By Caitlin R. Cruz

On May 31, 2009 a man walked into a church and shot Dr. George Tiller, an outspoken physician who specialized in third-trimester abortion care at his clinic in Wichita, Kansas. It wasn’t the first time Dr. Tiller had been shot; a similar attempt on his life had been made in 1993 when a woman shot Tiller multiple times as he was leaving the clinic. (He survived gunshot wounds to each arm.) But in 2009, the perpetrator killed him.

His assassination, which occurred while I was approaching the end of high school in nearby Nebraska, showed me that there was an entire movement of people fighting to protect for the politics I was only then just beginning to articulate.

Tiller’s murder as well as the threats of violence and the actual harassment loom over a large number of professionals and volunteers just trying to carry out their duties to patients. But for Julie Burkhart, an employee of Dr. Tiller who reopened his clinic after his murder, cowing to threats would be an affront to her boss’s legacy.

“All the good work we’ve done makes me incredibly sad that this had to come out of his death,” she told MTV News. “Dr. Tiller was a very compassionate, kind person. He cared very deeply about the people who came into his clinic. He was invested in helping people. He was not this person who anti-choice people try to twist into a monster. He was a kind and compassionate person. He had a lot of love in his heart. After his assassination, it was quite apparent that there was a vast, gaping hole in the reproductive rights movement.”

It took almost four years to reopen Dr. Tiller’s clinic. In that time, Burkhart founded Trust Women — directly inspired by Tiller’s own motto — to open clinics and provide abortion access and contraception to underserved communities, largely in the Midwest.

Despite the work of Trust Women and countless other organizations, abortion care is still fraught. The state of Missouri was in danger of becoming the first state with no abortion clinics since Roe. Legislators in multiple states have passed abortion bans that restrict the procedure to just weeks into pregnancy. It’s not a single-party issue, either: On May 30, Louisiana’s governor, Democrat John Bel Edwards, signed one of the strictest abortion bans in the country.

“This,” Dr. Diane Horvath, an OB/GYN in Maryland and a fellow with Physicians for Reproductive Health, said while describing the recent wave of bans, “is a really dramatic worsening of a problem that’s been going on for decades. There are already a lot of groups doing advocacy work, helping shelter patients, there are groups of people who are helping people get to a clinic that might be far away.”

Still, the safety of abortion providers, support staff, activists, and patients remains in flux. According to a new report on violence against abortion providers from the National Abortion Federation, there has been an increase in online hate speech, as well as in clinic obstruction, vandalism, and trespassing. While overall instances of stalking decreased last year, the stalking became “more targeted;” one abortion-care provider reported being followed at least four separate times. In 2018, providers reported 1,388 instances of hate mail or harassing phone calls. Dr. Horvath told MTV News that the idea of trespassing doesn’t always convey the seriousness of the offense. “People come on to the clinic property, up to the window or sometimes into the clinic with the express interest of causing a problem,” Horvath said.

Since Dr. Tiller’s death, those behind the anti-choice movement have largely shifted their strategy from winning a culture war to winning a legislative victory. Despite the 2016 Supreme Court ruling that states could not place undue restrictions on abortion providers in Whole Woman's Health v. Hellerstedt, there has been an explosion of growth in anti-choice legislation, most often backed by conservative lawmakers, at the state level. Reproductive rights have transitioned into a period of legislative attrition in addition to the real threats facing patients and clinicians. In 2015, three people at a Planned Parenthood in Colorado Springs, Colorado, were killed by a perpetrator; there are currently 24 legal abortion clinics in the state.

The pivot towards focusing on abortion in legislatures just means there’s yet another frontier on which to focus. To that end, advocacy groups are meeting the voters where they’re at; according to Reuters, 58 percent of Americans believe abortion should be legal. Trust Women also does door-to-door canvassing to identify pro-choice voters and advocate against anti-choice legislation. It’s an illuminating experience, Burkhart told MTV News: “Just because these states are hostile does not mean the majority of people in these states are anti-choice.”

It’s also never too late to get involved, Dr. Horvath adds. (Looking at you, cis men.) “The groups who have been most impacted by abortion restrictions have been involved because they have to be,” the Maryland-based physician told MTV News. “Abortion is already not accessible in most places in this country.”

“Dr. Tiller’s death affirmed that [doctors] have to keep on, keeping on,” Jodi Magee, the president and CEO of Physicians for Reproductive Health, told MTV News. “He had a saying, ‘Don’t let the protesters live rent-free in your head.’ I think the physicians decided to be George.”