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This article was published 7/5/2010 (2183 days ago), so information in it may no longer be current.
IN an unidentified hotel in the core of an unnamed American city, about 65 Canadians and 700 Americans have gathered for professional development.
An explosive-sniffing dog checks every room to make sure it's safe, while off-duty police officers with coiled wires behind their ears roam the halls checking passes. The passes identify this as the 34th annual meeting of NAF, an organization that dares not spell out its name.
Don't bother asking participants what they're up to. They've all signed confidentiality agreements before registering and have been warned not to leave conference materials lying around.
If you stumble upon this group, you might guess it's the women's caucus of the U.S. Central Intelligence Agency. Or an anti-terrorism brainstorming session.
The latter guess includes a grain of truth.
They're abortion providers, and while they are discussing issues as tame as quicker ways to take blood tests, they must always keep an eye out for domestic terrorists.
Since 1993, more than a dozen North American abortion providers have been shot or killed -- including Winnipeg's Dr. Jack Fainman, who survived a 1997 shooting, and Dr. George Tiller, killed in Kansas last year.
Tiller's daughter read her father's words at the conference as she accepted an award for his clinic: "Hardly anyone can escape a determined assassin, but what we must avoid is the character assassination that comes from living in chronic fear and anxiety."
Canadian delegates at the National Abortion Federation conference in Philadelphia - it's safe to write that now the meeting is over - were noticeably less fearful than their American counterparts.
The last arson attack on a Canadian abortion clinic was in 1992 - still unsolved - and the last butyric acid attack was in 1991. Canada missed the anthrax letter wave that ended with a 2003 conviction.
Abortion had seemingly fallen off the political agenda in a polite Canadian agree-to-disagree way until the Harper government's recent refusal to include access to safe abortions in the maternal health initiative for developing countries that Canada is promoting at next month's G8 summit.
Conservative Senator Nancy Ruth was apparently trying to be helpful when she advised angry aid workers this week to "shut the f up" or risk turning abortion into an election issue, but she instead fanned the flames. The federal Liberal party appears eager to take on Prime Minister Stephen Harper over abortion -- firing off a fundraising letter based on Ruth's comments.
It remains to be seen whether bringing abortion out of the shadows will reignite a culture war that puts clinic staff at risk -- or whether Canada is ready for a frank discussion that will help take away abortion's stigma and make clinics safer.
Dr. Konia Trouton of Victoria said Canadian abortion providers feel more secure than they used to when most worked in stand-alone private clinics. "People that are providing are doing it in very comprehensive settings ... alongside other activities."
Now that abortion is more integrated into the mainstream health system, a woman can sometimes go to a clinic for a birth control prescription, return to the same clinic for an abortion when her birth control fails and return again to find a midwife when she's ready to be a mother.
"It normalizes abortion, absolutely," Trouton said.
In Winnipeg, abortions are available at Health Science Centre's Women's Hospital and Women's Health Clinic, which absorbed the staff who used to work for Dr. Henry Morgentaler's private abortion clinic.
Protests still happen, but they're fairly peaceful.
However, National Abortion Federation president Vicki Saporta warns Canadian doctors, nurses and clinic administrators not to let their guard down. For one thing, anti-abortion extremists from the U.S. have been known to cross the border into Canada.
The suspect in three Canadian shootings - including Fainman's - is James Kopp, convicted of killing Dr. Barnett Slepian in New York in 1998.
"A group of people out there will never rest until abortion is no longer available. When they get frustrated by political setbacks, as they see them, they often try to take the law into their own hands," Saporta said.
In Winnipeg, many anti-abortion protesters are unintimidating Catholic seniors, but the Centre for Bio-Ethical Reform based in Calgary is recruiting a younger generation through universities across the country. The centre has brought its Genocide Awareness Project - billboards juxtaposing photos of Holocaust victims with photos of aborted fetuses -- to the University of Manitoba.
The provocative imagery has led some campuses to deny anti-abortion groups club status. The Centre for Bio-Ethical Reform has a disclaimer on its website noting that it "condemns all abortion-related violence against property or against persons," but there's still a fear that inflammatory rhetoric could trigger attacks from people who are mentally unbalanced.
Morgentaler, 87, looked frail and vulnerable as he was wheeled off the plane. The abortion rights pioneer and member of the Order of Canada has been the target of numerous threats and a few attacks. On this trip, his security appeared to be a posse of middle-aged women you wouldn't want to mess with.
They're burned out by yet another lengthy court battle to secure abortion services for women - this time in New Brunswick.
In that medically conservative province, women are still required to jump through a series of hoops to get publicly funded abortions. They need permission from a family doctor plus a gynecologist, and the procedure can only be performed in a hospital by a gynecologist. In the rest of Canada, family doctors perform most abortions, often outside hospitals.
If a New Brunswick woman travels out of province for an abortion because she can't find two local doctors willing to sign off, she won't get reimbursed because abortion is not on the list of inter-provincially billable services.
NAF is trying to change that, but "one province is standing in the way," Saporta reports. You guessed it: New Brunswick.
Manitoba will pay for abortions its residents obtain in other provinces - but only if they're done in hospital, creating logistical complications for women and extra expense for the government, according to NAF's Canadian director Dawn Fowler.
New Brunswick seems unlikely to prevail in court, since the restrictions on abortion in that province are similar to those Canada's Supreme Court threw out more than 20 years ago. Nova Scotia has already lost a parallel case.
Abortion rights advocates in New Brunswick, who are waiting for their next court date, accuse the provincial government of trying to stall the lawsuit through a series of expensive appeals until Morgentaler dies.
In the meantime, New Brunswick women are paying $600 or more at Morgentaler's private clinic for a procedure that is free in other provinces, under the Canada Health Act.
NAF Canada delegates met separately for a day in Philadelphia to hash out Canadian issues. The main item on the agenda was strategies for communicating with the public.
It's not easy to do that when your members are in hiding. Media are not allowed into NAF conferences and reporters are not even supposed to know they're happening. A Free Press reporter was allowed to hang around the margins of the event after learning about it through informal sources and passing security checks.
Saporta writes occasional letters to the Globe and Mail, but her organization is not widely known in Canada.
Its main job is setting the gold standard for abortion care - including publishing textbooks for providers.
NAF also has a patient assistance fund for those who fall through the cracks, including new immigrants not yet on a provincial health plan, students away from their home provinces and women who need help with travel costs. In Prince Edward Island, terminating a pregnancy always involves travel since there are no abortion providers in that province.
Donors to the fund, which has helped more than 30 women in the last two years, can get a Canadian charitable tax receipt.
The National Abortion Federation's toll-free hotline also offers options counseling and referrals. The group is looking for a new name to reflect that its work includes Canada - and now Mexico.
In the U.S., finding the money to pay for abortions is a widespread problem.
U.S. Secretary of State Hilary Clinton recently came to Canada and declared that "reproductive health includes contraception and family planning and access to legal, safe abortion," but her boss President Barack Obama is not so brave at home.
"We saw President Obama sign an executive order that reaffirmed long-standing restrictions on the use of federal funds for abortion care," Saporta said as she rallied her troops on the closing day of the conference. "It's time to redefine what being pro-choice means in the United States. You really can't be pro-choice and deny low-income women the same access to abortion care as wealthier women."
Fowler is keeping a wary eye on the Harper government's refusal to fund abortion in developing countries and a 2008 attempt by a Tory backbencher to introduce an Unborn Victims of Crime Act.
"If he became a majority Prime Minister, we're very concerned about would he ... start chipping away at women's access."
In an opinion poll by Ekos April 1, nearly twice as many Canadians described themselves as being pro-choice on abortion as pro-life. That proportion has not changed much in the last decade. However, Manitoba and Saskatchewan are the most anti-abortion region in the country, with the number who lined up on each side of the debate almost even, according to the Ekos poll.
An Angus Reid poll in January found the number of Canadians who felt all abortions should be publicly funded was about equal to the number who supported funding only for abortions done in medical emergencies. Seven per cent thought the government should not fund any abortions.
Anti-abortion groups say Canadians want limits on abortion.
In many American states, the procedure is hemmed in with rules Saporta believes Canada should avoid replicating.
"We've got a whole host of restrictions that do nothing to make abortion safer, but simply try to make it more difficult for women to obtain the care," she said.
"In some states, doctors are required to read scripts to patients that have been prepared by the state with medical misinformation, for example informing women that if they had an abortion, there would be an increased risk for them to develop breast cancer."
Canadian abortion providers aren't required to notify parents of their teen patients or get consent from those parents. "Most minors already involve their parents in these decisions and those who don't have very good reasons why they don't because they feel that they will be thrown out of the house or will be subject to abuse," Saporta said.
In the U.S., mandatory waiting periods can burden women who need to travel to find an abortion provider. Another rule designed to encourage second thoughts -- forcing a woman to view a live ultrasound of her fetus -- sometimes backfires on the anti-abortion movement, Saporta reports.
"Most abortions are done in the first trimester where, when you show women that ultrasound image, they feel relieved," because the fetus is hard to make out and much less developed than in the photos anti-abortion activists publish.
The number of abortions in Canada seems to have leveled off at about 100,000 a year. Numbers from Manitoba are harder to come by, since the Manitoba government only reports hospital procedures to Statistics Canada.
Abortion is the most common day surgical procedure for women, according to Fowler, and at least one in three North American women will have an abortion.
"Everyone has an abortion story. You may not have had an abortion yourself, but you definitely know someone who has," said Jennifer Klozik DeCapua, co-founder of U.S.-based 45 Million Voices. That's the number of legal abortions in the U.S. between 1973 and 2005.
The Michigan mother is a leader in the abortion "coming out" movement that has generated websites like www.imnotsorry.net to counter the anti-abortion movement's claim that ending a pregnancy leads to infertility, depression and regret.
Women who've chosen abortion point out that the decision to have a child can lead to medical complications, post-partum depression and regret.
A recent University of Manitoba study found an association between abortion and substance abuse and mental health problems. However, an abortion provider at Winnipeg's Women's Hospital said that doesn't mean abortion causes mental health problems or vice versa. She said the same factors that contribute to unwanted pregnancies -- abusive relationships, poverty, addiction, unstable housing, lack of social support -- put women at risk for mental health problems. "If there was a way to fix all that and also contraception was made more easily available, it would go a long way to decreasing the number of procedures that were required -- and hopefully even depression."
Klozik DeCapua, who used to work in family planning, was deeply affected by Tiller's murder. It made her realize that abortion providers are bearing the brunt of the hostility from anti-abortion extremists while the women they serve remain largely silent.
As the gay rights movement realized a generation ago, the greater the number of people speaking out, the less likely any one person is to be targeted.
So Klozik DeCapua told her abortion story at a vigil for Tiller and her organization provides forums - including at the NAF conference - for other women to tell their stories.
Conference delegates also talked about how to make time for women to tell each other their stories in the midst of busy clinics.
Fowler said she's not out to change the minds of Canadians who believe abortion is wrong. She just wants to make sure women weighing the decision are given evidence-based information and timely help.
Groups like NAF want pregnancy crisis centres to be forced to disclose if they don't offer abortion referrals, to prevent pregnant women being stalled until they're too far along to make that choice.
Fowler challenges the notion that abortion providers have a vested interest in women choosing abortion over motherhood or adoption.
Many of the professionals wandering the halls at the NAF conference could command a higher salary and have an easier life in a less controversial branch of medicine.
"Who wants to work in a hostile environment?" Fowler asked. "The people who provide abortion care are committed to supporting women."
Liberty, Justice and Abortion was the title of the National Abortion Federation's conference program, under a photo of Philadelphia's famous Liberty Bell.
The incoming board chairman honoured his peers at the awards ceremony as "patriots" in the tradition of the country's founders, who risked their lives to defend "inalienable" human rights.
The famous 1973 Roe versus Wade court case that legalized abortion in the U.S. was won on the basis of the U.S. Constitution - a document originally signed in Philadelphia.
"I'm sick and tired of the false patriots of idiot America," NAF's new chairman said, referring to the "tea party" protesters against Obama's health-care reforms.
Anti-abortion activists who consider themselves the true freedom fighters would be appalled, but for a few days each year, North American abortion providers have the rare luxury of debating on their own terms.