Gruskin’s Editor’s Choice in the January 2013 issue was a powerful statement underscoring AJPH’s commemoration of Roe v Wade (Gruskin S. Safeguarding abortion: a matter of reproductive rights. Am J Public Health. 2013;103[1]:4). This focus on abortion could not be more timely, not only in the United States but around the world, tragically highlighted by the death in Ireland last year of a 31-year-old woman who was refused an abortion after being told she would miscarry. Gruskin points out that the United States’s landmark judicial decision 40 years ago not only established the legal right to abortion in the United States but set the stage for dramatic advances in public health. Yet Roe has faced challenges that have frequently turned intimidating and in many ways have grown more intense in recent years. Gaining access to abortion services is still difficult for many women, and even seeking abortion has become severely stigmatized. On the other hand, Gruskin observes that important groups in the United States and worldwide have fought long and hard in defense of abortion services, increased training of abortion providers, and the right to abortion as basic to human rights. But to understand how best to prepare for battles yet to come, she urges us to sharpen both our historical and global perspectives.
Contributors to the January, March, and forthcoming April issues provide us with ample materials from both here and abroad to support Gruskin’s recommendation. In the January AJPH, Fried presents evidence that since Roe, the number of organizations working to protect abortion rights has grown to match the assaults against them (Fried MG. Reproductive rights activism in the post-Roe era. Am J Public Health. 2013;103(1):10–14); Yanow makes the case for removing barriers that limit the abortion services that primary care practitioners can readily provide (Yanow S. It is time to integrate abortion into primary care. Am J Public Health. 2013;103(1):14–16); and Paltrow argues passionately for the need to mobilize against the recriminalization of abortion and the recent insidious misuse of the criminal justice system (Paltrow LM. Roe v Wade and the new Jane Crow: reproductive rights in the age of mass incarceration. Am J Public Health. 2013;103(1):17–21). In this AJPH issue, Aksel et al. (page 404) describe the important work of Medical Students for Choice in promoting increased abortion-training opportunities for US medical students and residents; Kumar (page 400) offers a sobering account of the status of abortion in Sri Lanka; and Trueman and Magwenthu (page 397) describe the situation in South Africa that seems eerily similar to that in the United States.
Two additional contributions add the critical support of nuanced historical perspective. Joffe tells the remarkable story of abortion counseling from its relatively conflict-free early days to its troubled present (Joffe C. The politicization of abortion and the evolution of abortion counseling. Am J Public Health. 2013;103(1):57–65). She describes changes in the relationship between abortion counselors and their clients, noting that counselors once saw themselves as allies of feminist women seeking to exercise their political rights but now emphasize “head and heart” counseling for clients who are sometimes profoundly ambivalent and need empathic professional support. Schoen (page 416) also underscores professional evolution. She describes the early development of abortion clinics in the 1970s when major tensions existed between three rival models that competed to provide services: a medical model dominated by male physicians and hierarchic professional relationships; a feminist model focused on the empowerment of women; and an entrepreneurial model pursued by certain businessmen who saw a profit opportunity. Tensions between proponents of these models were often intense, but rival providers were able to work out many of their differences when they formed the National Abortion Federation (NAF) in 1976. The NAF proved important in the 1980s as antiabortion groups gained strength, because common cause and defensive alliance within the organization increasingly overrode earlier disagreements.
We can learn important lessons from all these articles, and not least from the historical essays by Joffe and Schoen. Collectively, they tell us that we need to stay alert to the sometimes subtle ways things change and to the danger of reaction as well as to the promise of progress. They also tell us that we should be prepared for novel approaches and new strategies as circumstances allow. We should remain open to the possibility that there may be a variety of ways to reconcile political and professional commitments and to forge new alliances if we are to be fully equipped for the robust defense of Roe v Wade that will assure it remains the fully implemented law of the land.