One of the first patients who came to our family-planning clinic in Billings, Mont., newly opened in 1969, sought help after she and her boyfriend had hitchhiked 500 miles from Billings to Colorado to terminate a pregnancy. Colorado was one of the five states where abortions could be legally obtained. They had heard about Colorado through his older sister, and were able to borrow enough money for the procedure but not enough for a bus ticket. She was 17, unmarried and so desperate to return home before anyone missed her that she did not stay for her follow-up appointment. Now she came to us for follow-up care, as well as birth control.
Although I was the mother of five children and a graduate of the Duke University School of Nursing, and had taught in two nursing schools, I knew little about abortion. Our patient was afraid to go to her family doctor because she was not sure what was legal or illegal. And neither was I. But I did know we could not prescribe her birth control — it was against the law for anyone under 18.
At the time, there were eight OB/GYNs in town. None of them would provide birth control to an unmarried woman; some wouldn’t provide it to anyone. Condoms, referred to as “sex-inciting devices” in the Montana constitution, had to be dispensed by a pharmacist. Abortion, obviously, was forbidden in most places.
For three decades, I worked as a nurse practitioner and director of Planned Parenthood clinics across Montana. I marched dozens of times for women’s rights, counseled hundreds of women about their options, housed at least 10 pregnant girls who had been kicked out of their homes and accompanied them to the delivery room. Some of them kept their babies; others chose adoption. The hardest times were when we had to inform women that certain tests had come back positive, that they needed to visit a physician for a biopsy. Before and after my retirement in 2001, there have been political attempts to control the work we did. With the recent announcement that President Trump is reviving a rule to deny federal Title X family-planning funds to organizations that provide abortions or make abortion referrals, the battle continues.
In 1970, we were able to expand our clinical services thanks to a grant under Title X, which provides funding for contraception, breast and pelvic exams, breast and cervical cancer screenings, education, and counseling, among other things. We followed the regulations scrupulously, even though some made no sense. We could teach teenage boys and girls about reproduction and sexually transmitted diseases, but we couldn’t provide them with medical services or contraceptives. We were required to perform a pap smear on every woman who came to us for the pill, which led many of our patients to believe that birth control must somehow be linked to cancer.
After the Supreme Court ruled in 1973 that women had a right to obtain an abortion wherever they lived, the board of our family-planning clinic considered opening an abortion clinic. The deciding factor was geography: It takes two days to drive across Montana, the fourth-largest state. We wanted women to have access to the services they needed. Thus began the fundraising to open four clinics across the state.
We adjusted to every regulation that came across our desk and made every accommodation for what we could and couldn’t say. We strictly divided the clinics so that not a penny of Title X funding was ever spent on abortion activities: two phone lines, two different staffs, two accounting systems. It wasn’t easy, and it wasn’t cost-effective. But we followed the rules.
Two of our clinics were burned down. Patients and staff members were harassed. The FBI advised the physicians and me to wear bulletproof vests. The doctors did, but I did not: If I lived in a place where I could be shot because I was providing care to our patients, so be it.
We went to court many times. One memorable instance: Abortion opponents claimed that because our clinics received state funds, everything we did was open to the public, and they wanted our patients’ records. We won that one.
And of course, there were the picketers, five or six a day every day. Some picketed our homes. Before Roe v. Wade, they picketed us for providing birth control. After, it was for abortion. I never could get angry at them. They had their beliefs, and they were willing to stand outside in subzero weather to protest. I don’t know that I could do that. I certainly didn’t want them to harass our patients. But they could harass me. That was their right, and I didn’t resent them for it. We even treated some of their family members — more than once, people who picketed later came in with their pregnant daughters for abortions. We never chastised them for it.
I was never stopped by picketers while out in public, but I certainly was — and am still — stopped by former patients who want to say thank you. I was at Costco last weekend, and a woman approached me. “You probably don’t remember me,” she said. It’s a common occurrence for me and other people in my line of work.
I had hoped the political conversation around abortion would fade. I had hoped that people who were firmly against abortion could take comfort in knowing that they would never be forced to have one. But our politicians have never let it fade. And yet women still want and need abortions. In a perfect world, no one would need one. Birth control would be perfect, finances would be perfect. But that’s not how it is.
It’s hard to know what will happen to clinics, or the women who rely on them, with this new regulation. There aren’t many physicians who are willing to provide abortions — they don’t want to be picketed — and community health centers don’t provide abortions. Wealthy women will always be able to secure abortions at private clinics that don’t receive Title X funds. But what about the women who don’t have the resources or the know-how, who can’t travel long distances ? Long ago, almost every town had someone who would perform abortions. In one small Montana city, everyone knew who it was: a local beautician. Before Roe, many women tried to self-induce abortions — with coat hangers, crochet hooks, knitting needles, lye soap — and they will go back to that if they can’t access the medical care they need. A desperate 17-year-old might be able to hitchhike 500 miles to get a safe, legal abortion, but a poor pregnant woman already struggling to feed her family won’t make that journey — not when a back-alley abortion is so much closer.