In the past several months, the pro-choice movement has faced its toughest challenges during the Obama administration to date: the insertion of language into the House and Senate health reform bills that, if passed, would place the most onerous federal restrictions on women’s access to abortion since Roe v. Wade. Both threats came from Democrats, one set of restrictions placed in the House bill by Congressman Bart Stupak (D-MI) and the other in the Senate bill by Senator Ben Nelson (D-NE).

Throughout the process, pro-choice advocates and supporters tried desperately to reverse the restrictions: calling their members of Congress, donating to organizations that lobby for pro-choice policies, and more recently promoting the candidacy of a pro-choice female candidate—Connie Saltonstall—against Stupak.

But how did those restrictions get into the health reform bills of a Democratic Congress in the first place? There is obviously a range of factors, including what was and was not anticipated. 

The pro-choice movement’s support for health reform was supposed to have hinged on language, negotiated by Congresswoman Lois Capps, to preserve the status quo of the Hyde Amendment, as terrible as it is, a law that is attached to appropriations bills from year to year and which prevents federal funding of abortions except in cases of rape, incest or the life of the mother.  The presumption at the outset was that keeping things under the radar and putting forth the Capps Amendment would ensure passage of health reform without a fight over abortion.

The presumption proved completely wrong.

Instead, first Stupak and then Nelson amended their respective bills to dramatically restrict the rights of women even to purchase private insurance coverage for abortion care.  And this week the health reform bill passed with the Nelson language intact.

So how did anti-abortion advocates and a back-bench conservative Democrat manage to so successfully persuade a Democratically-controlled (and presumably pro-choice-led) Congress to allow a vote on such a restrictive bill — let alone how did it come to pass? One answer may be found in the lobbying disclosures of the pro-choice movement.

Between 2008 and 2009, pro-choice organizations actually reduced their lobbying expenditures from $1.8 to $1.3 million. Planned Parenthood alone accounted for $385,000 of that $500,000 reduction in lobbying expenses; the rest came mostly from reductions made by NARAL and the Reproductive Health Technologies Project (RHTP).

Planned Parenthood told Rewire, “We think grassroots lobbying was one of the most effective tactics on healthcare reform. We wanted to invest more in [grassroots efforts] and make sure Congress heard from their constituents on this rather than from us.” PPFA in fact received grants from individual donors to conduct a grassroots lobbying campaign but not so much for lobbying Congress directly–though neither the grassroots strategy nor the DC-based lobbying effort was successful in the end in keeping abortion restrictions out of the final bill.

In the meantime, over the same period, specific anti-abortion lobbyists (represented mostly by the National Right to Life Committee and the American Life League) increased their spending from $600,000 to $710,000–a figure that does not include any of the official or unofficial lobbying undertaken by various religious groups, like the U.S. Conference of Catholic Bishops, or grassroots organizing conducted on the issue of health reform and abortion care such as through churches mobilized by the USCCB.

One question is why, with various reproductive health issues on the agenda, from the global gag rule to the provider “conscience” laws, were pro-choice groups drastically reducing their spending on lobbyists in 2009?  Because they finally had a full Democratic majority in power?

This can’t be the whole story: Even NARAL president Nancy Keenan told me in an interview before Stupak went to a vote that “A Democratic majority is not a pro-choice majority.”

Recognition that giving Democrats the reins did not necessarily mean success for a pro-choice agenda should have been clear early on in the Obama Administration. First on the pro-choice agenda was the global gag rule, with which Obama dispensed early on.  But while the end of the global gag rule was an important step, it shouldn’t have been allowed to mollify the pro-choice movement nor make them take a softer line on the administration.

Still, Democratic leaders asked the pro-choice movement to stay out of health reform debates initially to avoid politicizing the reform process, and rather than engaging the fight directly, both pro-choice Democrats and pro-choice groups accepted the Capps compromise language early on — apparently expecting that unilateral disarmament on healthcare reform would convince their opponents to remain out of the debate.

Bart Stupak and his backers in the United States Conference of Catholic Bishops and in the broader “pro-life” movement didn’t exactly take the pro-choice movement up on their olive-branch offering, choosing instead to do what it is that lobbyists normally do: push for as much as possible for the cause they represent. And push they did, introducing language in various committees, at first with little success–something for which Planned Parenthood takes due credit. 

But when push came to shove, House Speaker Nancy Pelosi announced that if putting the Stupak anti-choice language to a vote on the House floor and letting it pass was the cost of healthcare reform, so be it. In the end, pro-choice advocates were left with less than a week’s notice to marshal their massive but nascent grassroots campaign to defeat it.

Successful lobbying campaigns, like the one conducted by Stupak’s supporters, aren’t ginned up in a week or even a few months: they’re long, sustained sieges involving grassroots organization, lead time and constant pressure from lobbyists on members of Congress.

The pro-choice movement, having taken a pass on doing anything proactive to get a healthcare bill that recognized abortion as central to healthcare didn’t have the resources or sustained intelligence gathered to mount a last-minute reactive campaign either. And, in either case, they had already made the decision to support healthcare reform writ large, so they were stuck with a dual message: pass healthcare reform, but remove the abortion restrictions. Those kind of mixed messages make for a difficult grassroots campaign, and can make it sound like passing healthcare is of more importance that preserving women’s access to abortion services.

On the Friday before the final vote this weekend, Planned Parenthood spokesman Tait Sye told me: “Planned Parenthood is committed to fixing our broken healthcare system. Congress must fix the Nelson provision as part of healthcare reform and guarantee that reform will not result in women losing benefits they currently have.”

Of course, given the procedural maneuvers through which the House had to go to pass the Senate bill, and given the strength of the mobilization by an anti-choice minority, the only way to fix the Nelson provision now will be to go back at a later date and try to convince the very same Democrats who could not stand up for abortion care as health care during the process to now rescind those restrictions embedded in the bill. With the majority of the reform provisions, including the individual mandate, not set to go into full effect until 2014, Congress will likely wait a considerable amount of time before attempting any changes, and certainly with the 2010 elections so close at hand.

Meanwhile, coverage for abortion care will be eroded. There are certainly uninsured women who will eventually obtain coverage in a somewhat reformed market to the benefit of their health — including their reproductive health.  But there are also women that will likely lose access to their current coverage of abortion care because of this bill and this debate, and others, like the women who work for the Republican National Committee and the state of South Carolina who will lose their coverage more quickly as a result of political decisions.

Pro-choice women rely on (and donate to) groups like Planned Parenthood and NARAL Pro-Choice America to stand up and advocate for their access to abortion, first and foremost, and to hold the feet of supposedly pro-choice politicians to the fire on abortion access even when the going gets tough (and the tough go shopping for healthcare reform votes among rabidly anti-choice Democrats).

But, this time, at least, pro-choice advocates were not as willing as their pro-life counterparts to be the skunks at the garden party “just” to save access to abortion, or perhaps because they feared losing their own access to Democratic politicians who, unfortunately, too easily sacrificed the pro-choice movement for a political victory without putting up much of a fight on behalf of the pro-choice women who elected them.