed be an exception if the procedure is necessary to save the life of the women or the pregnancy is the result of rape or incest. In reality, because of the right to refuse medical services, many women are turned away by not just public hospitals but also private religious hospitals, which in many areas of the state are the only options.

So far, pro-choice forces have beat back attempts to require that mandatory counseling be face to face. The counseling can be conducted by phone or by mail. Since woman in the far edges of the state would have to travel from 200 to 300 miles to reach Louisville or Lexington, this would add yet another obstacle to their ability to obtain an abortion, since it would mean an overnight stay.

Young women under the age of 18 who have never been married or freed by court order from the care, custody and control of her parents must get the consent of at least one parent. There is no waiver for rape or incest, nor if the girl is a victim of child abuse. She can try and get permission from a judge, but she must prove that she is mature enough to make her own decision and convince the judge that it's in her best interest.

In this context, the importance of this clinic defense and others cannot be stressed enough. In the more than 30-year backlash against Roe v. Wade, full-service women's clinics have been forced to close across the state. Not only has access to abortion been all but eliminated, but the ability to obtain ob-gyn services have been severely reduced, jeopardizing woman's health across the state.

In many areas, hospital clinics are the only option, but because most of them are either public or Catholic, state and federal laws limit the ability of many low-income and rural women to obtain birth control or abortion counseling services even in the case of rape or incest. Women are turned away because of bans on the use of public funds and the right to refuse services.

KENTUCKY'S STRUGGLE for reproductive freedom is a long and determined one.

Before the late 1800s, midwives throughout the U.S. routinely performed abortions. The Catholic Church, probably Kentucky's strongest abortion opponent, allowed abortion until the "quickening" until 1869. In Kentucky, common law allowed abortions until a woman could feel fetal movement (quickening), up until about 20 weeks.

Kentucky was the last state to ban all abortions. Most states began outlawing abortion after 1860, not only due to pressure from social conservatives but also from the medical community. The attack on abortion from the medical community was aimed not only at the procedure, but at midwives.

Racism was also a contributing factor. White middle-class Protestant women wanting to limit their family size were turning to abortion as an alternative. But in the 1860s, the bigoted idea was furthered that "white/natives" were being "outnumbered" by Catholic immigrants and Black families. At this point, the question of "where life begins" was in no way a motivating factor for opposition to abortion.

The Comstock Law in 1873 banned the distribution of obscene materials through the mail. As a consequence, advertisements in magazines and catalogs for herbs, potions, douches and devices for birth control and abortion were also banned. This ban on reproductive information, including educational materials, remained for over 50 years in Kentucky.

During the Great Depression of the 1930s, women worried about being able to support large families, and they began to seek out ways to limit the number of children they had. In 1933, the Kentucky Birth Control League was founded in Louisville, with subsequent clinics opening in Lexington and Berea.

According to reports in the Courier-Journal newspaper, between the 1940s and the early 1970s, at least nine doctors were arrested for performing abortions, and five of these doctors were arrested multiple times. Thirty-nine former nurses and health care workers were also arrested for either performing or assisting in abortions.

In the early 1970s, a group of volunteers in Louisville started the Problem Pregnancy and Abortion Counseling Project. They used business cards with their name and phone number along with newspaper ads to reach out to women who wanted to end their unwanted pregnancies. Within a year, they had counseled 382 women, and 85 percent of them were able to obtain legal abortions with their help.

They didn't charge for their services and went to great lengths to get women to New York where abortion was legal. Shortly thereafter, University of Kentucky students also organized to help women get to New York for abortions.

On January 22, 1973, the ruling by the U.S. Supreme Court in Roe v. Wade changed everything. Overnight, abortions in the first trimester for any reason became legal.

States could still limit abortions in the second trimester, but would have to allow for the protection of the life of the mother. In the last trimester, they could prohibit abortions except to save the life or protect the health of the woman. This meant that every state would have to repeal their abortion bans and pass new abortion laws.

By the spring of 1973, abortion clinics began opening in Louisville. By 1976, there were 17 abortion providers in the state. Those numbers started declining in the 1980s, with only two remaining today.

IN THE wake of Roe v. Wade, Kentucky lawmakers had other ideas. When they reconvened in January 1974, the Senate introduced a bill that banned second and third-trimester abortions, required parental consent for minors and mandated a waiting period with counseling and written consent before an abortion. Despite attempts to stop it from getting out of committee, it eventually passed both houses.

Over the years, the American Civil Liberties Union (ACLU) has successfully challenged waiting periods and consent laws in court, guaranteeing access to abortion for rural women and teenagers who were most affected. But that changed in 1989 with Webster v. Reproductive Health Services and in 1992 with Planned Parenthood of Southeastern Pennsylvania v. Casey. States now had more authority to restrict access to abortion and anti-choice forces in Kentucky wasted no time.

The ACLU tried unsuccessfully to challenge the Casey ruling, which allowed a 24-hour waiting periods and mandatory counseling. Pennsylvania at the time of the decision had 61 abortion providers; Kentucky had just three. The ACLU argued that two separate trips of up to five hours to Louisville would make it almost impossible for rural women to obtain an abortion "placing and undue burden" on them. The Kentucky ACLU has fought and continues to fight every attempt to restrict abortion rights through legislation.

Another way that anti-choice forces have tried to stop women from having abortions is through "crisis pregnancy centers"--offices that provide misleading or fake information about abortion. In Kentucky, the Catholic dioceses opened an "abortion alternative" hotline and individual counseling in 1986. Now there are more than 40 centers in the state, compared to just two actual abortion providers. One of these centers is across the street from the EMW Women's Surgical Center.

On September 23, the anti-abortion campaign "40 Days for Life" begins. It will target clinics in more than 100 cities in the U.S. EMW will be one of them.

It's unfortunate that the "pro-life" movement doesn't focus its energy on living, breathing children--children suffering from hunger, dying from lack of medical care and access to clean water or those caught up in the crossfire of war. That would truly be a movement for life.

Kentucky currently has no laws on the books ensuring clinic access or protecting clients from verbal or other forms of harassment in their effort to enter the clinic, making it all the more urgent that pro-choice forces make their presence felt during this time.

A friend of my son in Kentucky who volunteers as an escort told me that he originally became interested after seeing a flyer, and intended to have only limited involvement. But the first time he went, the verbal abuse toward the women he was escorting was so vile and disgusting that he has been committed ever since. He convinced three other members of his family to join him.

Kentucky came close to passing a complete ban on all abortions in 2006. Even though pro-choice supporters have successfully prevented a face-to-face requirement on counseling and a requirement for fetal ultrasounds in the past year, the fight for reproductive freedom continues.

If the past, when abortion was a crime, taught us one thing, it is that a woman who wants to terminate a pregnancy will find a way. Banning the procedure didn't stop abortions; it only endangered women's lives. We need to keep abortion safe and legal, and make it available to women regardless of their income, age and locality.

The lack of a strong and vocal women's rights movement in Kentucky and the U.S. has allowed a gradual chipping away of our reproductive rights. We must send a clear message: Abortion on demand and without apology. If a woman does not have the right to make decisions concerning her own body and well being, than she has no rights at all. Reproductive freedom is essential if women are ever to achieve full equality.

Thanks to WENCHES and the ACLU's Reproductive Freedom Project for their assistance in the writing of this article.