“The representation of the world, like the world itself, is the work of men; they describe it from the point of view which is theirs and which they confuse with the absolute truth.”
—SIMONE DE BEAUVOIR
I remember the moment I became political. It was a rainy Sunday morning, 1976, and I’d allowed myself to stay in bed a little longer than usual. Monotonic radio voices intruded on my sleep . . . something about Henry Hyde and abortion. I sat up in bed, all ears. Republican Congressman Henry Hyde had succeeded in passing legislation that would effectively remove the right to abortion for women on Medicaid.
“If we can’t save them all, we can at least save some,” Hyde declared, referring to the pregnancies of black, Hispanic, and all politically and socially disenfranchised women who would now be unable to afford abortions. They were Hyde’s first strategic target, the opening salvo in his war against women. Because of their collective powerlessness and political vulnerability they made for an especially easy kill.
Hearing that news, my stomach clenched as I thought about the circumstances that brought many of my patients to the clinic, and the systemic inequalities that placed adequate health care out of reach for so many. Those women from whom Henry Hyde would callously cut off abortion rights were people I worked with every day. Many were unemployed, many had several children, most were poor and had nowhere to turn for help. My growing awareness that women’s reproductive freedom was precarious—that the passage of Roe was also the beginning of a war designed to have it reversed—was transformed into a sense of urgency and purpose that morning. I instinctively knew that my life had changed, that the five years I’d spent providing abortion services had led me to this moment. I recognized that if I wanted to truly advocate for women I’d have to reach out beyond the world of the clinic to the broader, more demanding and dangerous one of political activism.
My immediate impulse was to speak. If people would only see and understand the truth, they would do something to stop it! Ironically enough, my first action was to go through the halls of Queens College, knocking on classroom doors to ask whether I could address the class and hand out leaflets. Surprised professors invited me in and allowed me to distribute my pamphlet on the effects of the Medicaid ruling: how discriminatory it was, how it singled out poor women, minorities, and the young.
“My name is Merle Hoffman and I am here to talk to you about a crisis in reproductive care,” I told the students once their professors stepped aside to let me speak. “We must do something at once—poor women are being discriminated against, poor women will die!”
Uncomfortable silence. The students listened attentively, but there was hardly a response, much less the passionate outcry I’d hoped my news would elicit. Finally, a woman spoke up. “But we will always be able to get abortions. We can fly to London or Puerto Rico,” she said to nods all around. Of course. I was speaking to white, middle-class college students. They had their ways of dealing with an unwanted pregnancy if it happened to them, and they didn’t care to worry about those with fewer resources.5
I encountered a similar attitude when I spoke to the women’s group at a local Queens synagogue. They self-identified as women’s libbers who had made the choice of getting married, giving up their careers, and staying home with their babies. They had the money to fly to those abortion havens if rights were cut off in the US. No coat hangers, bottles, or back alleys for them.
I left, discouraged by their passivity and lack of empathy. In The Feminine Mystique, which helped to spark second-wave feminism, Betty Friedan outlined her view that the freedom to become a fully engaged person is personal and achieving a gender-neutral society with no barriers to women’s self-fulfillment is political. Her analysis did not go far enough to embrace issues of race and class. This disconnect became increasingly evident as I witnessed the demographic of my patients change after the Hyde Amendment was passed in 1976. In the beginning there had been a great deal of racial and class diversity at Flushing Women’s and other abortion clinics; everyone went to them. Even the daughters and wives of public figures and politicians frequently came to clinics for abortions.
The Hyde Amendment changed all that. Because New York was one of only four states that continued to have Medicaid funding for abortion, licensed clinics in our state began to see a large portion of Medicaid patients, mostly lower-middle-class women of color.6 Middle-class white women didn’t want to share facilities with poor minority women, so they found other places to get abortions. Clinics were increasingly thought to be dirty, unsafe facilities, fit only for those who could afford no other option. Gradually, the words “abortion clinic” in New York came to be synonymous with “Medicaid Mill”—a label with all the baggage of stigma, disgust, and racism that continues to this day.
This baggage was compounded by sheer ignorance on the part of middle- and upper-class women who claimed that clinic doctors were not as talented or professional as private gynecologists. As more and more women began to have abortions, there were inevitably unpleasant stories about experiences people had in clinics—long waits, scheduling mix-ups, personality conflicts. These complaints were endemic to any hospital or surgical procedure, but somehow with abortion they became writ large. The politics of abortion were beginning to poison the well of experience.
In fact, many doctors who performed abortions in their private offices were much less experienced than those who did hundreds of abortions each week in clinics. Private doctors had absolutely no regulations, many charging patients more money than the clinics for procedures they weren’t experts at conducting. Some doctors victimized illegal immigrant women in particular; since they did not have Social Security numbers, they were ineligible for Medicaid, and were forced to pay exorbitant prices to private providers. And hospitals—unwieldy in terms of space and operational function, incredibly cost prohibitive, and unwilling to deal with abortion politics—were often not feasible alternatives for women of any class.
Licensed facilities like Flushing Women’s were the best option for all women, wealthy or poor. We were required to meet hospital standards for care, staff, space, and management procedures, and our doctors were extremely skilled.7
The Department of Health conducted routine inspections to ensure that Flushing Women’s was meeting all of the promulgated standards and requirements. Each time, they spent two to three days reviewing hundreds of charts, looking at every piece of equipment, examining staffing patterns, and even staying in the ORs to watch procedures. During the exit interviews, when they reviewed their findings with me, I invariably talked with them about combating the “Medicaid Mills” stereotype that led so many to choose private practices and hospitals over clinics. Didn’t they have jurisdiction there? Couldn’t they do something to educate women about the crisis? Did it even matter if a clinic was better than a doctor’s office if few patients knew the difference?
They agreed with me that clinics were the best option for women seeking abortions, but they maintained that educating the public was not the mandate of the Department of Health.
Even some of the pro-choice activists who had fought for legalization felt there was a “dirtiness” about the business, that the providers were stained with blood, as it were. Once I was at Ellie Guggenheim’s Sutton Place apartment for a pro-choice fundraiser and I happened to mention second trimester abortions. She widened her eyes and turned up her nose. “You don’t do those, do you?”
This was the politics of abortion, the bifurcation of the realities of the procedure and the political arm of the movement. The philosophy of the early pro-choice activists had become unmoored from the provision of services. Now the clinics were gaining a pariah status, the doctors were being labeled “abortionists.”
Early second-wave feminists upheld reproductive freedom as the very foundation of women’s freedom and equality. Yet women’s struggle against gender violence had not ended with Roe. Their biological and historical inheritance of bloodshed through botched childbirths, illegal abortions, and forced sterilizations continued. Now the Hyde Amendment passed relatively unnoticed. Where was the great outpouring of political anger at this affront to low-income women? Where was the march on Washington? What the now silent pro-choice majority failed to see was that the denial of health care to people who needed it and the stigmatization of abortion clinics and providers would ultimately hurt all women, not just those who were poor and black.
The gap between the women who had abortions and the activists of the pro-choice movement who had made abortion legal had to be closed. The inability to really look at abortion reduced activists’ capacity to recognize the depth of this issue. How could they commit to the political passion necessary to fight for reproductive freedom and equality if they’d never been inside a clinic?
I wanted activists to speak with my staff. I wanted them to hear the stories of the eleven-year-olds who were raped by their fathers or uncles, the young women whose promising lives were waylaid by an accident. The physicality of abortion—the reality of the thing itself—made people uncomfortable. It involved pain, blood, anxiety, discomfort, and guilt, and it was easy for even die-hard feminists to hold the issue at arm’s length. But if they could only feel the weight of compassion after seeing patient after patient in counseling, holding their hands in the operating rooms—the preteens, the older women, the rainbow of lives that came through the doors, the stunning repetition of the event itself—perhaps they would understand how high the stakes were.
I suppose I was making the assumption that what so motivated me—the reality of abortion—would also inspire them. But their personal radicalization, like mine, had to be motivated from within.
AFTER THE POLITICAL AWAKENING I experienced with the passage of the Hyde Amendment, I became absorbed with finding new ways to right the systemic wrongs that were now so clearly visible to me. I had long been a fixture at HIP meetings and dinners, attending them with Marty in the role of his talented colleague. Armed with the confidence of my growing political energy, I turned my attention to HIP itself and the enormous opportunity it presented.
I was in a position to reach out to potentially thousands of women, thousands beyond those who came to my clinic for abortions. The majority of HIP’s subscribers were women making health care decisions for their entire families. If the powers that be refused to educate people, HIP could take on the role. Strategically, it would serve my vision and would also benefit HIP. By presenting itself as an advocate for women’s health, HIP would be at the forefront of a changing medical landscape, which would ultimately result in more subscribers; in other words, it was good for business.
At a social dinner with the president of HIP and Marty, I took the opportunity to pitch my program. First of all, why were there no gynecological evening hours? Women worked, and they needed that flexibility. And what about birth control? All HIP gynecological staff should be trained to counsel patients on their options. Finally, I proposed we have a conference with a combination of academic and political speakers and workshops to bring these issues to the forefront.
The potential publicity benefits for HIP were obvious, and a meeting was arranged for me with Julius Horowitz, the head of HIP’s public relations department, to begin the planning.
We decided on a combination of heavy-hitting speakers and educational workshops to highlight the themes of women as medical consumers and decision makers within the family and society. New York City mayor Abraham Beame was to be the keynote speaker, introduced by Marty. I would moderate a panel that included Bella Abzug speaking on “Women as Leaders” and Barbara Ehrenreich on the “Current Status of Women.” It would be a historic event, an entire conference on women’s health—a field that was hardly recognized.
First Bella spoke, in her ubiquitous hat, full throated and powerful, bringing the crowd to its feet. Here, for the first time, was the presence of a woman I wanted to emulate.
Everyone was high on the energy in the room when I took the podium for my speech, “Challenging the Medical Mystique: How Can Consumers Influence the Health Care Delivery System?” HIP physicians, politicians, patients, doctors from all over the country, press, and college students and professors filled the hotel’s main ballroom almost five hundred strong. Standing there, looking out over the crowd, feeling all the eyes on me in curiosity and expectation, I was at home. I felt I’d been destined for this reality.8
MARTY HAD BEEN SUPPORTIVE of my desire to organize the panel, advising me on logistics and helping me see it through to execution. He saw me as his student, his rising star, and I remember the sight of him beaming proudly from the audience when I stepped down from the podium at the conclusion of my speech. He was moving in powerful political circles and was drawing me into them, too. Everything that I did reflected back on him, and the light was growing to be very powerful. I was not just a midlife crisis, not just a trophy girlfriend, but his protégé.
After the stimulation of putting on the forum and the sublime satisfaction that came with its success, I realized that while I appreciated his professional support, it alone was no longer adequate. I was beginning to lose patience with our affair. Stealing moments in Marty’s office upstairs, sneaking off to have lunch dates, pretending to be merely work colleagues at HIP functions—it was all starting to feel stale. On Saturday nights and holidays, his time with his family, I was always in second place, alone. It had taken a couple of years for the glow of the romance to wear off and the reality of the powerlessness of my situation to fully hit me, but when it did, the desire—no, the demand—for him to leave his wife became the obsession of our relationship.
Marty also felt the confines of the adulterous cage. We had tumultuous, raging, exhausting arguments about whether he would leave his wife. One weekend he took me to New Orleans, telling his wife he was going to a conference. We stayed at the Royal Sonesta in a suite with rooms overlooking Bourbon Street. There was jazz pouring from every open doorway and dancing in the streets. I whimsically ordered two dozen white roses to put in the bedroom. But the romance quickly wore off, as it was apt to do then, and our lovely evening disintegrated into a screaming match on the street.
He finally had the realization that leaving his wife would mean leaving the prison of a life he no longer wanted. He could start over, show everyone that he was made of more than the small family practice and the constricting family ties that had so long defined him. He could show all the people who’d refused to let him into their WASP schools or country clubs that Marty Gold could have power and influence. And I would be the catalyst of his arrival.
We had our first public coming out as a couple at the annual LaGuardia Dinner Dance, the HIP gala dinner held every year at the Plaza Hotel. Wearing a long, light, thin-strapped black dress, I walked imperiously down the grand staircase in front of all the HIP physicians and board of directors. Someone dropped a plate of hors d’oeuvres when we entered. A couple came over and asked Marty, “Where’s Bernice?” I answered for him, “He’s not with her anymore. He’s living with me.” I loved the transgression and the power of that act, even though I suffered from needing the approbation of others.
I learned early in life that there is a heavy price for transgression . Marty had been known as a pillar of the community, a loving family man. Now the wives of his married friends prohibited their husbands from having social communication with him. And I was not a free woman anymore; I was living with a man more than twice my age, and my single friends slowly moved away from me. It was impossible to socialize with my coupled friends, too; Marty had nothing in common with their men, who were so much younger and just starting their careers. As a result, we lived relatively hermetic personal lives.
Our political lives, filled with dinners, parties, and dances, were always quite another matter. There were often formal events in major New York City hotels, and I was always seated with Marty at or near the main table. At one dinner, I met Jimmy Carter and heard him speak seriously about the threat of nuclear annihilation; at another, I chatted with Walter Mondale about health care. During a Bicentennial gathering in 1976 held by Jack Bigel, the top financial and bargaining adviser to many of New York City’s most powerful labor unions, Marty and I watched Operation Sail’s Parade of Ships on the Hudson from the balcony of his office building overlooking the New York harbor. After speaking with Bigel I overheard him tell someone, “That girl wants a career more than anyone else I know.”
Many of the events we attended were surreal, male-run affairs where misogyny and traditional roles were heavily on display. I would always dress very carefully for these occasions, choosing something from my collection of glamorous gowns, aware that it was not only my mind that was being presented. I had fun playing along, bantering with the men and engaging in their discussions.
That changed at a dinner Marty hosted to pitch a new idea for a business venture. Someone had the absurd idea to hand out soft plastic vaginas as party favors. The men passed them around, laughing and fumbling to fill them with dollar bills. Shocked, I made a disparaging remark, got up from the table, and stalked out. At another event, women dressed in bikinis and fur coats performed on roller skates during dessert. I stomped out of that one loudly, too, saying that they were treating women like animals and animals like commodities. Marty and I would have major rows after these scenes. I couldn’t believe he sat there and laughed at the disgusting behavior displayed by his colleagues. But to him, it was a joke. Men were men, and I was being a poor sport.
Our happier times were those we spent alone with each other, away from the politics, where we could allow our minds to drift from Flushing Women’s and HIP. Marty had finally served his wife with divorce papers, and we planned to marry as soon as it was finalized. Furious, she’d resolved to make this as difficult as possible, and decided to countersue, resulting in a very long, very expensive divorce. But we knew in the end we’d be together, and we were able to let ourselves be almost carefree when we took our weekend excursions to the countryside of New York and Connecticut, exploring romantic country inns, antique shops, and restaurants.
I had always loved the mountains and forests a couple of hours north of Manhattan. One leisurely trip took us across the Bear Mountain Bridge fifty miles outside of the city to Garrison on Hudson, a quaint Revolutionary War-era town.
We decided to purchase a house there, a 1960s, four-thousand-square-foot wooden structure with an indoor pool and a retractable glass roof, on six acres of mountainous land with a pond. Having only $25,000 between us as a result of the divorce settlement, Marty had to borrow $5,000 from my mother for the down payment on the mortgage.
Our home’s beauty was internal and quiet. I especially loved the pond, where I put up a large log to sit on, creating a kind of “green study” like the one Dostoyevsky was said to inhabit when he wrote. And there was one more touch that truly made Garrison feel like home: now that I had some land, I could finally act on my lifelong desire for animal companionship. I adopted a cat and two adorable Akita puppies, the first of many animals who would come to live with me there.
And so, alone together at our house in the country, Marty and I continued to explore the contours of our relationship. Life outside the city made our age difference feel more pronounced, and Marty, particularly sensitive to this, made efforts to show me he was still physically and emotionally youthful enough to keep up with me. Thinking back now, our foiled attempts to participate in youthful activities together underscored the fact that ultimately we had few things in common apart from our love. He was operating in another world, an older world where the roles of men and women were clearly delineated, and I was poised to tear down any barrier I encountered. There were dozens of reasons to break off our ties, and dozens of opportunities to do so.
And yet, in his way, Marty was as radically transgressive as I was. We had a core connection that ran true and deep and would prove to be unbreakable. Our continued partnership was in part practical. Flushing Women’s was often under attack from hostile forces at HIP who wanted to undermine Marty’s power base and close the clinic. I was often the surrogate target for these attacks. Marty had to be the protector, coming to my defense, sometimes to his political detriment.
But Marty’s belief in Flushing Women’s and the new ideas I brought to the project ultimately trumped his concerns about popularity and politics. He was my ally. It was a revolutionary time in health care and women’s rights, and we were on the front lines. The romance of it all still held me fast to our relationship.
THE SUCCESS OF THE Women’s Health Forum had left me craving a grander stage. Marty convinced the board that with the right platform I could garner a lot of positive publicity for HIP, and despite our philosophical differences, they were smart enough to see that a young, attractive, intelligent spokesperson for the fresh ideas discussed at the forum would put them on the cutting edge of health care. They set me up with Howard Rubenstein, HIP’s public relations guru, with the goal to evolve the concept of Patient Power to the level of a campaign that I could present to the public.
My account representative at Rubenstein’s firm wanted to start by booking me on a television talk show about breast cancer. There was just one problem: I knew absolutely nothing about it. I told him I wouldn’t do it.
I did, however, begin to read about breast cancer, the rate of which was extremely high on Long Island—very close to the population of women I served at my clinic. A short time later Dr. Gene Thiessen, a well-known breast surgeon, came to see me at Flushing Women’s.
This handsome man who looked as though he’d stepped out of a Ralph Lauren photo shoot swept into my office and told me he’d heard about Patient Power. He wondered if I would be interested in collaborating with him on a new program for breast cancer patients. In the seventies, when a suspicious lump was found in a woman’s breast she was asked to sign a consent form for a mastectomy before she even knew if her tumor was malignant. She was then placed under general anesthesia for the biopsy, and the questionable mass was sent to the hospital lab while the patient remained asleep on the operating room table. If a malignancy was discovered by the pathologist, the surgeon removed the offending breast. The severity of this protocol obviously frightened women away from going to the doctor for tests. Dr. Thiessen wanted to initiate a project designed to make women more aware of their treatment options and prevent unnecessary mastectomies.
I was impressed. Here was a surgeon who cared about women’s psychological well-being and who was trying to find a way to ease their way through the bureaucracy of cancer. Patient Power could surely be beneficial to these women.
I consulted with Dr. Philip Strax, a well-known radiologist who pioneered the use of prophylactic mammography to screen for early breast cancer. He had recently completed his groundbreaking study on thousands of HIP women. After meeting with him to organize a workable program, I founded STOP: the Second Treatment Option Program. Flushing Women’s became the first outpatient medical center to biopsy patients under local anesthesia outside of a hospital. Through our program we were able to put a stop to the practice of doing a mastectomy without the patient’s consent while she was on the table under anesthesia. It would be decades before this would become routine practice.
Dr. Thiessen later founded the Self Help Action Rap Experience (SHARE), a support group for survivors of breast and ovarian cancer to which I donated meeting space at Flushing Women’s. With its focus on peer option counseling, full disclosure, and separating the biopsy from the mastectomy,
SHARE fell within the paradigm of Patient Power that I created for women having abortions.
With the implementation of these programs and the expertise of the Rubenstein agency, media interest in Flushing Women’s began to escalate. Everyone was talking about women’s health. At first journalists were interested in SHARE and STOP, flooding Flushing Women’s with positive press coverage on the tenets of Patient Power. Soon, they became interested in me. It was gratifying to see journalists encouraging people to take the concept of educating women as patients seriously—and exhilarating to find myself becoming a public figure.
MARTY WAS AT the height of his own career as chairman of the HIP Medical Group Council. The other New York abortion providers, male physicians who ran clinics in Manhattan, had more in common with Marty than myself, and our relationship was far too competitive to allow collegial sharing. My isolation was suddenly broken one afternoon in 1976 when I received a packet in the mail from the National Association of Abortion Facilities (NAAF). It contained a questionnaire for abortion providers and an invitation to a national meeting they’d be holding that spring. I devoured NAAF’s agenda and long list of invitees. There were so many of us out there—enough to have an association!
Over three hundred representatives from abortion facilities all across the country traveled to Cleveland, Ohio, for a meeting that May. The impetus for the gathering was to adopt a NAAF constitution. Their early literature echoed my own priorities. It seemed that I had finally found my peers.
I listened attentively as the chair called the first order of business, the approval of NAAF’s proposed mission statement. I was immediately put off by the first line: “The purpose of this organization is to promote the interests of abortion facilities.”
What about the interests of women? I raised my hand and stood with what was the first objection of the organized session, stating that the purpose of the organization should be to serve the interests of abortion patients.
It was decided that my statement should be incorporated into the founding documents of NAAF. Later that day, people approached me to say that they’d been thinking the same thing, and they were happy that I was the one who’d had the courage to say it.
After the first day, I had noticed that there appeared to be a geographical distinction among the attendees. Many of the New York and New Jersey providers had been operating since the early seventies, before Roe. As licensed facilities we commiserated about the difficulties of regulatory compliance. Many of the “clinics” in other states were in reality unlicensed, private doctor’s offices. They tended to be headed by white, male Christians who had their own agendas.
A few months later the time came for the first election of the NAAF board of directors and officers, for which I had been nominated for vice president. But after attending a few meetings, participating in loads of discussions, and hearing the observations of others, I and my East Coast “supporters” came to feel that the organization would be better served if I were its president. A couple of nights before the election I was approached by Mel Cohen, Iggy DeBlasi, and a few others with the idea of challenging the election from the floor. I was conflicted. Of course I wanted to be president, but the notion that this coup could be unsuccessful filled me with anxiety. When they insisted our numbers were strong enough that there was a good chance I’d win, I made the decision to go forward.
I was elected president by just a few votes, but I lost some credibility and gained the resentment of a large part of NAAF. I realized there was not enough widespread support to solidify my power. The political lessons were hard. Mel Cohen had told me before the coup that he expected to be named chair of the Standards Committee if I became president. I easily agreed to the deal, focusing only on ensuring that I would get elected. But now I was forced to come to terms with the fact that the power I had gained was limited by the promises I had made to achieve it.
I shook off the negativity that trailed me after the election and moved forward aggressively, sending out meeting notices, working to form committees, and starting a NAAF publication called January’s Child. A few months later, NAAF combined with the National Abortion Council (NAC) to become the National Abortion Federation (NAF), of which I was elected the first secretary. By this time, I knew enough to accept my place in the power structure and wait my turn.
MY INVOLVEMENT in these organizations was also my official entry into the world of feminism. Some of those with whom I formed political alliances would go on to become lifelong friends. But as I worked with other members of NAF to write a pamphlet titled “How To Choose an Abortion Facility” using the tenets of Patient Power as a guide, I discovered that many early feminists active in the pro-choice movement had values quite different from mine. They were medical anarchists who wanted to deinstitutionalize abortion entirely, to wrest the power from the male medical establishment into what they called the “Self-Help Movement”—essentially women’s health care without doctors. Carol Downer was a leader of the movement, proselytizing self-examination and menstrual extraction (ME)9 and advocating the idea that women’s continuing struggle against male oppression demanded that they find ways to help themselves.
This challenge to male medical authority resonated powerfully with me—in some ways, it aligned with Patient Power—but I ultimately viewed these feminists’ thinking as separatist. It would essentially place women in ghettos. Why was it necessary for women to forgo all the clinical and technological advances that were part of the medical research and clinical establishment for protective or political purposes? Why should we adopt minimalist standards as a defense against the medical industrial complex, when we could find a way to incorporate it into our paradigms and use it to our benefit?
They were also ignoring the fact that abortion was acting as a catalyst for the development and growth of ambulatory, or outpatient, care in the United States. According to the Guttmacher Institute, first trimester abortion was and is the safest outpatient procedure that can be performed; fewer than 0.3 percent of abortion patients experience a complication requiring hospitalization. Abortion facilities were modeling a concept of service that combined basic education and informed consent with expert medical technology—treatment modalities that could be used for other surgical procedures like sterilizations, colonoscopies, breast biopsies, and orthopedic procedures. A great deal of minor surgical procedures could be done outside of hospitals at 50 percent of the cost. Abortion was changing medicine.
I did support the movement for trained nurse midwives to perform first trimester abortions, but I wasn’t comfortable with the practice of menstrual extractions. Because the MEs were conducted before a woman’s pregnancy could be confirmed by a blood or urine test, there was a 50 percent chance that the MEs were entirely unnecessary, potentially resulting in infections. I did not see ME as an innocuous procedure.
The most radical feminists believed that abortion, and all medical procedures, should be free of government involvement and free of cost. This struck me as wildly naive. How did they expect providers to pay for equipment, staff, and doctors? I was charging a minimal amount for the procedure, but I had to charge something. Yet the idea of making money through providing abortions was deeply antithetical to these feminists. Many had a problem with my way of operating, believing it impossible to be a feminist and a capitalist at the same time.
AS I BECAME more involved in defining the pro-choice movement, I grew increasingly aware of much greater challenges than these internal disagreements about how to make abortion available to women. From this vantage point I could see that the movement for women’s rights had enjoyed a brief period of public popularity in the early seventies that eventually led to the legalization of abortion and granted us the temporary luxury of debating the finer points of providing abortions. But before women really had the chance to move into their power, the public discussion began to move toward the construction of simplistic, judgmental abortion narratives designed to put women back in their place.
Two sides emerged, as if they were mutually exclusive. There was either the “right to life” or the “right to choose.” Women couldn’t help but internalize these narrow ways of seeing the issue and themselves accordingly. Abortion was a woman’s right, both legally, with the passage of Roe v. Wade, and as a matter of biology, equality, and justice. But each woman’s acceptance of her natural right was challenged and threatened by a Greek chorus screaming “murderer” at her for exercising that power.
This bifurcation was expressed eloquently by a young patient I once had. She was only nineteen years old. It was her first abortion, and she had come alone. “It was such a difficult choice for me to make,” she said softly. “The mother in me wanted so much to have it, to love it, to see it grow... The other part knew that it was impossible.”
The “other part”? For so many women, choosing abortion created this other—the one who would never have chosen this path, the good mother sitting in judgment and separating herself from the one choosing abortion. It was a formula for amplifying guilt and regret.
The growing political debate on abortion in the seventies took this reduction of women’s self-identity even further by positioning the woman and fetus as adversaries. There was no way that one could advocate for both; if you believed in the right to life of the fetus, then the woman, by definition, had to come second. And if you believed in a woman’s right to choose, the fetus took second place.
The pro-choice movement had to find a way to navigate these narratives. The simplest option was to negate the claims of the opposition. And so many pro-choice advocates claimed the fetus was not alive, and that abortion was not the act of terminating it. They chose to de-personalize the fetus, to see it as amorphous residue, to say that it was “only blood and tissue.”
What I saw running through those vacuum tubes when I first started my work was only blood and tissue, unformed and messy. It was easy to imagine the fetus as a bunch of cells that one could define as one wished. But even in the beginning I had an inkling that this mentality was the easy way out, that it didn’t go far enough to do justice to the experience of abortion.
The anti-choice movement claimed that if women knew what abortion really was, if only the providers had told them the truth, they would never have killed their babies. Organizations such as Women Exploited By Abortion (WEBA) and American Victims of Abortion (AVA) were composed entirely of women who’d had abortions, but had “seen the light” and become anti-choice activists.
But women did know the truth, just as I knew it, deep down, when I allowed myself to recognize it. Mothers saw the sonogram pictures, knew that sound bites assuring them that abortion was no different from any other benign outpatient surgery were false—knew that, as the antis say, “abortion stops a beating heart.” They knew that abortion was the termination of potential life.
They knew it, but my patients who made the choice to have an abortion also knew they were making the right one, a decision so vital it was worth stopping that heart. Sometimes they felt a deep sense of the loss of possibility. In the majority of cases, they felt a deep sense of relief and the power that comes from taking responsibility for one’s own life.
There is a reason that women have been having abortions, legal or not, for all of history. The act of choosing whether or not to have a child is often an act of love, and always an act of survival. “Choice” is sometimes not a choice at all. It is an outcome determined by the economic, physical, sociological, and political factors that surround women and move them toward the only action that allows them to survive at that point in their lives. Survival can sometimes be a woman’s act of staying alive, but it can also be her act of refusing to put what will become an impossible burden on her shoulders.
At times this reality would move me profoundly as I sat opposite the women I counseled prior to their abortions, acutely aware of the potential lives growing inside them that would soon cease to exist. I began to think critically, to come to terms with what was going on. Each time I did that, I came out of that process more committed than before. I had no conception, either religious or philosophical, that “life was sacred.”
My bond with my patients grew stronger as I held their hands and watched the blood flow through the tubes into the suction machine. I was aware of fetal existence, the meaning of that blood and tissue. But it never overshadowed the woman. To me, there was never a question about who should survive.
The pro-choice movement marched then, as it does now, under the banner of choice—of human and civil rights—that is always more nuanced than the pure white banner of “innocence” and “life” carried by our opponents. But attempting to simplify the issue, refusing to look at the consequences or true nature of abortion—the blood, the observable parts of the fetus, the irrevocable endings, the power of deciding whether or not to bring a new life into this world—reduces our capacity to register the depth of this issue and disrespects the profound political and social struggle women’s choices engender in our society.
Asking women to deny this truth, putting them in a defensive position, also perpetuates the shame, embarrassment, and ambivalence that the antis want women to feel. “They have abortions for the wrong reasons. They want to look good in bathing suits. They want to get their PhDs,” the antis have always said. Pro-choicers join in this chorus with sentiments like, “I wouldn’t have an abortion if I were married,” or “Why did she wait so long, until she was four or five months pregnant? If I were in the same set of circumstances, I would not have made her choice.”
But when “they” becomes “me”—when women are faced with the decision personally and choose to have an abortion—they are able to justify their own reasons as sufficient. When I started to notice this phenomenon I named it the “rape, incest, or me” position. It places undue importance on women’s reasons for making their choices, leaving room for the argument that abortion is wrong because women’s reasons for having abortions are wrong.
This position betrays a lack of commitment to reproductive freedom. When an individual makes a choice, it is the act of making it, the active will and power of the choosing itself, that has unconditional value. At its core, the issue is about separating the chooser from the choice. The woman is the only active agent in this decision-making process—not the state, the court, or any political body. In a world where men have historically defined criminal, ethical, moral, and religious aspects of communal and political life, a woman choosing abortion is exercising her right to decide what happens to her body, her life, and her family.
I remember an exercise given to abortion providers at a conference I attended. “If you had only one abortion left to give,” we were asked, “to whom would you give it? A woman with HIV, a twelve-year-old, a forty-eight-year-old, a woman who was raped, a woman who wants to finish her PhD? What about the woman who just doesn’t want a baby?” The catch, of course, is that all of these reasons for making the choice to have an abortion are equally valid. Why a woman makes a decision to have an abortion is not the deciding issue. She is making the choice that is right for her, and that is what matters.
If the personal is the political, as the feminist slogan goes, then abortion is the ultimate political act. It is not politics, but necessity that drives women’s choices, necessity that forms the political and theoretical foundation for the right to choose. To withhold that right for any reason is to deny women a piece of their humanity.
In the late seventies the pro-choice movement faced the same political question it faces today. How can we create a new narrative in which choice and reproductive freedom are the theory, and abortion is the practice? How can we transcend limiting narratives and start to identify with all women struggling to make choices, defending them rather than resisting that power through guilt and denial? How do we create a world where women can have abortions without apology?
IN 1978, after years of operating in the cramped basement where Flushing Women’s Medical Center got its start, I realized I needed more space to put Patient Power into practice. I wanted to build a facility that would serve as a model for other clinics around the country—perhaps around the world.
Flushing Women’s had grown to service over one hundred patients per week. We had enough financial stability to afford a rent that was not subsidized, agree to a multiyear lease, and assume the responsibilities of the projected costs that would come with designing a new space and hiring additional employees. The hard part was getting the Department of Health’s approval for a new location—and of course, convincing Marty and Dr. Orris that the project could succeed on its own terms.
In those years, finding landlords who would agree to rent space to an abortion clinic was not nearly as difficult as it is today. I found a seven-thousand-square-foot commercial space in a large building on Queens Boulevard owned by Samuel LeFrak. Marty was successful in getting HIP to countersign a twenty-year lease on the property, and soon I was ready to design, furnish, and open my own clinic.
My goal was to create the most noninstitutional environment I could imagine. I chose large, comfortable, purple and red chairs where patients could wait with their friends or significant others. The chairs would have been more fitting at a discotheque, but the patients loved them. The counseling rooms were warm and cheerfully decorated, and I chose not to furnish them with desks, to minimize the power differential between patients and providers. The ambulatory patient lounge had a kitchenette where post-surgery refreshments were prepared, and there was a dressing room where the patients could take their time before leaving the clinic. I filled the walls with artwork featuring powerful women, calm landscapes, and political posters.
Inside the examining rooms, patients received navy tailored smocks instead of gappy paper gowns so they would not feel so naked and vulnerable. I had warming trays for the speculums built into the exam tables, knowing that there is nothing quite as shocking and uncomfortable as the invasion of an ice-cold metal speculum.
My new clinic needed a name, something that embodied the spirit of the facility I was endeavoring to create. I held a competition among the staff to choose one. We collectively agreed that the best name would be simple. Choices. Wanting the letters to hold special meaning, I turned it into an acronym: Creative Health Organization for Information Counseling and Educational Services. I designed a logo to go with the name, a combination of the caduceus and the mathematical symbol for infinity, a visual expression of the myriad of medical choices my clinic would offer.
With the opening of its doors, Choices immediately garnered a great deal of favorable press. I became a person of interest and fascination. “What is abortion, really?” people would ask. “How much does it hurt?” “What is wrong with these women?” “Do you really see the fetus?” Choices became a teaching tool, a community space, a place where every question was welcome. A few friends and family members volunteered at the clinic. My mother came in a few times, handing out tea and cookies to patients in the recovery room.
I set up a gynecological and family planning practice and offered IUD insertions, diaphragms, and oral contraceptives. Patients who wanted to keep their pregnancies were welcome to take part in our prenatal program, and we delivered babies at our affiliated hospitals.
Perhaps the most unique aspect of Choices—the change that fully embodied my vision of Patient Power—was the role of counselors. I began calling them facilitators instead, feeling that the word “counselor” implicitly designated that person as having power to change or manipulate the counselee. The word “facilitate” means to assist, to make easier, to guide the way. At Choices patients weren’t forced into the passive role of medical victims. My facilitators were trained in family planning and abortion care and they functioned as a support system.
While degrees and credentials are factors in professional ability or expertise, the most important qualities that any individual in the health field can have are empathy, openness, and the ability to create a positive response within another individual—what I came to call “active loving.” The sessions at Choices were structured more like warm conversations than anything else. Medical information was given, consents were signed, abortion and other options were discussed, but all in an easy atmosphere where a person felt safe and autonomous till the end of her stay. There was never coercion; the existence of our prenatal program said that louder than any voice could. We facilitated each woman’s experience within her own reality.
ON JANUARY 7, 1979 my name was listed in a CUNY insert in the New York Times as a distinguished alumnus along with Sylvia Porter, Ruby Dee, Irving Kristol, Bernard Malamud, and two Nobel prize winners: Robert Hofstadter and Rosalyn Yalow. Articles in the New York Times, Newsday, Women’s Week, the Star, and the New York Daily News lauded the layout of Choices, the workshops I set up, and my ideas about Patient Power.
But my work was being noticed by others besides feminists and liberal journalists. I remember being in a plane coming back from a pro-choice meeting and learning, as we landed, that there had been demonstrators in front of Choices for the first time. I was amazed, frightened, and enraged; I suppose in some way I’d thought all that positive press would inoculate me, that no one would touch me if the New York Times was behind me. But like all abortion providers, I soon found I had as many enemies as I had friends.