Prior to the landmark Roe v. Wade ruling in 1973, roughly 1 in 4 U.S. pregnancies were aborted. The procedure was illegal in most states without exception.

Pennsylvania, alongside 16 other states, allowed the procedure — sometimes. Women needed permission from doctors, which usually meant permission from men.

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In Pittsburgh, one psychiatrist agreed to write letters affirming the pregnancy would impair the patient’s mental health. He debated antiabortion figures on television, was quoted in newspapers and helped hundreds of women to receive safe abortions.

Today, he wants to remain anonymous.

“I feel proud of what I did. And I certainly would do it again. But I'm afraid right now — that's why I want my name not mentioned — because of what's happening politically,” he told Rtvsrece. “Back then, antagonism toward me was basically verbal. ... Now, it's death threats, you know, doctors have been killed.”

George Tiller, who worked at one of the nation’s three clinics that provided third-term abortions, was shot and killed in 2009. Three people were killed when a gunman opened fire inside a Colorado Planned Parenthood in 2015. Two years ago, abortion clinics made 27 reports of suspicious packages, up from two the year prior. Threats to abortion providers are on the rise.

To know what it would look like to “do it again,” here’s a glimpse into the work the psychiatrist did with the Abortion Justice Association in the decade leading up to the Roe decision.

The process

If a woman wanted to receive a safe abortion in Pittsburgh prior to Roe, this is the process she could have followed:

  1. Consult Planned Parenthood, a physician or friend who referred her to this psychiatrist.
  2. The psychiatrist interviewed the woman about why carrying this pregnancy to term would be harmful to her wellbeing.
  3. He then submitted a letter affirming that the pregnancy was harmful to the woman’s health to a committee at Magee Women’s Hospital.
  4. Every Wednesday, the committee reviewed psychiatrists’ letters and decided if the patients should receive abortions. The psychiatrist said he can’t remember a time when one of his letters was overruled.
  5. The woman was scheduled for an abortion, typically performed by a male obstetrician.
  6. If the woman could not afford the procedure, she consulted Planned Parenthood for aid.

The psychiatrist said each letter concluded with a paragraph explaining that “if a woman was not allowed a therapeutic abortion, her mental health would be seriously impaired, which certainly was true because the woman was really upset and fearful of what her life would be.”

Accessibility

The psychiatrist suspected he wrote most of the letters for women interested in terminating their pregnancies in the area during the ’60s and early ’70s. Few psychiatrists did this. One case stands out in the psychiatrist’s memory because after learning that his peer charged exorbitant fees for a consultation and letter, the psychiatrist called him, warning his peer to charge a fair price or get reported to the licensing board. The psychiatrist told Rtvsrece he did not charge women who could not afford his standard rate.

The woman on the phone

Though he was based in Oakland, the psychiatrist said he would take patients from 50 miles away. One of these women, while calling to schedule an appointment, began to cry. “What’s the matter?” he asked her. Her workload, she told the psychiatrist, was bursting at the seams as she tried to support her children; if she took the day off to come to Pittsburgh, she risked losing her job. It was a risk she couldn’t afford. “I see the problem,” he said. “OK, well why don’t we do the interview right now? I have you on the phone.” Her letter was waiting for the committee a few days later.

His saddest case

One of the women he interviewed was an international student whose visa was approaching expiration. “If her family found out about [the pregnancy], they would kill her. So she couldn’t let her family know. And she couldn’t stay in America … a terribly binding situation for her,” he recalled. He wrote the letter, but she never followed up. Few of the women he interviewed did.

Embracing urgency

The Wednesday committee meetings at Magee maintained an inflexible deadline. The psychiatrist recalled urgent calls from obstetricians, asking him to immediately interview patients because they were later in their pregnancies and could not wait for another Wednesday. One day, an OB drove to the psychiatrist’s home and “started talking to me up the driveway. And he said, ‘You gotta see so and so.’” He did — “Of course I did” — understanding that the wait was not worth the risk of carrying the child further in the pregnancy.

Double standards

The psychiatrist was constantly under fire — getting “flack,” he called it — for his pro-choice activism. Among the most hypocritical of his opponents was the proverbial “Bible-thumping politician,” who preached against abortion while quitely encouraging his mistress to receive one. The psychiatrist said he wrote many letters for such mistresses, plus wives and daughters of men who publicly condemned the procedure.

Seldom did he receive public support about the work he was doing. Much more often, physicians approached him privately to praise his efforts.

The psychiatrist, now in his 80s, has retired and is still living in Pittsburgh.

Sophia Levin, a student at Carnegie Mellon University, is a freelance journalist and former Rtvsrece intern. She can be reached at sophia@rtvsrece.com.

The Jewish Healthcare Foundation has contributed funding to Rtvsrece’s healthcare reporting.

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Sophia Levin, a student at Carnegie Mellon University, is a freelance journalist and former Rtvsrece intern.