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Abortion Providers Facing Threats, Restrictions, and Harassment
This report documents the heroism of abortion providers whose dedication to women’s reproductive health compels them to act despite severe personal and professional sacrifices. It details the pervasive stigma — including legal restrictions and intimidation/harassment at clinics — against abortion within the medical and general communities that allows private and government attacks to persist.
Learn more about why abortion providers are human rights defenders and what can be done to protect them from the harassment, discrimination, legal restrictions, and stigma they experience.
- Method &, Scope of the Investigation >,
- Executive Summary >,
- Human Rights Framework >,
- Three Categories of Attacks &, Obstacles: Intimidation &, Harassment, Legal Restrictions, &, Stigma >,
- Conclusion of Investigation >,
- Recommendations >, Teleconference and Webinar >,
- Glossary >,
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Method and Scope of the Investigation
The Center for Reproductive Rights conducted semi-structured interviews with 83 abortion providers and 29 women seeking abortions in Alabama, Mississippi, Missouri, North Dakota, Pennsylvania, and Texas from November 2008 to February 2009. The states were chosen for geographic diversity and because they met all or most of the following criteria: 1) significant, recent anti-abortion activity, 2) legal restrictions on women’s access to abortion, 3) regulations that single out abortion providers, and 4) unresponsive or inadequate law enforcement.
Clinics and individual providers were recruited to the study from the pool of Center for Reproductive Rights clients, National Abortion Federation and Abortion Care Network members, and Planned Parenthood affiliates. A diversity of locations and settings was sought, where such diversity exists within a particular state. At the same time, we sought to interview providers and women seeking abortions at the clinics who had experienced significant burdens in the provision of abortion. All interviews were conducted privately, participants gave written informed consent in advance of the interviews.
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Three Categories of Attack &, Obstacles: Intimidation &, Harassment, Legal Restrictions, &, Stigma
Despite the Supreme Court’s recognition of women’s constitutional right to abortion more than 35 years ago, the reproductive rights of women in the U.S. remain under attack. Human rights defenders should be protected and aided by the government in the promotion of fundamental rights. Unfortunately, the harassment, legal restrictions, and persistent stigma documented in this report deter physicians from providing abortions, resulting in a shortage of doctors. INTIMIDATION AND HARASSMENT. Like other human rights defenders throughout the world, abortion providers face intimidation, harassment, and violence in the course of carrying out their work. Anti-abortion activity at clinics runs the gamut, from peaceful First Amendment-protected activities to civil and criminal offenses, with many behaviors in a legally contested area in between. While outright violence has decreased at most facilities, the legacy of past murders, bombings, arsons, and assaults is well-known, prompting clinics to take new threats seriously. Despite the government’s obligation to provide specific and enhanced protection to abortion providers, local law enforcement at many sites is uninformed, unresponsive, or even hostile. As a result, clinics make a significant investment in time and resources to protect their staff and patients. Clinic staff and physicians also experience picketing, stalking, smear campaigns, and harassing leafleting at their residences and other threats to themselves and their families.
LEGAL RESTRICTIONS. Governments should make it easier, not more difficult, for individuals to realize their human rights and defend the rights of others, including reproductive rights. Often, they do not. This report documents discriminatory restrictions aimed at prohibiting abortion providers from exercising their profession and providing services. In many states, providers face legislation designed to deter the provision of abortion services.
- Mandatory Delay and Biased Counseling. Each of the states in this report requires a “waiting period” of 24 hours between the time a woman receives “counseling” and/or state-mandated information and obtains an abortion. Across the board, providers agree that there is no medical reason for these requirements. Laws requiring two in-person visits particularly burden women and providers and have the worst effects where there is a severe shortage of providers. Women who have the fewest financial resources, are geographically most isolated from providers, or have later pregnancies are most at risk of being harmed by the barriers that these restrictions impose.
- Medical Practice and Facilities Requirements. Abortion clinics are singled out in many states for discriminatory medical practice and facilities requirements. These laws and regulations bear no relationship to medical evidence concerning the safety of abortion services and are not imposed on other healthcare services that carry similar medical risks. Although the regulations have no medical purpose, they impose a significant burden on providers and on women’s access to abortion. These regulations often require extensive renovations of existing facilities or entail building a new, custom-designed facility, which can cause providers to temporarily close or stop providing services altogether. Inconsistent and arbitrary enforcement of regulations by state health departments also creates uncertainty, increases workloads for clinic staff, and takes time away from patient care.
- Funding Prohibitions. While Medicaid covers medically necessary services for poor women, federal funding restrictions explicitly prohibit coverage of medically necessary abortions except in cases of rape, incest, or life endangerment. Lack of funds frequently causes women to delay an abortion while they raise the money to pay for it. These delays can result in later abortions, potentially increasing risk to the woman’s health. A significant percentage of poor women, unable to afford and access the service, forgo abortion altogether.
STIGMA. Stigma creates needless obstacles for human rights defenders and can erode the number of active providers in a community. Stigma related to abortion is widespread in all six states, in both the medical and general communities. Stigma legitimizes harassment and intimidation, permitting them to take place with impunity. Legal restrictions on abortion promote and reinforce abortion as a stigmatized service, distinct and marginalized from other healthcare services.
Stigma results in economic pressure on physicians not to perform abortions, including by the presence or threat of anti-abortion activity at their private practices. Many medical practices and institutions prohibit doctors from performing abortions, even outside of the practice or hospital. Physicians may refuse to refer patients for abortions, or for other services performed by physicians who are abortion providers. Patients in several states expressed apprehension about their regular physician finding out that they had an abortion because they know that the doctor disapproves. The negative attitude of medical professionals contributes to women’s fear, lack of information, and negative experiences when seeking to obtain an abortion.
General community stigma affects clinics that provide abortions in a number of ways. Many landlords and service vendors are unwilling to enter into business relationships with providers because they do not want to be associated with abortion. Towns use zoning restrictions to harass or prevent clinics from locating there. Often stigma is intertwined with safety and economic concerns about being targeted by protestors. Lack of evident support for clinics in turn enhances stigma and endorses impunity for abortion opponents who seek to harm providers.
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Conclusion of Investigation
The Center for Reproductive Rights’ investigation demonstrates that abortion providers, such as those interviewed for this report, are human rights defenders — and that they are routinely targeted, by both government and non-government actors, for the work that they do in supporting women to exercise their fundamental right to make decisions about their reproductive lives. The U.S. has an affirmative obligation to protect abortion providers — both because of their status as human rights defenders, and because of the key role they play in ensuring that women are able to realize their rights to reproductive autonomy and health.
The Center for Reproductive Rights encourages the government at all levels to adopt and enforce measures to improve the safety of providers and to eliminate laws that impede their work. The medical community has a significant role to play in strongly condemning attacks on abortion providers, reversing the marginalization of abortion from other medical care, and creating opportunities for new providers to train and practice. Also, without efforts at the community level to educate policymakers and the public that abortion is a significant component of reproductive healthcare, health workers who provide abortion will continue to experience the cumulative effects of intimidation, harassment, legal restrictions, and stigma.
Women seeking abortions — and particularly those who are most vulnerable — will continue to confront a scarcity of abortion services and bears the brunt of legal restrictions on abortion, including funding restrictions. As the report shows, proactive efforts by clinics and physicians can minimize the harms to physician availability and patient access, but they cannot eliminate them.
Moreover, the tactics of intimidation, harassment, and legal activism that anti-abortion activists use are dynamic, constantly reinventing themselves in new forms that burden abortion providers. The stigma surrounding abortion is well-rooted in society and requires consistent effort and vigilance to change the beliefs and norms that anchor it. Urgent action is required to recognize abortion providers as human rights defenders. Advocates and policymakers at all levels must pursue remedies to promote and protect the rights of providers and hold perpetrators of violations accountable.
