CINCINNATI - Passing motorists are used to seeing protesters outside the Women's Med Center in the Dayton, Ohio, suburb of Kettering but the scene one sunny Sunday morning last spring caused many to do a double-take.
About 300 anti-abortion activists held signs and prayed as a Catholic priest clutched a Rosary and performed an exorcism in front of the clinic.
The Rev. Tim Ralston told reporters he was trying to purge the medical facility of the "evil" that had accumulated there due to the abortions performed regularly.
"The devil doesn't always manifest himself, but I'm sure it did some good," said Vivian Koob, head of the Elizabeth New Life Center, an anti-abortion counseling center located near the clinic.
The exorcism also attracted its own protestors, some of whom beeped their car horns, hoping to interrupt the ritual.
Such is the state of attitudes toward legalized abortion four decades after a historic Supreme Court ruling decriminalized the medical procedure nationwide.
Tuesday marks the 40th anniversary of the Roe v. Wade decision. On Jan. 22, 1973, the high court ruled 7-2 that a right to privacy under the due process clause of the 14th Amendment extended to a woman's decision to have an abortion.
But the court added the right wasn't absolute; it must be balanced against the state's legitimate interest in regulating the procedure to protect women's health and prenatal life.
Before the decision, abortion was illegal in 30 states, including Ohio, Kentucky and Indiana, and allowed – mostly under certain, specified circumstances – in 20 others.
Only four states (Alaska, Hawaii, New York and Washington) allowed abortion on demand for women, regardless of reason or timing.
During that era, some women still had abortions; they just did so covertly and often without getting the proper medical expertise or access to equipment that would ensure their safety. In 1965, for example, illegal abortions accounted for nearly one-fifth of all pregnancy- and childbirth-related deaths in the United States.
Nowadays, the debate rages on about whether abortion is a private decision that ultimately should be made only by women directly involved, or is a moral decision that involves the taking of a human life and which should be restricted or prohibited by society.
Division over in the debate remains wide. A poll by the Pew Forum on Religion and Public Life released last week found 63 percent would not want to see Roe v Wade completely overturned while 29 percent would want the controversial ruling overturned. Those opinions reflect little change in Pew polls conducted over the past 20 year.
Each side of the debate tries to frame the issue in terminology that suits them best. People who want abortion to remain safe and legal aren't pro-abortion; they're "pro-choice." Similarly, people who oppose the procedure aren't anti-abortion; they're "pro-life."
Sue Momeyer remembers what life was like for women with unintended pregnancies before Roe v. Wade.
Momeyer moved to Oxford in 1969 with her husband, shortly after they had a baby. Although she was a housewife for a few years, as her child grew older, Momeyer became increasingly aware of the need for an OB/GYN clinic for female students at Miami University.
At the time, there was no medical facility of that type in Oxford and the campus health service didn't provide such care. The university also had a "no car" rule back then, meaning it was difficult for female students to travel to nearby cities like Hamilton or Fairfield for health care.
Through her friends in the medical field, Momeyer knew the sometimes disastrous consequences of desperate women dealing with unplanned pregnancies.
"The numbers of women coming into hospitals suffering from the effects of having an illegal abortion were staggering," she said. "In the 1960s and ‘70s, what propelled the cases that led to Roe v. Wade in many ways was this health care aspect."
In 1973, Momeyer helped open the first Planned Parenthood clinic in Oxford, and served as a volunteer there. Over the years, she would become more involved in the cause, eventually becoming executive director of the Butler County Planned Parenthood. By 1998, when that chapter merged with the Cincinnati office, Momeyer became CEO of the joint organization. A few years later, the Dayton and Cincinnati offices merged. When she retired in 2006, Momeyer was president of the Planned Parenthood Southwest Ohio Region.
Now, at age 70, Momeyer is disturbed by efforts to overturn Roe v. Wade.
"Many younger people sort of take it for granted, because for most of their lives abortion has been legal and more or less available," she said. "(But) the effort to chip away at the availability of abortion has been relentless."
A report by the Guttmacher Institute, a nonprofit group that works to advance reproductive health, including abortion rights, found that 2012 was a busy year for abortion foes.
"Over the course of the year, 42 states and the District of Columbia enacted 122 provisions related to reproductive health and rights," the report stated. "One-third of these new provisions, 43 in 19 states, sought to restrict access to abortion services. Although this is a sharp decrease from the record-breaking 92 abortion restrictions enacted in 2011, it is the second highest annual number of new abortion restrictions."
Ohio is home to arguably the most restrictive proposal in the nation. The so-called "heartbeat bill" would ban abortions after the first fetal heartbeat is detected, as early as six weeks into pregnancy. Although Ohio Senate President Tom Niehaus (R-New Richmond) blocked a vote in November, advocates vow to reintroduce the measure this year.
At the same time, a Gallup poll last year indicated 77 percent of Americans think abortion should be legal in some or all circumstances. That stance is strongest among people under age 30.
Whether the findings symbolize America's deeply divided psyche on the issue, or show that extremists on both sides of the debate are driving the agenda, it's clear that abortion remains just as volatile a topic as it was in 1973.
Paula Westwood, executive director at Right to Life of Greater Cincinnati, is hopeful that efforts to overturn Roe v. Wade will be successful.
"We will continue with bold legislative efforts at the state level, which many states are doing, in protest of federal policies," Westwood said. "Those of us in the states will also support and encourage federal Congressional efforts to protect innocent human life."
She added, "We will continue to educate on all assaults on human life through the many means now possible. For if people truly understand the value of each human life, it will not matter who is in the White House, who are the judges on the courts, or what laws are on the books -- they will choose life regardless."
Perhaps the largest and most well-funded opponent to abortion is the Roman Catholic Church. There are 77.7 million Catholics in the United States, including more than 498,000 in the Cincinnati Archdiocese.
According to church officials, the roots of its opposition can be traced to the Didache, a church treatise from the 2nd Century. It states, "There are two ways, one of life and one of death; and between the two ways there is a great difference."
Also, Catholic officials cite a Biblical passage, Jeremiah 1:5, as basis for its anti-abortion imperative. It states, "Now the word of the Lord came to me saying: Before I formed you in the womb I knew you, before you were born, I consecrated you; a prophet to the nations I appointed you."
A recent church teaching, the Gospel of Life, states:
"We live the Gospel of Life when we live in solidarity with the poor of the world, standing up for their lives and dignity. Yet abortion and euthanasia have become preeminent threats to human dignity because they directly attack life itself, the most fundamental human good and the condition for all others. They are committed against those who are weakest and most defenseless, those who are genuinely ‘the poorest of the poor.'"
But while Catholic sentiment has been more or less steadfast against abortion over the decades, that wasn't always the case for many of America's other denominations.
An article by Valerie Tarico of AlterNet examined how many Protestant denominations were once more accepting of abortion, up until the early 1980s.
Among its many citations, the article quotes Bruce Waltke, of the Dallas Theological Seminary. In 1968, Waltke said, "God does not regard the fetus as a soul, no matter how far gestation has progressed. The Law plainly exacts: ‘If a man kills any human life, he will be put to death' (Lev. 24:17). But according to Exodus 21:22–24, the destruction of the fetus is not a capital offense… Clearly, then, in contrast to the mother, the fetus is not reckoned as a soul."
There are many more such statements about abortion from that era, including a 1971 resolution passed by the Southern Baptist Convention affirming that abortion should be legal not only to protect the life of the mother, but also to protect her emotional health.
For most anti-abortion advocates, however, any harm done to fetuses is akin to sanctioned murder and shouldn't be tolerated.
"When Roe v. Wade was enacted, all that is now known about prenatal development and abortion's physical, emotional, and psychological toll on women was not known," Westwood said.
"Ultrasound technology has opened a window on the womb, allowing many women to bond very early with their unborn babies," she said.
The court's ruling has helped foster a more callous attitude toward life during the past four decades, anti-abortion advocates insist.
"While there are no positives other than feeding selfishness, abortion has produced a major negative impact on our culture," said Phil Burress, president of Citizens for Community Values, a conservative group based in Sharonville, Ohio.
"The number one negative impact is respect for human life. One can easily connect the dots for anyone under 40 years old, who never knew a time when pre-born babies were protected," Burress said. "Since we taught those under 40 that life is disposable, then why stop at the most innocent? If we send a message that we don't respect pre-born babies then why respect 5- and 6-year-old children?"
Abortion supporters, however, insist that view is an oversimplification which has little to do with reality.
"Abortion is a deeply personal and often complex decision," said Cecile Richards, president of the Planned Parenthood Federation of America. "A woman should have accurate information about all her options around her pregnancy."
"To protect their health and the health of their families," Richards said, "women must have access to safe, legal abortion services without interference from politicians.
"We all know none of us can walk in another woman's shoes," she said. "A woman needs to be able to make her own decisions, in consultation with her doctor and with her family, about her (family planning)."
Maybe no one is more conflicted in the abortion debate than "Jane Roe" herself – Norma McCorvey, the Dallas woman whose effort to get a legal abortion led to the historic decision.
In 1969, when she was 21, McCorvey became pregnant with her third child. At first, McCorvey claimed she was raped so she could get an abortion under the laws in Texas at the time. But when police noted no sexual assault report had been filed, McCorvey admitted she lied.
She then retained two lawyers to help her get the procedure. The legal battle lasted three years, during which McCorvey gave birth to the child and placed it for adoption.
Many years later, McCorvey converted to Christianity and became an abortion opponent. She now does TV commercials for Right to Life, and speaks at events around the nation against abortion.
Critics, though, believe McCorvey, who according to a Vanity Fair writer sought payment for an interview, is just trying to cash in on her celebrity.
The most recent data shows the right to an abortion won by McCorvey 40 years ago is one that appears not to be exercised as much in recent years. The abortion rate dropped by 5 percent from 2009 to 2010, the largest-ever single year decrease.
Abortion advocates attribute the drop to increased access to contraceptives and information about reproductive health.
Anti-abortion advocates insist they won't stop their efforts to overturn Roe.
"The pro-life movement is the people who march for life in Washington during the coldest month of the year. We stand in front of abortion centers and pray in all kinds of weather, stared at and sometimes ridiculed," Westwood said. "We do thankless tasks to get pro-life officials elected. We write letters, testify to protect the vulnerable at statehouses, volunteer at pregnancy help centers, and much more."
"We do this because little ones who deserve life are being snuffed out," she said. "And if we don't stand up for them, no one will. We will never go away."
Many abortion supporters, like Momeyer, think the intransigence will be the anti-abortion movement's undoing.
"There is a sleeping giant aspect to the abortion issue," Momeyer said. "If abortion rights were to start being rolled back, there would be a serious retrenchment, especially with young people. A lot of people think abortion will always be safe and legal. If that were to change, it would energize whole segments that are quiet right now."
"I hope it doesn't come to that."