A rich history of activism translated into innovative strategies
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As a catalyst for change, the Abortion Access Project (AAP) has a rich
legacy of ground-breaking programs that shapes the strategic
nationally-focused reproductive rights organization it is today.
Founded in 1992 by physicians and social justice activists, its origins
reflect the intersections between reproductive health and justice that
are the foundation of the AAP approach. AAP’s pioneering strategies to
advance concrete and lasting improvements in the accessibility of
abortion care as well as its emphasis in building cross-sector
relationships and alliances are core values since the organization’s
grassroots inception. While the organization has matured into a
rigorous professional organization, AAP has never lost the activist
spark that ignited it. Its current efforts and future directions build
off what has been unique and most successful about AAP in the past and
are inspired by the compelling story of ground-breaking ideas born of
an activist vision. The history of AAP, a marriage of activism and
professionalism, is the strong foundation for the organization’s
current work with its own unique contribution to reproductive health
and rights movement.
In the early 1990s abortion politics in the United States had taken a
decidedly ugly turn. Far-right extremists disappointed by stalled
attempts to push through federal anti-abortion legislation had turned
to terrorizing women and abortion providers, and their plan was
working: Women routinely had to be escorted through crowds of menacing
protestors to reach the clinic or health center where they sought
abortion care; many were too intimidated to try. Abortion providers
were leaving the field in large numbers, and no new generation was
stepping up to fill the resulting gap in services, as fewer medical
training programs required – or even offered – clinical abortion
instruction. Thanks to funding restrictions and other obstacles, poor,
young and other vulnerable women suffered most from diminished access
to safe abortion. In this extremely hostile climate, in the summer of
1992, a group of long-time advocates for social justice in Boston
decided that targeted action was urgently needed. They created the
Abortion Access Project (AAP) to protect and enhance women’s ability to
exercise their legal right to safe abortion. It began as a coalition of
organizations and volunteers, including activists and health-care
providers determined to stop erosion of access to abortion in their
home state.
From this humble yet bold beginning, the Abortion Access Project has
evolved into a respected professional organization, with talented
staff, a national scope and an impressive record of achievement. Having
moved far beyond street protests and other hallmarks of its activist
origins, AAP now engages in strategic yet cutting-edge collaborations
with a range of local, state and national partners, all focused on
enhancing women’s access to safe abortion. Yet AAP’s present retains
the spirit of its past. Bold interventions to rectify injustice still
informs every action, strategy and collaboration that AAP
undertakes. Perhaps what distinguishes it most is its dedication to
catalyzing innovative action by others to address challenges to
abortion access, which, sadly, are still pervasive. This quality, along
with its clear vision of women’s need for accessible abortion care, the
obstacles that stand in their way and strategies to overcome those
barriers, ensures that AAP will continue to make a unique, valuable
contribution to reproductive health and rights in the United States.
AAP’s activist origins: women with a mission
Many of the women who were instrumental to AAP’s founding and early
work had come of age in the civil-rights, anti-war and feminist
movements of the 1960s and ’70s. Co-founder Marlene Gerber Fried, for
example, was a tireless campaigner for social justice within and beyond
the academic community. Her political engagement in civil rights dated
to the assassination of Dr. Martin Luther King Jr. and her experience
teaching at a Philadelphia alternative school during black families’
subsequent public-school boycott.
Judy Norsigian, whose Boston Women’s Health Book Collective sponsored
AAP during its formative years, had spearheaded a revolution in women’s
health care as co-author of the groundbreaking publication Our Bodies,
Ourselves.
Susan Yanow regularly marched in civil-rights picket lines with her
activist mother as a child and protested the Vietnam war during high
school and college. Her dedication to social justice increasingly
included attention to women’s health issues. Yanow says she became a
reproductive-rights activist “the day I got my period and realized what
that meant … that I could have a child and that it would have a huge
impact on my life.”
Yanow met Fried one day in the late 1970s – neither is sure what year
-- after a leaflet posted in a neighborhood laundromat led her to a
meeting of the Massachusetts Childbearing Rights Alliance. The group,
which Fried had helped found, soon morphed into the Boston Reproductive
Rights Network (or R2N2). The women became close allies in its fight
against injustices affecting disabled women, women of color and others.
Members protested and campaigned for gay and lesbian rights. They
stimulated debate about race- and class-biased promotion of new
reproductive technologies. And every October, they organized a march in
memory of Rosie Jimenez, a Mexican-American single mother and college
student who died after an illegal abortion in 1979 -- the first victim
of the federal Hyde Amendment prohibiting Medicaid funding for
abortion.
The pace was frenetic, recalls Fried, who in 1993 helped create the
National Network of Abortion Funds to help low-income women get
abortions. “We were political activists. These weren’t jobs, they
didn’t have hours or boundaries,” she says. “It was not ideal but it is
how we functioned, with a core of people who shared those values, so
you could count on them.”
Access to abortion began to occupy more of R2N2’s agenda in the early
1990s, as Operation Rescue and other abortion-rights opponents gained
momentum. In 1992, Fried, Yanow and other activists began forming
practical alliances with health-care providers to complement
legislative strategies focused on abortion access. Their aims,
according to a funding proposal, were “to increase the number of
abortion providers, increase the availability of abortion services,
demand accountability from health care institutions, and return control
of the abortion issue to the women’s community.”
With a small initial grant from the Haymarket Fund, the Abortion Access
Project was formed as a project of R2N2. Yanow volunteered to run it
while maintaining her private social-work practice.
Evolution of focus and tactics
AAP’s early work clearly reflected the influences of its activist
founders. Its first public event, for example, was a “speak-out” at
Boston’s historic Faneuil Hall on the 20th anniversary of Roe v. Wade,
where women and health-care providers shared personal stories about the
impact of lack of access to abortion services.
Other initiatives included telephone surveys to assess whether
hospitals provided abortion, followed by pickets and letter-writing
campaigns to pressure those that did not to change their policies, and
an annual directory of Massachusetts abortion providers, to help women
know where to find services. Through these and other activities, AAP
doggedly focused attention on a single, critical question: “Abortion
may be legal, but who can get one?”
The hard work paid off: As early as 1993, several hospitals responded
to pressure from AAP and began offering abortion services or removed
anti-choice gatekeepers who hindered women’s access to care. A publicly
funded medical school offered its first course on clinical abortion
skills. Buoyed by such successes, in mid-1994, AAP convened its first
statewide networking conference to share its strategies more broadly.
As AAP’s approaches became more effective and more widely known,
external events confirmed the importance and urgency of its
mission. With Operation Rescue in its heyday, the climate surrounding
abortion rights and access was steadily worsening. Anti-abortion
activists’ unrelenting assault on women’s rights and health culminated
on December 30, 1994, in the murders of two Boston-area clinic workers
and the wounding of five others by a young fanatic. These tragic events
shocked and profoundly saddened but also mobilized abortion-rights
supporters to fight even harder.
“On a very personal level,” Yanow says, “ I felt like I had to do more.”
Her response included borrowing a room in her husband’s Cambridge
computer store to serve as the Abortion Access Project’s office and
obtaining a grant from the Ms. Foundation for Women to allow AAP to
hire its first staff person, Rosemary Candelario – initially for only
10 hours a week.
Emergence of core expertise
With Yanow devoting countless hours as unpaid executive director, AAP
began developing more ambitious and focused plans for increasing
women’s access to abortion. National donors such as the Jessie Smith
Noyes Foundation, the David and Lucile Packard Foundation and the Open
Society Institute began to provide support, recognizing that AAP was
addressing barriers to abortion access in ways that no others were.
“As we collaborated more and more with national organizations, we got
the sense of where the holes were,” says founding director Yanow. “We
were always very conscious of not being duplicative. We wanted to be
nimble enough to fill in the gaps as we learned about them.”
Then as now, AAP drew inspiration and direction for its work from its
vast network of grassroots contacts and did not wait for extensive
documentation before acting to address a problem. Listening closely to
health-care providers and educators, women’s health advocates and women
themselves, AAP identified and responded to emerging needs more quickly
than larger, more mainstream organizations could.
For example, when doctors told Yanow and her colleagues that their
difficulty finding nurses willing to participate in abortion sometimes
delayed women’s procedures, increasing clinical risks, AAP
investigated. Its survey of nursing-education programs in Massachusetts
revealed inadequate coverage of reproductive-choice topics such as
family planning, counseling, emergency contraception, and especially
abortion.
The implications were chilling, explains Kathy Simmonds, who managed
AAP’s nursing-education initiative until late 2006. “If [abortion] is
not in mainstream education, then nurses don’t understand its
importance,” she says, “and they don’t know how to do options
counseling.”
Additional research suggested that negative attitudes toward abortion
among nurses – in part reflecting lack of exposure to it during
training – also hindered women’s access to care. AAP responded by
developing training opportunities and materials directed at nurses and
later founded the Reproductive Options Education (ROE) Consortium for
Nursing, a learning and advocacy forum for nursing faculty committed to
reproductive rights.
This work evolved alongside a broader initiative to expand the pool of
abortion providers by involving new cadres of non-physician health
personnel, in addition to nurses. AAP and its partners recognized
earlier that nurses, nurse practitioners, physician assistants, and
nurse-midwives collectively known as mid-level providers or advanced
practice clinicians (APCs) -- have both the capabilities and the
numbers to be an important part of the solution to the crisis of
declining abortion services. It developed a systematic process of
organizing to enlist and train them, which includes: building statewide
coalitions of supportive stakeholders; developing clear legal bases for
APCs to provide abortions; generating broad support among APCs and
other relevant clinicians for expanding their role in abortion
care,;and developing training opportunities for interested clinicians.
In 1998, with the Planned Parenthood League of Massachusetts, AAP
sponsored its first medication-abortion training for APCs. Through
partnerships with the National Abortion Federation and Planned
Parenthood, this work soon expanded to New England and eventually
nationwide.
AAP’s emphasis on enhancing health-care professionals’ opportunities to
learn clinical abortion skills also included medical students. Through
a network of activists, clinicians, medical educators and others
committed to offering abortion training, AAP helped to develop training
sites for medical residents, to raise money to support training them,
and to promote integration of abortion into nursing and medical school
curricula and family-practice medicine. These efforts have proved an
effective remedy to medical curricula’s all-too-common omission of
instruction in abortion-related topics, which still is a major factor
underlying the nationwide shortage of abortion providers.
Increasing the availability and accessibility of hospital-based
abortion care, through local organizing to pressure health-care
institutions to fulfill their duties to provide abortion care, evolved
as another important focus. After numerous victories in New England, in
1998 AAP took this model to the national level, joining with the
National Abortion Rights Action League of New York (now NARAL
Pro-Choice New Yrok) and the Chicago Abortion Fund to create the
Hospital Access Collaborative. By 2000, the Collaborative was making
safe abortion services more accessible in 23 states and Puerto Rico.
From its earliest days, advocacy was central to all AAP’s
activities. For instance, many advanced practice clinicians do not
initially view abortion as consistent with their scope of
practice. “AAP’s real strength,” says Simmonds, “is in bridging worlds
between activists and health professionals and raising awareness within
the professions.”
AAP’s advocacy also included public education to raise awareness of
obstacles to abortion and encourage people to see it as an integral
part of health care. Among the organization’s distinctive, nationally
recognized initiatives was a 1996 campaign that placed ads in public
subways and buses. The ads presented statistics on limited access to
abortion, underscored by the slogan: “Abortion access: Without it,
you’ve got no choice.” A 1998 series of public-transit ads featured the
difficult choices facing real women and the impact that lack of access
to abortion services had on their lives.
As the success of these well-developed core competencies suggests, by
the end of the ’90s, AAP had matured tremendously from its origins in
grassroots activism. By 2000, it was able, finally, to offer executive
director Susan Yanow a salary.
AAP matures
The year 2000 marked an important milestone for reproductive health
care in the United States and for the Abortion Access Project. After
long, politically motivated delays, the U.S. Food and Drug
Administration approved the medication-abortion drug mifepristone
(RU486), greatly enhancing women’s options for abortion and,
potentially, access to care. The same year, AAP began a deliberate
process of completing its transition to an organization with
well-defined, effective strategies and professional staff.
Focused on how they could most effectively improve women’s access to
abortion, AAP leaders took several important steps in the next few
years. In 2004, they hired a new executive director, Melanie Zurek,
whose background is in family-planning education and program
management, and strengthened AAP’s organizational structure and
management capacities. Under Zurek, the organization also
re-conceptualized the role of its board of directors, leading to more
strategic selection, greater diversity of skills and perspectives, and
more direct engagement of directors. Currently, for example, the board
includes a prominent abortion researcher, several advanced practice
clinicians, and program and policy experts. All have been actively
involved in strategic planning, to a degree that Zurek says is unusual
and – according to several directors – extremely gratifying.
Perhaps the most important, distinctive development in AAP’s
post-millennial transformation has been its decision to invest, as a
primary strategy, in building a network of local organizers or field
consultants, who have become the backbone of AAP’s
achievements. Building on their local knowledge and contacts, they work
to train new abortion providers and, above all, to create enabling
environments in which other individuals and organizations assume
leadership in improving access to abortion care.
Deb VanDerhei directed a family planning and abortion clinic for 15
years before joining AAP as a field consultant for Wisconsin, Montana
and Washington State. Her work to mobilize and nurture networks of
activists and health-care professionals has had remarkable results. In
Washington, for instance, partners have obtained legal rulings
affirming advanced practice clinicians’ authority to provide both
surgical and medication abortion; helped medical residency programs
introduce or expand abortion training; and matched residency programs
with high-volume service-delivery sites able to provide hands-on
training opportunities to students.
Now, VanDerhei says, abortion is offered in more central locations in
Washington, reducing many women’s need to travel -- and take time from
families and work -- to seek care. Women now receive care sooner even
at clinics and practices that already offered the service, she
adds: “They don’t have to wait for the day the doctor comes in.”
But what worked in Washington may not be what works best elsewhere,
because every has distinct geography, politics and regulatory
environments. One of AAP’s greatest strengths, VanDerhei says, is that
it does have “a cookie-cutter approach.”
“AAP makes the investment in legal research and then, and only then,
[invests] in an on-the-ground field consultant,” she says. “They have
been very successful in hiring consultants who are very well connected,
so they get a bigger bang for the buck. They give us free rein and
trust that we understand what methodology to use. They understand that
you can never replicate one project in another state.”
Nancy Foss, AAP field consultant in northern New England, agrees that
understanding the local dynamics of change is essential. “Like any sort
of good change, it comes from a little bit of energy spread around a
lot of different areas,” she says. “My primary job is making sure that
the right people know the right people.”
In addition to facilitating training, AAP field consultants provide
critical ongoing support, helping ensure, for example, that trained
clinicians join practices that allow them to perform abortion. With the
business of health care changing so fast, supporting providers’ ability
to use their new skills requires field consultants to stay ahead of the
curve on issues such as malpractice insurance. That quality has always
been central to AAP’s approach and character.
A catalyst for change
Largely thanks to this strong network of local organizers, each major
initiative established in AAP’s earlier years has continued to grow in
depth, momentum and impact. For instance, its groundbreaking work to
expand the pool of abortion providers has evolved to include students
and professionals in a range of categories and specialties, with
increasing emphasis on family practice and primary-care medicine.
In addition, AAP is now an established national resource in abortion
training and the integration of abortion content into health
professional education. It provides resources to physicians, clinicians
and health-profession students and faculty through print and electronic
newsletters and bulletins, educational forums and other mechanisms.
But perhaps more importantly, local partners for whom AAP has
facilitated advocacy, training and other activities increasingly are
assuming ownership for sustaining that work -- exactly what AAP has
always had in mind. Executive Director Melanie Zurek affirms that AAP’s
primary interest is in serving as an incubator.
“We are going to continue to be the catalyst organization that seeks
out innovative ideas and builds collaborations or coalition efforts
around them,” she says.
A crucial part of that role is identifying emerging and urgent needs
and piloting approaches to meet them, which has always been a strength
of AAP. One such need on which the organization is now focusing is
improving access to abortion for women who are most underserved. One
potential strategy is to further diversify the types of clinicians and
settings that provide abortion by, for example, integrating medication
abortion into the community health centers that serve many poor and
rural women.
“Before, we were developing new classes of health professionals
providing abortion – aiming simply to create more abortion providers,”
Zurek says. “Now, we’re shifting our focus to the setting. We want to
develop providers who are going to be most effective in reaching women
in most need.”
Another need is to better understand and address gaps in information
and referral that hinder or delay women’s ability to receive timely
abortion care. “We’re hearing that it can be enormously difficult to
get a woman scheduled for a procedure,” Zurek says, “particularly in
hospitals. We want to know why.”
In responding to these and other needs, AAP remains committed to
meeting the real world needs of women and providers, if necesssary. “We
want to be an organization that will be responsive, meet people where
they are,” Zurek says.
One example is its pioneering work on self-induced abortions, an
increasing phenonomen in the U.S. , particularly among immigrant
women. Notes Zurek, “This signals a real problem where abortion is safe
adn legal. No woman should feel like self-inducing is her only
option. At the same time, if women are going to do it, AAP wants to
find ways to help keep they healthy and safe.” Once again, AAP’s
grassroots connections helped it identify a need. “Through health-care
workers in community clinics, we started hearing about women taking
common medications to self-induce,” Zurek explains, “and we recognized
it as an emerging public-health issue. We were not going to wait large
studies to act.”
Instead, AAP began collecting information itself, including by
interviewing health-care providers serving primarily immigrant
populations in Massachusetts. That led to a collaboration with two
research organizations to explore the issue and develop interventions
to promote women’s health and safety.
“We want to really understand the reasons women in the U.S. are
choosing to self-induce abortion with misoprostol before we decide on
interventions,” Zurek says. “We don’t want to assume to much.”
Values, vision and know-how for the future
As its work on self-induced abortion suggests, AAP’s ambitious vision
for the future builds on its core strengths and preserves its
fundamental values, including emphasis on local organizing,
responsiveness, coalition-building, innovation and an unwavering focus
on improving access to safe abortion for all women in the United
States.
“About abortion,” Zurek says, “we’re staying focused. We feel that’s
how we can make the best contribution to the broader reproductive
health and justice movement.”
In responding to these and other needs, AAP remains committed to
meeting the real world needs of women and providers. “We want to be an
organization that will be responsive, bold, meet people where they
are.” Zurek says.
In recent years, AAP has observed a widening range of social, political
and legal conditions relating to abortion across states and
communities. Growing and increasingly diverse restrictions on abortion
and uneven decline in the availability of services were increasing gaps
in access while threatening all women’s autonomy and health, and each
woman’s struggle to obtain abortion services was becoming more
individualized as America’s healthcare inequities and income
disparities increase.
In the spring of 2006, AAP engaged staff, its board of directors, AAP
field consultants, and an interdisciplinary team of partners from the
reproductive rights and funding communities in a comprehensive
strategic assessment and planning process to respond to these
trends. They reaffirmed their commitment to abortion and focused their
mission to ensure that all women can access safe abortion in every
state--in any legal or regulatory context. This mission is backed by
strategic priorities that include engaging and supporting a wide
variety of health professionals who care and want to do something about
women being able to access abortion; identifying and filling critical
gaps in access; and promoting innovative ideas about abortion service
and training. More broadly, the process directs AAP toward a vision of
the organization as a hub for the development and dissemination of
innovative ideas about abortion with a continued emphasis on
collaboration with advocates and providers and a clear commitment to
improving access for women – particularly those women who, because of
income, age, race or geography, face disproportionate barriers to
access.
“We have some new directions, but we’re also still rooted in what was
good about us in the past,” says Zurek. “Our early roots in activism
and social justice have informed a unique approach to strengthening
services and helping women exercise their rights. AAP unites activism
and advocacy with service delivery and training in a really innovative
way that is an important part of the movement and ultimately of women’s
autonomy and health.”
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