As Susan Cahill Faces a Vandalized Clinic, a Reminder of Her Contribution to Abortion Access


By now, many in the abortion rights community have heard about the horrific vandalism that recently took place at All Families Healthcare in Kalispell, Montana, the family medicine practice of Susan Cahill, a physician assistant (PA). Cahill includes abortions as one of numerous services offered to her patients and this clearly was the reason for the attack. As reported at RH Reality Check and elsewhere, Cahill’s clinic was completely destroyed and remains closed as of this writing. Less well known, however, is Cahill’s important role, more than 20 years ago, in a consequential event in U.S. abortion care history—an event that continues to resonate today.

In the late 1980s, staff at the National Abortion Federation (NAF) began to hear increasing concerns from member clinics about their difficulties in finding doctors to work at their facilities. (The number of abortion providers peaked in the United States in 1982.) Terms like the “graying of abortion providers”—referring to the cohort of committed abortion doctors who had witnessed the pre-Roe era and were nearing retirement age—and “provider shortage” entered the lexicon of the abortion rights community. In response, NAF, along with the American Congress of Obstetricians and Gynecologists (ACOG), organized a symposium called “Who Will Provide Abortions?” which took place in October 1990 in Santa Barbara, California. The symposium, dominated by physicians both associated with NAF and other, more mainstream medical groups, resulted in a number of important initiatives, including the founding of a postgraduate fellowship program in abortion and family planning and the establishment of requirements for abortion training in OB-GYN residencies.

One of the most significant events that occurred at that symposium was the participation of Susan Cahill from Montana and Rachel Atkins, also a PA, from Vermont. The peculiarities of laws in their respective states permitted abortion provision by PAs, and both these women had amassed an impressive safety record by 1990. Cahill, who had been trained in abortion care in her PA program right after Roe, had worked since 1976 with James Armstrong, a family physician in private practice in Kalispell, while Atkins worked at the Vermont Women’s Center, a (now closed) facility that provided a full spectrum of reproductive health services. Both women presented at the symposium, which this writer attended, and made an enormous impression on the attendees. In a highly unusual move for that time, given normal medical politics and hierarchies, the published report of the symposium stated that “appropriately trained midlevel clinicians … offer considerable promise for expanding the pool of abortion providers” and recommended training for certified nurse midwives, nurse practitioners, and physician assistants. (The term “midlevel clinicians,” which was in use then to refer to these three groups, has been largely replaced by “advanced practice clinicians” [APCs].)

The argument for the entrance of these health-care providers into abortion care received a further boost at a second symposium organized by NAF in Atlanta in 1996, which was focused specifically on APCs as abortion providers, and where Atkins and Cahill played a leading role. Since those two meetings, a number of medical organizations—including ACOG, the American Public Health Association, the American Academy of Physician Assistants, the American College of Nurse Midwives, and the National Association of Nurse Practitioners in Women’s Health—have issued statements in support of abortion training and provision by APCs.

Susan Cahill, along with her colleague and friend Rachel Atkins, was a pioneer in bringing APCs into abortion care, and thus in expanding access to the procedure in underserved areas. Currently, according to NAF, APCs are providing medication abortion in 15 states and aspiration abortion in six. Indeed, one of the few current bright spots in the beleaguered abortion providing world, at this time of unending states restrictions—the recent passage in California of legislation allowing APCs to provide aspiration abortion (they already were permitted to perform medication abortion)—can be seen as a legacy of the revolution that Cahill, Atkins, and their allies started some 20 years ago.

Cahill has now provided abortions—both medication and aspiration—in Montana for nearly 40 years, continuing on her own after James Armstrong retired. Anti-choice politicians in her state have made concerted efforts to stop her abortion practice, at one point passing a law specifically targeting her. The Montana Supreme Court eventually upheld her right to provide abortions.

The recent destruction of Cahill’s clinic was not her first encounter with domestic terrorism. In 1994, the office she shared with Armstrong was firebombed (and eventually rebuilt).

The model of care Cahill has offered all these years—the integration of abortion with primary care—is exactly the vision many have had of how to respond to the reproductive health needs of women in rural communities. Abortions, she told me, represent about 10 percent of her practice. As Cahill wrote in an opinion piece in her local paper after the vandalism:

I have performed health care services for 38 years. I have patients who have been coming to me for that long. I have seen their parents and their children. I provide first trimester abortions AS PART OF THAT SERVICE because I know that the same women who at one time in their life want and are joyful about being pregnant, may, at another, find themselves unable to bring a child into the world. That crisis used to cause them their lives. The truth is that abortions are very simple and safe procedures that most medical professionals, especially those who are trained in women’s medicine, can and should do.

The destruction of Cahill’s facility not only imposes further hardships on women in the region, who now must make a trip of several hours to access safe abortion care—the vandalism also deprives, at least for the time being, the three generations of locals for whom she has been providing primary care. These patients, men and women, are also casualties of the abortion wars. As Cahill wrote to me, speaking of anti-choice terrorism, “When will this ever stop?”

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  • KingMeIam

    I thought physicians took an oath to preserve life….not destroy it.

    • Arekushieru

      Thanks for admitting that you don’t think women are human lives! As we’ve already said that pregnancy is the second most risky medical condition for women. Also, they took an oath to do no *harm* to the *patient* from the Hippocratic Oath, which is outdated, in ANY case. Do look up the definition of harm, and you will see that it does NOT apply to the fetus in abortion. Do look up the definition for patient as well, while you’re at it. If the fetus can be a patient, the only possible reason it COULD have been one is because it sought medical treatment. If a fetus can seek medical treatment, then why can’t newborn conjoined twins, in order to be separated? And that brings us to ANOTHER question. If these, or any other, conjoined twins disagreed on whether to be separated or not, by YOUR logic, the one that should be saved is the smaller one while actually harming the LARGER one, JUST as you would like to see in the case of pregnancy. You are disgusting.

      • Jason Kindle

        harm |härm|nounphysical injury, esp. that which is deliberately inflicted: it’s fine as long as no one is inflicting harm on anyone else.
        Hmm, in the case of abortions, sounds like it applies to the fetus to me.

        • Arekushieru

          Nope. We are talking about legal definitions, here. Do look them up once in awhile, as you also seem to have difficulty recognizing the legal definition of domestic terrorism. Besides, any injury that is caused to the fetus is not deliberately inflicted. If it were, then the fetus deliberately harms the woman during pregnancy and childbirth, but no one seems to be concerned about THAT. Hypocrisy, as usual.

          • Jason Kindle

            I make one statement and you extrapolate a trend? Glad you’re not a scientist.. You’re not a scientist are you, please tell me you’re not?

          • Arekushieru

            What the fuck are you talking about, now? I wasn’t talking about trends, at all. Especially, none, REMOTELY before you posted this comment and before I edited my own. Seriously, DO try to keep up once in awhile.

          • Jason Kindle

            You’re a very angry person, take a breath, you may have been using legal definitions but i’m not. By the way, why do so many women on this site feel like they have to caps lock so many words? Do you think it makes you sound more clear?

          • Jennifer Starr

            Actually, I think Arekushieru was being quite civil, all things considered.

          • Jason Kindle

            Hey Jennifer, i’m still waiting for you to define what a person is besides only having been birthed. Were you planning on answering that?

          • goatini

            Rights and citizenship accrue to persons at birth.

          • goatini

            Typical misogynistic male silencing attempt upon females – the “angry” BS nonsense.

          • Arekushieru

            Yes, I get ANGRY when someone tries to take away my rights just because I’m a woman, especially when THEY will never have to worry about their rights being attacked by the law, specifically or society, in general. YES, I get angry when someone then berates women for being too emotional, as if only THEY have a right to get angry when their rights are attacked because they’re DA MENZ. YES, I get ANGRY when your ilk (remember, not extrapolating trends, here!) claims Pro-Choice women are too coldhearted, then when women DO get angry, whine about how emotional they’re being! Hypocrites.

            Like I said, who cares if you weren’t using legal/medical definitions. Those are the ONLY definitions that matter. Besides, *I* was using them in that manner, in a post YOU replied to. Changing how you were using the definitions, therefore means that you were changing the goalposts, like a typical anti-choicer. If you find reason 2 inconsistent, I WOULD like to point out that I clearly outlined how I was using them and for what reason (reason #1, that is), something you couldn’t be bothered to do, at all Too bad so sad.

            Finally, shouldn’t your question have given you the very answer you’re looking for? After all, you’re only addressing the WOMEN, here. *Gasp*, why, could that be because it is only the WOMEN who are affected by your forced birther policies??? And nice patronizing tone, you ass. As if our only purpose is to be CLEAR when you KNOW you’ve enraged, and rightfully so, a highly intelligent group of women who will CLEARLY always understand better (than you) how ONLY women will be mainly affected, not only personally, but in society and the population, at large.

          • Jason Kindle

            You said “you people, your movement.” You obviously don’t know, so i’ll help you out, “you people” for a cause and “movement” have trends. How did you come to to conclusion I was of a people or movement? Let’s pay attention lady.

          • Jennifer Starr

            You pretty much spout the same old tired talking points as the rest, the same stuff that we’ve heard and read at LiveActionNews, LifesiteNews, Abolish Human Abortion, Jill Stanek’s site and the like.

          • Jason Kindle

            I’ve never heard of any of those sites, but thanks, I may check them out some day.

          • goatini

            Suuuuuure you haven’t.

          • Arekushieru

            Uh, no, you pay attention. Did I SAY that I was extrapolating anything from what YOU said? So, for one, no, the TRENDS weren’t being extrapolated from you. For TWO, neither were they being extrapolated from anything ELSE. But I DID extrapolate ‘you people’ and ‘movement’ from ONE MOMENT IN TIME. Meaning that I was using YOUR definitions and matching up their inconsistent usage with similar practices made by other anti-choicers. In essence, as part of my reply to your post below, who cares about whether or not you were using legal/medical definitions (and I’ll get into that when I reply DIRECTLY to that post), you CONVENIENTLY ignored the rest of my post that did respond *directly* to your OWN definitions. Oops.

            But, look MA, no TRENDS.

            No wonder I put a lot of words in All Caps. It seems to be the ONLY way that you people ever get ANYTHING through those thick skulls of yours.

        • goatini

          A zygote, blastocyst, embryo, or fetus is not a person, citizen or “anyone”. Rights accrue to citizens at birth.

      • Arekushieru

        To Betty Taylor whose reply is in moderation: No, abortion is NOT murder. Murder IS illegal killing with malice aforethought. And abortion fits NONE of the criteria!

        According to biblical scripture, so are men. But I can kill them without any thought if they even attempt to rape me. But, yet, you have no problem with that, DO you? So, your comment about *fetuses* (NOT babies) being made in the image of God (oh, great. I just got a mental image of God looking like a fetus), is actually irrelevant, even according to your OWN logic. Btw, even if God was occupying my body, I’d still have the same right to remove Him from there if I didn’t want Him there. Mary, HERSELF, is living proof of that, at least if you believe that Jesus was God (I don’t, since I’m Unitarian). She CHOSE to have Jesus, well, as much as she could given that she was a very young teenager. But, of course, that’s irrelevant, given that anti-choicers such as you, believe that a woman is NEVER too young to be forced to give birth. Sick.

        Finally, in order for there to be a gift, it must be wanted by BOTH the recipient and receiver. Therefore, since my mom was the Pro-Choice person who CHOSE to have me, and I like my life just fine, my life IS a gift. But, anti-choicers are actually the ones who would LOVE to turn everything that is a gift into something that isn’t. In your world, children would not be gifts, but duties and consequences. After all, people wouldn’t be having children because they WANTED them, even though God ‘clearly’ wanted the women to have them.

  • Jason Kindle

    Susan Cahill is dangerous to those who have no voice, she should be ashamed.

    • expect_resistance

      You should be ashamed by supporting domestic terrorism as should all anti-choicers.

    • Arekushieru

      She is dangerous to women, who have no voice, as the Pro-Life faction, and our misogynistic society (which obviously includes YOU) quite often enforces on them? After all, they give fetuses more voices than anyone BORN. Oops.

      • Jason Kindle

        You’re are really good a labeling people you don’t know.

        • Arekushieru

          Nope, I’m not labeling ANYONE. ANYONE who is Pro-‘Life’, anti-choice, ‘anti’-abortion, NOT PRO-CHOICE, is a misogynist, and you have proven that you are NOT Pro-Choice

        • Jennifer Starr

          I’d say that you’ve pretty much proven yourself to be a misogynist.

    • Jennifer Starr

      Susan Cahill is a hero who helps women. She should be proud.

    • goatini

      Women have voices with which to make choices.