Intimate Wars

by Merle Hoffman

  While Daily gathered his followers to pray on their beads outside my clinic, I was helping to run what I deemed a sort of underground railroad. Women from states with restrictive abortion laws were traveling to New York to have their procedures—just like my first patient who had traveled to my clinic from New Jersey so many years before. I lowered the fees for out-of-state clients and welcomed them to my clinic.

  Business was booming. In the early days, when Choices served two to five patients per week, I understood very quickly what women needed from an abortion provider: immediacy of access, affordability, confidentiality, safety, compassion, and dignity. The system I had developed to address all of those needs—creating the ancillary services of the counselors, and leaving the physicians to do the technical work—had proven successful. We grew exponentially until we were seeing over five hundred patients for abortions per week. With my staff of 115 I was basically running a midsize hospital. At our height we performed almost twenty thousand abortions per year, over one hundred per day, making us one of the largest abortion facilities in the United States.

  Nearly 97 percent of the abortions were done in the first trimester at a cost of $300. Later term abortions, because of their increased risk, were priced higher. Almost all of the New York clinics charged the same fees. The only price wars were waged by unscrupulous physicians who preyed on illegal immigrant women, charging them unconscionably higher rates, knowing they were afraid to go to a licensed facility for fear of having their status revealed. Abortion, unlike other medical procedures, did not go up in price with inflation. Even so, Choices started to become very profitable. I was quite pleasantly surprised when I made my first million dollars.

  I was generous with salaries, including my own and Marty’s (who functioned as the medical director), but most of the profits went back into the clinic. I frequently offered new services at Choices and always did my best to subsidize poor women’s care. We were famous for never turning a patient away. At least once or twice per week I would get a call from the front desk or a counselor starting with the words, “I have this patient . . .” The power to be able to help them gave me a great deal of pleasure—but I could only have that power if I had the money to service it.

  I was the only woman owner of a licensed abortion facility in New York, yet my feminist peers often made me feel as though I was doing something wrong. Many in the movement felt a real activist should be struggling financially, or at least be working for a nonprofit. How, they wondered, could I be a radical feminist and a successful entrepreneur? I was “making money off the movement” (which could be said of every abortion provider), even more than most because I was not one of the doctors performing the abortions, but the person who hired them. Male abortion doctors faced less opprobrium, anyway; the fact that they were making money off abortions did not tarnish them the way it tarnished me. I was a woman, a feminist, a radical, a writer, a publisher, and an activist, and I was making a hell of a lot of money. Something wasn’t right.

  My relationship with money has always been nuanced and complicated. I have felt its deprivation, earned a lot of it, saved it, given it away, risked it, been on the verge of bankruptcy twice, invested it well, and spent it unwisely. I have been envied for it, abused for it, and used for it. Money has given me many types of power. With it I have been able to run my clinic the way I want it to be run, create new programs, and hire talented staff. I have been able to travel and move in worlds I would not otherwise have had the chance to enter.

  Money has given me the power to support political campaigns and donate to worthy causes. In the nineties I spent half a million dollars every year publishing On the Issues and started a 501(c)3 called the Diana Foundation so that I could donate to feminist groups and individual radicals that had no access to institutional funds.21 I donated to the campaigns of pro-choice politicians like Schumer and Hevesi, and of course paid for political actions put on by the PCC.

  But at times that ability has almost seemed like a one-sided pleasure. It was a brutal education in reality for me to see how so many friends and allies slipped or dropped precipitously away when I almost went bankrupt. Many women were passively resentful of my money. I would go to dinner with friends, and they would apologize for picking a restaurant that was not “one I was used to,” although I was as comfortable eating at a diner as I was in an expensive restaurant. It became difficult to know for sure whether people connected to me in true friendship or because of my money. But eventually I came to feel comfortable with this part of my self-presentation. Just as the scandal of my love affair left its residue on me, made me who I am, the distinction of being a wealthy feminist became part of my persona.

  IN THE 1980S I noticed an influx of Russian émigrés coming to me for abortion services. The immigration policies of the Soviet Union had eased, and masses of Russians were finding their way to New York City. Abortion was the major form of birth control in the Soviet Union, and many of the women had had ten or twenty before coming to Choices. For these women, the issue of abortion posed no questions of morality, ethics, or women’s rights versus fetal life.

  I’d been to the Soviet Union once, in 1983, with Marty and a group of his colleagues. A friend who was familiar with the culture begged me to take a suitcase full of contraceptives: pills, diaphragms, condoms. My concerns about arbitrarily distributing hormonal medication and diaphragms that would not be fitted by physicians were laughed off. “They need anything and everything they can get.” After learning that the two most popular forms of birth control were douching with lemon juice and jumping on cardboard boxes when periods were late, I stuffed my bags full.

  At the time Russia was still a communist country. It was impossible to escape the feelings of state control and oppression. We would get on a bus and no one would smile or meet our gaze; the energy of the place was stifling. I could not stay in a situation where I knew that every word I spoke was being listened to or taped. We left three days early to go to Norway.

  The Soviet Union’s power to astound confronted me again when a thirty-five-year-old Russian woman came to Choices for her thirty-sixth abortion. The patient expressed relief at the supportive and positive aspects of the clinic as opposed to the brutal conditions with which she was familiar, but seemed quite resigned to having as many abortions as necessary. Like many Russian women, she was violently opposed to using birth control. Most Russian gynecologists promoted the idea that the pill caused cancer, and preached the virtues of repeat abortions. Of course, the fact that many of them subsidized their three-dollar-a-month salaries by doing abortions in women’s homes might well have had an influence on their thinking.

  The only contraceptive devices locally produced were condoms. These were so poorly made that they were called “galoshes,” and few men consented to using them. In Russia the obstetric wards were empty of patients, and one out of three women who sought second trimester abortions in hospitals died from complications. My patients told me story after story of lives blighted by sterility, sexually transmitted diseases, and domestic violence. One woman confided that the brutality of the state maternity wards was Russia’s most effective means of family planning. The lack of choice resulted in an alarming number of abortions performed both legally and illegally in Russia. It was impossible to get an accurate number, but it was estimated that between five and 18 million abortions were performed annually as compared to 1.6 million in the United States.

  I could not turn away from this situation. In 1992, Joy Silver, the Choices marketing director, arranged for two Russian feminists from I and We Magazine who had heard about my facility to visit me. My philosophy of informed medical consumerism astonished them. In Russia, you got whatever treatment was being offered at the moment. If they had a stock of old-fashioned spiral IUDs, that’s what was dispensed. If they had high dose estrogen pills, that’s what was prescribed, regardless of any individual contraindications or preferences.

  When they got home they faxed me an official invitation
to lead a team of physicians and counselors from Choices to go to Moscow for an educational exchange. We would be meeting with gynecologists from state-subsidized Teaching Hospital Number 53 to demonstrate state-of-the-art women’s health care. Three months later I was on my way to Russia with nine of my staff.

  MY HOSTS HAD ARRANGED for us to stay in a prerevolution-ary mansion that functioned as a government artist colony where pensioned writers and old artists retired. Marty came along as part of my entourage of Choices staff, a role that infuriated him. He became even more upset when I asked to have my own room; I had a lot of pressure to deal with—giving speeches, meeting international press. I tried to explain this, but Marty perceived it as a public embarrassment in front of the Choices staff, especially the male doctors. Here we were as husband and wife and I was asking for my own room, a public declaration that he did not have sexual access to me. He was sullen and cold, even threatening. “I made you, I can break you,” he told me more than once. But I insisted, and we slept in separate rooms.

  Resolving to brush off his anger and focus on my mission, I dove into the first day of meetings and interviews. Most of the women I spoke with seemed to be insulated from feminist thought and the feminist movement as we knew it in the United States. They referred to me as Miss or Mrs. Hoffman, and one of my staff corrected them and wrote out “Ms.” “But isn’t she married?” they asked. I explained that yes, I was married, but that it was not necessary that my marital status be public. They loved that!

  There was no word for “counseling” in the Russian system, because they didn’t perceive a need for it. Abortion was not only the status quo, but the only choice the majority of women had to control their fertility. There was no organized opposition on religious or moral grounds (although there was a growing American right-to-life presence in Moscow), and women regarded their multiple abortions pragmatically, as a way of “getting cleaned out.” I wondered whether bringing to Russia the concepts of choice and responsibility, the need for women to think deeply about birth control and abortion, the need even for counseling prior to abortion, would contribute to an anti-abortion groundswell. Would I inadvertently be introducing anxiety or guilt to an already overburdened and oppressed female population? After all, the slogan of many pro-choice activists in the US—“Abortion on demand and without apology”—was a reality in Russia. But because there were no other choices, abortion had little to do with freedom and privacy and much to do with oppression and coercion.

  The day I was to participate in an educational symposium at the Moscow Literary Society, I awoke with an intense feeling of excitement. I would make my presentation and challenge the assembled physicians and journalists to create a truly revolutionary society. During my talk I stressed what I knew to be true in the most personal and political sense: if one accepts that the exercise of free will defines what it is to be moral and fully human, then women who lack the information to make choices are destined to remain second-class citizens.

  Along with translated copies of my birth control pamphlet, “Birth Control Facts and Fiction: The Choice Is Yours,” T-shirts, and magazines, I had brought seven thousand condoms with me to distribute after the presentations. When the time came to hand them out, the journalists, students, and physicians turned into a swarming mob. I was surrounded as a frenzy of hands reached out to grab the condoms, leaving me breathless and amazed.

  My staff was scheduled to perform abortions and Norplant inserts at the state teaching hospital. It would be the first time Norplant had been inserted into Russian women, and the first time abortions would be performed there with state-of-the-art technology. Students, gynecology residents, and the administrative staff of the hospital hovered around the operating room tables. There were three patients in the operating room; multiple abortions were often performed at the same time, without any type of anesthesia. It was faster and more efficient that way. The women came in their own nightgowns because there were shortages of paper supplies. They placed themselves on the table and followed orders.

  The next day I had a meeting at the Russian Family Planning Association, one of the only voices calling for a reasoned and intelligent family planning program. The director, Inga Grebesheva, was famous for being the only woman deputy of the Central Committee of the Communist Party. The energy of the women in that room was so strong, I urged them to take immediate action. We decided to draft an open letter to Boris Yeltsin outlining the grave conditions of women’s health care and demanding economic funding for birth control and education. I asked Grebesheva if she could have it done by the next day so that leading feminists at the Feminist Roundtable where I would be speaking could sign it. She smiled and told me, “I’ve been writing it in my head for four years.”

  When we returned to New York, Marty had a change of heart about the anger he’d felt on our trip. An enormous bouquet of flowers was waiting for me on my desk at Choices on my first day back. The card read, “Darling—you are an international star. With love and admiration, Marty.” But I’d already put Marty’s dark moods and manipulations out of my mind. I was thinking about Russia.

  My trip had received international support, with profiles in the Economist and the London Times detailing the work I had done there. The Russian media had celebrated my project, proudly displaying my picture on the front page of the Moscow Times and reporting that we had “made history” on our trip. Dr. Grebesheva told the press that “until Hoffman suddenly landed on our heads,” she had almost given up trying to improve the plight of Russian women. “It is only her enthusiasm and energy that prods me into renewing our own campaign. If Merle wants to start a Choices model clinic in Moscow, we promise to find her premises tomorrow.” Indeed, I was considering replicating Choices there. I could offer Russian women state-of-the-art family planning and counseling, as well as high quality abortion care. Russian women needed a safe harbor, a feminist outpost. I felt I had to do it.

  TWO YEARS LATER, with great excitement and a sense of destiny, I boarded the plane for Moscow to build Russia’s first feminist medical center. I would call it Choices East. I was aware of the odds: out of thirty-three hundred American /Russian joint ventures formed in 1993 in Moscow, only three hundred were still operative the next year. The American press carried endless stories of the difficulties of doing business in Russia. Apart from the basic challenge of negotiating with people whose core philosophy was for seventy years built around hostility to free markets, I had to take up the challenge of bringing a feminist consciousness to life in a highly misogynist, authoritarian society.

  I began thinking in terms of “capitalism with a conscience,” a term I coined that had been met with scorn by some American feminists. Perhaps with the enormous economic and political changes in Russia at the time, my take on capitalism would find fertile ground. At that time in Moscow there was what was called soft and hard currency; soft was the ruble, which all the Russians were paid with and used, and hard was the dollar, the franc, the pound, the deutsche mark—the money that was used by foreigners to both purchase goods and bribe officials to get what they needed. I wanted to charge the Russian women for abortions in soft money—about three rubles, equivalent to about fifteen American dollars. I would charge foreign women between $100 and $150 in hard money. The idea was to subsidize the poor women with the profits or surplus that was made from doing abortions on foreigners.

  The Russians I spoke with were aghast at this idea. They wanted to have two separate services, one for foreigners and one for Russians—sort of like one for cash and insurance patients and one for Medicaid patients. This surprised me. Wasn’t subsidizing the poor a core belief of Communism—“from each according to his ability, to each according to his need”?22

  Much had changed in Russia since my first exploratory visit in 1992. The rise of fascistic nationalism promoted by Vladimir Zhirinovsky had produced rampant inflation, and growing disillusionment with American capitalism due to the loss of their life savings had left much of the population anxi
ous, frustrated, and despairing. Organized crime had grown at alarming rates, a 43 percent rise in the previous five months. Gang violence, too, was so common that the Moscow Times reported a rate of one bomb attack every two days, mainly carried out against bankers and businessmen as gangs battled for control of the city. I’d felt relief on my first visit to Moscow upon discovering that pornography was almost nonexistent, but now I saw it everywhere. The Russian version of Cosmopolitan greeted me with the question, “Would you rather have sex or chocolate?” The opening of Russian markets to all things American, like Snickers bars and McDonald’s, included imports of our special brands of fundamentalist misogyny: tapes of Jerry Falwell and Jimmy Swaggart now graced Russian television. The American right-to-life movement sponsored a weekly half-hour television program, and a recent right-to-life conference in Moscow boasted five hundred attendees.

  I was not surprised to learn that the attacks on me in the press began before I hit the ground. A former KGB general, one Alexander Sterligov, leader of the Russian National Assembly and an ally of Zhirinovsky, was worried that under Yeltsin the mortality rate exceeded the birthrate for the first time since World War II. Calling my plans to set up a women’s clinic in Moscow an “anti-Russian ploy,” Sterligov was quoted as saying, “We will not put up with Russians having more coffins than cradles.” Not only were women the victims of repeat unsafe abortions, now they were being made to feel guilty for having them on both religious and political grounds.

  I knew not to graft my American feminist philosophy onto Russian reality. My mission was to work with the Russians on an equal basis; that way they could adapt the Choices philosophy of Patient Power to their Russian sensibilities. The philosophy could then grow organically and be replicated in other parts of the country.