My first awareness of anti-choice harassment and violence came in 1981 when I was in the fourth grade. My best friend’s father had his tires slashed. He was an obstetrician/gynecologist in a large metropolitan area, and he provided abortions. I don’t remember my mother or friend explaining what abortions were, or why he had his tires slashed. I was simply aware that women had them, doctors did them, and many people who wanted them stopped used violence to convey their message.

Today, as a physician who provides abortions, I worry about the growing number of state-level restrictions on abortion. In addition to imposing unnecessary and damaging limits and requirements on women’s medical care, do these anti-choice laws contribute to a social climate in which it is acceptable to terrorize me, my colleagues, and our patients?

Harassment and Vandalism Linked to Anti-Choice Laws

As a first step toward determining the connection, if any, between a state’s anti-reproductive-health-care laws and acts meant to impede or stop abortion care, Mitchell Creinin, MD, Kristin Schumacher, PhD, and I conducted a study. The results are forthcoming in the journal Contraception. We found a statistical association between the severity of a state’s laws restricting abortion and contraception and the incidence of harassment that targets abortion providers and their patients. In other words, facilities that provide abortions in states with heavy restrictions on contraception and abortion experience more harassment than do their counterparts in states whose laws tend not to interfere in patients’ decisions about birth control and abortion.

Harassment includes but isn’t limited to anti-choice protesters videotaping or photographing patients, approaching or blocking cars, recording patients’ license plates, making threatening phone calls, filing frivolous lawsuits, creating noise disturbances, forming clinic blockades, and posting patient or staff information on the Internet. We discovered a similar association between a state’s restrictions on abortion and contraception and the occurrence of “minor vandalism” at abortion clinics: broken windows, nails or oil on driveways, graffiti, garbage tampering, and glue in locks.

When state governments pass needless restrictions on reproductive health care, they can be perceived as giving anti-choice extremists implicit permission to wreak havoc on abortion providers and the women they serve. Our legislators must reckon with the consequences of the laws they make, even if those repercussions are unintended.

Our Methods

For our study, we used responses from a July 2010 Feminist Majority Foundation survey of 357 abortion providers or facilities that provide abortion in 50 states to determine their experiences of anti-abortion activity. We grouped their responses and analyzed them in relation to NARAL Pro-Choice America’s 2011 grading of state laws in the United States (A, B, C, D, and F) as they relate to restrictions on contraception and abortion services.

Our analysis revealed that abortion providers in states graded C, D, or F on NARAL’s restrictiveness scale—e.g., Wisconsin (C-), Florida (D), or Texas (F)—were much more likely than providers elsewhere to be targets of harassment and minor vandalism. States with a grade of A, like Oregon and New Mexico, were less likely to be targets. Our study is silent on the relationship between incidents of violence, like homicide and arson, and state laws; in 2011, the number of such crimes was too low to qualify for our state-by-state statistical model.

Anti-Abortion Violence

Until very recently, I provided abortions in a state with an F—Pennsylvania. Whenever I arrived at the clinic in Pittsburgh, I walked a gauntlet of protesters who pleaded with me not to kill my baby or, if they knew I was a doctor, not to kill other people’s babies. But in the world of abortion provision, I am fortunate. I haven’t been the target of violent threats—not like the volunteer I know at a clinic elsewhere in Pennsylvania who was asked by a protester, “How do you prefer to die? By knife or by bullet?”

I wish I could say this kind of incident is rare in Pennsylvania (and everywhere else, for that matter). But in Pennsylvania, anti-abortion protesters who harass and intimidate patients and physicians have the implicit sanction of their state government. Through onerous restrictions that have no medical purpose, the state’s laws single out for punishment the women who need abortions. Why shouldn’t a protester follow suit?

In medicine’s first study of anti-choice violence, Dr. David Grimes et al., pointed out, “… anti-abortion violence in the United States from 1977 to 1988 … was the first time in our nation’s history that health-care providers have been singled out as targets of violence in pursuit of a social agenda.” In this 1991 paper, the authors estimated that property damage caused by anti-abortion activists had already reached $7.6 million, mostly from bombings and arson.

Two years after the study’s publication, Dr. David Gunn became the first person to lose his life to an anti-choice killer. Since then, a total of eight people—four physicians and four clinic workers—have been murdered by anti-choice extremists, most recently Dr. George Tiller. Five others have been seriously injured. The violence isn’t limited to homicide. Just last year, two abortion providers were the targets of fires that authorities categorized as either arson or bombings. When a state government hinders abortion access with baseless restrictions, it adds fuel to the anti-choice fire.