Intimate Wars

by Merle Hoffman

  I spent hours counseling husbands, lovers, sisters, and mothers whose fury at their daughters’ betrayal needed a kind of salve I couldn’t give. “Let her get local anesthesia,” they said. “Let her really feel the pain so she knows never to do it again.” The daughters’ heads lay on my shoulder as I sat on their beds, wiping tears of relief or regret or both, whispering comfort, giving absolution, channeling rage, sharing life.

  “I would want to keep this pregnancy, if only . . .” I learned that it is in the “if only” that the reality of abortion resides. It’s there in the vast expanse of a lived life—the sum of experience, the pull of attachment, the pain of ambivalence. “If only” is a theme with thousands of variations.

  If only I wasn’t fourteen.

  If only I was married.

  If only my husband had another job.

  If only I didn’t give birth to a baby six months ago.

  If only I didn’t just get accepted to college.

  If only I didn’t have such difficult pregnancies.

  If only I wasn’t in this lousy marriage.

  If only I wasn’t forty-two.

  If only my boyfriend wasn’t on drugs.

  If only I wasn’t on drugs.

  If only . . .

  I bore witness to each woman’s knowledge of holding the power to decide whether or not to allow the life within her to come to term.

  The act of abortion positions women at their most powerful, and that is why it is so strongly opposed by many in society. Historically viewed as and conditioned to be passive, dependent creatures, victims of biological circumstance, women often find it difficult to embrace this power over life and death. They fall prey to the assumption, the myth, that they cannot be trusted with it.

  Many women came into the counseling room and said, “I’m not like all those other girls in the waiting room; they don’t seem upset about it at all; I don’t take it as lightly as they do.” Or, “I never thought it would happen to me, I never really believed in abortion.” They felt guilty about not wanting to be mothers yet, about getting pregnant even when their birth control was what failed them, guilty about not insisting that their men put on condoms—or that they neglected to put in their diaphragms. And sometimes they felt guilty about not feeling guilty. Theirs was a pervasive sense of sin, if not in the biblical sense, then in the personal one of not living up to their own self-image. They felt they should have known better.

  But they found a kind of redemption at the clinic, facilitated by counselors and staff who did not devalue, but supported them. Redemption in the form of rescue from an unwanted and unplanned pregnancy, and everything that meant. Redemption in the form of demystification, neutralization, and acceptance.

  Abortionomics

  “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 a
bortion 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 colleague
s 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.