For weeks, jurors in Philadelphia heard grim testimony about deaths and squalor at Dr. Kermit Gosnell's inner-city abortion clinic. While they listened, the murder case reverberated far beyond the courtroom, changing — at least for the moment — the tone of the national debate on abortion.
Groups supporting legal access to abortion, after major successes in the 2012 national elections, find themselves on the defensive as they distance themselves from Gosnell.
"All of us are appalled by the substandard illegal practices," said Vicki Saporta, who as CEO of the National Abortion Federation represents hundreds of U.S. abortion clinics. "But to make the leap to say that's indicative of the state of abortion care throughout the U.S. is absolutely false."
Anti-abortion activists, in contrast, are energized by the case, citing it in fundraising appeals and renewed efforts to expand state restrictions on abortion.
"It's very seldom we get such an opportunity to look at the realities of what's happening in abortion," said Dr. Donna Harrison, president of the American Association of Pro-Life Obstetricians and Gynecologists.
Gosnell, 72, is charged with killing five people — a patient and four viable babies that prosecutors say were born alive. Among scores of other counts, he also is accused of performing abortions after Pennsylvania's 24-week limit.
Jury deliberations began April 30 and are scheduled to resume Monday.
Anti-abortion groups have seized on the case as a chance to reach an audience beyond their regular followers. Those efforts were enhanced midway through the trial when abortion opponents used social media to accuse some national news outlets of a "blackout" of the case, resulting in increased news coverage.
Certainly, there's been national attention. Beth Burkstrand-Reid, a University of Nebraska law professor who teaches courses about abortion and gender issues, says her students have been coming up to her before and after class to talk about the case.
The horrific allegations against Gosnell — whose clinic was licensed but hadn't been inspected since 1993 — have prompted the abortion-rights lobby to repudiate him as a "rogue operator" employing practices far outside the norm.
"This was an incredibly horrible situation and when it came to light, he was somehow associated with the abortion community, which he's not," said Elizabeth Nash of the Guttmacher Institute, a research group which supports abortion rights. "It's taking a long time for that message to get out. He does not represent abortion care in this country."
Anti-abortion groups are trying to make the case that he does, arguing that lax regulation and callous attitudes have allowed dangerous conditions to persist in many clinics.
They also contend there's little practical difference between what Gosnell is charged with — killing four babies who were born alive — and a late-term abortion.
The trial "shows people that abortion is about killing human beings that have arms and legs and in this case, a lot of attention has been focused on necks and spines that can be cut. They're alive and something has to be done to them to cause them to die," said David O'Steen, executive director of the National Right to Life Committee.
One anti-abortion group, Live Action, has used the case to publicize the latest in a series of undercover videos it has made at abortion clinics.
"Gosnell Not Alone in Late-term Abortion Brutality," declares a news release about videos which, according to Live Action president Lila Rose, show abortion providers discussing possible outcomes of late-term abortions that she depicts as infanticide.
Another group, Americans United for Life, is using the case to bolster its promotion of state laws requiring abortion clinics to meet the same safety standards as outpatient surgical facilities.
"You are going to see legislators taking a look at this horrific situation in Philadelphia and say, 'We do not want this in our state,'" said spokeswoman Kristi Hamrick.
Anti-abortion activists were already feeling emboldened by the Republican electoral gains of 2010. Since then, GOP-dominated state legislatures have passed more than 160 restrictive abortion measures — more than in the seven previous years combined, according to a tally by the Guttmacher Institute.
In the 2012 election, abortion-rights supporters countered by accusing the GOP of waging a "war on women," and some anti-abortion Republicans lost high-profile Senate races.
Now the Gosnell case is providing abortion opponents with fresh ammunition as they seek tighter clinic regulations and additional restrictions on late-term abortions. For example, they are citing the case in urging Congress to ban abortions in Washington, D.C., beyond the 20th week of pregnancy, based on the disputed premise that a fetus can feel pain at that age.
Eleven states already have so-called fetal pain laws, though only six are in force. Courts have blocked enforcement in three states, while in two states the measures have yet to take effect.
Late-term abortions are relatively rare. According to federal data, about 92 percent of abortions are performed at 13 weeks of pregnancy or earlier.
In Pennsylvania, the Gosnell case has already had a direct impact on policy.
A law that took effect last year raised safety standards for abortion clinics, including requirements for wider hallways and doorways, bigger operating rooms, and full-time nurses. The law also mandates unannounced inspections.
Since the law's enactment, five of the state's 22 abortion clinics have closed, according to the Health Department, though reasons for the closures vary.
Abortion-rights supporters say the Gosnell case illustrates the need for increased access to abortion services, not less. They argue that restrictions drive down the number of reputable providers and force desperate, low-income women to turn to unsafe options, as was often the case before the Supreme Court's 1973 Roe v. Wade decision established a nationwide right to abortion.
"The kinds of restrictions that the anti-choice lobby has been trying to put in place for years and years are the exact kinds of restrictions that keep people like Kermit Gosnell in business," said Ilyse Hogue, president of NARAL Pro-Choice America. "Peeking at Gosnell's clinic is like peeking into U.S. history pre-Roe v. Wade."
Dr. Anne Davis, who is medical director for Physicians for Reproductive Health and provides abortions as part of her practice in New York City, says abortion is among the safest medical procedures.
"There are always going to be bad actors in any profession," she said. "The harder it gets to access abortion, the wider the door for bad actors."
It's too soon to gauge whether the Gosnell case will sway public opinion and alter abortion politics over the long term.
Eric Ferrero of Planned Parenthood, the leading provider of abortions in the U.S., said he took heart in national polls that consistently show most American support legal access to abortion. "I don't doubt that extremist politicians and activists will try to use the case to fan the flames," he said. "When two-thirds of the public is against you, you look for a game-changer at every bend."
President Barack Obama, who supports abortion rights, waded into the debate on April 26, becoming the first sitting president to make an in-person address to Planned Parenthood.
Obama vowed to help fight against state abortion restrictions that he said are designed to "turn back the clock to policies more suited to the 1950s than the 21st century."
The president did not mention the Gosnell case, but he attacked legislators in North Dakota, Mississippi and elsewhere who want to "ban or severely limit access to a woman's right to choose."
Pennsylvania lawmakers were among the first anywhere to approve restrictions on abortion. The state's 1980s-era abortion laws required women to wait at least 24 hours for an abortion and to receive information from a doctor about abortion risks and alternatives.
Yet in the case of Gosnell's clinic, enforcement was lacking. Prosecutors said Gosnell employed untrained, unlicensed workers in a deplorable facility with broken or unsterile equipment.
A Philadelphia grand jury report in 2011 said Gosnell routinely performed illegal, third-trimester abortions and cut the spinal cords of hundreds of infants born alive.
According to the report, Gosnell's clinic had not been inspected since 1993. It said the state Health Department stopped inspecting abortion clinics in the 1990s out of a desire to avoid "putting up a barrier" to women seeking abortions.
Claremont McKenna College professor Jon Shields, an expert in abortion policy, described the U.S. abortion system overall as "unusually permissive" compared to most Western countries.
"Most of the industry is self-regulated and generally that works pretty well," he said, crediting such groups as Planned Parenthood and the National Abortion Federation with high standards.
"But then you get a lot of clinics that ... are interested in cutting costs," Shields added. "We know a lot less about these clinics."