The Roe v. Wade decision is 25 years old today, and Americans are as conflicted about abortion as ever. They are, on average, certain that women should retain the right to abortion, with limits, while being deeply disturbed about the details of the abortion procedure. The conflict appears untenable, and yet the support despite the discomfort is a measure of how important this right remains to the public a quarter century after the ruling.

In Roe v. Wade, the Supreme Court defended a woman’s right to privacy, based on the 14th Amendment. It ruled that a woman, in consultation with her physician, may choose to end her pregnancy. This right is unlimited by state interference in the first trimester. After that the state has a compelling interest to protect a woman’s health, until fetal viability, when a state may ban abortion, except when necessary to preserve the life or health of the mother.

Though the core of Roe has been upheld in more than a dozen Supreme Court cases since 1973, the idea of abortion has not rested easily on the American conscience. There is no reason that this difficult, at times agonizing, decision should. It confronts the most complex questions of how life is defined and what it means to be human. No thinking person makes a decision to have an abortion easily — more often, it is out of desperation.

The decision is even more difficult because the vehemence on the fringes of the abortion debate have precluded the opportunity for a woman’s public mourning when she has made this choice. A loss, however voluntary, still can be painful. But how can pro-choice advocates admit sadness over a decision they nevertheless feel necessary without opponents seeing it as anything but capitulation?

Abortion is driven further into secrecy not because protesters have used strong moral arguments but because they have used fear. Fear for doctors of being screamed at or harassed or picketed or, in rare cases, shot. Fear has changed the climate around the abortion debate, but has brought Americans no closer to understanding each other in this emotional issue.

In a sense, the 1990s has seen abortion returned to its pre-1973 era, not through force of law but by the success of protests against the procedure. Abortion is moving into a metaphorical back-alley of medicine. Fewer and fewer doctors will provide abortion services or even will train for them. Twenty-five years ago, the Supreme Court ruled that women have a right to abortion; now, through reduced access, they are facing a greater burden to exercise that right.

The cost of this is nearly forgotten. In 1965, 17 percent of all deaths due to pregnancy and childbirth were the result of illegal abortions. Making abortions legal nationwide made them safe, saving thousands of lives. Keeping them not only legal but available will be the challenge for the next 25 years.