Abortion providers and reproductive rights advocates were alarmed, but unsurprised, by the findings of a new report showing that threats of violence against abortion providers have doubled since 2010.

The National Clinic Violence Survey, conducted by the Feminist Majority Foundation, received survey responses from 242 U.S. abortion providers. The survey found that there have been significantly higher levels of threats and targeted intimidation of doctors and staff in recent years.

DuVergne Gaines, the director of the National Clinic Access Project and one of the authors of the report, told Rewire that one of the biggest challenges in creating the survey was determining how many clinics remained open after the passage dozens of anti-choice laws by Republican-controlled state legislatures.

“That was a sobering exercise,” Gaines said.

These laws, targeted regulations of abortion providers (TRAP), have forced clinics around the country to close.

The survey found that nearly one in five clinics experienced severe violence. Severe types of anti-choice violence affected 19.7 percent of clinics nationwide, down from the 23.5 percent of clinics that reported experiencing severe violence in 2010.

The percentage of clinics affected by threats and targeted intimidation tactics increased from 26.6 percent to 51.9 percent, and this dramatic surge in serious and targeted threats is seen as one of the most important findings in the survey.

“That is a pretty grave and dramatic increase,” Gaines said. “That is an area that we thought we would see an increase, but not such a huge jump.”

The survey suggested a correlation between threats and harassment against abortion clinics and providers and the amount of anti-choice legislation that has been introduced and passed by lawmakers in those states.

“They are emboldened,” Gaines said, referring to anti-choice activists. “They feel as though they can intimidate with impunity. That I see has a direct relationship to these legislative attacks.”

Tammi Kromenaker, director of the Red River Women’s Clinic of Fargo, North Dakota, told Rewire that legislation introduced by state lawmakers around the country not only threatens to close clinics and restrict access to reproductive health care, but also exposes the clinics to greater visibility and likelihood of harassment.

Lawmakers proposed a host of anti-choice bills, of which five became law, during North Dakota’s 2013 legislative session. Two of those laws have been blocked by federal courts. Kromenaker said both the passage of laws and the subsequent court battles contribute to abortion clinics becoming targets of anti-choice violence and harassment.

Anti-choice activists have often distributed pamphlets or postcards in communities with photographs of and personal information about abortion clinic physicians and staff.

“I’ve never seen pictures of our doctors be put on postcards like we got this year,” Kromenaker said.

The survey found that the share of clinics affected by the distribution of such pamphlets targeting doctors and clinic staff has increased from 18.8 percent to 27.9 percent.

“They Experience Vitriol”

Dr. Willie Parker, a physician who provides abortion care in Alabama, Georgia, and Mississippi told Rewire that he is “disappointed but not surprised” by the survey findings. Parker said he is glad to see the data support what he knows anecdotally to be true.

“The decrease in the percentage of clinics and facilities that have experienced physical violence has been offset by the direct threats to providers,” he said.

Many abortion providers do not speak publicly about the services they provide, but Parker has been one of the most visible abortion providers in the country. “I approach it from a place of principle and moral imperative,” he said of his decision to provide abortion care.

The Jackson Women’s Health Organization, Mississippi’s last clinic, is one of the most visible abortion clinics in the country, not just due to its bright pink exterior, but because of the legislative and legal battles that have been waged over its right to remain open, and the constant presence of anti-choice protesters outside its gates.

Parker became a provider at the JWHO clinic in the summer of 2012. “I caught the wave at the top of the crest,” Parker said.

Dozens of anti-choice bills have been introduced in the Mississippi legislature over the past few years. A bill that was passed by the GOP-dominated legislature threatened to close the JWHO until a three-judge panel of the Fifth Circuit ruled that it was unconstitutional.

Parker believes one of the reasons for the increase in protest activity at the clinic is because it’s become symbolic for anti-choice activists, who he thinks would claim credit if the clinic is forced to close due to state regulations.

The survey found that 25 percent of all clinics report they experience anti-choice protest activity at their facility on a daily basis. “We are certainly among the clinics that have protesters every day,” Parker said. “It has become a kind of site of pilgrimage for protesters.”

Parker said society’s tendency to “ostracize or to otherize” people not conforming to social norms contributes to the stigma of abortion. “The people who oppose abortion have used that and exploited the fact that we live in a community that has marginalized women by promoting an understanding or men’s and women’s roles that is very antiquated.”

While Parker acknowledges the “great strides” that have been made in women achieving equality and parity with men, he knows structures of oppression remain. “The marginalization of women and the shaming of women simply because of biological realities of procreation or reproduction that plays out in their bodies has been quite effective,” he said.

“Shaming is so effective because shaming can reach the places where the law can’t.”

Parker said his patients experience this shaming in the form of protesters who line the fence of the JWHO. “They experience vitriol. They are told that they are bad women. They are told that they are terrible mothers. They are told that they are murderers. They are told that they can’t be Christian,” Parker said.

Parker tries not to focus on the many different ways anti-choice lawmakers and organizations attempted to restrict access to reproductive health care because, he said, it can “wear on you.” Parker also sees the correlation between legislative efforts and the increase in harassment.

“With the increased regulation of faculties, it’s almost as if [anti-choice activists] have been able to hijack the state and get the state to do their bidding, in my opinion, which is an abuse of regulatory authority.”

“They figure out ways to affect the clinic without physically damaging them, which allows the protesters to focus their efforts on harassing and intimidating providers,” Parker said.

Reproductive rights advocates worry about the future and what effects restrictions and continued harassment will have on access to reproductive health. “Instead of going back to the future, I think we’re going to go forward to the past,” Parker said.