In October, Dr. Diane J. Horvath-Cosper wrote a piece for the Washington Post called "Being a doctor who performs abortions means you always fear your life is in danger."
This was published almost a month before an anti-abortion gunman killed three people and wounded nine at a Colorado Springs Planned Parenthood. But Horvath-Cosper's op-ed wasn't some spooky premonition; it was a natural response to the dramatic uptick in anti-abortion threats and attacks against reproductive health clinics that started in July of 2015, right after a series of videos attacking Planned Parenthood came out.
But about a week after the November 27 Colorado Springs attack, Horvath-Cosper says the chief medical officer of the hospital where she works called her into a meeting. He said she had to stop her public advocacy for abortion, because he didn't want to "put a Kmart blue-light special on the fact that we provide abortions at MedStar."
Horvath-Cosper, 37, had never dealt with anything like this before, she told Vox in an interview. (The hospital didn't return a request for comment.) She knew nothing about employment law or anything like that. But when her department chair passed on advice from the chief medical officer that she shouldn't hire an attorney because it would be seen as an "aggressive move," she decided it was probably time to hire an attorney.
And, as the New York Times first reported Monday, she ended up filing a civil rights complaint against her employer for violating a law that was originally intended to protect doctors who oppose abortion. She argues the law also protects her right to speak out in favor of it.
The conscience of an abortion provider
The 1973 Church Amendment was the first "conscience clause" law passed after the Supreme Court legalized abortion in Roe v. Wade. It was designed to prohibit federally funded entities from discriminating against doctors who morally objected to abortion.
But the language of the Church Amendment doesn't specify which moral views about abortion are protected. It hasn't really been used to protect pro-choice people before, but there's also nothing preventing that. It prohibits discriminating against a doctor "because of his religious beliefs or moral convictions respecting sterilization procedures or abortions."
And Horvath-Cosper says she started providing abortions out of a strong sense of moral duty.
She was raised Catholic, and grew up in a pretty conservative area in the Midwest. But she says that like many other providers she knows, her upbringing and her faith guide her commitment to providing services for women.
"My parents taught me to help the people who needed help," she said. "I feel like there are plenty of people to take care of women who are having babies. There are not a lot of people taking care of women who need abortions and don't want to be pregnant for a variety of reasons."
She first caught the advocacy bug while working with feminist groups in college. She started a chapter of Medical Students for Choice at her medical school, then went on to do some legislative advocacy and writing.
A major turning point for her, and the reason she wrote the Washington Post piece, was when she found not just herself, but also her daughter, featured on an anti-abortion website. The site lists the names, photos, addresses, and other information for doctors who provide abortions (or "abortionists," as the website calls them).
Given her public advocacy, Horvath-Cosper says she expected to find herself on one of those sites at some point. What she didn't expect was to see her 15-month-old daughter's face on the website too, in a photo with Horvath-Cosper that had been lifted from social media.
"Though the site claims to be 'informational' in nature, the real purpose is clear," Horvath-Cosper wrote in her article. "There is no better way to intimidate and incite fear than to target a family member, especially a child. The message is unambiguous: I’m being watched, and so is my daughter."
While this terrified her, it also made her feel determined to be more outspoken about abortion, not less, she told Vox. "I thought this is something that people should know about. That the climate is this bad, that people are seeing their children on anti-abortion terrorism websites. That's unacceptable."
The necessity of speaking out
Advocacy isn't just part of Horvath-Cosper's personal conscience; it's also supposed to be part of her job.
Horvath-Cosper is working at MedStar as part of the Family Planning Fellowship, a national program that trains doctors in family planning and abortion practices. The program has three main components: clinical work, research, and advocacy.
Advocacy in this field is essential, Horvath-Cosper said, in part because of what's known as the "graying" of abortion providers. A lot of good doctors first decided to enter the field because they wanted to prevent the horrors they saw during the pre-Roe v. Wade era. Now a lot of those doctors are retiring, and they're not being replaced by enough young practitioners.
There are a lot of reasons for this — the daily reality of anti-abortion threats that Horvath-Cosper wrote about, the steady separation of abortion from the rest of medical practice, and inadequate training on abortion for medical students.
The Family Planning Fellowship is designed to compensate for the training deficit, but it will take a lot of advocacy and organizing to shift the cultural and structural forces that can make providing abortions so marginalizing and scary for doctors. It will take doctors pushing for their practice to be treated just like any other medical service — an essential part of women's health care that deserves to be provided seamlessly along with other services, not isolated so that it can be more easily targeted by restrictive laws and disruptive protests.
"Abortion has not been seen as a legitimate part of women's health care, and it so is. It's so common," Horvath-Cosper said. "And people will continue to need this service whether or not it's legal and available and safe."
Horvath-Cosper said she also understands that it's a lot easier for her to speak out in Washington, DC, than it might be for a fellow provider in, say, Alabama or Mississippi. But that's why she feels all the more obligation to do her part.
All of this makes MedStar's actions more baffling and unfair, said Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center and a co-counsel in Horvath-Cosper’s complaint. Silencing Horvath-Cosper not only prevents her from doing work that her program requires, it also hurts the practice of family planning medicine, both now and in the future.
"That's one of the things that upset Diane so much," Borchelt said. "They're not only telling her she couldn't speak out, but also indicating they would not change that policy for future family planning fellows."
Horvath-Cosper's fellowship ends in June (and she still reports to work as usual, she said), so it's possible her lawsuit won't conclude until she's already finished with MedStar. But that's fine, she said, because this is about more than her — it's to ensure others like her don't have to deal with MedStar's policy, while also showing other likeminded doctors that there is a law to protect them.
It's also about making sure MedStar really is as safe as it can be. Horvath-Cosper said she understands where the hospital is coming from. Both she and they want to provide quality care and make sure doctors and patients are safe, she said.
But before trying to make themselves safer by "muzzling Diane," Borchelt said, the hospital should consider implementing all of the safety precautions recommended by the National Abortion Federation, of which it is a member. They've hired a security guard and installed cameras, Borchelt said, but they should also be doing other things NAF recommends, like installing alarms and shatterproof glass and doing ID checks.
And as scary as extremist anti-abortion terrorism can be, cowering in silence and living in fear just gives the terrorists what they want. And it's not just about the firebombers and the doxxers, either, Horvath-Cosper said. Of course we as a "civilized society" shouldn't have to deal with any of that, but we also shouldn't have to deal with people "yelling at patients coming into clinics."
It's all part of a spectrum of intimidation, and it's all made possible because abortion is such a marginalized and isolated medical service, performed more in stand-alone clinics that are easier targets than regular doctors' offices and hospitals.
"Some of us need to be vocal — the more the better," Horvath-Cosper said. "Until people are really talking about this as a necessary, normal medical service, we're not going to get the cultural change we're working for."