The billboards, placed prominently near Delaware's abortion clinics, say it all: "Don't Let Your Job Put You In Prison."
Spurred by the murder trial of abortionist Kermit Gosnell — which landed him and several of his Philadelphia clinic employees in prison — pro-life activists are expanding their battle to curb the practice by cajoling, beseeching or just plain scaring abortion clinic workers into leaving their jobs.
While much of the nation's long-running battle over abortion rights has been fought in courts and legislatures, pro-life advocates think that targeting the workforce that staffs the nation's abortion clinics could prove equally potent in the long run.
"We've had a lot of success with clinic workers in the past," said Mark Crutcher, president of Life Dynamics Inc., which assists in billboard and other campaigns. The horrific revelations of unsanitary and unsafe practices at the Gosnell clinic has only fueled the campaign.
The post-Gosnell message to workers gets "real simple," Mr. Crutcher said: "You are in a position where you can be a witness. Or you can be a defendant."
Abortion clinic directors dismiss these tactics as part of a failed strategy to curb abortion rights by targeting industry workers.
Sidewalk protesters "are part of the scenery. They're there, we ignore them," said Chrisse France, executive director of Preterm abortion clinic in Cleveland.
"When we see those fliers, it's like, 'Pfft, give me a break,'" said Tammi Kromenaker, director of Red River Women's Clinic in Fargo, N.D., the state's only abortion clinic.
No one works in an abortion clinic in North Dakota without a deep commitment, Ms. Kromenaker said, "so I don't see any of our staff being vulnerable at all."
However, an organization led by former abortion clinic director Abby Johnson said it already has helped 85 workers exit the abortion industry.
"We are there to say there are other options out there," said Ms. Johnson, who founded And Then There Were None in 2012.
The message of her nonprofit ministry is, "No abortion clinic workers, no abortion clinics, no abortions. It starts with the workers."
Hard data about abortion clinic workers — coming or going — are hard to come by.
Planned Parenthood Federation of America reports that it employs 25,000 staff and volunteers at its 750 health clinics, which include clinics that do not provide abortions. The Guttmacher Institute doesn't count clinic staff, a spokeswoman said, but tallies 1,793 abortion providers, including the Planned Parenthood clinics, independent clinics, hospitals and physician offices across the country.
An abortion facility may have anywhere from a few staff members to dozens, clinic directors say.
Charlotte Taft, director of the Abortion Care Network, estimates about 1,000 staff members in member clinics.
If clinic employment data are soft, figuring how many clinic workers have left their jobs for any reason is even more of a guessing game. In addition to Ms. Johnson's numbers, there is evidence of clinic workers leaving the industry from the Society of Centurions of America, which regularly hosts "healing" retreats for former clinic workers.
However, Centurion gatherings are intended to be small and personal, and the two workshops held this year had fewer than 20 former clinic workers, said workshop leaders the Rev. Frank Pavone and the Rev. Terry Gensemer.
Undeterred by an apparently small defection rate, pastors and pro-life activists have long homed in on disillusioned abortion clinic workers, including doctors, administrators, secretaries, nurses, technicians and clinic guards.
Yes, some workers left "under their own steam," but others were helped along "by what might be called tugboats in human form," Mary Meehan wrote in a 2,000-word article in Human Life Review called "The Ex-Abortionists: Why They Quit."
Pro-life activists say the grisly daily aspects of abortion are what propel workers out the door.
Many people take clinic jobs for the paychecks, and they may not even "believe" in abortion. But over time, they can find themselves "working tech" — assisting the abortionist in the exam room or "piecing together the pieces of the baby after an abortion," said Ms. Johnson, who for years ran a Planned Parenthood clinic in Texas until she had a dramatic change of heart after participating in the abortion of a 13-week-old fetus.
"That's why they call us," she said. The workers say they were hired to help in the front office, but now have been called to the backrooms to keep their jobs, and they find they "can't do it anymore," said Ms. Johnson, who told her own story in a 2010 book called "Unplanned."
Some people leave after a divine epiphany.
As a 19-year-old college student, Dr. Beverly McMillan said she left the Catholic Church, embraced secular humanism and became an abortionist. She opened the first abortion clinic in Mississippi in 1975.
But then the day came when "I realized I was looking at what I was doing and an immense sadness came over me," she told an audience at Our Lady's Center in Ellicott City, Md., in September.
"I thought to myself, five minutes ago, this [tiny arm] was attached to a child. What am I doing?" said Dr. McMillan, who has returned to the Catholic Church and is now a pro-life speaker.
Abortion clinic directors counter that their staffs are extraordinarily loyal to abortion care and can't be "enticed" to leave.
"I've said for all these 40 years: This is not a job. This is a calling," said Ms. Taft, whose network represents more than 70 independent abortion clinics.
"Most of the clinics I know of are in business because they care about women," said Ms. Taft, who started as a clinic counselor in 1975 and ran a clinic for 17 years.
"So if you have a clinic that is providing abortion services because of that deep care for women, their hiring and their training likely reflects those values," she said. In her personal experience, she said, clinic staff met regularly and talked "to make sure that the staff felt good about the work we were doing."
"People aren't leaving. I know if you ask any of our [45-member] staff, they'll say, 'We love the work that we do,'" said Ms. France, who runs the largest independent clinic in Ohio.
However, it's not uncommon for young women to "come into this work right out of college and then leave in a few years," she said. These women "want to change the world," but can see that "they're not going to get rich doing this kind of work," so they go back to school to become social workers, medical professionals or lawyers.
Many of these young women look back on their time at Preterm with pride, Ms. France said. "They strongly believe in women's moral agency to make their own choices," and they will say later that working at Preterm "changed my life."
According to recent research, however, stigma and harassment commonly come with the job.
Ironically, a major reason people work in abortion clinics is that they want to "help people." But many of those staff members face stress, isolation, rejection and "an intense fear of violence" as part of their jobs, Dr. Lisa Harris of the University of Michigan Health System said in an Web seminar this summer.
Dr. Harris is involved with a pilot project called Providers Share Workshop to study experiences of clinic workers and develop support systems for them.
Some of the project's early findings were that 89 percent of clinic workers said they felt "unappreciated by society" and half experienced "verbal or physical harassment."
The Gosnell effect
Pro-choice leaders insist that the Gosnell incident will not have lasting effects because he was "a rogue" and not representative at all of the industry as a whole.
"No, no, no," Ms. France said when asked about "other Gosnells."
There are hundreds of clinics, and 13 in Ohio, she said. "Certainly, we all give good care. We are regulated, and we want to do good work."
"Gosnell was very much a rogue and had nothing to do with what good abortion care is," Ms. Taft said.
Ms. Kromenaker cited a survey released in August by RH Reality Check, an online publication on reproductive-justice issues, that looked, state by state, for other unethical abortion providers along the lines of Gosnell.
"And they found, in fact, there are not," Ms. Kromenaker said.
But pro-life activists dispute that, and clearly want to make the Gosnell case into an object lesson for all clinic workers.
"Dr. Kermit Gosnell is not alone" in the kinds of "inhuman practices" he and his staff performed at their Philadelphia clinic, said Lila Rose, president of Live Action, citing her group's "undercover" videos at abortion clinics. The abortion industry is "united," Ms. Rose said. If there's a problem in one clinic, "you're going to find it in another one."
Former clinic workers in Texas and Delaware already have come forward to speak publicly about abuses they encountered.
Some of the Delaware clinic whistleblowers "literally feared for their [health care] licenses," said Nicole Collins, president of Delaware Right to Life, which has run radio ads and put up billboards this fall as part of its outreach to clinic workers.
In Texas, Mr. Crutcher's organization has prepared postcards for more than 600 clinics that warn about the risks of exposure to crimes such as income tax evasion, Medicaid and insurance fraud, and failure to report statutory rape.
The cards "tell people, 'Hey, if you are doing something illegal and you don't want to go to jail, you'd better call these people,'" Mr. Crutcher said.
Also, lawyers with Alliance Defending Freedom are standing by to talk to anyone who is worried about repercussions from leaving a clinic job.
In addition to criminal or civil issues, some clinic workers may fear their employers will pursue them over "imagined confidentiality agreements" or block unemployment compensation, said the alliance's attorney Michael Norton, who is also a board member of Ms. Johnson's group, And Then There Were None.
In all of these cases, he said, Alliance Defending Freedom can offer pro bono legal support to make sure a worker's information is "used in a cooperative way" with law enforcement officials. Its job is "keeping them out of harm's way," Mr. Norton said.
Regardless of why a person leaves the abortion industry, officials at the Society of Centurions of America say, they are prepared to offer comfort and counseling.
"Centurions is a true Christian ministry in that it doesn't just serve people who left to convert. It is for people who left on their own, for their own reasons as well," said Brian Gibson, executive director of Pro-Life Action Ministries in St. Paul, Minn., a well-known sidewalk-counseling group that housed the Centurions program for years.
The society, named after the Roman centurion who repented for his participation in Jesus Christ's crucifixion, offers private counseling and workshops to former clinic workers.
"We see a constant stream of people coming for help," said Father Pavone, national director of Priests for Life, which now runs the group.
By design, Centurions is "not a high-profile type of ministry," said Father Gensemer, international director of the Charismatic Episcopal Church for Life in Birmingham, Ala., who led a workshop in September with Father Pavone.