Analysis Abortion

Back-Alley Abortions in 2011: How Anti-Choice Zealots Force Women to Go to Dangerous Clinics

Daniel Denvir

The Medicaid ban on abortion funding and state restrictions requires poor women in Philadelphia and around the country to face horrific choices when they need an abortion.

This article is cross-posted with permission from Alternet.

Dr. Kermit Gosnell has been charged with murdering one woman and seven newborn babies at his rogue clinic, called the Women’s Medical Society, in West Philadelphia. Though it’s too early to predict this case’s full political impact, it’s certain that anti-abortion groups will use it to push for further restrictions on women’s reproductive rights. But the legislation pushed by these anti-abortion conservatives is what has forced women into such life-threatening situations. Poor women throughout the United States cannot afford safe abortions and in consequence sometimes make extremely dangerous choices.

“Because of the Medicaid ban on abortion funding and state restrictions, poor women in the state and in Philadelphia really face horrific choices about what to do if they have an unwanted or unplanned pregnancy, or a pregnancy that poses significant health problems,” says Rose Corrigan, a professor of politics and law at Drexel University. “So what I’ve seen is that women often shop around for abortion services. Women are so poor that a few dollars really make a difference.”

Corrigan is also a volunteer at the Women’s Medical Fund, a Philadelphia organization that offers financial assistance to poor women seeking abortions. She says that her organization has been advising women against visiting the Women’s Medical Society since the mid-1990s.

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“When women would call us we’d say, ‘There’s a reason it’s cheap. Don’t go there.’”

“I think it’s also that abortion has become so stigmatized and that abortion care has become so ghettoized from mainstream medical care,” says Susan Schewel, executive director of the Women’s Medical Fund. “It means that people aren’t talking about where’s a good place to go and where’s a safe place to go. And when women are harmed they’re afraid to go the authorities. We’ve talked with people here who have been mistreated at this clinic. And we’ve asked them to report it to proper state government authorities, and they said, ‘No way would we do that.’”

Some women did complain and the grand jury report faults the State of Pennsylvania for a catastrophic failure of oversight. Law enforcement officials in Philadelphia only became aware of the clinic in the course of an unrelated investigation into allegations that Dr. Gosnell was illegally distributing narcotics like Oxycontin.

“The grand jury investigation revealed,” according to a press release from District Attorney Seth Williams, “that, for over two decades, government health and licensing officials had received repeated reports about Gosnell’s dangerous practices. No action was ever taken, however, even after the agencies learned that women had died during routine abortions under Gosnell’s care.”

“Many organizations that perform safe abortion procedures do their own monitoring and adhere to strict, self-imposed standards of quality,” according to the grand jury report. “But the excellent safety records and the quality of care that these independently monitored clinics deliver to patients are no thanks to the Pennsylvania Department of Health. And not all women seeking abortion find their way to these high-quality facilities; some end up in a filthy, dangerous clinic such as Gosnell’s.”

The Women’s Medical Society, which opened in 1979, largely treated poor women of color. Dr. Gosnell, who was not certified as an ob/gyn, is charged with the murders of 41-year-old Nepali refugee Karnamaya Mongar and seven infants, and a number of other violations. Nine other clinic employees face murder and other charges. According to the grand jury report, Dr. Gosnell provided more attentive care in cleaner rooms to white women from the suburbs.

“I think that the failure of the state, when there have been these complaints for years, speaks to the way abortion isn’t considered normal health care, that abortion is segregated off from regular health care,” says Corrigan. “I really don’t think that if these complaints were coming in about another doctor the state would have ignored it. I really think it’s also about women being punished for having an abortion.”

Many patients would visit Dr. Gosnell for late second-trimester and illegal third-trimester abortions. Limited access and information can delay women seeking an abortion.

“In our experience,” says Schewel, “we find a lot of women do what we call chasing the fee,” where poor women try to raise money for an abortion that gets more and more expensive as the pregnancy progresses. She says that stigma and misinformation also delay the procedure.

“The huge majority of abortions in this country are done in the first trimester, even first eight weeks, of pregnancy. Again, it’s about access: people not knowing where to go, that they even can get an abortion. To me what’s most striking is that throughout the globe and throughout history, women will do whatever it takes to end a pregnancy that they don’t want to carry to term. And this is an example. Whether abortion is legal or illegal, whether it’s accessible or not accessible, women who need to end a pregnancy will do whatever they need to do.”

The Hyde Amendment bars the spending of federal Medicaid dollars on abortions. States like New York fund abortion services with state Medicaid dollars. But Pennsylvania, like 26 other states, does not. NARAP Pro-Choice America gave Pennsylvania an F grade for reproductive rights, ranking it 41st out of 50.

According to a 2006 study by the Women’s Medical Fund, there were 4,500 women covered by Medicaid in the five-county Philadelphia area who wanted to terminate a pregnancy and could not afford to. Making things all the more difficult, most health-care providers do not perform abortions.

“If doctors felt more comfortable performing abortions in private offices,” says Corrigan, “if more hospitals provided abortion, if there wasn’t such a stigma around abortion, we wouldn’t see women dying.”

There is a two-tier reproductive health system in the United States, and even pro-choice politicians seem loath to upset the status quo. Rural women throughout the country lack access to abortion clinics, including women in 82 percent of Pennsylvania counties. But even in cities like Philadelphia, home to a number of clinics, cost can be an insurmountable obstacle.

”Pro-choice politicians want to talk about keeping abortion legal but don’t want to talk about restoring federal funding for abortion,” says Corrigan. “That’s part of this tragedy: we’re willing to let women die as long as our suburban mothers and daughters can get an abortion.”

Political opponents of abortion are already making use of the Philadelphia story to campaign for tighter restrictions on abortion.

In recent years, anti-abortion activists have cited the high rates of abortion among black women, calling abortion a form of “genocide” against the community. There is no small degree of irony–and cynicism–in the conservative campaign given the right’s history of blaming young and poor welfare recipients for their fertility.

And in states throughout the country, conservatives have been chipping away at reproductive rights through legislation requiring ultrasounds prior to abortions or laws recognizing “fetal pain.” On the national level, many advocates accuse Democrats of lessening their commitment to abortion rights. In many ways, policies on abortion rights have been heading in reverse.

“This was like a pre-Roe v. Wade clinic,” Schewel says. “And I think that as abortion access becomes narrower and narrower and more and more limited, there will be more and more of these types of providers.”

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions

 

Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.

071midyearstatecoveragetable

But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.

071midyearstateeligibilitytable

The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

071midyearstateabortionstable

In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.

News Abortion

Pennsylvania’s TRAP Law Could Be the Next to Go Down

Teddy Wilson

The Democrats' bill would repeal language from a measure that targets abortion clinics, forcing them to meet the standards of ambulatory surgical facilities.

A Pennsylvania lawmaker on Wednesday introduced a bill that would repeal a state law requiring abortion clinics to meet the standards of ambulatory surgical facilities (ASF). The bill comes in response to the U.S. Supreme Court’s ruling striking down a similar provision in Texas’ anti-choice omnibus law known as HB 2.

A similar so-called targeted regulation of abortion providers (TRAP) law was passed in Pennsylvania in 2011 with bipartisan majorities in both the house and state senate, and was signed into law by former Gov. Tom Corbett (R).

SB 1350, sponsored by Sen. Daylin Leach (D-Montgomery) would repeal language from Act 122 that requires abortion clinics to meet ASF regulations. The text of the bill has not yet been posted on the state’s legislative website.

The bill is co-sponsored by state Sens. Art Haywood (D-Philadelphia), Larry Farnese (D-Philadelphia), and Judy Schwank (D-Berks).

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Leach said in a statement that there has been a “nationwide attack on patients and their doctors,” but that the Supreme Court’s ruling upholds the constitutionally protected right to terminate a pregnancy.

“Abortion is a legal, Constitutionally-protected right that should be available to all women,” Leach said. “Every member of the Pennsylvania General Assembly swore an oath to support, obey and defend the Constitution of the United States, so we must act swiftly to repeal this unconstitutional requirement.”

TRAP laws, which single out abortion clinics and providers and subject them to regulations that are more stringent than those applied to medical clinics, have been passed in several states in recent years.

However, the Supreme Court’s ruling in Whole Woman’s Health v. Hellerstedt that struck down two of the provisions in HB 2 has already had ramifications on similar laws passed in other states with GOP-held legislatures.

The Supreme Court blocked similar anti-choice laws in Wisconsin and Mississippi, and Alabama’s attorney general announced he would drop an appeal to a legal challenge of a similar law.