WASHINGTON - Social worker Susan Hill started running an abortion clinic in Orlando, Fla., a week after the Supreme Court legalized the procedure in its Roe vs. Wade decision 30 years ago today.
Hill, who now runs six clinics in six states, was there during the mid- to late 1970s as the abortion rate rose and doctors flocked to the field. She was there during the 1980s, as the rate of abortions peaked and then leveled off. Wearing a bulletproof vest to and from work, she was there through the 1990s when abortion providers became the target of violence - even murders - and it was nearly impossible to attract doctors.
Through it all, she says, little has changed on the front lines - inside the clinics - in 30 years. The women she sees still have the same problems and are still mostly single women or divorced mothers, working women 18 to 30 years old.
But she is struck by the question they almost always asked 30 years ago and never ask today: "Is this legal?"
Abortion has been on a steady decline since the start of the 1990s, recently falling to its lowest rate since 1974, especially among teen-agers. But it is still one of the most frequently performed surgical procedures in the country and has become a right ingrained in the culture and largely taken for granted - even as activists on both sides have kept the battle alive and percolating for three decades.
"This generation doesn't see abortion as anything that was fought for," says Hill. "They've never known anything else. They can't imagine not being able to obtain one."
Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion, according to the Alan Guttmacher Institute, a reproductive health research center that supports abortion rights but whose data are considered reliable by both sides of the debate. The institute estimates that more than 39 million abortions have occurred since women gained the right to a legal abortion in 1973.
The public's position on abortion has remained consistent over the past 30 years, mirroring where abortion is in the law: Most people support the right to abortion but don't object to certain restrictions such as parental consent requirements.
Activists on both sides, however, oppose any compromises and have continued to keep the issue in the political caldron.
Last night, all six Democratic candidates for the 2004 presidential nomination, sharing a stage for the first time, appeared at an abortion rights event sponsored by NARAL Pro-Choice America. The event foreshadowed the prominent role abortion is likely to have in the next presidential campaign.
And today, thousands of activists on both sides are staging rallies here to mark the 30th anniversary of Roe vs. Wade, with President Bush planning to address the March for Life Fund's abortion protest via satellite.
In the years since Roe, the profile of women seeking abortions has changed slightly, according to the Guttmacher Institute report that studied trends between 1973 and 2000.
Increasingly, abortion is sought by ethnic and racial minorities, women who have had at least one child and, since 1994, poor women - perhaps a result of economic pressures that discourage larger families or make contraception less available.
But overall, the Guttmacher report showed a steady decline in the abortion rate - 21.3 abortions per 1,000 women ages 15 to 44 in 2000, compared with a rate of 27.4 per 1,000 women in 1990 and a high of 29.3 in 1980 and 1981. The sharpest decline was among 15- to 19-year-olds.
The reasons for the falling numbers are hard to measure, says Lawrence B. Finer, assistant director of research for the Guttmacher Institute.
But he says a key factor in recent years is the increasing use of emergency contraception, or the "morning after" pill. Finer estimates that 51,000 pregnancies were averted by emergency contraception in 2000, accounting for 43 percent of the decrease in abortions since 1994.
Among teens, a decline in sexual activity and increased use of contraception - coinciding with the AIDS epidemic - have contributed to a lower rate of pregnancy, and thus abortion, the Guttmacher report says.
Activists on both sides, while welcoming the lower numbers, have their own interpretations. Anti-abortion forces point to new technologies such as sonograms that they believe have convinced more people that life begins at conception.
"Just about everyone has seen a sonogram," says Laura Echevarria, spokesman for the National Right to Life Committee. "People didn't realize a baby looks like a baby very early on. The humanity of the unborn child is now undeniable."
Abortion rights advocates, for their part, say the restrictions that the courts, Congress and state legislatures have allowed since Roe, starting with the 1976 federal Hyde Amendment that prohibited Medicaid from paying for most abortions, have blocked some women from access to abortion.
"That's the disturbing side" of the fall in numbers, says Elizabeth Cavendish, legal director of NARAL.
In states such as Wisconsin, a two-day delay law might have contributed to the 21 percent decline in abortions, although it's also possible that women there who wanted to avoid the waiting period traveled out of state for the procedure.
Conversely, in Maryland, one of 15 states where abortions increased throughout the 1990s - from 31,260 in 1992 to 34,560 in 2000 - access is fairly unrestricted, with parental notification, but not consent, required, no waiting period and state funding for some abortions for poor women.
Abortion rights supporters, however, attribute the rise in Maryland to inadequate state funding for contraceptive services for low-income women.
Although neither side of the national debate is declaring victory, both have had a significant hand in shaping the landscape that has emerged since Roe.
Abortion rights supporters have rebuffed repeated attempts to overturn Roe, and they won FDA approval in 2000 of RU-486, a drug that induces abortion without surgery.
"At some broad level, we're winning. That doesn't diminish the fact that reproductive rights have been significantly eroded and are imperiled in the future," says Cavendish.
Anti-abortion forces have succeeded in high court rulings that have allowed states to place restrictions on women seeking abortions, such as mandatory counseling or waiting periods, the consent of one or both parents for minors and bans on insurance coverage or use of public funds.
In the past seven years, states have enacted a total of 335 measures that place restrictions on abortion, says NARAL.
With Republicans now in control of the White House and both houses of Congress, a new wave of anti-abortion legislation is expected to be debated this year, including a bill to ban a late-stage procedure that opponents call "partial-birth abortion."
"You do what you can in the sense of what the current atmosphere is congressionally and across the country," says Echevarria of the National Right to Life Committee.
The anti-abortion movement has also been successful at driving down the number of doctors willing to perform abortions by sustaining the stigma attached to the procedure, pushing through legal and regulatory constraints that make it too costly or burdensome for doctors to include abortion in their practices and, in the case of the more militant groups, harassing providers.
According to the Guttmacher study, there were 37 percent fewer abortion providers in 2000 than there were in 1982 and 11 percent fewer than in 1996.
Through all of the battles and campaigns of the past three decades, public opinion on the issue has remained "rock-hard in terms of its consistency," says Karlyn Bowman, an analyst at the conservative American Enterprise Institute.
In 1975, a Gallup poll found that 21 percent of Americans thought abortion should be legal under any circumstance, compared to 24 percent today; 54 percent thought it should be legal only under certain circumstances, compared to 57 percent today; and 22 percent thought it should be illegal in all circumstance, compared to 18 percent today.
Although the public has strongly held views on abortion, only a small percentage of voters consider it the single most important issue.
"It isn't going to engage most Americans unless they see a real threat," says Bowman. "And I don't think they do at this point."
The 2004 Democratic presidential contenders are hoping to change that. With vacancies expected on the Supreme Court by 2008, they are arguing that Bush's re-election would mean a more conservative court and, thus, the possible overturning of Roe.
Some believe that abortion has become such a part of the fabric of the nation - a right the majority of Americans expect and want - that the public would revolt against attempts to reverse the 1973 decision.
David Garrow, a legal historian at Emory University who has studied the abortion debate, believes it is "inconceivable" that a future Supreme Court would overturn it, if only because doing so would represent "a self-inflicted wound institutionally for the court."
But anti-abortion activists still see nothing less than the dismantling of Roe as their goal.
"This has to be a time when we get serious," says Teresa R. Wagner, an anti-abortion legal analyst and lobbyist. "After 30 years, if the fundamentals of the big picture haven't changed, we have to make some changes."