John Dunkle paces along a narrow alley waiting for his cue.

As clinic escorts hoist heavy blue tarps to shield patients from the phalanx of anti-abortion protesters assailing them, Dunkle springs into action.

Megaphone in hand, the spry 72-year-old stakes out the door barking lurid catcalls at anyone and everyone entering the Allentown Women’s Center.

By day’s end, the retired English teacher will have bolted across that alley at least a dozen times.

Until one day when the scene took a much more sinister turn.

Days after the May 31 execution-style murder of Wichita physician George Tiller by an anti-abortion extremist, Dunkle sidled up to a clinic escort and asked:

Which way would you rather die — by bullet or the slow torturous death of a knife?

So goes the abortion wars. What could be sloughed off as callous behavior in the midst of heated debate is causing renewed alarm among law enforcement experts.

Menacing behavior is on the upswing nationwide and is proving to be emblematic of a growing extremism against clinics by militants emboldened by Tiller’s death. Currently, federal authorities are currently investigating more than two dozen cases of suspected violent criminal acts or serious threats, according to law enforcement insiders.

And that trend is prompting officials to question the effectiveness of the federal law created to serve as a deterrent to clinic violence.

Playing cat and mouse

In the years following the landmark 1973 U.S. Supreme Court decision Roe v Wade affirming legal access to abortion services, organized protests grew in number and intensity.

In 1994, after decades of escalating extremism, President Bill Clinton signed the Freedom to Access Clinic Entrances (FACE) Act to provide both civil and criminal remedies to stem clinic violence and blockades.

The law prohibits “certain violent, threatening, obstructive and destructive conduct that is intended to injure, intimidate or interfere with persons seeking to obtain or provide reproductive health services.” The new rules also defined federal penalties for clinic property damage and destruction that had been the early aim of radical abortion foes primarily through bombing, arson and vandalism.

The intent of FACE was also to provide needed clarity for local law enforcement agencies on the often murky degrees of separation between constitutionally-protected free speech and public safety threat.

Even as the law was initially vigorously enforced violence-prone abortion opponents have adapted to test its limits.

Dunkle’s scrapes with the law offer a telling roadmap.

In 1994, he was arrested along with 20 members of a nomadic extremist group, the Lambs of Christ, for physically blockading a Rochester, N.Y., clinic by chaining themselves to a junked car dropped near the door. It took police and firefighters hours to extract the protesters. The protesters were charged in federal court with a miscellaneous civil rights violation, collectively fined $20,000 and ordered to stay away from the clinic.

Except, the permanent injunction, like others before FACE, did little to thwart the protesters. The Rochester clinic and others in western New York would be the scene of violent and repeated clashes with local police for years to come despite repeated injunctions, unpaid fines and brief jail stints. The mayhem unleashed by extremists also provided cover for increasing violence that resulted in the deaths of four people and wounding of five at clinics in Buffalo, Brookline, Mass., and Pensacola, Fla., in 1994.

Over the next dozen years, Dunkle continued his protests while building connections to one of the most virulent extremist groups, the Army of God, a shadowy network that advocates a paleo-conservative Biblical justification for the murder of abortion providers.

In 2007, Dunkle publicly resurfaced in northeast Pennsylvania and once again came to the attention of federal authorities. The devout Catholic posted on his blog that a Philadelphia-area physician should be shot in the head to prevent her from providing abortion services. He was charged with a FACE Act violation and slapped with a permanent injunction barring him from making death threats or otherwise intimidating clinic patients and staff.

But it seemed to have little effect.

Now, when Dunkle and his megaphone aren’t holding fort outside Lehigh Valley women’s health centers, he’s reveling in the exploits of other ideological extremists.

He operates a website that mimics one operated by the Army of God. On it he features serialized manifestos and unrepentant letters from anti-abortion protesters imprisoned for murders, bombings, arsons and attempted attacks against clinics. A point noted by a U.S. District Court judge in his 2007 injunction ordering federal authorities to periodically monitor Dunkle’s site for compliance.

Federal prosecutions don’t keep pace

The situation prior to the FACE Act and in the ensuing 16 years following its enforcement points to a grim reality for reproductive health clinics, staff and patients.

Prior to FACE, the National Abortion Federation tallied 1,641 violent incidences and 8,110 disturbances at clinics between 1977-93. The most violent acts — homicide, kidnappings, stalking, arsons, bombings, butyric acid attacks and clinic invasions — are nearly always attributed to anti-abortion extremists directly connected to or inspired by militant Christian organizations.

Since 1994, the Justice Dept. has prosecuted just 19 civil and 45 criminal cases. The prosecutions have overall been very successful — 62 convictions, one pre-trial diversion and one dismissal because the defendant was deemed incompetent to stand trial. Yet, they pale in contrast to the thousands of reported incidents.

Meanwhile, U.S. Attorneys are currently prosecuting four cases, including one for a death threat targeting the family of a physician in Boulder, Colo. They also notched another conviction Apr. 28 in New York City involving a blockade of a long-targeted clinic in Manhattan. The defendants will be sentenced June 10.

The Mountain West has not been immune to anti-abortion violence. Arsons, bomb threats, fake anthrax letters and death threats have plagued clinics in Colorado, Montana New Mexico and Utah. Some have been prosecuted under FACE while others have not.

The incident and prosecution trends also reveal another truth in enforcing the FACE Act. Some types of violations, like bombings and arson, which alone carry heavy federal sentences have decreased significantly while other crimes are skyrocketing. Again, signaling an evolution in the violence-driven protesters’ tactics to thwart local law enforcement efforts while continuing their mayhem.

Bead-holders versus bomb-throwers

Anti-abortion activists may be united in their anger over Roe but they occupy two very distinct camps.

Motivated by a sense of personal morality, flocks from mainstream Christian churches and affiliated institutions invoke their constitutionally-protected free speech rights to express their opposition.

Largely peaceful, the protesters often recite rosary prayers, sing hymns or try to distribute well-intended but medically inaccurate literature outside the clinic. The more zealous of the bunch resort to shouting at patients about abortion alternatives — a tactic dubbed “sidewalk counseling” by proponents.

In broad terms, the “bead-holders” prefer to legally challenge Roe v. Wade by incrementally restricting abortion services through onerous state and federal laws.

The other end of the protest spectrum is so radicalized that even the most staid law enforcement insiders and religious figures are increasingly describing their actions as domestic terrorism.

They are bomb-throwers, literally and figuratively.

A May 1988 RAND Corporation report on domestic terrorism provides one of the earliest mentions of militant anti-abortion groups as threats to national security. The analysis notes that during the early 1980s these groups were among the most active terrorist movements in the United States. Ideologically-driven “anti-abortion terrorist cells” conducted nearly 50 percent of all domestic terrorist activity in 1984 and 1985.

Groups like the Army of God, Lambs of Christ, Missionaries for the Preborn and the various Operation Rescue splinter groups created from internecine power struggles, all espouse the violent rhetoric, paleo-conservative theocracy and hyper-militancy typically used to describe armed anti-federalist militias and racist groups. And, like other terrorist groups, they are highly networked.

Proselytizing with self-published manuals on arson and bomb-making techniques, they fuel their adherents with fiery, convoluted fundamentalist Biblical interpretations.

Throughout the now 22-year-old report RAND specifically names the Army of God as domestic terrorists — the group to which Dunkle and Tiller’s murderer Scott Roeder have allied themselves. Further, the analysis found that law enforcement officials frequently dismissed evidence of an armed, organized anti-abortion network that threatens national security.

Today, that’s no longer the case.

Over the coming days, RH Reality Check will explore the FACE Act. We’ll be asking tough question about its effect as a deterrent to clinic violence and obstruction. State, local and federal law enforcement officers are talking candidly about jurisdictional issues that impede arrests and prosecutions. And we’ll assess the rise of militant anti-abortion groups and potential new solutions to ensure public safety.

NEXT: Anatomy of FACE. How a violent anti-abortion protester has terrorized a clinic for more than 30 years — and why he’s still there.

This piece, which appeared in RH Reality Check is one of a series of original criminal justice journalism projects around the country produced by 2010 John Jay/H.F. Guggenheim Fellows. They were coordinated with editorial input by Joe Domanick, Associate Director of the John Jay College Center on Media, Crime and Justice. We thank the Harry Frank Guggenheim Foundation for their generous support of this project.

While Congress and the White House dither on health care reform, state lawmakers across the country grapple with the practicalities of the uninsured, discriminatory gender rating and mandated care.

In Colorado, a seemingly feel-good bill, HB 10-1021, to require insurance plans to cover maternity care and contraception is fraught with problems that could have and should have been solved by the long-delayed federal legislation.

However, in today’s highly charged political realm with spiraling state budget deficits and the lingering effects of a recession that just won’t quit, even motherhood and apple pie can’t get a unanimous vote in a crucial election year.

A reproductive health care mandate bill passed its first major hurdle on a largely party line 37-27 vote Tuesday in the Colorado House with some surprising defections by pro-choice lawmakers.

A peek behind the legislative sausage-making curtain exemplifies the deep political divisions being created with incremental approaches by states to fix an intractable and unsustainable national health care crisis.

Emilie Ailts, executive director of NARAL Pro-Choice Colorado, laid down a pre-vote challenge to conservative lawmakers to channel their much ballyhooed family values:

“Will the anti-abortion, anti-birth control, anti-comprehensive sex education politicians vote their purported values, which they claim are about healthy babies and healthy families? House Bill 1021 provides a clear opportunity for these anti-choice lawmakers to enact responsible policies that can reduce the need for abortion by ensuring women have access to the prenatal care they need for healthy pregnancies.”

Twenty six of the “no” votes were cast by GOP members. None of the dozen Republican House members with longstanding anti-choice records who voted against the bill, including some who amended and approved it in committee days before, returned calls for comment. The amendments that significantly watered down the bill and specifically noted that abortion care was not covered were eventually thrown out by the House after flexing its 11-vote majority.

However, the biggest danger with the bill is the caustic stew of ideological posturing, political gamesmanship and over-promised and under-delivered health care reform that could leave a bitter taste in the mouths of an increasingly surly mid-term electorate.

Two unexpected opposition votes from pro-choice lawmakers are especially telling about the skittish local mood.

A controversial move to transfer operation control of three secular Denver area hospitals to a Catholic health care system expected to take place on Dec. 31 appears to be on hold pending federal approval.

The unexpected delay by the Federal Trade Commission to bless the transaction may provide local critics with a last gasp effort to continue fighting the deal. Community members and medical professionals contend the transfer would unfairly subject comprehensive reproductive health and end-of-life care to church doctrine over patients’ needs. The Catholic church considers abortion, contraception, elective sterilization and termination of invasive life support as “intrinsically evil” and refuses to provide these medical services or respect patients’ advance directives.

The disputed takeover in Denver exemplifies the very serious implications for the 127 non-denominational hospitals that succumbed to merger fever with cash-flush Catholic health care systems in the 1990s. According to a study by Catholics for a Free Choice, half of merged secular-Catholic hospitals suspended most or all of their reproductive health care services. Eighty-two percent denied emergency contraception to rape victims — and more than a third refused to provide a referral.

But for some tax-exempt, nonprofit hospitals co-owned by secular and church interests, there was little more than a wink and a nod to church mandates on care. Comprehensive reproductive health care services quietly remained available.

That care came later under close scrutiny in 2001 when the U.S. Conference of Catholic Bishops revised its Ethical and Religious Directives for medical care to address “misinterpretation and misapplication of the principle of cooperation with other-than-Catholic organizations.” In other words, the church would no longer turn a blind eye to reproductive health and end-of-life care at its secular partner facilities that did not meet strict Catholic orthodoxy.

MergerWatch.org notes several examples of broken promises by Catholic health care systems to preserve reproductive health services at non-religious hospitals it acquired through mergers. Typical reasons included newly installed diocesan bishops with more dogmatic views on medical directives or the Vatican overturning decisions made by previously autonomous bishops.

More importantly, the local hospital policymaking was a little noticed precursor to the bare knuckles strategy on recent display with the church’s relentless lobbying for the 2009 Stupak and Nelson amendments to further restrict access to abortion care via publicly-subsidized health insurance plans. At the same time, the Catholic Archdiocese of Washington, D.C., threatened to end social service programs for tens of thousands of poor residents if the city council approved a same-sex marriage ordinance.

Now, the Denver hospital takeover is offering a glimpse of the intense pressure being brought to bear by the church on its health care partners. The Vatican’s renewed insistence on complete doctrinal influence on patient care is bolstered by very real threats to hold desperately needed institutional capital funds hostage until its theological demands are met.

And that once delicate balance between serving patient needs and adhering to strict Catholic medical directives is unraveling in plain sight.

The National Institute for Reproductive Health released this week a funny new video on a not so funny subject — unintended pregnancies.

According to the Web site, Don’t Drop the Ball.org:

Why New Year’s Eve?

New Year’s Eve is not a good night for birth control use. Condoms break. Pills are forgotten. In fact, sales of emergency contraception more than double in the days after December 31st, according to January 2009 statistics provided by Teva Pharmaceuticals, makers of Plan B One Step ® (the one-pill version of emergency contraception).

What is emergency contraception?

Make a birth control plan before New Year’s Eve. But if that goes wrong, as things can, know that you have a back-up option with emergency contraception. Emergency contraception is birth control that prevents pregnancy after sex. It is not the abortion pill. It’s available at the pharmacy counter without a prescription for women 17 and older, even in just one pill. If you are under 17, you’ll need a doctor’s prescription. For more information click here.

The locked, clear plastic case bolted onto the grocery store shelf resembles a little condom jail. They can’t get out and you can’t get in unless somebody with a uniform and a big set of keys unlocks the door to freedom.

It’s well known that condoms are an inexpensive and effective method for preventing pregnancy and the spread of sexually transmitted infections. But first you have to get them. Finding them in the store can require iron-willed determination and the tracking skills of a bloodhound.

Anecdotal reports began trickling in more than a year ago to members of the Prevention First Colorado Coalition that condoms were either being locked up on store shelves or stocked behind pharmacy counters. But no one from the coalition of reproductive health organizations and women’s community groups knew for sure whether access was truly restricted statewide.

“Our primary concern is ensuring that all Coloradans regardless of where they live or their income have access to the family planning tools and services that they need,” said Toni Panetta speaking on behalf of the coalition. “We also recognize from a public health perspective that there are issues related to condom availability to help prevent the spread of STIs, HIV or AIDS.”

So with a little help from 17 men and women I connected with via Twitter, Facebook and email, we scattered across the state in search of condom displays in grocery and drug stores. Our sleuthing took us to 64 chain retailers, convenience stores and organic markets in urban neighborhoods, suburban strip malls and rural towns in all four corners of the state.

Too embarrassed to trudge to the store and buy a box? One of our intrepid researchers found ample condom supplies on Amazon.com that can be mailed in a discrete box to your home or office within one day. The online bazaar even offers discount shipping and customer reviews of its prophylactics to ensure you are completely satisfied with your purchase. Though the ubiquitous “new and used” link for discounted items at Amazon is a bit creepy as well as the recommended purchases of action figures and the “Santa Buddies” video.

But if you need them now, our in-store reconnaissance found: We’ve got condoms. Lots of them. Right on the store shelves — though sometimes in some really strange places.

View Retail access of condoms map in a larger map

Just one of the 64 stores, we surveyed did not carry condoms at all. An employee at Sprouts, a natural food chain grocery in Boulder, said limited shelf space prevented the store from stocking such items.

The Downing Super, a store in a low-income Denver neighborhood that one enters through a metal detector, keeps its condoms behind the cash register so customers must request them. The store manager claims that theft problems forced the store to pull them from shelves. The Food Marketing Institute backs up his worry about sticky-fingered customers. Condoms rank 23rd among the 50 most frequently shoplifted grocery items.

The remaining 62 of 64 stores stocked a fairly wide variety of condoms but the quantity was much more limited in some lower income communities. In one Safeway store in a northwest Denver neighborhood with a high proportion of African-American and Latino residents, just three boxes were left on the empty shelf next to fully stocked displays of light bulbs and school supplies. Panetta expressed concern about the disparities and pledged to investigate.

While other urban retailers weren’t quite so short-handed the differences were stark between the quantity and type of condoms on the shelves in urban and suburban grocery and drug stores.

In decidedly more upscale Boulder, Colo., one can purchase a 12-pack of Naturalamb’s for $41.95 retail at Walgreen’s. Nothing says I love you like a $3.49 prophylactic which the manufacturer does not recommended for STI protection and one Amazon reviewer noted are “slimy, cold and smell strange” but gave it five stars for excellent sensation. Another Boulder store stocked condoms next to the cash register with the impulse buy items, like candy and butane lighters.

Whether the shelves are well-stocked or not, just finding the condoms can be an adventure in shopping.

Need a box of your favorite latex prophylactics? Besides the typical partnering with feminine hygiene products, try checking the bleach aisle where one busy Longmont, Colo., Safeway keeps its condoms. Going from natural to synthetic extremes, organic soap and pantyhose departments also seem to be popular places to stock condoms.

Wound care and diabetic supplies were also frequent neighbors of Trojan and Durex products. As was pairing them with diet supplements, vitamins and weight loss products.

Then, there’s the psychological retail approach with condoms placed next to shelves of baby food and stuffed animals. One store even combined their condom display with pregnancy tests and antacids. How’s that for marketing genius?

Believe it or not, there’s a real consumer science to how and where condoms are placed on shelves.

A 2006 U. of Connecticut study found significant differences in condom purchasing behavior of men and women.

Researchers created a mock drug store and placed condoms next to other grocery items deemed positive (health products like vitamins and nutrition bars), negative (tampons and antacids), sensual (massage oil and sexually suggestive magazines) and neutral (toothpaste, soap and cotton balls).

Men were significantly more likely to acquire condoms when they were in the sensual aisle than any other shelf placement. Though they were pretty immune and decidedly less self-conscious no matter where the condoms were located. On the contrary, women expressed more embarrassment in the sensual aisle and were significantly less likely to take the condoms there and with the negative product groups than any other place in the simulated store.

The researchers found that the conventional retail wisdom that stocking prophylactics near feminine hygiene products for women shopper’s convenience is actually nearly as big a turn off as shelving them near the hemorrhoid cream and adult diapers.

So to the Kmart manager in Loveland, Colo., where the condoms are in the triple-threat area — in front of the pharmacy window and next to the antacids and pregnancy tests — you might want to consider moving them for everyone concerned. The unintended birth rate in Larimer County is 39 percent and STIs are on the rise.

Where are condoms stocked in your neighborhood stores? Add a comment to this story with condom availability (on the shelf, locked in a case or in the pharmacy) and the name and address (street, city, state and zip code) of the store so we can build out our map beyond Colorado. And let us know what other products they’re stocked near too.

This story originally appeared at RH Reality Check.

Outrage over the Stupak-Pitts amendment to the House health reform bill ignores a bigger problem: it kills competitive advantage.

By inserting theological beliefs about reproductive health care into the private health insurance market, conservative House members have breached a no-mans land in the One Holy Apostolic Free Market they claim to worship.

With heavy lobbying by the U.S. Conference of Catholic Bishops, the Stupak-Pitts amendment creates a favorable competitive situation for the 624 Catholic hospitals across the nation — a lucrative business that spent $85 billion dollars in 2007 and encompasses 13 percent of the health care sector.

The Denver-based Catholic Health Initiatives is now the largest of the church’s hospital systems in the country with 78 hospitals and 40 long-term care facilities in 20 states and operating revenues exceeding $9.6 billion ranking it sixth among all for-profit and charity health care networks.

It goes without saying that the church opposes abortion, contraception and sterilization on theological grounds which is they’re right as a private business.

But those medical directives also drive away patients that secular and other religiously-affiliated hospitals use to their advantage by emphasizing that they respect patient-physician decision-making on difficult medical decisions. Plus, from a cold, calculating green eyeshade perspective, sepsis from botched back alley abortions and multiple child births is a lot more expensive to cover than contraception.

With good odds that some sort of health care reform bill will pass Congress and be signed by the president, the potential for profit-making is unprecedented.

Congressional health insurance reforms promise the prospect of 36 million uninsured Americans — who are currently self-rationing care, paying on sliding fee scales, or not paying at all — flowing into hospitals, clinics and outpatient facilities via subsidized insurance, mandated policies and more affordable options in the proposed insurance exchange. Of the total uninsured, an estimated 15 million women of reproductive age could be eligible for coverage.

But this is where things get tricky.

One of the many factors patients use in choosing an insurance network physician is one with in-patient admitting privileges to a local hospital with the best reputation. And with these young, newly insured patients hospital loyalty could result in lots of billable revenue over their lifetimes.

Except the religious directives that restrict reproductive care creates a huge dilemma for Catholic hospitals trying to penetrate the billion dollar women’s market share in a brutally competitive health care sector. And that’s setting aside the fact that women make most medical decisions for their entire family. The power of their purse is great.

So the bishops used Stupak-Pitts to erase that competitive disadvantage. Make no mistake, health care — be it private, for-profit or public charity — is a business not for the faint of heart. And no less so for a Capitol Hill lobbyist with a clerical collar.

The $2.5 trillion health care industry now represents 18 percent of the nation’s gross domestic product and is expected to double in less than 10 years. And those projections were made well before “health care reform” ever passed Barack Obama’s presidential campaign lips.

And now as the Senate enters the arena, we are faced with a critical question: Is the role of Congress to surreptitiously do the stealthy bidding of private business — even those who have the power of absolution, political or religious — against its secular industry rivals?

A version of this commentary appeared at RH Reality Check.