Another doctor warned Brigham, “You can’t do second-trimester abortions. You just started out, and you don’t have the skill level.” Illustration by Tomer Hanuka

In May of 1990, several hundred physicians gathered in a conference hall at an Atlanta hotel, as uniformed guards stood at the door. Colleagues traded tips about installing bulletproof glass in their offices and spoke about fielding hate mail and death threats. It was the annual gathering of the National Abortion Federation, or N.A.F., a professional association with a beleaguered membership. At the time, fewer than a fifth of the counties in the United States had abortion providers. Since the mid-eighties, clinics across the country had been blockaded, vandalized, and firebombed. Most of the physicians at the conference were well into middle age. The right to safe, legal abortion, which had been established by Roe v. Wade, in 1973, would be rendered meaningless if a new generation of providers didn’t emerge soon.

There was at least one younger face at the conference: Steven Chase Brigham. A handsome, genial man in his mid-thirties, with a square jaw and sandy brown hair, Brigham was a recent graduate of Columbia University’s medical school. Articulate, well dressed, and polite, he seemed unusually relaxed and upbeat for an abortion provider.

“You sort of notice the newbies, and he seemed like a very personable young man,” Dr. Suzanne Poppema, a former director of N.A.F., recalls. “He was just getting started in the abortion-care business, and was really eager to learn and ask questions.” When talking with N.A.F. members, Brigham repeatedly emphasized the importance of treating patients with respect. Dr. Curtis Boyd, one of N.A.F.’s founders, says, “He knew all the right things to say. He’s very charming.”

By the mid-aughts, Brigham was the owner of a large chain of abortion clinics, American Women’s Services. There were more than a dozen branches, in four states: Virginia, Maryland, Pennsylvania, and New Jersey, where he was based. The chain had expanded, in part, because he advertised aggressively, promising “caring and supportive” counsellors and “very low fees.” In addition, the number of abortion providers had continued to decline, creating a vacuum that Brigham was able to fill. “Dedicated to Reproductive Freedom and Quality Women’s Healthcare,” the Web site of American Women’s Services proclaimed, above a photograph of a smiling female physician in a white coat.

Brigham, who was born in 1956, grew up in a middle-class family in Toledo, Ohio. A gifted athlete who excelled at wrestling and tennis, he also stood out academically. In 1974, he enrolled at the Massachusetts Institute of Technology, where he double-majored in physics and applied biology. He then entered an M.D.-Ph.D. program at Columbia. Although he embarked on a Ph.D. in molecular biology, he never completed a dissertation. Upon receiving his M.D., he did a yearlong internship in internal medicine at the Westchester Medical Center, then bounced around jobs: a few spells in emergency rooms, a stint at a smoking-cessation clinic.

One day, while reading the classifieds in the Times, Brigham noticed that a gynecology center in Flushing was soliciting applications for a staff-physician position. Although he was not trained as a gynecologist, he applied, and he was hired. He soon found himself observing, and then performing, various medical procedures there, including first- and second-trimester abortions.

Brigham could see that there was a high demand for abortion, even in places where it was viewed with skepticism or hostility. In 1990, he travelled to a small, conservative town in southeastern Pennsylvania called Wyomissing and signed a lease to rent space on the ground floor of an office building. For someone who had spent the previous decade in New York City, Wyomissing—a few miles west of Reading—was a curious destination. It was also a daring place to open an abortion clinic. Brigham told the building’s owners that he intended to start a family-medicine practice, with abortion integrated into a broader repertoire of care.

Brigham began placing ads for abortion services in the Yellow Pages. The ads drew a steady stream of pregnant women to his office—and a steady stream of protesters, armed with placards and bullhorns. The commotion escalated, eventually prompting the owners of the building to petition a judge for a temporary injunction against the protesters; after the request was denied, they successfully obtained an injunction against Brigham, who, they claimed, had misrepresented the nature of his medical practice. The controversy attracted extended scrutiny in the local press. One morning, Brigham later recalled, he glanced at the front page of the Reading Eagle and spotted a story, below the fold, about a minor international development: the implosion of the Soviet Union. Above it was yet another story about the turmoil outside his clinic.

Many doctors in Brigham’s position would have decided that there were easier ways to make a living. But he seemed immune to such stress. “Nothing bothers him,” a former colleague told me. “I don’t think he gets rattled.”

Even before Roe v. Wade, the demand for abortions overwhelmed the capacity of those willing to supply them. In 1972, a year before the Supreme Court’s ruling, a hundred professors of obstetrics signed a statement suggesting that practitioners who did not have moral objections to performing abortions should help meet the “staggering” demand for the procedure, once it was legalized. “If only half of the 20,000 obstetricians in this country do abortions, they can do a million a year at a rate of two per physician per week,” the statement noted. “Already we do more than a million other pelvic operations every year.” This generation of obstetricians had seen women wheeled into emergency rooms, one after another, because they had paid someone without proper training to terminate their pregnancies.

After Roe v. Wade, many doctors believed that they could quietly incorporate abortion into their practices without inspiring hostility from pro-life activists. Among them was my father, Shalom Press, an Israeli immigrant who, only weeks after the Supreme Court ruling, arrived in Buffalo to complete an ob-gyn residency. By the mid-nineteen-eighties, he had opened a private practice there that offered many services, from delivering babies to performing abortions. Despite this approach, his practice was soon besieged by protesters. By 1988, my senior year in high school, the parking lot at his office teemed with protesters brandishing signs calling him a “baby-killer.” They shouted and thrust pamphlets at his patients. Some of the protesters picketed our home. Eventually, they started blockading the doors of his office, in order to prevent women from entering.

The intimidation, the harassment, and the threats all help explain why Brigham was so enthusiastically welcomed when he started attending N.A.F. meetings. But not everyone in the pro-choice community was impressed by him. In 1991, according to a report in the Eagle, Nancy Osgood, the executive director of Planned Parenthood in Lancaster County, Pennsylvania, sent a representative to visit Brigham’s clinic in Wyomissing to determine if the facility should be placed on the group’s referral list. While inspecting the facility, the representative noticed that important equipment was missing, including a sonogram machine. The clinic had no written arrangement with a hospital in case something went wrong. Although Brigham advertised “low fees,” women were charged extra for things that were usually included in the price, like Pap smears and post-abortion checkups. Osgood was disturbed by these findings, and did not put Brigham’s clinic on the referral list.