Any day now, President Bush's secretary of health and human services, Michael Leavitt, is expected to deliver a parting blow to women's reproductive freedom: new regulations further limiting access to abortions, contraceptives and accurate information about reproductive health care options.

If that happens, it will be a big victory for the far-right - one, as it happens, that is partly rooted in an old controversy involving Sarah Palin's church, her former obstetrician and the small local hospital serving Wasilla, Alaska.

In 1992, a coalition of some 20 evangelical churches in Alaska's Matanuska-Susitna Valley - including the Wasilla Assembly of God Church, where Ms. Palin was baptized at age 12 - captured control of the operating board of the community's Valley Hospital.

The new board promptly voted to bar doctors from performing abortions at the hospital with limited exceptions for cases of rape, incest, dire medical necessity or where a doctor documents "the fetus has a condition that is incompatible with life." The policy change left Alaska without any hospital where a woman with, say, a negative amniocenteses result or other problem not included among the exceptions could obtain a second trimester abortion at a doctor's discretion. Such procedures account for about 10 percent of all abortions.

Dr. Susan Lemagie was by then the only physician in the state who performed elective abortions after the first 12 weeks (incidentally, she delivered the first two of Ms. Palin's five children). She and the Mat-Su Coalition for Choice sued to overturn the new restrictions.

During this period, as incidents of violence against abortion clinics and doctors around the country mounted, Dr. Lemagie's medical office became the target of anti-abortion protesters. Recalling the fraught atmosphere in a 1997 opinion piece in Newsweek, Dr. Lemagie's daughter, Sarah, wrote that her mother "no longer talked about managed care and AIDS; she talked about buying a bulletproof vest."

(Around this time, Ms. Palin, who was elected Wasilla's mayor in 1996, served on another hospital board.)

Finally, in 1997, the Alaska Supreme Court ruled 4 to 0 in Dr. Lemagie's favor, holding that Valley Hospital was a "quasi public" institution because it was the only hospital serving the community and received millions of public dollars. As such, it could not deny a woman's "fundamental right" to abortion, which is secured by the broad right to privacy embedded in the state's Constitution.

The outcome reverberated nationally. Supporters of reproductive rights felt bolstered. Those opposed seized upon the Alaska decision and like developments elsewhere to call for Congressional passage of the so-called Abortion Non-Discrimination Act.

Individual health care providers long had the right to refuse to perform or assist in abortion or sterilization procedures on moral or religious grounds. The bill proposed extending that right to hospitals, H.M.O.'s, insurance plans and an array of other health care institutions. Under the bill, any law or regulation mandating such services was deemed "discriminatory," and could trigger a loss of federal financing.

When the House Energy and Commerce Committee held a hearing on the bill in 2002, among the witnesses was Karen Vosburgh, a Valley Hospital board member and a leader of the Alaska Right to Life group. The bill passed the House but was blocked in the Senate.

The issue did not fade away. In 2004, a version of the bill known as the Weldon Amendment was tacked onto the spending bill for the Labor, Education and Health and Human Services Departments. It remains in force.

Now, Mr. Leavitt appears poised to enlarge the Weldon Amendment's reach, for example, by adding abortion counseling and the provision of accurate reproductive health information to the list of services health care providers may refuse. He also would open the door for providers to decline to make emergency contraception available, even to rape victims.

It's a long way from Wasilla to Washington. Yet, the impact of that far-away abortion brawl is being felt still.