When Smith is inside and among friends, conversation will often turn to the Kansas doctor who spent $90,000 to bombproof his car; the San Francisco friend who faces trial for murder; the incessant death threats; the hit lists; the ceaseless scorn.
"It's like life in a combat zone," says Smith, a former Green Beret, during a pause between appointments at his Bay Area practice. "You watch people on the sidewalk. You watch people out of the side of your vision. You watch people's hands."
Smith is, of course, an abortion doctor. He's a member of what has become a dwindling rogue caste within organized medicine, and he's angry and resentful. It wasn't supposed to be this way. A quarter-century ago on Jan. 22, the U.S. Supreme Court handed down the Roe vs. Wade decision legalizing abortion, and an era of shame, subterfuge, and fear was supposed to have ended. Abortion providers and their clients imagined themselves stepping out of the cold into a new epoch, where abortion was to have been treated as any other safe legal medical procedure.
While women's groups in San Francisco and elsewhere plan celebrations for the 25th anniversary of Roe vs. Wade -- often described as the defining moment of the modern U.S. feminist movement -- doctors, social workers, and sociologists concede that the availability of abortion is in a downward spiral.
For a variety of reasons, during most of the time Roe vs. Wade has been the law of the land, abortions have become increasingly difficult for women to obtain. Demographers began noting the paradox in 1982. The decline in the number of women with unintended pregnancies who received abortions is a trend that has continued more or less steadily to the present.
Last month the government's Centers for Disease Control and Prevention released figures showing that the number of abortions reported in 1995 had declined 15 percent during the previous five years to 1.2 million annually. That number is exactly the same as the high end of researchers' estimates for the yearly number of abortions performed in America during the 1950s, according to a 1958 Planned Parenthood Federation document.
"While it remains legal in the United States, access has been seriously eroded in the past decade," says Vicki Saporta, executive director of the National Abortion Federation, the professional association of physicians who perform abortions.
Dr. Smith is more adamant.
"There are cycles in history, and I'm convinced we are going back. Fewer and fewer people will be doing this. Those that do will be marginalized in such a way that fewer will be doing it at all," Smith says. "Perhaps not philosophically, but mechanically, the anti-abortion people are winning. Even the women's groups can't see this. They don't support us. They give us nothing. Oh, that's right -- they are having an anniversary dinner next week honoring us.
"Give me a break."
The reasons for the dwindling availability of abortion services are many and varied, but they all find their roots in America's odd, century-old national obsession with the procedure.In neighboring conservative, Catholic Mexico, abortion is widely available and a political non-issue -- as is the case in most of the rest of the world.
Abortion doctors' fear of violence has been much publicized, but the decreasing number of abortion training programs for physicians, the ambivalent attitudes in the medical field toward abortion, and the rise of managed medical care also have contributed to the trend toward fewer on-demand abortions in post-Roe America.
The Earthshaking Decision That Wasn't
In January of 1973, what had been a lively, state-by-state debate over abortion was stanched when the U.S. Supreme Court decided that states may not protect "fetal life" until after viability -- the point at which a baby can survive outside the womb. Supreme Court rulings in 1989 and 1992 preserved the basic tenets of the Roe decision, but they allowed for some state restriction on early abortions.
Twenty-five years later, it is not at all certain whether Roe vs. Wade has had as broad an effect as imagined. The pre-Roe era is often described as a time when back-alley butchers maimed women, and girls were cloistered to have children in secret. It's true that the Roe decision dramatically reduced the number of women who were injured and killed by botched abortions. But the extent to which the decision made it easier for women to have abortions is much less clear.
In the years leading up to Roe vs. Wade, some 600,000 legal abortions were being performed annually in states where abortion was allowed, notably New York. In states where the procedure was outlawed, however, hospitals sometimes found loopholes.
"In the days before Roe vs. Wade, in my institution, we had the 'abortion committee.' It was composed of a doctor, a layperson, a psychologist, and a minister. It was a body to whom the woman would present herself," Dr. Smith says. "They would talk with her about her reasons for wanting to do the abortion. The trump card was, she'd say she was going to commit suicide. It was a joke. All she had to do was emote, play the trump card, and she'd have an abortion. So there were a lot of legal abortions."
The Ambivalence of Doctors
To understand why abortion access has dwindled during the last decade, it helps to understand the medical profession's ambivalent attitude toward the procedure. Polls consistently show that more than 80 percent of medical doctors favor legalized abortion, says Carol Joffe, a professor of sociology at UC Davis. But ever fewer doctors are willing to perform, never mind openly defend, the procedure.