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.’”

Leaders from Planned Parenthood Action Fund, NARAL Pro-Choice America, and People for the American Way penned a letter Thursday urging Sen. Ted Cruz (R-TX) to drop anti-choice activist Troy Newman from the GOP presidential candidate’s coalition over Newman’s violent rhetoric on reproductive health.

“While there are a number of coalition members whose records raise serious concerns, Troy Newman’s history of violent rhetoric and harassment toward women’s health providers is truly beyond the pale,” reads the open letter to Cruz.“Especially in an environment where anti-women’s health violence is on the rise, Newman’s extremism and violent rhetoric should be condemned, not given a platform by a major presidential campaign.”

The letter points to a recent report from the National Abortion Federation (NAF) that found “a dramatic increase in hate speech and internet harassment, death threats, attempted murder, and murder,” which coincided with the release of the Center for Medical Progress’ (CMP) deceptively edited videos smearing Planned Parenthood by accusing the health-care organization of illegally profiting from fetal tissue donations.

Newman co-founded CMP in 2013, though he later separated from the anti-choice front group that has worked with GOP legislators in attacking funding for Planned Parenthood. 

“Cruz’s decision to give Troy Newman a formal role in his campaign is completely unacceptable. No person aspiring to be the next president of the United States should have anything to do with someone whose record of violent rhetoric includes calling for the execution of abortion providers,” Michael Keegan, president of People For the American Way, said in a statement. “And no politician should be allowed to pander to violent anti-choice extremists without being called out. With Ted Cruz’s all-important Indiana primary coming up, it’s past due for Cruz to fire Newman from his campaign team.”  

Newman is one of Cruz’s most extreme allies, as Rewire has reported. Newman is the president of Operation Rescue, an anti-choice group that moved to Wichita, Kansas in 2002 to continue its campaign to intimidate abortion provider Dr. George Tiller, who was shot dead in 2009. Though Newman issued a statement condemning Tiller’s killer, the phone number of a member of Operation Rescue was found on the dashboard of the killer’s car.

Newman has his own history of violent rhetoric, having argued in his book Their Blood Cries Out that those who have abortions should be treated as murderers and that abortion care providers should be executed.

He was detained by Australian authorities in October after an Australian lawmaker raised concerns that Newman’s speaking tour would contribute to the “harassment and intimidation” of people trying to access reproductive health care in the country.

Nevertheless, Cruz praised Newman’s work after the extremist offered his endorsement in November. “We need leaders like Troy Newman in this country who will stand up for those who do not have a voice,” Cruz said.

Newman in January was appointed to co-chair Cruz’s anti-choice coalition, Pro-Lifers for Cruz.

“Troy Newman is an anti-choice extremist and misogynist ideologue who has argued that the murder of abortion providers is justified and that the attacks of 9/11 were retribution from God against legal abortion,” Ilyse Hogue, president of NARAL Pro-Choice America, said in a statement condemning Newman’s extremism. “Troy Newman has no place in this campaign and I encourage Ted Cruz to surprise us all and send him packing.”

An effort to lift the ban prohibiting military facilities from providing on-site abortion care failed Wednesday in the U.S. House of Representatives.

Reps. Jackie Speier (D-CA) and Marc Veasey (D-TX) sought to enable service members and their dependents to pay out of pocket for abortion care at defense medical facilities (MTFs). Under federal law enacted in 1996, the U.S. Department of Defense cannot provide abortion care at such facilities, even if a pregnant person shoulders the cost, except in cases of rape, incest, and danger to the pregnant person’s life.

Speier during a marathon markup introduced the amendment in the House Armed Services Committee, which considered legislation (HR 4909) setting the fiscal year 2017 parameters for national defense. The National Abortion Federation (NAF), a professional association of abortion providers, sent the committee a provider letter and coalition letter in support of lifting the ban on abortion care in MTFs. NARAL Pro-Choice America offered support via a fact sheet.

The amendment failed by a vote of 37 to 25.

Speier, prior to the House Armed Services Committee’s vote on her amendment, faulted federal law for preventing service members from exercising the same constitutional right to an abortion as the civilians they protect.

“This issue is important because so many of our service members who get pregnant, who need an abortion, are finding themselves in really dangerous situations,” Speier said.

Service members stationed across the United States face significant hurdles in obtaining abortion care. Ellsworth Air Force Base in South Dakota restricts service members to travel boundaries, but the nearest abortion provider falls outside of that range, Speier said.

“Additionally, challenges both domestically and internationally include disclosing personal health information to their commanding officer in order to travel off base; approval by the unit commander, which might take days or weeks; the need to seek approval of mileage pass; limited or no access to a car; and local facilities abroad that are substandard, unsafe, or have language barriers,” she said. “Members, this is just the right thing to do for our service members.”

Republicans on the committee disagreed. Rep. Trent Franks (R-AZ), the lawmaker behind the anti-choice misinformation campaign to ban so-called sex-selective and race-selective abortions, was among those who condemned the amendment.

Rep. John Fleming (R-LA) touted the exceptions to abortion access codified in federal law. He claimed that many active duty health-care providers would opt out of performing the abortions, forcing the military to hire civilian providers and invest in equipment at the expense of taxpayers. “This will, in effect, create a government-run Planned Parenthood on all of the military bases,” he said.

Fleming said no one is preventing a service member from going off base and using the “great transportation” available to access the abortion facilities that exist in every state. But a recent investigation found that abortion clinics nationwide are shuttering at a dramatic rate.

As a result of state-level targeted regulation of abortion providers laws and, in some instances, anti-choice violence, a Bloomberg report found that at least 162 clinics that provided abortion services have either closed or stopped offering abortion since 2011, with 21 clinics opening during that time. The clinics have closed in 35 states home to a combined population of 30 million women of reproductive age. Missouri is one of five states with only one abortion clinic, as anti-choice state laws have closed all but the Planned Parenthood St. Louis clinic.

Veasey rebutted Fleming by citing the hurdles he has witnessed firsthand after the Texas state legislature passed the “draconian” HB 2. The law has left the state with one legal abortion provider for every one million Texans who could become pregnant. “This burden would be huge on the military women in the state of Texas,” Veasey said.

Speier is a vocal pro-choice advocate in the House. She serves on the GOP-led House select panel targeting fetal tissue research and consistently criticizes the panel’s tactics, as her Republican colleagues continue to rely on the widely discredited smear videos alleging that Planned Parenthood profited from fetal tissue donations.

“You know, this hearing belongs in a bad episode of House of Cards,” Speier said during last week’s inquiry into fetal tissue “pricing.” Republican lawmakers during the hearing repeatedly referred to the sale of “baby body parts” even though an independent third party disproved the heavily edited Center for Medical Progress videos.

NAF officials slammed the anti-choice lawmakers who blocked the amendment.

“This ban on abortion care in MTFs will continue to harm service women and their families until anti-abortion lawmakers allow a women and her doctor, not politicians and JAG Officers [the legal branch concerned with military justice and law], to decide when and where she will be able to obtain the medical care she needs,” NAF President and Chief Executive Officer Vicki Saporta said in a statement. “The House Armed Services Committee should be working to expand access to health care for our service women and their families, not continuing to restrict it.”