On a frigid evening in January, Dr Katie McHugh welcomed 20 guests into her Indianapolis home and prepared to tell them a secret she had kept for seven years. They had come for a Planned Parenthood fundraiser party; among them were her father and two sisters. As they gathered in her living room, sipping wine, McHugh’s hands shook.

“I was quite nervous, but I wanted to get my secret out as soon as I could,” she says. “I said, ‘Welcome. I’m glad you’re all here. I’m Katie McHugh. I’m an OB-GYN here in Indianapolis, and I’m also an abortion provider.’ My father visibly flinched. Then I stopped to take a breath, and everyone applauded, including my family.”

After the event, to her surprise, her Republican father donated to Planned Parenthood. “He gave me this big hug and said, ‘I’m so proud of you, but I’m worried about you.’”

Until that night, McHugh had told no one but her husband and a few close friends about her part-time work as an abortion provider at one of nine abortion clinics in Indiana. She had never told her conservative-leaning parents or three sisters, despite them being an unusually tight family. Nor had she told her two young children, neighbors, or colleagues at the university where she works as a professor of clinical obstetrics and gynecology.

“I knew it would cause angst in my community and potentially increase risk to my family,” she says. “I worried that certain relatives would be ashamed of me.”

On the frontline: 12 hours in a besieged abortion clinic Read more

Despite living in the proverbial closet, McHugh had been receiving hate mail from anti-choicers since April 2016, when she published an op-ed in the Washington Post arguing against new legislative restrictions on abortion in Indiana. (She identified herself in the op-ed as an obstetrician-gynecologist, but did not mention that she herself moonlights as a provider.) Letters admonishing her that “abortion is murder” arrived at her office in Indianapolis. Her Twitter and Facebook inboxes flooded with messages saying she should get raped or murdered.

The harassment she endured after simply advocating for reproductive rights confirmed her belief that it was safer to keep quiet – to let people keep assuming that she “just liked to talk about abortion” but didn’t actually provide it herself.

That changed this past winter, when she was the target of another wave of vitriol on social media. This time, the hate mail came not from strangers, but from people she knew. Outraged that she had posted about reproductive rights in a Facebook group, conservative acquaintances banned her from the group and told her that she didn’t deserve to be a doctor, that they would never refer to her practice again.

“It was the only response I’ve gotten that really upset me,” she says. “I’ve gotten consistent hate mail from my local peers since then.”

Instead of pushing her into deeper silence, this harassment provoked her to come out of the closet.

“I thought, ‘This is ridiculous.’ I’m playing into this game by being quiet and secretive. It makes me feel like I’m ashamed of this work, which I’m not – I’m actually so deeply proud of it.”

McHugh is one of five formerly closeted abortion providers who spoke to the Guardian about their recent decisions to come out about their work. Fed up with mounting threats to reproductive rights – including a pending abortion ban in Alabama that would punish providers with up to 99 years in prison, a push to close the last clinic in Missouri, and a president who tweets about doctors “executing babies” – these providers are finally breaking their silence about the cause to which they have devoted their lives.

Facebook Twitter Pinterest Dr Katherine Farris works as an abortion provider at several Planned Parenthood clinics. Photograph: Jeremy M Lange/The Guardian

Pushed into the closet

Before Roe v Wade, the landmark 1973 ruling that enshrined a woman’s right to choose, anyone who helped terminate an unwanted pregnancy was a criminal under US law. Criminalization did not put a stop to abortion, of course – estimates of the number of illegal abortions in the 1950s and 1960s range from 200,000 to 1.2m per year – but it did force so-called back-alley providers to perform the procedure under extreme secrecy.

Take, for example, the Jane Collective, an underground network of amateur female abortion providers that launched in Chicago in 1965: to avoid being identified, “The Janes”, as they dubbed themselves, often blindfolded their patients. In 1972, police raided one of the collective’s secret apartments and arrested seven members. While shackled in the police van, the Janes fished the index cards bearing their patients’ names from their pockets, tore them up, and swallowed them. Each was charged with up to 110 years in prison. (The charges were dropped after Roe v Wade passed the following year.)

Nearly 50 years later, many providers still feel pressured to operate in secrecy, even when the job “feels like a calling”, as McHugh puts it. In a 2014 study about abortion stigma, 66% of providers reported difficulties surrounding disclosure. Many fear getting shunned by their communities, fired from their day jobs, or targeted by anti-choice protesters.

Death threats, intimidation and harassment have increased drastically at US abortion clinics since Donald Trump’s election, according to the National Abortion Federation. A survey found that, in 2018, nearly half of US abortion clinics experienced at least one incident of severe violence, threats of severe violence and/or severe harassment.

Feeling muzzled can take a psychological toll. Dr Angela Marchin, an OB/GYN in Colorado, says that lying by omission to her conservative, midwestern Catholic family about providing abortions made her feel “almost like a fraud”, as if she were leading a double life.

“I was one person when I was around my friends and coworkers, then would go home and have to be someone different,” Marchin says. “I almost felt ashamed or guilty about it, like I wasn’t standing up for what I believed in. But I didn’t want to be shunned by my family.”

In April, when Texas lawmakers were considering a bill that would allow the death penalty for patients who get abortions, Marchin tweeted her own abortion story. During her first year of medical school, she got pregnant after being unable to pay $70 a month for birth control. Her local Planned Parenthood helped her get a medical abortion. “Now I am an OB/GYN dedicated to helping other women achieve their goals,” she wrote.

The tweet went viral. Since then, she has been building up the courage to come out as a provider to her family during an upcoming family vacation.

“I’m planning to put my foot down and stand up for what I believe in to my family,” she says. “It’s so important for people to understand how normal and common [abortion] is, especially now, and that I’m not a bad person for doing this. In fact, I’m doing it out of the goodness of my heart and at great risk to myself.”

Dire consequences for speaking up

While moonlighting at an abortion clinic in Oklahoma City, from 2016 to 2018, Dr Maya Bass used a burner phone to communicate with her patients. Knowing that protesters sometimes go through clinics’ garbage, she had all her paychecks and other mail from the clinic sent to her parents’ house in Philadelphia.

“I didn’t want anyone to know my address,” Bass says.

She set up security cameras at her house, even though her neighborhood had “zero crime”. When she gave guest lectures to Oklahoma University’s Medical Students for Choice group, on such subjects as “how to use a manual vacuum aspirator”, she insisted that the lectures be listed as “taught by an anonymous doctor”.

Her car was listed in the name of her husband, a member of the military, so that if a protester at the clinic looked up her license plate, “they’d get this military guy”, she says. “The backup plan was that if any protesters ever came to our home, we’d move to the military base and be protected by giant tanks.”

It wasn’t just the wrath of anti-choice activists that concerned Bass. She also worried that disclosing her part-time involvement in abortion care would get her fired from her full-time job as a family medicine physician.

“The CEO of the health center where I worked was extremely anti-choice,” she says. “I was nervous that if he found out, I wouldn’t be able to do family medicine any more.”

“The problem of employment discrimination is enormous for doctors who want to perform abortion healthcare,” says Noel Leon, a lawyer at the National Women’s Law Center. “I have talked to dozens of clinicians who have faced – or who fear – dire employment consequences when they have disclosed their commitment to abortion access.”

Facebook Twitter Pinterest Dr Rathika Nimalendran works as an abortion provider at a health clinic in North Carolina. Photograph: Jeremy M Lange/The Guardian

A 2018 report authored by Leon, who provides legal support to doctors who perform abortions, offers the disconcerting example of a doctor who was threatened by a senior partner of a private OB/GYN practice during a job interview: “If I ever find out you did elective abortion any time in your professional life, you’ll never practice medicine in [this state] again. Do you understand that?” the partner said.

Such discrimination is particularly harsh at Catholic-owned or affiliated hospitals, which make up 14.5% of all acute-care hospitals in the United States, and which often explicitly prohibit their doctors from performing abortions in their off hours, even at unaffiliated clinics. Since many abortion clinics are staffed primarily by part-time employees, these restrictions can lead to staffing shortages where providers are needed most. In some cases, a doctor’s ability to keep helping women is contingent on whether she keeps quiet about it.

Dr Rathika Nimalendran, who drives by a giant Confederate flag every morning on her way to her full-time job at a family health clinic in rural North Carolina, keeps the fact that she moonlights as an abortion provider a secret from her mostly conservative Christian patients.

“I feel like I’m two different people,” she says. “But I grew up in a south Asian family in Florida, so I’m used to the idea of code-switching. As a woman of color, I feel doubly careful. A few of my patients have made comments about my gender and ethnicity.” Sharing her commitment to abortion access could invite further scrutiny and jeopardize her work at the family clinic.

Last September, tired of staying quiet, Bass moved from Oklahoma back to her hometown of Philadelphia, where she talks openly with friends and family about working in abortion care.

“I’m still in the process of coming out,” she says. “Coming out on social media is the hardest. I keep wondering, if I tweet about reproductive health, is this going to bring protesters to my house?”

Facebook Twitter Pinterest Women protest in New York to demand abortion rights for all women. Photograph: Peter Keegan/Getty Images

‘It sucks to have to hide what I do’

Dr Katherine Farris, a self-described former “pro-life, Catholic girl” and family physician in North Carolina, long feared that coming out as an abortion provider could impact not just her own career, but her husband’s, too.

When she first decided to become a provider, after reading The Story of Jane: The Legendary Underground Feminist Abortion Service, written by a former member of the covert collective, she never expected she would have to maintain some of the secrecy under which the Janes operated. But then she moved to a town in “the buckle of the Bible Belt in the south”, she says. “We had a lot of anxiety about the impact it could have on my husband’s job if it became known that I’m a provider.”

She has now lived for 16 years hiding her part-time work as a provider at Planned Parenthood from all but her immediate family and a handful of friends. When people ask what she does, she answers vaguely, saying she works at a “multistate women’s healthcare organization”.

“I truly believe I’m making the world a better place by helping women have bodily autonomy,” she says. “It sucks to have to hide what I do.”

She came out to her closest friends only after knowing them for years. “I’ve been terrified every time I’ve done it,” she says. “But I’ve been met with nothing but love [and] gratitude, actually, for what I do. If I could be confident that that would be everyone’s response, I would be more open.”

When it comes to anti-abortion acquaintances, she says, “it would never occur to them that I might be a provider, because I’m fun and friendly, and they have this idea that providers are demons”.

Facebook Twitter Pinterest Pro-choice supporters protest in front of the Alabama state house as the state senate votes on the strictest anti-abortion bill in the US. Photograph: Christopher Aluka Berry/Reuters

As Roe v Wade hangs in the balance, pro-choice advocates now fear a day when all abortion providers are once again forced underground. In the first five months of 2019, 378 abortion restrictions were introduced across the United States. Nine states have now passed laws to outlaw abortion or forbid it past a certain point in pregnancy.

So many women in the US lack access to reproductive healthcare that secret networks around the country are now emulating the Janes, discreetly training women to provide safe abortions outside of the law and the medical establishment, hoarding misoprostol and building manual vacuum aspirators from mason jars in their bedrooms.

“We can never go back to that,” Farris says. In recent months, she has taken steps to break her silence, getting involved in more advocacy work: along with McHugh, Nimalendran, Marchin, and Bass, she is a 2019 fellow at Physicians for Reproductive Health, a not-for-profit organization offering doctors advocacy training such as the Leadership Training Academy.

“My rage is overcoming my anxiety,” Farris says. “This legislation is going to tear women’s lives apart. I can’t stay silent in the face of it. It feels a bit scary to be open. But it’s been exhausting to keep such an important part of my life a secret. I can’t imagine that what will come in the future will be more exhausting.”

Scared, but proud

Since coming out to friends and family at her Planned Parenthood fundraiser, McHugh has started talking about her work “all the time”, she says.

On the 10th anniversary, in June, of Dr George Tiller’s murder at the hands of an anti-abortion extremist in his church, she tweeted: “Being an #abortion provider can be scary, intimidating, and challenging but it is some of the most fulfilling work I do. This would not be possible if not for the work of the giants before me, like Dr. Tiller. #AbortionIsHealthcare and I am #Proud2Provide.”

After this announcement, many of her local colleagues vowed to stop referring patients to her family medicine practice. Extended family members stopped talking to her and her husband. She was not surprised.

“I’m not going to change their minds and they’re not going to change mine,” she says. “I’m okay with that. It’s their choice. Turns out I’m all about choice.”



