Choice, Before and After

Emma Ottolenghi and Judy Tyson want Vermont women to remember how it used to be. Back in the years before 1972, getting an abortion wasn’t a matter of making an appointment at the local clinic. In those days, a Vermonter with sufficient funds and savvy could get a referral from the Clergy Counseling Service to a big-city provider, usually a doctor working in an unmarked room. Or she could fly to England to have the procedure. The U.K. legalized abortion in 1967.

But most local women didn’t have enough money for the trip, which left them with two options: self-induce, or obtain the illegal procedure under non-sterile conditions. Sepsis and hemorrhage were frequent results. Deaths allegedly occurred, but unlike other states, Vermont did not report the numbers to the Centers for Disease Control.

New York liberalized its abortion laws in 1970. Two years later, Vermont overturned its law forbidding doctors from performing abortions. A year later, on January 22, 1973, the Supreme Court legalized abortion nationwide in its momentous Roe v. Wade decision.

Ottolenghi of Waterbury Center and Tyson of Sharon, both 72-year-old physicians, provided some of the first legal abortions in Vermont. Now, as the 35th anniversary of Roe v. Wade approaches, they want to remind new generations of the choices women used to face.

That’s because the law is more imperiled than ever, according to these veterans of the women’s movement. With recent challenges like the ban on so-called “partial-birth” abortions, a woman’s right to choose is being eroded by a newly conservative Court that may continue in this vein for years to come — no matter which party is in the White House.

“The Supreme Court, as it’s now constituted, could turn it over to the states,” says Ottolenghi carefully. Her muted accent comes from her Italian birthplace; she emigrated to Ecuador with other Jewish families in 1939, “for obvious reasons,” she says. If the Justices “want to look good,” Ottolenghi goes on, “they say, ‘We’re not going to legislate such things; it’s up to you.’”

“It would be a pretty drastic thing if they tossed it back to the states — a significant number could say it’s illegal,” agrees the more garrulous Tyson, Philadelphia-born and New Jersey-raised. “But we’re not going back to making abortion illegal in this country. Women have come too far in all areas of life for that. Of course, they’ve come that far partly because they were allowed to take command of their reproductive life.”

Both these pioneering women doctors worry that, with the cultural memory of pre-Roe days fading, women won’t feel compelled to protect their rights.

For the past two years, Ottolenghi has been working full-time to promote women’s reproductive health in Guatemala, Bolivia, Russia and South Africa. Fabrics and trinkets from abroad fill the sunny front room of her Waterbury Center house, which is perched at the top of a dirt road with a view of Camel’s Hump. Tyson, now retired from her ob-gyn teaching position at Dartmouth and 21 years as medical director of Planned Parent-hood, has driven up from Sharon at her friend’s request. Judging from Ottolenghi’s two dogs’ cheerful greeting, she’s a frequent visitor. “I wouldn’t want this interview to happen without her,” Ottolenghi said earlier by phone. “Judy and I did everything together.”

The two friends met at the University of Vermont Medical College when Ottolenghi was teaching women’s health and Tyson was pursuing her degree. Ottolenghi had earned her M.D. at McGill in 1961, the rare woman in her class, and interned in Washington, D.C. — though, unlike Tyson, she never completed a residency in obstetrics-gynecology. In 1967, she moved with her husband and four children to Vermont, where UVM’s director of ob-gyn allowed her full outpatient responsibilities. “The rules were looser then,” she recalls.

Tyson earned her medical degree in 1970, one of “one or two” women in her class of 60. A self-described late bloomer, she had put herself through med school as a recently divorced mother of two. She interned in New York City, the same year the state legalized abortion, and recalls that change’s impact on her patients and herself.

“As a medical student [at UVM], I’d had the experience of telling a woman her pregnancy test was positive, then telling her what her options were: either the Lund Center” — familiar to all UVM med students from a required rotation — “or a visit to her doctor for more counseling,” Tyson explains. “I knew her options in life would be truncated as a result of having a child.”

But in New York, “suddenly I could offer a third option, and it was like night and day.”

Another change she noticed was even more stunning. “There used to be a septic-abortion ward in every hospital — a roomful of beds reserved for women who had gotten sepsis from unsafe abortions,” Tyson says. “It used to be called the Septic Tank, in the sort of gallows humor” of the medical community. At her New York City hospital, those 40 or so beds were always full. After legalization, Tyson saw them empty out: “Once abortion was legal, that ward was never needed again.”

Ottolenghi interjects that abortion is the “safest, most successful minor surgery available today.” Gathering up a stack of photocopied articles in support, she points out that respected international reproductive-health research institutions have shown that laws against abortion do not affect its incidence. A paper from the Guttmacher Institute records that in Africa, where abortion is illegal in most countries, 29 women per 1000 get abortions; in Europe, where it is generally legal, the incidence is 28 per 1000. “Even family planning is not infallible,” Ottolenghi points out. The only demonstrated effect of laws restricting abortion, according to the Guttmacher report, is a higher incidence of infection from the procedure.

A desire to empty those sepsis beds may have motivated Ottolenghi’s colleague at UVM, ob-gyn resident Jackson Beecham, when he sought to challenge Vermont’s abortion law. The law criminalized doctors who provided the service, but not women who obtained it — making it possible to argue, Tyson says, that women seeking abortions were being forced to put their own lives in peril. Beecham brought the issue to court by asking one of his patients to sue him. Eleven months later, when Roe passed, Vermont was one of 17 states that had already decriminalized abortion.

Everyone expected the Vermont ruling to make abortions available right away, says Tyson. But at first, nothing happened. UVM’s ob-gyn department, in a bit of strange timing, had just merged with its parallel department at Fanny Allen — a Catholic hospital. Realizing a separate clinic was needed, Ottolenghi and Tyson teamed with a deeply committed group of local feminists. “People gathered in a basement on Church Street — bankers, lawyers, nurses, doctors. It was all done quietly,” recalls Tyson. According to her, the president of Chittenden Bank offered to back a small loan; Sister Elizabeth Candon, president of Trinity College, helped organize personnel. Within eight months of the ruling, the Vermont Women’s Health Center was up and running in Colchester, and moved to a larger facility on North Avenue in Burlington within a year.

UVM faculty came to the Center a few hours a week to provide the first abortions, but they were soon overwhelmed. When a call went out for two house physicians, Tyson and Ottolenghi were the sole applicants. They were trained on an early technology, a syringe method named after its non-medical founder, Harvey Karman. Each worked two days a week; Tyson commuted from her home in Sharon and spent the night in Burlington.

By 1973, the group had made the pioneering decision to train physician’s assistants to provide abortions, thus circumventing the problem of a doctor dearth. Soon women’s health clinics across the country emulated the Center’s model; subsequent studies proved that the procedure was equally safe whether performed by physicians or their mentored assistants.

The women who came for abortions broke all the stereotypes, Tyson says. Contrary to assumptions of the time, they were not irresponsible “hussies” but women of all ages, from all economic and social strata. Every two weeks, a mini-bus full of women came down from Montréal, Ottolenghi adds.

Tyson remembers one deeply conflicted woman who sought an abortion. Catholic and the mother of two children, now pregnant by another man, she had already consulted with her priest and other counselors, who told her her choice would “condemn her to Hell.” But she remained resolute: She was separated from her husband and knew he would take away her children if he found out about her pregnancy. “And a mother just can’t leave her children,” Tyson adds, in a tone of fervent empathy.

Despite the obvious need it revealed, the Center faced opposition only a few years after opening. “During the time when this was germinating and exploding and we were all feeling so high,” recounts Tyson, “my lawyer friend called me and said, ‘Judy, the backlash is coming. Don’t you know?’ I didn’t know what she was talking about. But everything she predicted came true.”

A lawyer from a powerful local Catholic family started mounting legal arguments against the Center in 1974. In 1978, someone threw a Molotov cocktail at the clinic entrance. Many of the Center’s workers began wearing bullet-proof vests to work, Tyson recalls, though she chose to go without protection. In 1990, Operation Rescue staged a series of large-scale protests, trying to block women from entering, and described the Center in its fliers as “a coven of lesbian witches.”

Nevertheless, by 1996 the Vermont Women’s Health Center was providing approximately 500 abortions a year. In 2001, it merged with Planned Parenthood of New England [1], with which the Center already shared much of its personnel, including Ottolenghi and Tyson. Starting in 1969, the duo staffed Planned Parenthood’s “Under 21 Clinic” that dispensed contraception without parental consent to young women — “a real innovative idea” at the time, according to Ottolenghi.

Today, Vermont is unusual in that it still has no laws restricting abortion. It’s one of only seven states that allow non-physicians to perform the procedure. But limitations are encroaching: New Hampshire passed a strict parental-consent law in 2003 that wasn’t repealed until last year. Title X, which funds birth control for the poor, has lost 60 percent of its funding over the last 10 years, according to Ottolenghi.

“No one wants an abortion; it’s a tough choice,” she says. “Anyone who comes to get an abortion, or knows they might be pregnant, has already done the thinking. The large majority feels relief when it’s over. They really feel fine; they don’t think they’ve made a mistake. The Right spins the few people who have regrets.”

Attitudes appear to be changing. “Teens now feel guilty” about their choice to abort, reports Tyson, paraphrasing her colleagues who still see patients. Two recent movie hits — Knocked Up and Juno — feature young women who reject the option of aborting their unplanned pregnancies. Tyson thinks the country has moved less to the right than the media would have it, but Ottolenghi counters with recent poll figures: Currently, less than half of Americans think abortion should be available on demand.

How did the cultural zeitgeist shift so far from the days of Roe v. Wade? “It’s because abortion is available,” says Tyson without hesitation. “It’s been available for so long, we don’t think we need to protect it.

“I was in China once,” she continues, “and they were recruiting people to tell how it was during the Cultural Revolution under Mao. Because people had really forgotten. I think we need to do the same thing with those days before Roe.”