Tuesday, April 08, 2014

Huffington Post and "Back-Alley" Alarmism: Part 1

Part 1: Was It That Bad Then? Is Now an Improvement?

Laura Bassett of the Huffington Post lamented "The Return of the Back-Alley Abortion."

The Introductory Cautionary Tale

Bassett begins with the story of  Karen Hulsey, who became pregnant out of wedlock in 1969 in spite of using a diaphragm. Her boyfriend turned out to be married, and, predictably, said that he would not help raise or pay for the child. Instead, he offered to arrange and pay for an abortion in Mexico. Karen was "ashamed and embarrassed," afraid as a Catholic of the spiritual ramifications, and "wrestled with the decision and was three months pregnant by the time she agreed to go.

Her lover put her on a chartered plane, which landed in a field and was met by a woman who took her to a tiny "clinic" with dirt floors. Karen, as a nurse's aid, worried about how sterile the instruments could be in such a place. After a "very rough" examination, the doctor sedated her for the abortion. Karen woke up during the procedure to find herself being raped. Afraid for her life, she pretended to still be unconscious and waited until the abortionist was finished before pretending to come out of anesthesia.

After being told that the aborted baby was a little boy, Karen was given a Kotex and sent home with a retained placenta. She ended up hemorrhaging and needing emergency care.

Later she suffered from incompetent cervix and had three miscarriages before undergoing surgery that enabled her to give birth, though the little girl was two months premature and weighed less than three pounds.

At first, Karen felt that she was being punished by God for what she'd done to her first child.  "I think that's baloney now," she says, "and that's why I'm willing to talk about it."

Was Karen's Experience Typical?

Bassett, as spokesperson for abortion-rights advocacy, asserts that what Karen endured was the status quo before 1973, when the Supreme Court's Roe vs. Wade decision "ruled that states must make abortion legal at least until the fetus is viable, around 22 to 24 weeks into pregnancy." (She conveniently omits that the SCOTUS also mandated that states make abortion legal until birth but allowed for restrictions that Roe's companion decision, Doe vs. Bolton, defined so broadly that any reason the woman gave would suffice.)

Basset then asserts, citing Planned Parenthood's research arm, the Alan Guttmacher Institute (AGI):
[B]efore Roe, as many as 1.2 million women a year in the U.S. resorted to primitive, self-induced abortions or sought out illegal, amateur providers. Thousands of women ended up in hospitals each year with severe complications related to illegal abortions, and in 1965 alone, nearly 200 women died from those procedures.
Abortion Deaths

I have to give Bassett and the AGI credit for at least not dragging out the hoary and long-since discredited claim of 5,000 to 10,000 maternal deaths a year before Roe, so her assertion about the number of deaths is at least accurate. However, it's still misleading.

What she and the AGI conveniently omit is what was happening both prior to and after 1965. What was happening? Abortion deaths were plummeting, (see graph, right).

Credit is due not to legalization since, as you can clearly see, neither the first states legalizing abortion nor abortion-rights advocates' beloved Roe vs. Wade made so much as a blip in the trend. What was keeping women from dying was improvements in medical care. Thus, modern abortionists and their cheerleaders are claiming credit for other people's hard work.

The Numbers

AGI and Bassett equivocate some more with the claim that "as many as 1.2 million women a year in the U.S. resorted to primitive, self-induced abortions or sought out illegal, amateur providers." The weasel words "as many as" allow them to point out that technically, the assertion is not a lie. The actual number can be anything less than 1.2 million and still, from a strictly mathematical standpoint, the statement would be true. But the number is highly misleading.

According to the Centers for Disease Control, just over 600,000 women availed themselves of the newly-legalized abortions in 1973. In order for the 1.2 million illegal abortions number to be true, one of two things would have to have been happening:
  1. Half of all women undergoing abortions ignored the legal abortion facilities that were operating openly, advertising their presence, and instead chose to resort to underground, clandestine, secretive illegal abortion practitioners.
  2. Half of all women who would have otherwise resorted to abortion decided to forgo that choice once legalization made abortions easier to obtain.

The truth is, with legalization the number of women resorting to abortion annually climbed steadily, and did not approach 1.2 million until 1978.

The Abortionists

Mary Calderone
Regardless of the actual numbers, which logic tells us must have been fewer than 600,000 a year, what were the illegal abortionists like? Were pre-Roe abortions truly "primitive, self-induced abortions" or the work of "illegal, amateur providers"?

Let us turn to the experts on that issue. In 1955, Planned Parenthood Federation of America held a conference on induced abortion in the United States. As PPFA's medical director, Mary Calderone, concluded in "Illegal Abortion as a Public Health Problem" (American Journal of Public Health, July 1960), roughly 90% of pre-legalization abortions were performed by doctors, about 8% by the woman herself, and about 2% by non-physicians.

Nancy Howell Lee published her data based on interviews with women who had obtained abortions before legalization (The Search for an Abortionist, University of Chicago Press, 1969), and concluded that 89% of pre-legalization abortions were done by physicians, an additional 5% by nurses or others with some medical training, and 6% were done by non-medical persons or the woman herself.

Since both sources agree on the approximate 90% perpetrated by physicians, this number is probably fairly accurate. They disagree on the breakdown of non-physician abortions. I estimate that numbers were probably about 5% trained non-physicians (nurses, midwives, surgical technicians, etc.), 3% untrained accomplices, and 2% the woman herself.

The Quality of the Abortionists

Mary Calderone didn't classify the typical illegal physician-abortionist as a quack:
Call them what you will, abortionists or anything else, they are still physicians, trained as such; and many of them are in good standing in their communities. They must do a pretty good job if the death rate is as low as it is
Alan Guttmacher
Alan Guttmacher, then-PPFA President and the man for whom the AGI is named, concurred:
The technique of the well-accredited criminal abortionist is usually good. They have to be good to stay in business, since otherwise they would be extremely vulnerable to police action. (M.D. Babies by Choice or by Chance, 1959)
As far as I've been able to see in my research into pre-legalization abortion deaths, the only circumstances under which quack abortionists of the "back-alley butcher" type were able to thrive was in communities where abortion was perceived as an ordinary and reasonable thing for a woman to do and any abortionist was seen as a helpful, well-meaning person who ought not to be punished even if he killed his patient. Where abortion was frowned upon, prosecution not only of the abortionist but of accomplices as well was the norm. In other words, a strong abortion-rights presence protected all abortionists, including quacks.

The True Picture

Clearly, pre-Roe America wasn't a country plagued with seedy, coathanger-wielding abortionists who maimed over a million women a year. Yes, there were some quacks, but unless abortion-rights people in positions of power or influence stepped in on their behalf, they were arrested and shut down, leaving the competent doctors who practiced without injuring their patients and thus drawing attention to themselves.

What we had was perhaps half a million women going to competent physician-abortionists, with a minority using a trained non-physician and a very few resorting to the untrained or themselves.

What Changed With Legalization?

As I've already noted, legalization had no effect on maternal mortality whatsoever. Did it have a change on practice?

As one would expect, the doctors who were perpetrating illegal abortions prior to legalization would hardly shut down their abortion practices. With legalization they could begin to openly advertise.

If there was any change in the quality of the care provided, it was for the worse once the threat of prison. Four erstwhile criminal abortionists that I know of had no patient deaths prior to legalization, but each went on to kill two women after legalization.

Milan Vuitch
They gambled with their patients' lives: Benjamin Munson sent his patients home with retained fetal parts; Jesse Ketchum performed hysterotomy abortions, which are like a c-section but with the intent of delivering a dead fetus, in the motel where he set up shop; Milan Vuitch used dirty instruments, left anesthetized and unconscious patients unattended for hours on end, and kept patients in his home overnight when they suffered complications.

Kermit Gosnell
The most famous -- nay, infamous -- "back-alley butcher" who hung out his shingle legally was Kermit Gosnell, whose Philadelphia "house of horrors" was flea-infested and littered with cat feces. Patients were routinely doped within inches of their lives by his unqualified staff -- two of whom had never even finished high school -- before Gosnell would show up for the day. Viable babies were routinely delivered alive and then killed via "snipping" -- cutting through their spines with surgical scissors.

Abortion-rights supporters tend to dismisse men such as these as "outliers," not at all representative of "high quality reproductive health care." This claim is a bald-faced lie.

Benjamin Munson
Vuitch and Munson both enjoyed high status within the abortion establishment. Vuitch's New York Times obituary praised him as a "fighter for abortion rights." Munson was a member of the prestigious National Abortion Federation. While not as high-profile as Vuitch or Munson, Ketchum got regular referrals from Clergy Consultation Service, a network that arranged abortions prior to Roe vs. Wade.

These men were not renegade abortionists that no reputable prochoicer would send women to. They were as mainstream as it was possible to be.

As for Gosnell, he worked part-time at a National Abortion Federation member clinic which would collect his fee and turn late-abortion patients over to him for care. These women ended up moaning on the blood-stained recliners in Gosnell's facility. The word to properly describe Gosnell isn't "outlier." It's "employee."

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