Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco.
Reading the Grand Jury report on Women’s Medical Society in Philadelphia, the now-closed abortion clinic ran by Dr. Kermit Gosnell, is stomach turning. This was truly a chamber of horrors: a filthy facility, with blood stained blankets and furniture, unsterilized instruments, and cat feces left unattended. Most seriously, there was a jaw dropping disregard of both the law and prevailing standards of medical care. Untrained personnel undertook complex medical procedures , such as the administration of anesthesia, and the doctor in question repeatedly performed illegal (post viability) abortions, by a unique and ghastly method of delivering live babies and then severing their spinal cord. Two women have died at this facility and numerous others have been injured. What remains baffling is how long this clinic was allowed to operate, in spite of numerous complaints made over the years to city and state agencies, and numerous malpractice suits against Dr. Gosnell. Indeed, it was only because authorities raided the clinic due to suspicion of lax practices involving prescription drugs that the conditions facing abortion patients came to law enforcement’s attention.
As information about this clinic spread, many have understandably compared Women’s Medical Society to the notorious “back alley” facilities of the pre-Roe era, when unscrupulous and often unskilled persons (some trained physicians, some not) provided abortions to desperate women, in substandard conditions . This is an apt comparison. But Gosnell’s clinic should not only be understood as a strange throwback to the past. Women’s Medical Society represents to me an extreme version of what I have termed “rogue clinics,” facilities that today prey on women, disproportionately women of color and often immigrants, in low income communities.
As I have written in my recent book, Dispatches from the Abortion Wars, “that such clinics can flourish until the inevitable disaster occurs…is a ‘perfect storm’ caused by the marginalization of abortion care from mainstream medicine, the lack of universal health care in the United States, and the particular difficulties facing undocumented immigrants in obtaining health care.” All these factors helped explain why women came to Gosnell’s clinic, in spite of its location in Philadelphia, a city with several reputable abortion facilities. Among the saddest things I have read in the wake of this disaster is the account of a Philadelphia social worker, pointing out that the community health center which serves the same low income neighborhood in which the Gosnell clinic was located is considered to be one of the city’s best facilities. But as a recipient of federal funding, of course this center could not offer abortion care.
So why did Gosnell’s patients not go to a better, i.e. safer, abortion clinic, for example, the Planned Parenthood in downtown Philadelphia, no more than a few miles from Women’s Medical Society? One very poignant answer to this comes from a statement that one of Gosnell’s patients made to the Associated Press. The woman had initially gone to this Planned Parenthood for a scheduled abortion, but “the picketers out there, they scared me half to death.”
Another reason women came to Gosnell’s clinic is that he undercut everyone else’s prices. As numerous abortion clinic managers have told me over the years, for very poor women—who are way over-represented among abortion patients—differences of even five or ten dollars can be the deciding factor of where to go. The price list at Women’s Medical Society, listed in the Grand jury report, shows that in 2005, a first trimester procedure was $330., while the average price nationally then was about one hundred dollars higher. For a 23-24 week procedure, Gosnell charged $1625., while the relatively few other facilities in the Northeast offering such abortions would have charged at least one thousand more.
Still another reason drawing women to this clinic was that it became widely known that Gosnell was willing to flout the law and perform post-viability (i.e. post-24 week) abortions even in cases where women did not meet the very strict legal guidelines of a life-threatening or serious illness or were carrying a fetus with a lethal anomaly. In a horribly unfair vicious cycle, the poorest women often take time to raise the funds for an abortion, and then find themselves past the cutoff for procedures available early on--and facing a higher cost for an abortion. When women in these situations realize that they neither have the funds to pay for a later procedure, and/or can’t find a reputable provider that will perform their procedures after 24 weeks, they end up at places like Women’s Medical Society.
Predictably, in response to the story of Dr. Gosnell’s clinic, the antiabortion movement has been calling for additional massive oversight of all clinics, and claiming that all abortion providers resemble this outlier. But the overwhelming majority of abortion-providing facilities in the U.S. are not rogue clinics and legal abortion has achieved a remarkable safety record, the aberration of Gosnell-like providers notwithstanding. According to the Guttmacher Institute, the death rate from abortion performed in the first eight weeks of pregnancy is one in one million. The right lesson to be drawn from this tragic story is that there will be more unnecessary deaths among the most vulnerable women in our society until affordable and accessible abortion is made part of mainstream medicine.