Dr. Paul versus the States
- ingewriting
- Oct 30, 2024
- 16 min read
Updated: Jun 8
Over fifty years after Roe v. Wade, abortion is illegal again in 13 U.S. states. Abhorrent, says Dr. Maureen Paul, who continues to fight for abortion access. Whatever personal sacrifices it may take.
Originally published in Dutch in De Groene Amsterdammer, October 30, 2024.
Dutch interview about the making of at De Groene Amsterdammer Podcast.
The symbol of the city Worcester, in Central Massachusetts, is a heart. It is where the Nipmuc tribe was forced to allow Jesus Christ to enter their hearts when the British founded a praying town in 1673. In 1774, the American Revolution came alive with the Worcester Revolt, before the town evolved into a beating heart of industry and European immigration during the 19th century.
This is the city where Alexander Paul, son of Lithuanian immigrants, finds work in a shoe factory during the late 1920s. First on the assembly line, before slowly working his way up to head of sales. It’s where he meets Margaret Connelly, daughter of Irish immigrants, who works as a secretary at the factory office. The couple marries in 1940 and has five children; three sons and two daughters. Their eldest daughter, born on September 19, 1949, is named Maureen Elizabeth.
Maureen has yearned for freedom for as long as she remembers: quintessentially American, yes, but a scarce commodity in a family ruled by Catholicism and an authoritarian father. Half of Maureen's childhood is spent breaking those rules, the other half locked in her bedroom, forever grounded by her father for two or three months at a time.
Her mother has a more poetic sense of punishment. When she spots the young Maureen swinging on the rotary laundry rack in the backyard with her little sister, stark naked and in full view of the neighbors, she washes their mouths out with soap and tightly spins their hair into bright pink curlers, like a kind of plastic rosary. It will become Maureen's earliest memory.
The only place where Maureen is able to live up to her father's expectations is at school. His own parents taught Alexander Paul the importance of hard work. He personally places high value on education. Good grades will offer his children the opportunities he didn't have, even though he got ahead in life without a high school diploma.
Maureen always brings home good reports and becomes valedictorian of her high school. It is because of her father that Maureen continues to take education seriously throughout her life—something she’s still grateful for. But as soon as Maureen gets into college, she selects a campus as far away from her parents as they allow her to go.
As an English student at Michigan University, Maureen gets her first taste of the freedom of the Sixties. She sips her first alcohol and smokes her first joint. She shares her dorm with Sally, a farmer's daughter who studies computer science. Sally shows Maureen rooms filled wall to wall with the world's very first computers. But what truly impresses Maureen is the pure love that Sally exudes; one she’s never known at home. When Sally gives Maureen a hug, it’s as if she’s entirely surrounded by it.
Before long, Maureen and Sally are inseparable. When they're not in class, they’re usually found in the basement cafeteria, where cards are played deep into the night. One night, in line for food, a tall boy with brown hair that casually falls over his blue eyes, strikes up a conversation with Maureen. His name is Jim. They run into each other more often, chat some more, and after a while they begin dating.
Jim isn’t Maureen's first boyfriend. In high school there was Carl, who was tall like Jim, and also had dark hair casually falling over his striking eyes. Carl and Maureen used to hang out in front of the local bodega with their friends. Sometimes they’d go bowling, or dancing, or to the movies. It was a true high school romance, which abruptly ended when Maureen's family temporarily moved to Missouri for her father's work. In the three years they were together, they never went past first base.
As a university student, Maureen still knows very little about sex. It was never discussed at her Catholic high school, aside from being warned to never do it. She didn’t get much further scouring her parents' Encyclopedia with a friend. And her brothers only told Maureen that there were two types of girls in this world: those you marry and those you have sex with. The latter, they warned her, always end up alone.
For over a year, Maureen holds off on having sex with Jim. He doesn’t seem to mind, but a friend of Maureen's warns her that their relationship will not survive if she remains prudish. The rigor of the fifties has long since given way to an era of free sex and love.
Maybe it is time for the next step, Maureen decides. When the moment finally arrives, after a shared bottle of cheap wine on a picnic blanket behind one of the dorms, she mostly hopes it will be over soon.
***
It must have happened that first night. Two months later, the school nurse confirms Maureen is pregnant. The school is obligated to inform her parents, but the nurse gives Maureen a few days to tell them herself.
Maureen doesn't want to. What she wants is an abortion, which is still illegal in America in early 1968. Hawaii will become the first state to allow abortion without medical necessity in 1970. Roe v. Wade, which will secure the right to abortion during the first trimester on a national scale, won’t be decided until 1973.
Like Maureen, hundreds of thousands of women search for access to abortion during the Sixties, in a country where it is still a criminal offence. Money, connections, and luck do offer some opportunities, in most cases neither safe nor hygienic. Some women do end up with understanding doctors, who knowingly break the law because they’ve witnessed countless women come into the emergency room violently ill or mortally wounded after self- or poorly-performed abortions. Some women end up with "doctors" who are not medically trained. Some doctors assault or rape their patients, knowing they’re not likely to report the abuse. And then there are underground networks like the Jane collective, a volunteer network of about a hundred women in Chicago, which safely terminated some eleven thousand unwanted pregnancies through a system of secret codes and safe houses during the 1960s.
Maureen doesn't know about any of this. Looking for help, she confides in people on the periphery of her circle of friends. One girl says she has an uncle who may be able to help her. When Maureen knocks on the girl's apartment door later that evening, a man in a blue uniform is waiting inside. For a moment, Maureen thinks he is coming to arrest her, but the man calmly explains what she needs to do. He mentions code words, the address of a building in a strange city she has to travel to alone, and a price of three hundred dollars.
Maureen barely has enough money to travel, let alone three hundred dollars for a procedure. In a panic, she calls up a family friend asking him to lend her the money in secret. The next day, Maureen’s mother and eldest brother are at her door.
"Pack your suitcase, we're going home," her mother hisses. Silent and numb, Maureen goes with them, onto the plane, back to Massachusetts.
***
Maureen's father is waiting at the kitchen table. He has always been an intimidating figure — a big man, loving at times, who can burst into an overwhelming rage without warning. Today, that rage seems to fill the room entirely. Only fragments of what her father yells at her get through to Maureen; that she's a whore, that the whole family will go to hell, that her mother will die of grief. But also that he has spoken to their family doctor, Dr. Rosen. That he’s arranged an appointment with the Therapeutic Abortion Committee in Boston and that they are leaving the next morning.
Therapeutic Abortion Committees are a new phenomenon, created in response to a rubella epidemic and the thalidomide scandal of the 1960s, during which tens of thousands of children with malformed limbs were born due to the side effects of a drug meant to treat pregnancy nausea. Anonymous committees could now decide whether an abortion was medically necessary, based on a pelvic examination, a personal statement and conversations with a social worker. Why her strict Catholic father let Maureen go to such a commission, she does not know. It’s not until decades later that Maureen learns his sister had lost her uterus in the 1930s after an illegal abortion, and was never able to have children.
For an entire day, Maureen is physically and mentally put under a magnifying glass. At the end, she takes a seat next to her father in a generic office. "I'm sorry, the commission has rejected your request," the social worker opposite her tells them. There are still options for a legal abortion in Puerto Rico or England, the woman says. But Maureen knows she might as well have told them that abortion is only possible on the moon.
Back home, Maureen’s father presents her with two other options: either she goes to a Catholic home for unwed mothers, or she marries Jim. Maureen has never heard of the Magdalene laundries or the abuse and violence that takes place there, but she knows enough to sense that she must stay away from such a home at all costs. When she calls Jim that night, he agrees. Two days later he arrives in Massachusetts.
As soon as Jim shakes her father's hand, the latter's gaze shifts to Jim's shoulder-length hair. That night, Maureen suddenly hears her father's voice booming through the wall. "I won't talk to you about marrying my daughter until you get a haircut!" Jim bursts into her room and asks Maureen to pack her suitcase. In the kitchen, her mother is busy baking a cake. The last thing Maureen sees as she closes the door behind her, is her mother's tears falling into the batter.
From a cheap motel in Canada, Jim and Maureen wait for the storm to blow over. But then Maureen's little sister calls them, warning that their father wants to arrest Jim for kidnapping. According to Massachusetts law, Maureen is still under her father's guardianship. He can send her to a home against her will, unless she gets married. A few days later, Jim and Maureen are in the back of a car on their way to town hall. Sally, insisting they should still make the day beautiful, pins a white corsage on them.
Jim and Maureen both quit their studies. They move into a small apartment and Jim finds work with the railways. The fairy tale that Maureen grew up with — of a prince on a white horse and a happy ever after — has given way to what feels to her like a living nightmare. She is nineteen years old, married against her will and four months pregnant. She has no job, no diploma, and no contact with her family. Just when Maureen thought the whole world was opening up to her, all doors are shutting in her face.
Together, Jim and Maureen decide to give the child up for adoption. As the baby grows and moves inside her, Maureen feels lonelier than she ever has. Friends come by and use drugs in her living room, expanding their horizons. Maureen quietly watches from the sidelines. Her pregnancy passes in a misty haze, peppered with flurries of doctor's appointments, signing contracts, and images of herself crying on the shower floor.
As soon as her contractions start, Maureen panics. She has never been in so much pain. She’s never attended pregnancy classes and does not know what to expect, or that she has to breathe through the pain. She feels like she has lost all control, including over her body. The painkillers she is given at the hospital are soon followed by a haze with loud voices telling her to push. Everything around her is completely white; the ceiling, the walls, the sheets, the coats. "Wow, she can push!" someone shouts. Then there’s a loud cry and a flash of paper with an inky footprint.
Maureen awakes in a maternity ward with happy mothers, feeling she is being punished. As if she needs to be reminded of what her life could have been like under different circumstances.
The marriage to Jim ends pretty quickly after that. Maureen moves in with two college girls she barely knows and finds work as a waitress in a restaurant. She tries to suppress the depression she falls into with amphetamines. She hardly sleeps or eats. One night, seeing herself in a mirror, Maureen is startled by the emaciated face looking back at her.
She knows then she has a choice. She can continue to neglect herself until she drops dead sooner or later, or she can choose another path, one in which she continues to live. She doesn't know what that path will look like, but she quits drugs cold turkey.
***
Whether the protest movements of the Seventies will change the world as radically as they set out to is then still unclear, but regardless, they offer Maureen everything she needs: a community, a purpose, an education. She moves into a communal home where Jim and his new girlfriend also live. Maureen doesn't care. She gratefully immerses herself in lectures, literature and heated discussions about civil rights, racial segregation, war, and nuclear weapons. When Maureen is fired for wearing a protest bracelet to work, her friends stage a boycott protest in front of the place where she waitresses. The next day, she has her job back. It makes a lasting impression on Maureen. Finally, she feels supported by the people around her.
And then there is Frank Mather, the young writer and passionate Marxist who urges Maureen and her friends to fight for a better world. Cautiously, she opens herself up to romance again, but Maureen no longer believes in fairy tales. And when a friend asks her to come with her to Seattle, she doesn't think twice. It is time for a fresh start. Where better than on the other side of the country?
In Seattle, Maureen is swept up by the second wave of feminism. She moves into a women's commune and joins a feminist study group. There, she learns about the limitations of traditional family structures, about the gender construct, about female anatomy and sexuality. She realizes how her own experiences fit into a larger narrative of patriarchal oppression, not only of women but of all kinds of marginalized groups. Within her idealistic bubble, Maureen feels like she can generate real change with those around her.
She gets involved in the Open Door women's Clinic, one of the first Self Help Clinics for women in America. Under the guidance of a doctor from Washington University, Dr. David Eschenbach, Maureen and other women perform pelvic exams and menstrual extractions for those who need it. They organize educational events on recognizing, preventing, and remedying pregnancies and common gynaecological ailments. Maureen also works as an exam model for university students, whom she gives feedback on her experience during gynecological examinations.
For the first time in a long time, Maureen feels like her life is really hers again. That’s when she decides to get pregnant. She won't give up the child this time, but will raise it together with the women in her commune. In retrospect, she should have consulted with Frank, but Maureen wanted to make her own choices without interference. Moreover, she knows their casual relationship doesn't provide a basis for a family. Maureen quits taking birth control and gives birth to her second daughter, Dillon, at 23.
Completely smitten with women's medicine, Maureen enrolls at university. When Dillon is two years old, they move to Boston together, where Maureen studies medicine at Tufts University from 1975 to 1979. She shares Dillon's upbringing with women in a new commune. When she returns to Seattle for her specialization as a gynecologist, her roommate Karen, who is like a second mother to Dillon, joins them.
That's when Maureen learns her mother is terminally ill.
Just before she moved to Boston in 1975, Maureen had tried to reconnect once. But when she told her parents that she'd given up her first daughter, they became angry, saying they could have raised the child for her. Since then, there's been no communication. But now her mother wants to visit, meet her granddaughter, and see Maureen again. As the bond with her mother slowly recovers, Maureen decides to finish her specialization back in Boston, closer to where her parents live. But the bond with her father remains painfully strained, especially when her mother dies in 1981.
Meanwhile, Maureen puts all her energy towards her medical career. After graduating as a gynecologist in 1984, she further specializes in environmental and occupational medicine. In the late 1980s, she founds the Center for Reproductive Hazards. As one of the few experts in this field, Maureen publishes a textbook, Occupational and Environmental Reproductive Hazards: A Guide for Clinicians. She also remains active in abortion, environmental, labor and peace activism, and performs abortion procedures in local clinics in the evenings.
In these years that Maureen reinvents herself, American abortion law is undergoing a transformation of its own. In 1980, the Hyde Amendment puts an end to government funding for abortion, leaving it unaffordable for many. In 1992, the case of Planned Parenthood vs. Casey creates a legal loophole for pro-life activists. Discouragement tactics such as mandatory waiting periods, parental consent, informing partners and misleading information about the risks of abortion are now freely introduced. Moreover, abortion has never been fully embraced by the medical world. Maureen teaches abortion procedures to educate the new generation throughout her career, but many medical programs barely teach abortion, if at all. Well-trained doctors and clinical support staff are notoriously hard to come by.
The anti-abortion movement, meanwhile, is becoming increasingly hardlined and aggressive. Demonstrations outside abortion clinics are quickly becoming the standard. Clinics are shelled, set on fire and bombed. In 1993, abortion doctor David Gunn is shot dead in front of his clinic. On December 30, 1994, a man named John Silva opens fire with a semiautomatic weapon in the waiting room of Planned Parenthood in Brookline, Massachusetts. He then drives on to another clinic, where he shoots several employees before fleeing.
Maureen works part-time at both clinics, but is at the gym when the shootings happen. From that moment on, abortion patients and employees across America must enter clinics through a metal detector. Fewer and fewer people are willing to accept the very real risks of providing abortion care.
It is precisely this chaos that convinces Maureen to move to the front lines. In 1998, she starts as medical director of Planned Parenthood in Boston. Her car is attacked by protesters on a daily basis. For a while, she is getting stalked. Once again, Maureen feels supported by her community. When pro-life activists protest in front of her house, her neighbors organize a counter-protest. When zealots chain themselves to tables in the clinic's treatment rooms, Maureen and her colleagues stoically continue in another part of the building.
With the National Abortion Federation, a national network for abortion physicians, Maureen and her colleagues draft guidelines and protocols for American abortion clinics. In 1999, she publishes a groundbreaking textbook on abortion care, republished in 2009 and still taught at universities.
She learns a lot from young and African-American activists, who in the early 1990s work with the reproductive rights movement to create greater awareness of the impacts of race, gender, poverty and language barriers on reproductive rights and access to abortion. Maureen acts as an expert witness in multiple abortion court cases, as she continues to defend the right to abortion on as many fronts as possible.
Meanwhile, she is losing more and more friends to anti-abortion terrorism. Dr. Barnett Slepian, who is shot through the window at his kitchen table in New York in 1998. Dr. George Tiller, who survives an assassination attempt in 1993 and asks Maureen to work at his clinic, is murdered at his church in Kansas in 2009. Colleagues in conservative states receive death threats daily, including letters containing anthrax. In Boston — but also in San Francisco and New York, where Maureen later works as medical director of Planned Parenthood — the right to abortion is officially protected by a Democratic majority. But the threat of anti-abortion terrorism is never far. Together with two hundred other doctors, Maureen's name is listed on the anti-abortion website the Nuremberg Files. When a doctor is injured by an attack, their name is grayed out. When murdered, their name is crossed out.
It doesn't feel personal to Maureen until she receives a call from a Canadian newspaper in the late nineties, telling her they have received a death threat to her. The letter contains cut-out photos and scribbles depicting her rape and murder. As Maureen listens, her entire body begins to tremble. She ignores the advice to hide out in a hotel. Overwhelmed by everything, she just wants to be at home. Dillon comes home from college to stay with her. Outside, a van with FBI agents keeps watch. The person who sent the letter is eventually arrested and Maureen takes a special safety training. Cameras are installed outside her house, and she never takes the same route home. But she refuses to stop working.
Maureen never expected Roe v. Wade to be overturned after 50 years. As soon as a majority of the US Supreme Court – including three conservative judges appointed by Donald Trump – decide in June 2022 that abortion is no longer a constitutional right, thirteen states immediately introduce laws that make abortion practically impossible. Maureen can hardly believe it, but immediately jumps into action with her friends and colleagues. If states want to restrict access to abortion, they will help people get around those restrictions.
Abortion funds already raise money for transport and procedures, and volunteer networks for free shelter and transportation rapidly expand. People are shuttled from states with an abortion ban safely to clinics elsewhere in all kinds of ways. Since the Covid pandemic, abortion pills can be prescribed remotely by a doctor and sent to patients across the country. Maureen and a number of her colleagues decide to take advantage of this with a new organization: Massachusetts Medication Abortion Providers (MAP).
As soon as they launch in September 2023, MAP receives requests from all over America. Based on extensive questionnaires, Maureen writes out prescriptions, after which abortion pills are packed by volunteers during so-called "packing parties’. Those who cannot pay the standard 250 dollar fee can transfer the minimum of five dollars: the rest is reimbursed via donations. MAP soon helps around six hundred Americans access abortion every month, most of them from states with strict abortion bans.
A so-called ‘shield law' in Massachusetts ensures that Maureen and her colleagues cannot be prosecuted from other states and that the applicants are automatically seen as local patients for their treatment. Everything is done entirely according to the rules – for their own safety and that of others, and with the help of pro bono lawyers, they keep abreast of the latest legislation and carefully adhere to it.
Laws that criminalize the provision of abortion assistance in various states mean that Maureen can no longer travel freely. She has not seen her brother in Florida since the first Covid lockdown. As soon as she crosses the state border, she could be arrested. Her brother cannot come to her because of health issues. Maureen does not know if she will see him before he dies, but the help that she can offer with MAP is ultimately worth the personal sacrifices she has to make.
***
For decades, Maureen keeps what she does hidden from her father. He knows she is a doctor, he doesn't know the details. When Maureen tells him she is writing a book, he keeps asking her when he can read it, every time they're on the phone. “Soon," she answers, even after the book has long been published. Only when her father is 95 and the end is near, does Maureen finally gather the courage to be honest.
"Daddy, I brought you my book," Maureen shouts to her by then half-deaf father in 2011, handing him a copy. With squinting eyes, he carefully brings the cover up to the tip of his nose. "Is it about abortion?!" he exclaims. Maureen nods, takes a deep breath, and asks her father if he knows that every eight minutes, somewhere in the world, a woman dies from an unsafe abortion. "I have dedicated my career and life to preventing that," she says.
Her father looks at the book again. The moment can't have lasted longer than a minute, but to Maureen it feels like an hour. Then, Alexander Paul looks down at his eldest daughter. "You know what I think?" he says, holding the book up high above his head. "I think the pope should read this!"
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