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The losses hit Cahill harder now. She says she contemplated retirement after being evicted from her Meridian Road office earlier this year. The thought of starting over again was daunting, especially because Cahill knew from experience how tough it would be to find a new location. It had taken her two months to find the Meridian Road office. She says Flathead building owners aren't exactly eager to rent to a well-known abortion provider who draws picketers carrying graphic signs, or worse.
But as Cahill considered the decision, she realized she wasn't ready to retire. Plus, the prospect of leaving women for hundreds of miles without access to abortion kept her up at night.
In recent years, Cahill terminated roughly 230 pregnancies annually. She also offered free services to women who couldn't afford health care and solicited community donations to help pay for gas and hotels for patients traveling long distances.
For all of the controversy surrounding her practice, Cahill provided one of the most common medical procedures in this country. According to the Centers for Disease Control and Prevention, half of all pregnancies are unplanned. In 2011, health care professionals administered 1.06 million abortions. Even with an overall decline in the number of abortions performed between 1980 and 2011a decrease health care experts attribute largely to increasing access to contraception—current data indicates that one in three women will terminate a pregnancy before the age of 45.
Even with ongoing demand for the procedure, fewer professionals offer it. Between 1996 and 2011, the number of abortion providers in the United States declined from 2,042 to 1,720, according to data compiled by the Guttmacher Institute, a nonprofit committed to advancing reproductive health and abortion rights. Bloomberg news reported that between 2011 and 2013 an additional 73 clinics across the country closed.
In Montana, the drop in providers has been even more extreme. According to Guttmacher, there were 23 abortion providers in the state in 1978. There are roughly five today. Most women go to clinics to terminate pregnancies, rather than to independent physicians or hospitals. In Montana, only three clinics now offer surgical abortion: Blue Mountain Clinic and Planned Parenthood in Billings and Helena.
Cahill understands the situation, but she's still not sure about her future. She's committed to taking the summer off as she considers whether or not to open another clinic. As Montana loses providers, Cahill says she's simply unwilling to serve any longer as a high-profile holdout with a target on her back.
"I can't do this alone anymore," she says. "I just can't. I won't do it alone anymore."
Cahill's former colleague and partner, Dr. James Armstrong, remembers when abortion was illegal. He says he can't forget the women he treated while attending New York Medical College in the 1950s who attempted to terminate their own pregnancies.
"They could get a heavy piece of wire," Armstrong recalls. "And they'd, examining themselves, try to put the wire in the opening of the cervix and poke around with it until they interrupted the pregnancy enough that the woman would go ahead and miscarry."
Armstrong is now 84 and hard of hearing, but he's still able to rattle off abortion statistics with ease. Referencing data compiled by the Guttmacher Institute, he notes that history proves women will always find ways to terminate unwanted pregnancies, regardless of legal prohibitions.
Before the U.S. Supreme Court legalized abortion in 1973, women received—or performed on themselves—between 200,000 and 1.2 million abortions annually, according to the Guttmacher Institute. While it's tough to discern how many of those women got sick or died from the procedure, smaller snapshots provide some insight. In 1962, for instance, Harlem Hospital Center in New York admitted nearly 1,600 women for abortion-related ailments, such as infection, hemorrhage and damage to the uterus or reproductive organs. In 1968, the University of Southern California Los Angeles County Medical Center reported admitting 701 women sick from abortion-related sepsis.
"The numbers of women having complications from illegal abortion, sometimes self-induced trauma and things like that," Armstrong says, "was really epidemic mass proportions."
It was with that backdrop that the U.S. Supreme Court in 1973 legalized abortion. The lawsuit before the court was filed under a pseudonym of Jane Roe on behalf of a 22-year-old Texas woman named Norma McCorvey, who was pregnant with her third child. She argued, in the lawsuit filed against Dallas County District Attorney Henry Wade, that Texas' law banning the procedure unless the mother's life was in jeopardy violated constitutional assurances to privacy.
The court agreed with McCorvey. In one of the most controversial cases ever decided by the court, justices agreed that assurances to privacy entitle women to make their own reproductive choices. In the majority opinion written by Justice Harry Blackmun, the court noted further that, while some argue life begins at conception, that belief is not universal. Judaism, for instance, holds that the first breath marks life's beginning. Christian theology, meanwhile, held that a male fetus can be considered alive 40 days after conception. That number was 80 days for a female. Prior to the 19th century, before a fetus showed signs of movement, it was, as Blackmun noted, "regarded as part of the mother, and its destruction, therefore, was not homicide."
By the time of the Roe v. Wade decision, Armstrong had moved to Kalispell and opened a medical practice. Because of his experience treating women who had received botched abortions, he felt compelled to offer the procedure.
Armstrong's practice thrived in the 1970s, prompting him to seek additional assistance to meet demand. The timing was good for Cahill, who was looking to move west after graduation from the State University of New York at Stony Brook's physician assistant program. Once in Montana, she found that she had a lot in common with Armstrong. They shared Long Island upbringings, New York City medical school educations and, as they would learn in the years to come, the fortitude to withstand legal and extralegal attacks.
Cahill recalls waking up at about 3 in the morning on Oct. 11, 1994, to the sound of her neighbor, the local fire chief, pulling out of his driveway. Three hours later, Armstrong called Cahill to deliver the news: Their clinic had been firebombed.
The attack resulted in $200,000 worth of damage and prompted Armstrong to invest an additional $50,000 in security upgrades, including a fire and bulletproof door and a thick Plexiglass window between the reception area and the clinic's office.
The perpetrator, Richard Andrews, also admitted to torching six other abortion facilities in Montana, Idaho, Wyoming and California, including Blue Mountain Clinic. In February 1998, Andrews, who was the former leader of a group called the Christian Coalition for Public Policy, pleaded guilty in federal court to eight counts of arson. (He torched one clinic twice). A judge sentenced him to 81 months in prison.
"For some reason," Cahill says, "I thought that would be the end of it."
That wasn't the end of it. In the 1990s, the pro-life movement began morphing into a powerful political force. Cahill was threatened with arrest in 1995 after state lawmakers, at the urging of the Montana Right to Life Association, passed a bill making it illegal for physician assistants to perform abortion. Because Cahill was the only PA in the state at the time providing the procedure, the legislation became known as "the Cahill law."
Cahill, along with Armstrong and three other plaintiffs, including Blue Mountain Clinic, fought the legislation all the way to the Montana Supreme Court and the U.S. Supreme Court. Two years later, they won.