"...In 1973, hospitals made up 80 percent of the country’s abortion facilities."

[Cerridwen]

The New Abortion Providers

By EMILY BAZELON
Published: July 14, 2010

On a clear and mild March day in 1993, the Operation Rescue leader Randall Terry spoke at a rally in southern Florida against abortion. “We’ve found the weak link is the doctor,” he told the crowd. “We’re going to expose them. We’re going to humiliate them.” A few days later, Dr. David Gunn, an abortion provider, was shot and killed outside his clinic in Pensacola, Fla., about 500 miles away. It was the first of eight such murders, the extreme edge of what has become an anti-abortion strategy of confrontation.

Terry understood that focusing on abortion providers was possible because they had become increasingly isolated from mainstream medicine. That was not what physicians themselves anticipated after the Supreme Court’s 1973 decision in Roe v. Wade. An open letter signed by 100 professors of obstetrics and gynecology predicted that free-standing clinics would be unnecessary if half of the 20,000 obstetricians in the country would do abortions for their patients, and if hospitals would handle “their proportionate share.” OB-GYNs at the time emphasized that abortion was a surgical procedure and fell under their purview.

<snip>

But the clinics also truly came to stand alone. In 1973, hospitals made up 80 percent of the country’s abortion facilities. By 1981, however, clinics outnumbered hospitals, and 15 years later, 90 percent of the abortions in the U.S. were performed at clinics. The American Medical Association did not maintain standards of care for the procedure. Hospitals didn’t shelter them in their wings. Being a pro-choice doctor came to mean referring your patients to a clinic rather than doing abortions in your own office.

This was never the feminist plan. “The clinics’ founders didn’t intend them to become virtually the only settings for abortion services in many communities,” says Carole Joffe, a sociologist and author of a history of the era, “Doctors of Conscience,” and a new book, “Dispatches From the Abortion Wars.” When the clinics became the only place in town to have an abortion, they became an easy mark for extremists. As Joffe told me, “The violence was possible because the relationship of medicine to abortion was already tenuous.” The medical profession reinforced the outsider status of the clinics by not speaking out strongly after the first attacks. As abortion moved to the margins of medical practice, it also disappeared from residency programs that produced new doctors. In 1995, the number of OB-GYN residencies offering abortion training fell to a low of 12 percent.

<snip>

(emphasis added)

http://www.nytimes.com/2010/07/18/magazine/18abortion-t.html?adxnnl=1&pagewanted=all&adxnnlx=1429393007-eyWtGXPvlOd5PFN+AKkp4A

As usual, much more at link than can be represented by 4 paragraphs.

In the earliest days of the women's rights movement, family planning and many of its tools, were illegal in the US. Birth control, even information/education about birth control, could result in jail time and/or fines. Abortion was one piece of the family planning tool kit. Education about their own bodies, their pregnancies and how to avoid pregnancy, i.e., birth control, were all once there and many have made it into the "mainstream;" well, at least if you have the money. Abortion, was the tool chosen to attack women with regard to family planning. Poverty and the "war on drugs" would be additional tools used against poor white women and all women of color.

[beam me up scottie]

1. Link?

[Cerridwen]

2. Oops. Adding. Thanks. n/t

[beam me up scottie]

5. A first-trimester abortion is low-risk, relatively simple and fast...

A first-trimester abortion is low-risk, relatively simple and fast — a skilled doctor can do it in less than five minutes. It’s the traditional province of OB-GYNs, but it also fits easily within the scope of care of family-medicine doctors, who do other minor procedures, like endometrial biopsies, which screen for uterine cancer. So far, only a small number of the family-medicine residencies offer abortion training. But those programs are attracting applicants — they have higher match rates, which means greater success in recruiting the residents they want.

Technological advances have made it easier to shift abortion to the earlier stages of pregnancy. Tests have become sensitive enough to detect pregnancies two weeks after conception. The M.V.A., or manual vacuum aspirator, is gradually replacing the electric pump as the equipment of choice for first-trimester procedures. It’s about 10 inches long, costs only $30 and looks like the kind of appliance you might find in a kitchen drawer. Lawrence Leeman, a family physician at the University of New Mexico, describes how he convinced skeptical nurses that their primary-care clinic could handle abortion by coming to a meeting with his M.V.A. supplies in his coat pocket. Even smaller, of course, are the pills for a medical abortion.

Most facilities that offer surgical abortions now offer medical ones too. And in fact, Godfrey also does medical abortions up to nine weeks: she gives patients the pills misoprostol and mifepristone (formerly known as RU-486) and sends them home for an induced miscarriage, with a follow-up visit to make sure there are no complications. When the Food and Drug Administration approved medical abortion 10 years ago, abortion-rights advocates hoped that the method would move into the offices of doctors who don’t do surgical abortions. That shift hasn’t much happened. But medical abortion has helped to increase the number of very early abortions. It has long been an abortion-rights selling point that almost 90 percent of the abortions in the U.S. are performed before 12 weeks; in addition, four years ago, the proportion of procedures performed before 9 weeks reached 62 percent. The statistic points to a paradox: Anti-abortion advocates succeeded in focusing the country’s attention on graphic descriptions and bans of late-term abortion even as more and more women were ending their pregnancies earlier and earlier

DOCTORS WHO PERFORM abortions are startled by some poll numbers showing that for the first time, more Americans call themselves pro-life than pro-choice — a shift that includes young people. I saw hints of that discomfort. Medical residents with a moral or religious objection can always choose not to participate in abortion training, and in Godfrey’s program this year, four out of seven did not take part. When I visited the Planned Parenthood in Rochester, a 29-year-old pediatric resident came to watch the nurses counsel patients about their options but chose not to see an actual abortion. “I don’t know how I personally feel morally, and I’m never going to do one,” she said. “So if it could bother me if I saw one, then what’s the point?”

Back in the 80's there was talk of an abortion underground where trained professionals would perform the procedure for women who didn't have access to safe legal abortions.

Since so many states have decided to pass laws that will close most clinics we may have to revisit that idea.

[Cerridwen]

7. I wouldn't be surprised to find it exists.

Much of it may be off-shore right now but I would not be surprised to find pockets around certain parts of the US for those who know where to look.

[beam me up scottie]

10. If it does I'll volunteer again.

I will do whatever I can - transport, house, finance, whatever they need.

[Brickbat]

11. Jane.

http://www.fwhc.org/jane.htm

Heather Booth, then a student at the University of Chicago involved in civil rights and antiwar movements, found herself sought out by a few young women who were pregnant, scared, and desperate. They had somehow heard that Booth knew of a safe abortionist. Soon others began to call, prompting Booth and several other young feminists to found JANE, an anonymous abortion service that provided counseling and acted as the go-between for pregnant women and doctors willing to perform the procedure.

Appalled at the exorbitant procedure fees and upon discovering that their main abortionist wasn't a licensed physician, the women of JANE learned to perform illegal abortions themselves. Eventually, the underground collective performed over 12,000 safe, affordable abortions. Word of the illegal alternative was spread through word-of-mouth, cryptic advertisements, and even by members of Chicago's police, clergy, and medical establishment.

Little remains to document the organization's clandestine existence. Most of JANE's records were destroyed to protect the participants, leaving the women themselves to tell their stories. JANE: AN ABORTION SERVICE utilizes in-depth interviews, archival footage, and the few remaining personal effects to bare witness and illuminate this once-hidden refuge.

JANE was comprised of a cross-section of the political community of the early 1970s. They included members of the National Organization for Women, student activists, housewives, and mothers - a diverse group that shared one conviction – that access to safe and affordable abortion was every woman's right. Now, almost a quarter of a century later, JANE: AN ABORTION SERVICE powerfully documents a group of courageous women who were willing to translate their politics into action by providing safety and dignity to women of all backgrounds.

[beam me up scottie]

12. They were the inspiration.

I lived in Pennsylvania in the late '80's and many of us were terrified that our rights were about to be legislated away.

25 years later and it's so much worse.

[jmowreader]

13. I have thought an "abortion underground railroad" would work

Because the United States has not yet made it a crime to cross the state line for a medical procedure, the Abortion Underground Railroad would provide low-income women living in states that ban abortion with round-trip bus fare to a more rational state.

[beam me up scottie]

14. That was part of it too.

It already exists in a way, one group helped my friend's sister travel to Ohio to get a third trimester abortion.

We all chipped in to help - house sitting, child care and rides for follow up care when she came home.

[yeoman6987]

3. I mentioned having abortions done in hospitals

And did not get a warm reception from here. I think it makes sense but some don't think so. I guess the procedure will stay in clinics.

[Cerridwen]

4. I'm not surprised; by either of your comments.

The randall terrys of the world have had the focus of the media blurred around them for decades. Had the media hammered on them like they do with some of the manufactured "scandals" of the day, people might have known what the r/w was cooking up.

[NaturalHigh]

15. I seriously doubt that most doctors would want that.

A good many doctors are against elective abortions. I doubt they would want to put themselves in the middle of this debate. Also many good hospitals have a religious affiliation, and they will never allow it.

[niyad]

6. thank you for this excellent piece.

[Cerridwen]

8. Hey, niyad. You're welcome. And thank you for all the great posts you put up. n/t

[niyad]

9. and you are welcome in return!

[mountain grammy]

16. The "pro life" label is bullshit

Anti choices are not pro life. Against abortion? Don't have one. Nobody has the right to make decisions for others.

Good article , thanks.

[roamer65]

17. Mifepristone or misoprostol should be OTC.

That ought to wind a few people up, but they really should be OTC drugs.

[Freddie]

18. Used to work at a suburban community hospital

In the 80s and 90s we had 2 OB practices on staff for childbirths and GYN surgery. One group did the occasional abortion, the other did not. We got picketed every Saturday. When the doc group which did abortions folded up, the hospital board decided to no longer allow the procedure. That's probably what happened to most hospital programs.
Ironically, this hospital, like many, decided that childbirth was a $$-loser and they closed the maternity unit a few years ago too.