Learning the Right Lessons from the Philadelphia Abortion Clinic Disaster
Learning the Right Lessons from the Philadelphia Abortion Clinic Disaster
Carole Joffe: Lessons from the Philadelphia Abortion Clinic Disaster
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 for 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 cords. 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, despite 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 an extreme version of what I have termed ?rogue clinics,? facilities that today prey on women, especially women of color and immigrants, in low-income communities.
As I wrote 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 help to 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 who pointed out that the community health center that serves the same low-income neighborhood in which the Gosnell clinic was located is considered one of the city?s best facilities. Because it is a recipient of federal funding, this center could not offer abortion care.
Why did Gosnell?s patients not go to a better, safer abortion clinic, like 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?over-represented among abortion patients?differences of even $5 or $10 can be the deciding factor in 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 national average price was about $100 higher. For a twenty-three to twenty-four week procedure, Gosnell charged $1625, while the relatively few other facilities in the Northeast offering such abortions would have charged at least $1000 more.
Still another reason women came to this clinic was that Gosnell was widely known for his willingness to flout the law and perform post-viability (as in, post-twenty-four week) abortions, even in cases where women did not meet the very strict legal guidelines of having a life-threatening or serious illness or carrying a fetus with a lethal anomaly. In a horribly unfair, vicious cycle, the poorest women often take time to raise funds for an abortion and then find themselves past the cut-off for procedures available early on?and thus facing a higher cost for an abortion. When women in these situations realize that they neither have the funds to pay for a late procedure nor can find a reputable provider that will perform their procedures after twenty-four weeks, they end up at places like Women?s Medical Society.
Predictably, in response to the story of Dr. Gosnell?s clinic, the anti-abortion movement has called for additional massive oversight of all clinics, claiming that all abortion providers resemble this outlier. But the overwhelming majority of abortion-providing facilities in the United States 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 abortions 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.
An earlier version of this post appeared at Beacon Broadside.
