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Abortion law

30 years after Roe v. Wade: Lessons about Abortion from the San Francisco Nine
By Carole Joffe
January 2003

In 1966, nine highly respected obstetrician/gynecologists affiliated with leading medical institutions in San Francisco suddenly found themselves threatened with the loss of their licenses. The California Board of Medical Examiners decided to prosecute them for "professional misconduct" because they had been performing hospital-based abortions on women who had been infected with rubella (German measles). Such abortions became increasingly common in the 1960s, due to growing evidence of the link between this disease and birth defects. (Between 1962 and 1965, some fifteen thousand babies were born with defects attributed to a rubella epidemic).

The case of the "San Francisco Nine", as the group came to be known, illustrates the tremendous uncertainty under which responsible physicians performed abortion before the Roe v. Wade decision in 1973. Even before legalization, physicians were permitted some leeway to provide abortions when the life or the health of the woman was at risk. But they had to make subjective judgments in these cases-there was no one standard of a sufficiently serious "threat to a woman's health." As a result, doctors of that era felt themselves operating in a grey area between illegality and legality, not knowing if their judgments would be called into question by the legal system, or by fellow physicians with different attitudes toward abortion. In fact, just one individual -- a strongly antiabortion member of the Board of Medical Examiners -- instigated the decision to charge the nine San Francisco doctors.

Ironically, this prosecution had an unintended effect. The case galvanized the medical community, both locally and nationally. The predicament of the San Francisco doctors crystallized how untenable the situation then was with respect to abortion. If physicians acted in accord with their best medical and ethical judgment, they could suffer dire consequences. Edmund Overstreet, then vice-chair of the department of obstetrics and gynecology at UCSF, and a leading spokesman on behalf of the nine physicians, said, "We do not believe that violation of an archaic statute is unprofessional conduct."

A group of influential professionals, drawn mostly from the legal and medical communities, organized a Citizens Defense Fund on Therapeutic Abortion, which raised money to defray the doctors' legal expenses. Over two hundred professors of medicine, including the deans of 128 medical schools from across the country, signed an amicus brief on their behalf. Ultimately, the charges against the " Nine" were dropped.

The case reverberated in California and across the nation. In California, it gave new momentum to a bill, previously introduced in the legislature, that reformers had designed to broaden the grounds on which abortion would be legally permitted in the state. In 1967 this law passed, and a reluctant Governor Ronald Reagan signed the California Therapeutic Abortion Act.

The San Francisco incident also contributed to medical organizations' growing dissatisfaction with the abortion situation: in 1968, the American College of Obstetricians and Gynecologists endorsed more liberalized abortion laws; two years later, delegates at the annual meeting of American Medical Association for the first time voted for in favor of legalizing abortion.

In subsequent years, however, the San Francisco medical community and many of their counterparts in other states took different approaches to abortion. In San Francisco, abortion care has long been well established in mainstream medical institutions. For example, faculty in the department of ob/gyn at UCSF has pioneered new models of service delivery, researched new abortion techniques and developed training programs for residents that are a model for the nation.

But in other states, the medical community has largely retreated from active involvement in abortion. This is not because this group no longer supports legal abortion. Polls suggest exactly the opposite. Rather, bowing to political pressures and fears of controversy, much of mainstream medicine avoids abortion care, and refers patients to freestanding clinics. The safety record of such clinics is excellent, but their lack of connection to other medical institutions has contributed to the marginalization of abortion provision in many locations. In many states, such as South Dakota, Kentucky, and Utah -- where leading medical figures in 1966 openly supported the San Francisco Nine -- there are today very few abortion facilities at all, and no formal training of residents in ob/gyn programs. Nationally, some 87% of U.S. counties are without an abortion provider.

The San Francisco medical community can offer a powerful lesson to its colleagues elsewhere: that medical schools with strong programs in abortion care, research and training do not suffer any loss of reputation. UCSF is consistently ranked among the top ten medical schools in the country, and its women's health program was recently rated by U.S. News and World Report as number two in the country.

30 years after Roe, we can say that much has changed -- medically, politically, socially -- since the days of the San Francisco Nine. But much remains the same. Some women will always need abortion as part of normal reproductive health care. And doctors who provide abortions deserve the support of their colleagues.

Carole Joffe is a professor of sociology at U.C. Davis and a Visiting Professor at the Center for Reproductive Health Research and Policy at UCSF.

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