The murder of Dr. George Tiller, a family physician and one of the nation's only providers of late-term abortions, has deepened the anxiety and apprehension of physicians who provide family planning services, especially abortion, according to providers and physicians' organizations.
There is nothing new about the fear that pervades abortion services in the United States, with Dr. Tiller's murder only the latest in a long string of murders, attempted murders, and bombings. Dr. Tiller himself had been shot in both arms in 1993, and his clinic in Wichita, Kan., had been bombed in 1985.
But “when there is a pro-choice [presidential] administration, the fringe violence movement becomes more desperate and acts out,” Dr. Nancy L. Stanwood, a board member of Physicians for Reproductive Choice and Health, said in an interview.
“We knew violence would probably go up. Of course, we are horrified that a murderous act happened so quickly,” said Dr. Stanwood of the department of obstetrics and gynecology at the University of Rochester (N.Y.).
The loss of Dr. Tiller, who Dr. Stanwood described as a careful, compassionate physician, poses a real blow to providers of prenatal care who depended on him for referral of difficult and tragic cases, she said.
“We've all had that dreadful ultrasound result. We all do screening amniocentesis, [chorionic villus sampling], and anatomic ultrasounds, and we know we're going to find terrible things now and then. We could refer patients to him and know he was a colleague with the medical skill and compassion to help these patients at a time of desperate need,” she said.
Dr. Stanwood added that an increase in the number of residency programs and fellowships that train physicians in safe abortion procedures gives her hope that intimidation will not further undermine the availability of family planning services to American women.
But a study by the National Abortion Federation and the American College of Obstetricians and Gynecologists found that antiabortion harassment and violence has been a top contributor to a precipitous decline in the number of abortion providers over the years.
Social stigma and marginalization, professional isolation, and peer pressure also factor into the decline, the study found.
Echoing Dr. Stanwood's predictions, many observers believe that extremist antiabortion rhetoric, as well as more mainstream protests, have escalated in the past few months, following the election of President Obama, who advocated abortion rights during his campaign.
Abortion clinics reported a sharp increase in the number of harassing telephone calls they received during the first 4 months of Mr. Obama's presidency, 1,401, compared with 396 during the last full year of George W. Bush's presidency.
Just weeks before the murder, buses carrying physicians to ACOG's annual meeting in Chicago negotiated a daily gauntlet of protesters lining the route, each displaying oversized, gruesome photographs of purported aborted fetuses. Billboard trucks circled the convention hotels. “Why do you hate babies, doctor?” one sign read.
At the ACOG meeting, researchers from the University of California, San Francisco, reported on findings from interviews with 30 ob.gyns. who had received abortion training at four residency programs 5-10 years previously.
The surveyed physicians detailed a highly adversarial culture surrounding abortion services, identifying professional barriers that included threats from other physicians and administrative hurdles, reported Dr. Jody Steinauer, Lori R. Freedman, Ph.D., and researcher Mitchel Hawkins.
Providing such services “is a great way to make no friends amongst the ob.gyns. and to have no family practice docs refer to you,” said one physician interviewed during the study.
One ob.gyn. recalled a partner asking him to sign a contract with a group that said, “I would not do terminations on certain genetic problems, like trisomy 21.”
Several others received direct intimidation. One potential employer told a candidate for an ob.gyn. position, “If I ever find out you did elective abortions … you'll never practice in [this state] again.”
Against this backdrop of nonviolent pressure, Dr. Tiller's murder may be an anomaly or may signal a return to violence that reached new heights during the 1990s, when President Clinton, another pro-choice advocate, was in office.
In all, there have been 8 murders and 17 attempted murders of physicians and allied health care workers involved in abortion services since 1977, according to statistics from the National Abortion Federation, a membership organization of abortion providers.
Professional organizations reacted swiftly to the murder in Kansas.
“There is no excuse, no explanation, and no justification for this brutal slaying of a courageous and honorable physician who provided safe and legal reproductive health care to women who otherwise might not have received it,” ACOG said in a statement. The statement called the killing “chilling and deeply disturbing,” noting that it occurred as the nation's leaders are searching for a “middle ground” on the topic of abortion. “There is no middle ground when it comes to violence of this nature.”