Demonstrations for and against the question of abortion are going on all this week outside a clinic in Germantown, Maryland, in the suburbs of Washington, DC. Opponents of abortion have also broadened their attack to seek greater restrictions on sex education and reproductive health. They have particularly targeted government funding and services contracts for the medical charity Planned Parenthood. As that plays out, the BMJ spoke with a physician at the traditional epicentre of the US abortion wars.
Shouts of “Mila, Mila, don’t kill any babies!” greeted Dr Mila Lee Means as she stepped from the front door of her home towards the car. The 54 year old physician was on her way to the office in Wichita, Kansas where she practises medicine and one day hopes to add abortion services as part of her solo practice.
Pro-life organisers are using harassment and changes in the law to prevent that day from ever arriving.
Put your finger on the centre of a map of the United States and it is likely to hit Wichita. The metropolitan region of 630,000 lies in the wheat belt and is a centre for small aircraft manufacturing as the home of Cessna, Beechcraft, and Learjet.
It also is the epicentre of the struggle for abortion rights in the US. Dr George Tiller ran one of only three clinics in the entire country that performed “late-term” (post 21 weeks) abortions. The pro-life group Operation Rescue staged daily protests outside the clinic for years on end.
Tiller’s clinic was firebombed in 1986. An anti-abortion fanatic shot him in both arms in an assassination attempt in 1996. Another shot Tiller through the head while he was attending church, and he died instantly on 31 May 2009.
Mila Means trained with Tiller in the 1980s. “A year after he was murdered, nobody had stepped up to the plate to offer services in Wichita, and that is when I started looking into maybe becoming a provider,” she told the BMJ during a recent phone conversation.
Some of her patients had asked where they might go for an abortion. “They didn’t want their partner to know they were pregnant and simply couldn’t travel the three hours [to the nearest available provider] I was seeing that the services were not available, and that was changing women’s lives here in Wichita. I decided to go ahead and get involved.”
A year ago she purchased Tiller’s equipment used for early but not late-term abortions.
Opposition arose almost immediately. The landlord sued to prevent her from providing abortion services at the office, and she agreed to seek another location. But Operation Rescue learned of each potential site and harassed the owners who might rent to her.
“They would visit the people’s [owner’s] home at night. They even vandalised one of the buildings; they painted in red letters ‘wake’ across the front of the white building. Those people really did want to lease to us, but they got too scared to,” Means said.
She now sees that delay as a blessing because abortion opponents pushed a law through the Kansas state legislature that imposes onerous restrictions on providing those services.
“The regulations say it has to be a minor surgical centre with all of the regulations for that. They regulate the size of the janitor closet; it has to be 8 foot by 8 foot. You have to have all of the resuscitative equipment necessary for infants and children even though they would never be using the facility. I think that we would even have to have a blood bank.”
She began training on procedures to deliver early term abortions at another regional clinic. By the second day protesters had traced her license plate number and greeted her with, “Mila, why did you travel 300 miles to kill babies?”
The ongoing harassment has made her “definitely more aware of security issues.” Organisers who included her on a church panel discussion of abortion spent $700 on security because of it, while others have simply dropped discussion of the topic because they cannot afford to provide adequate security.
Means praises the local police, the FBI, and other law enforcement agencies for their diligence. They provided training to her office staff “on how to protect themselves” soon after the initial protests erupted. And they have been responsive whenever other demonstrations arose.
“There is a real awareness in the police community that maybe they dropped the ball when Tiller was murdered and so they really want to avoid that situation again.” Means says, “They are being really responsive.”
The court system gets a lower grade. “I was involved with trying to get an injunction against one woman who sent threatening letters stating that everyone would know where I was, what vehicle I drove, and some day there would be explosives under the car; very specific threatening things that our justices decided did not constitute threat but were just a form of free speech.”
Local and state judges are elected in Kansas. Means notes that all of the local judges “make donations to the organisation Kansas for Life, which is another one of the anti-abortion protest organisations here.” She believes that ideological commitment by the judges compromises her ability to get a fair hearing.
A few of her fellow physicians in the local community have been quietly supportive, but they do not want to be publicly identified with Means.
A handful of patients with pro-life views have left her practice over the last year, while others with those views have chosen to stay because of the quality of care. And the visibility has attracted new patients who appreciate her stand. Means adds, “I had a patient yesterday who said that since I was pro-choice I wouldn’t be judgmental about other areas of her life.”
The protests and harassment still unnerve Mila Means a year after they began, but they have not deterred her. They have served only to strengthen her resolve.
“I have financially and personally sacrificed to continue to be in this position, and I am pursuing the ability to provide abortions because I really believe that this is a right for women and that, regardless of the costs, we need to work toward reinstating women’s rights in our area of Kansas,” she says.
Bob Roehr is a biomedical journalist based in Washington, DC, and a regular contributor to the BMJ.