Recently, federal agents raided Dr. Kermit Gosnell's clinic in Pennslyvania and discovered one of my worst nightmares realized: an unsafe clinic, with unsanitary conditions, sketchy staff, and to top it all off, fetus parts in jars. The doctor has killed at least a couple women, injured more, and who knows how many women who went there and just had a bad experience. So why did women go there? It had a terrible reputation. The answer: Gosnell charged very low prices. Women who were going there couldn't afford the extra it cost to go to a safe clinic. So, essentially they had two choices - carry an unwanted pregnancy to term, or go to this super sketchy clinic that was affordable, and hope for the best. Not really very good choices, huh?
First of all, I'll address the idea that carrying an unwanted pregnancy to term is not a very good choice. Plenty of women beg to differ, and doctors who listen to and care about them learn from them. Dr. Alec Bourne, who had challenged the British abortion law by performing an abortion on a teenage girl who'd been raped by soldiers, nevertheless wrote in his memoir:
"Those who plead for an extensive relaxation of the law [against abortion] have no idea of the very many cases where a woman who, during the first three months, makes a most impassioned appeal for her pregnancy to be 'finished,' later, when the baby is born, is thankful indeed that it was not killed while still an embryo. During my long years in practice I have had many a letter of the deepest gratitude for refusing to accede to an early appeal."
Ambivalence -- even to the point of rejecting the pregnancy -- is normal in early pregnancy. Accepting and adjusting to the pregnant state is a normal developmental task of pregnancy.
Abortion minded women, given a chance to address their concerns, often change their minds, as was noted by Planned Parenthood Medical Director Mary Calderone:
[1955 Planned Parenthood abortion conference] members agreed, and this was backed up by evidence from the Scandinavians, that when a woman seeking an abortion is given the chance of talking over her problem with a properly trained and oriented person, she will in the process very often resolve many of her qualms and will spontaneously decide to see the pregnancy through, particularly if she is assured that supportive help will continue to be available to her.
It strikes me as very dubious at best to "treat" a normal and self-limiting phenomenon, such as ambivalence and early rejection of the pregnant state, with such a drastic and irreversible step as abortion. It makes no more sense than acceding to a stonefish victim's impassioned plea that the effected limb be amputated, without informing the patient that the pain will abate and the patient will again be glad to have retained the limb.
Typically the distress, and thoughts of aborting, abate around quickening -- when the fetus itself, rather than the mere state of being pregnant -- becomes real to the woman. And now modern technology frees us of a prior time constraint. The woman no longer need remain conflicted and distressed until 16 or more weeks into the pregnancy. Viewing an ultrasound of her embryo or fetus can allow the woman to resolve her ambivalence, and to commit to seeing through the pregnancy.
Aren't health care professionals supposed to look for the least drastic option? And showing the patient an ultrasound and referring her to supportive services is much less intrusive and invasive than performing an abortion.
Now, I have to give credit where credit is due: Evidently there were some abortion supporters trying to get Kermit Gosnell's filthy abortion mill closed down:
CHOICE, a Philadelphia abortion referral service, contacted the state medical board about Gosnell because some of his patients had called CHOICE with appalling stories, said Brenda Green, the organization's executive director.
"We were told that we could not file a complaint. It had to be a patient. It could not be a third party," Green said.
Here's part of where the problem lies. Gosnell's practice wasn't a clinic. Thus, the health department couldn't just step in and do an inspection. As a private physician's office (however much it might look like a clinic to a prospective patient), Gosnell's abortion facility could only be investigated if a patient herself complained.
It seems to me that one solution would be to not allow abortions to be preformed in non-clinic settings.
So, you just had a terrible experience in a medical facility and want to file a complaint -- but in order to do so you must be willing to submit all your medical information including the abortion you just had, and be able to travel two hours to another city to go to a hearing. And people wonder why more reports weren't filed.
That's not right -- for filing a complaint about abortion or any other botched procedure or quackery. The complaint should be sufficient to get at least a cursory investigation going, and if more information is needed, then the board can come to the patient. (I must note, patient's names are redacted from medical board documents.)
What can we do to make clinics that don't provide the best care possible better? And what can we do to make sure a clinic like Dr. Gosnell's never exists ever again?? Can we create some sort of regulatory commission? Since clearly, the health department dropped the ball on this one big time. How we can get this information to low income women?
I am beyond delighted to hear this coming from a prochoice source. I have some suggestions.
1. Start holding the National Abortion Federation accountable. Too many prochoicers assume a NAF member is a high quality abortion provider. That ain't necessarily so. The existing policing organization needs to actually start policing its own members.
2. Local referral groups can get copies of Warren Hern's Abortion Practice. Hearn includes a chapter about how to assess whether or not a facility is following recommended standards of abortion care.
3. Local prochoice groups can also do docket searches, etc., on practitioners to get the inside scoop. This primer was written for prolifers, but the techniques for finding out what's what remain valid.
4. Spread the word among organizations likely to make abortion referrals.
I would be more than glad to extend support to prochoice individuals and groups, without in any way trying to convince them to outlaw abortion. Just contact me.
"What happened inside that building is not the real story. The real story is why women sought care there at all," Schewel said. "This prohibition on Medicaid payment leaves desperate women vulnerable to substandard providers."
Actually, no. The CDC's own research indicates that eliminating public funding for elective abortion reduces the incidence of abortion-related hospitalizations among Medicaid-eligible women. Even when all other factors are adjusted for, public pay patients still have a higher compilation rate than private pay patients.
The real story is the way the focus has become on "How do we arrange legal abortions for these women?" rather than "How do we identify and address these women's real needs." Which takes us back to where I started.