This piece is published in collaboration with Echoing Ida, a Forward Together project.

Across the United States, billboards are visible evidence of the contentious abortion debate. Enlarged images of fetuses, cherubic babies, distressed women, and Bible verses tower over highways and byways like anti-abortion sentinels overseeing America’s culture wars.

Notice I didn’t mention images that show happy, pro-choice women, for it’s a lopsided roadside debate.

Rarely do we see billboards promoting abortion rights or the broader ideals of reproductive justice; there are few examples like New Voices Cleveland’s recent sponsorship of these billboards that affirmed, in the wake of the police killing of 12-year-old Tamir Rice in the city, that reproductive justice includes the right to parent and protect children. Abortion opponents have effectively cornered the market on this advertising medium and, to paraphrase a hackneyed phrase from “American Idol” judges, have made the billboard their own.

But the good news: The billboard is just a tool (like video is a tool)—and tools can be harnessed for any movement. In fact, past abortion-rights advocates used billboards to good effect—even before Roe v. Wade. Ideological warfare about abortion via advertising has a long track record, though it’s a past largely forgotten in history’s fog and the present’s relentless attacks on abortion rights. Today’s reproductive rights and justice advocates can’t afford to forget that past. They may need to “go back to the future” to resurrect this tool in an era where women face increasing restrictions on abortion, and providers face proposed laws that would curtail their ability to offer reproductive health care to women most in need.

So what is it that advocates need to remember or learn? For starters, many early billboards functioned as straightforward advertising for abortion—even when it wasn’t widely legal. This roadside sign popped up in McGrann, Pennsylvania, in 1971 and pointed people to neighboring New York state, which had legalized abortion in 1970.

Similar billboards featuring phone numbers began sprouting like giant flowers on the American landscape. As this picture demonstrates, referral services—some nonprofit and some that operated as for-profit entities—also took to streetsides before Roe to tell women that they could find health care in the form of abortion and sterilization.

Distributing information about abortion through billboards or other advertisements was not without risk; those who did so could face arrest. In 1972, Charlottesville, Virginia, newspaper editor Jeffrey Bigelow was charged with running advertisements for a New-York based abortion referral service and convicted under a state law banning any public promotion of abortion services. The case eventually made its way to the U.S. Supreme Court, but took a back seat to the bigger challenges to abortion bans: the cases that would become Roe and Georgia’s Doe v. Bolton. Bigelow v. Virginia was eventually decided in 1975; Bigelow’s conviction was overturned because there could be no limits on the advertising of a service that had become legal.

At the same time, the young anti-abortion movement was also rolling out its own billboards, said historian Jennifer Donnally, a Hollins University visiting professor who researches abortion politics and the new right. From the early days when anti-abortion advocates were organizing against state-level abortion law reform, they have made billboards a key part of their messaging.

“Anti-abortion billboards began to appear on highways in New York, Massachusetts, Michigan, and Washington [state] prior to the 1973 Roe v. Wade decision as part of statewide campaigns against abortion repeal efforts,” Donnally told Rewire.

Many of those billboards were tied to specific ballot measures or potential law changes. In 1970, when Washington state planned a referendum where voters could decide to allow abortion in some circumstances, opponents (and their billboards) came out in full force. “Kill Referendum 20, not me,” implored a billboard picturing a fake fetus cradled in an adult hand. Accused of using tasteless scare tactics, Voice of the Unborn (the group behind the billboards) replied through a representative, reported the New York Times in October of that year: “They show an exact medical school replica of a 4-month-old baby. If the billboards seem to be shocking, perhaps it’s the idea of abortion that’s shocking.” (The referendum passed with 56 percent of the vote, and allowed women and girls to have abortions if they requested them, with the consent of their husbands or guardians, and if the procedure was performed by a licensed physician.)

Donnally noted that anti-abortion billboards have taken different forms and served many purposes over time. They moved from makeshift messages in cornfields to slick public-relations creations, and they mobilized supporters in different ways according to the movement’s age and successes.

“The publicity billboards educated the public and recruited potential activists. Behind the scenes, efforts to place billboards trained anti-abortion activists in fundraising and media relations while also [making] activists feel effective when the movement was in its early stages, following setbacks or celebrating victories. Sometimes, billboard campaigns were sophisticated. Other times, a farmer in a rural area who had a hard time connecting to anti-abortion chapters concentrated in cities and towns took action into his or her own hands,” added Donnally. “They made a plywood anti-abortion sign and posted it on their land next to a heavily traveled highway.”

After the Bigelow ruling, anti-abortion advertising gained steam in the mid-1970s. A February 1976 Village Voice article called John C. Willke, then a practicing obstetrician and a future president of the National Right to Life Committee, the “visual aids guru of the pro-life movement.” Willke’s first visual aids were often slideshows that Willke and his wife presented in talks to high schoolers.

But, according to the article, Willke’s “newest project [was] the creation of the three billboard posters. The least offensive reads ‘Abortion: A woman’s right to choose.’” “Choose” was crossed out and replaced with “kill.” A second billboard depicted tiny feet and this text: “This baby won’t keep his mother awake at night … at least not yet.” Willke planned to erect a fetus billboard atop a building across from a Minnesota hospital that provided abortions, the article added.

Willke’s focus on the fetus and abortion’s supposedly negative and life-changing effects on the woman—now cornerstones of anti-abortion rhetoric—was an experimental and emergent strategy then. Emphasizing abortion as an emotional harm and women as its simultaneous victims and perpetrators, right-to-life groups were often explicit when telling their members how to best deploy billboards. An undated newsletter from the Jackson, Mississippi-based Christian Action Group provided hand-drawn illustrations of possible billboards, one showing “baby’s first visit to the doctor,” a menacing-looking physician holding a black sack and a frazzled woman hovering in the background. Also included was a sample billboard that showed a hand wielding a scalpel, labeled “a pro-choice pacifier.”

The illustrations came with this advice on using billboards to the best advantage: “One form of ‘advocacy advertising,’ such as political advertising, is to convince people of the justification of your point of view. Another is to make people ashamed to be with your [opponents]. These billboards are the latter.” Cultivating and multiplying shame was a tactic. As abortion opponents’ philosophy went, Americans—even the most well-intentioned or those ignorant of the “real” story about abortion—needed to be confronted visually with their silent complicity.

When Roe came under significant legal challenge in the 1980s, billboards became even more overtly political. In 1988, the year before the U.S. Supreme Court decision Webster v. Reproductive Health Services that allowed states to restrict abortion, a Planned Parenthood billboard showed six male (and mostly anti-abortion) Supreme Court justices holding their own sign saying “Freedom of Choice,” but with Chief Justice William Rehnquist slamming his gavel on the word “of” and Justices Harry Blackmun and Clarence Thomas holding a replacement sign with the word “from.” Also in 1988, anti-abortion activists experimented with a new form of advertising by placing anti-abortion placards in Atlanta taxis during the Democratic National Convention there.

A year later, in 1989, Prolife Across America was up and running. It works as an anti-abortion billboard mill, cranking out design after design (as well as radio spots and other advertising).

Therein lies the difference: Billboards have been institutionalized in anti-abortion media strategy and organizations, but they seemed to fade from the strategic agendas of reproductive rights organizations. In 2014, the Prolife Across America/Prolife Minnesota tax return reported that its designs were emblazoned on more than 6,000 billboards, reaching Americans stuck in traffic or driving to work every day with its larger-than-life messages. The group often says those messages are hotlines for pregnant women, educational, and roadside ministry all wrapped into one. Other organizations provide templates or the actual printed vinyl panels that bear the messages and drape over the standard billboard frames for prices as cheap as $200 (not including the cost of billboard rental, which varies widely according to geography, company, and the estimated number of motorists and views at given locations).

As the billboard has become a consistent anti-abortion platform, the messages billboards have carried read like a conversation between abortion opponents and other social movements. Billboard makers have blatantly adapted the slogans of feminism and civil rights and even the images of Black political leaders such as Frederick Douglass or Barack Obama—and with varying degrees of deftness or tone-deafness.

By the 1990s, billboards in the Midwest had reworked a common feminist bumper sticker to read “Pro-life: The radical idea that fetuses are people.” Later, billboards took an explicitly racial turn. In 2011, billboards proclaiming “Black & Beautiful” alongside pictures of Black infants appeared in Oakland, California. Sponsored by the anti-abortion group Issues4Life, the billboards appropriated the language of the Black Panther movement, which had its most well-known and vocal chapter in the Bay Area city.

Images and messages on billboards that explicitly targeted Black communities—and paved the way for others aimed at Latinos and Asians—were not entirely new. As scholar Gillian Frank has pointed out, a 1972 Michigan referendum about changing that state’s abortion law pushed anti-abortion groups to begin developing brochures that pictured Black babies and compared abortion to slavery, now old-hat anti-abortion fare.

More than 20 years later, diverse groups protested the encroachment of racist billboards in their home communities. In Oakland in 2011, Strong Families and a coalition of multiracial groups joined forces to persuade CBS Outdoor to take down controversial signage—a campaign similar to one used a year before by the Atlanta-based SisterSong Women of Color Reproductive Justice Collective when billboards also owned by CBS and claiming that “black children are an endangered species” appeared in the Georgia capital. Earlier this year, the reproductive justice group SisterReach successfully pushed for the removal of anti-abortion billboards in Tennessee.

Yet the hand that giveth does taketh away. Contemporary groups fighting for abortion access find that many billboard and other advertising companies reserve the right to deny or take down controversial content. And those contractual stipulations mean that some companies will reject outright advertising that specifically references abortion or simply points women to services—for fear that the other side will cause a ruckus and demand its removal. Fears of the “A-word” have made it into the online world, with Google determining that abortion ads were “non-family-safe” content and categorizing them with adult advertising and entertainment.

Whatever the advertising format, it’s clear that this type of commercial and political speech isn’t going away. And few people know that better than Jasmine Burnett, New Voices Cleveland’s field organizer in the Midwest. In 2010, she led the campaign to take down a SoHo, New York, billboard that proclaimed the most dangerous place for a Black person was the womb, and this year, Burnett was a driving force behind the Cleveland billboard.

Burnett said that it’s not enough to mount defensive campaigns that respond to the propagandistic billboards that increasingly dot urban and mostly Black neighborhoods. What’s necessary is billboard activism that moves beyond reproductive rights’ preoccupation with abortion and, in keeping with a reproductive justice lens, addresses the racism that’s an American bedrock.

“Anti-abortion billboards are an affront and an attack. [In doing the billboards, New Voices Cleveland] wanted to provide other spaces for creative thought, affirmation, and liberation,” said Burnett. “We work for the full health and well-being of Black women and people. For us, full health means having a different image of ourselves, being able to control and discuss our reproduction, and thinking about how we navigate self-determination in the midst of white supremacy.

“There are not many [billboards or other advertising] that talk about Black people’s lives,” Burnett added. “And we wanted our billboards to say, ‘We support your decision and right to parent or not parent. And we care about your life.’”

A California State Senate panel on Monday approved a bill to subject continuing education providers to greater scrutiny after Rewire revealed that national organizations were teaching classes for state nursing credit based on anti-choice ideology.

SB 1039 promises to shore up the lax oversight of continuing nursing education, by directing the state Board of Registered Nursing (BRN) to audit continuing education providers at least once every five years, and to revoke the approval of violators.

The reform measure tightens class standards by requiring courses to be “related to the scientific knowledge or technical skills required for the practice of nursing.” Passed in a 6-2 vote, the legislation now heads to the Senate Appropriations Committee.

State Sen. Jerry Hill (D-San Mateo), who chairs the Senate Business, Professions, and Economic Development Committee, introduced the reforms after a Rewire investigation in January exposed the BRN’s lax oversight and regulatory loopholes that allowed anti-choice groups to teach questionable medicine.

“The changes make the requirements for standards stronger,” Hill said in an email. The committee and BRN representatives crafted the reform language.

Rewire’s investigation described how some of the nation’s more prominent abortion rights opponents gained the BRN’s approval to teach continuing education courses on “abortion pill reversal”—a treatment rejected by the medical establishment—and other scientifically baseless topics.

After reviewing the state-approved applications of three organizations—Heartbeat International, Care Net, and the National Institute of Family and Life Advocates—Rewire found the providers failed to disclose to the board the medically dubious subjects they taught to nurses.

Heartbeat International, for example, taught the class “Abortion Pill Reversal and Your Clinic” for continuing education credit to nurses at a St. Louis conference last year. On its state application, however, the group said it was teaching “Knobology Applications: Or How to Get Better Pictures.”

Care Net is touting its state approval on the brochure for its annual conference, scheduled for September in Orlando, Florida, where it is offering courses for California continuing education nursing credit.

State law requires the BRN to vet the providers, which range from private companies to universities. But the board doesn’t approve the materials that providers teach.

As Christina Sprigg, chief of licensing and administrative services with the state board, previously told Rewire, “We do not approve courses, we only approve the providers.” The board approved 82 percent of the 764 providers vetted between 2012 and 2014.

A legislative analysis prepared for Monday’s hearing on SB 1039 cited Rewire’s reporting on the deficiencies in the BRN’s oversight:

“The Miseducation of California Nurses: Legal Loophole Enables Spread of Anti-Choice Medical Myths,” highlighted a BRN CE Provider, Heartbeat International, offering credits to nurses who take a class about undoing a pill-induced abortion; a procedure unsupported by sufficient evidence. When confronted with the information, the BRN was basically nonresponsive to the reporter and cited code sections that restate that the BRN approves the provider and the provider accepts full responsibility for course content and instructor qualifications. According to the acting EO, the BRN began looking further into the CE provider when the reporter started looking into them for this story. BRN indicated they do not audit CE providers regularly, but do look into them when an issue with one is raised.”

The providers identified in Rewire‘s investigation, Heartbeat International and Care Net, remain in good standing, according to the BRN website.

The BRN between 2001 and 2014 failed to audit a single continuing education provider, according to a 2015 joint oversight report prepared for the state Senate Business, Professions, and Economic Development Committee and the California State Assembly Committee on Business and Professions.

The oversight report laid out more than a dozen reforms, telling the board to tighten the standards applied to continuing education (CE) classes and continuing education providers (CEP):

The BRN has said it’s running out of money and, without a fee hike, may need to cut staff. In the past few years, the BRN has loaned the state General Fund $13.3 million, and has been paid back $3 million.

The man behind a pair of 2013 arson attempts at a Planned Parenthood health center in Joplin, Missouri, has pleaded guilty, the U.S. Department of Justice announced Monday.

Principal Deputy Assistant Attorney General Vanita Gupta and Tammy Dickinson, the U.S. attorney of the Western District of Missouri, said Joplin resident Jedediah Stout, 32, also pleaded guilty to committing arson at the Islamic Society of Joplin mosque in 2012.

The plea led to one count related to damage to the mosque, two counts of arson at the Planned Parenthood clinic, and one count of violating the Freedom of Access to Clinic Entrances Act.

Stout told federal, state, and local investigators that he attacked the mosque because he didn’t “like Islam as a religion,” according to the Justice Department release. The fire destroyed the religious building and many of the donations made there during the Muslim holy period of Ramadan.

Stout during the recent court hearing admitted that he used the same kind of incendiary device in the mosque arson that he used during the arson attempts at Planned Parenthood in October 2013.

He admitted that he targeted the clinic because it provided reproductive health services, federal officials said. The facility in Joplin, which does not provide abortion care, is one of two associated with Planned Parenthood of the St. Louis Region and Southwest Missouri.

The Justice Department said both instances of attempted arson at the Planned Parenthood were captured on surveillance cameras and featured Stout throwing items containing an accelerant onto the roof of the facility and igniting material attached to the accelerant. Authorities apprehended him shortly thereafter.

Gupta, who leads the Justice Department’s Civil Rights Division, said in a statement Monday that the Justice Department would “continue to vigorously prosecute violence against reproductive health services providers and crimes motivated by religious animus.”

Statistics released by the National Abortion Federation noted a surge in violent acts against abortion providers nationwide over the past year.

Since 1977, the NAF report said, there have been 11 murders, 26 attempted murders, 42 bombings, 185 arsons, and other incidents of criminal behavior directed at abortion providers.

Stout remains in federal custody without bond. He is subject to a maximum sentence of 61 years in federal prison without parole under federal statutes.

The Justice Department said a sentencing hearing will be scheduled after the U.S. Probation Office completes a pre-sentence investigation. The department’s Civil Rights Division is prosecuting the case in collaboration with Assistant U.S. Attorney Jim Kelleher of the Western District of Missouri.