Weighing in on Kermit Gosnell

by Erin Arizzi

A couple of weeks ago, I attended a screening of the new documentary, After Tiller, at Full Frame Documentary Film Festival in downtown Durham.

After Tiller is an incredible film about late-term abortion care in the U.S. The film follows the daily routine of the four doctors that continue to perform late-term abortions in the wake of the murder of their colleague, Dr. George Tiller. For those who may be unfamiliar with the story, Dr. George Tiller was a life-time advocate for women’s reproductive health care, and ran an abortion care clinic in Wichita, Kansas that performed late-term abortions. After multiple threats on his life by extremists in the so-called “pro-life” movement (in 1986, his clinic was firebombed, and in 1993, he was shot in both arms) he was murdered by anti-abortion activist Scott Roeder at his church on a Sunday morning in May of 2009.

The doctors profiled in the film After Tiller have continued the mission of George Tiller–in spite of constant threats to their own lives–because they feel they have a medical obligation to provide safe health care services to women in desperate situations. Much of the film shows us doctors in consultation with patients. In these conversations, we get to hear women explain why they are seeking a late-term abortion. In many cases, the patients are in great agony, because their pregnancies were very much wanted, but prenatal testing has shown that the fetus is not healthy or viable, and so they have decided to end the pregnancy. Other women have sought a late-term abortion because for a variety of reasons, they could not gather the funds together in time for a first trimester abortion.

I work for NARAL North Carolina, so I spend a lot of time thinking about abortion care and policies that affect women’s access to reproductive health. But in spite of my familiarity with the subject, I found this film incredibly moving. I left feeling even more committed to the idea that structural change must happen if we are to get beyond the kind of divisive arguments that so often occur in the public sphere around abortion access. And my resolve was strengthened again last week, as I watched the media run with the Kermit Gosnell story.

There is a scene in After Tiller where a young woman is talking to her doctor, and explains that she already has three children, and she simply cannot afford to have any more. She does not want to give her baby up for adoption; she feels very strongly about her decision to have an abortion. The doctor asks why she did not seek care sooner, if she knew she wasn’t going to continue with her pregnancy. She explains that she could not come earlier, because she did not have the money. One of her children was sick and needed to be hospitalized, and as time passed, the price of the abortion kept increasing, making it more and more difficult for her to come up with the money. She was able to finally seek out care only when she received her tax return.

People often wonder why any one would wait 20 weeks to have an abortion. The people who ask that question are unfamiliar with the harsh economic reality many Americans face.

According to the National Women’s Law Center’s (NWLC) analysis of the most recent census data: as of 2010, the poverty rate among American women had risen to 14.5%. In our state, the rate of poverty among women is even higher, at 16.8 %.  [Note, in 2011, a single mother’s  poverty threshold was an annual income of $17, 916]. The Hyde Amendment, which passed in 1976, forbids federal funding for abortion except in cases of rape, incest, or life endangerment. A woman’s “mental health” is not adequate cause for federal funding, nor is fetal impairment. So except in these extreme cases, it is against the law for North Carolina women to receive public assistance to pay for abortion care, leaving low-income women in increasingly desperate positions.

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Why would patients seek care at Kermit Gosnell’s horrific clinic? One reason: he was offering care at a deeply discounted price. Abortion care, despite what you may have heard, is not cheap. According to the Guttmacher institute, in 2009, the average price of a first trimester abortion in the US was $470. The price only increases as time progresses. According to ThinkProgress, a first trimester abortion at Gosnell’s clinic was $330. A late-term abortion at Gosnell’s clinic was $1,625, about thousand dollars less than what it would cost at one of the legal abortion care clinics that offer late-term services. The difference between $470 and $330 may not seem like much to you, but for a woman living paycheck to paycheck, $140 might pay a month’s rent. The hard reality is that for many women, Gosnell’s clinic may have been the only affordable option available.

No one in the reproductive justice movement condones Gosnell’s actions. Contrary to what our opponents say, we would like women to have access to all of their options, and we would like them to be able to make choices that are not determined by their personal finances. Yes, we want all women to have access to affordable, safe, and legal abortion. But we also want women to have access to the full range of reproductive options.  Whether they choose adoption or motherhood, young women need more than the rhetoric of the anti-choice movement, they need access to pre-natal care, health services, child-care services, and education. We also want all women (and men) to have access to (and education about) contraception, so that unwanted pregnancies can be avoided altogether.  Finally, we want women to be able to have abortions early on, when the health risks are minimal, and the procedure is safest. But this can only be accomplished if state governments work to promote the health of women, families, and children, by giving them access to choice. If state governments continue to shut down clinics by creating unnecessary regulations (as the NCGA’s proposed TRAP law aims to do,) we are creating the conditions for more, not less, Kermit Gosnells.

Erin Arizzi is the Communications Intern at NARAL Pro-Choice North Carolina. She is a PhD student and teaching fellow in Communication Studies at The University of North Carolina at Chapel Hill. She has a Masters Degree in Rhetoric from UNC-CH, and a BA in English from Villanova University in Pennsylvania. 

Small Bill, Big Consequences: Duke Student Sarah Van Name takes on SB 308

[Guest Writer Sarah Van Name’s entry is cross-posted with permission from DevelleDish, a student-run blog at Duke University]

Friends, it’s been a bad mont­­h for abortion rights. First, Arkansas introduced the most restrictive abortion law in the States, banning all abortions at twelve weeks. Then, not to be outdone by ultra-conservative Southerners, North Dakota passed a bill outlawing abortions at weeks. That’s before most women even know they’re pregnant. These laws are egregious and unconstitutional, and they’ve been taking up a lot of news space. Enough space that a tiny, comparatively quiet bill called SB 308 has slipped under the radar in North Carolina. But it would be a mistake to let it go unnoticed.

On March 13, the North Carolina General Assembly introduced SB 308, an amendment to the Women’s Right to Know Act and one more reason to be ashamed of our state’s legislature. The amendment would add two more restrictions to a law that already does far too much to limit women’s access to abortions. First, the doctor performing the abortion would have to be physically present during the entire abortion procedure and on the premises until the patient leaves the facility. Second, that doctor would have to have admitting privileges to a hospital within 30 miles of the facility where the abortion was performed.

For those of you who aren’t familiar with the Women’s Right to Know Act, let me acquaint you with this truly horrible piece of legislation. As part of the wave of intense anti-choice bills that swept the nation in 2011, it includes a parental consent stipulation, a 24-hour waiting period, and the requirement that the doctor give a wide variety of medically irrelevant information to any woman seeking an abortion, including a list of adoption agencies and pictures of what the fetus looks like at that time in the pregnancy. (The woman is required to view this packet, amongst other material.) Someone at the clinic even has to give the woman an ultrasound and offer her the chance to hear the fetal heartbeat; she must sign a waiver if she chooses to close her eyes or decline to hear the heartbeat. Essentially, the Women’s Right to Know Act means that any woman looking for an abortion is bombarded with unnecessary information aimed at forcing her to change her mind.

In trying to convince people that laws like this are harmful, one of the problems I’ve encountered is that a lot of its provisions sound reasonable in theory. If you strip away the rhetoric of both the right and the left and actually comb through the meat of the bills – you can look at the original bill here and the amendment here – sometimes it’s hard to pinpoint why, exactly, a certain stipulation is anti-choice.

Take the example of the 24-hour waiting period. A woman must come to the clinic, talk to the doctor, and then wait 24 hours before she returns to actually have the abortion. On the surface, it might seem all right: no harm in waiting a day for a procedure, and it might be good to have some extra time to consider such an important choice.

Okay. Sure. First of all, there’s the extraordinary audacity of lawmakers telling a woman she hasn’t sufficiently thought through such a decision. Are you kidding me? Give us some credit. But beyond that, there is real harm in having to wait a day, because many women don’t live near an abortion clinic. 86% of North Carolina counties have no abortion provider, and 50% of North Carolina women live in those counties. Low-income women may not be able to take time off from work, obtain childcare, or figure out transportation for the sometimes hours-long drive necessary to get to an abortion provider. And if she has trouble getting time, care, and transportation for one visit, the trouble will be multiplied if she has to go there, come home, and then repeat the next day after the waiting period is done. It’s not as simple as it seems.

Some anti-choice provisions, like the 24-hour waiting period and the ultrasound, are constructed to discourage women themselves from obtaining an abortion. Others, like the amendments in SB 308, target the abortion providers.

There is no medical reason for the doctor to need to be present for the entirety of the abortion and until the woman leaves the premises. A new study, done over six years, confirms what many people already knew: abortions are safe when practiced by nurse practitioners and physicians’ assistants. The only conceivable reason for requiring the doctor to be present for so long would be to cut down on his or her time and, therefore, the number of patients he or she can see.

Abortion providers also don’t need admitting privileges to a hospital: abortions, especially in the first trimester, are incredibly safe when performed in a sterile medical environment. Complications are very rare. But requiring that doctors have admitting privileges to a local hospital is a favorite tactic of anti-choice legislators. In some cases, there might not be a hospital within thirty miles of the clinic. If there is, the hospital will often refuse to grant privileges – not because of any real medical reason, but because they don’t want the trouble. In a recent WRAL story on SB 308, a spokesperson from Planned Parenthood explained that when a similar law passed in Mississippi, “no providers were given admitting privileges…The hospitals, quite frankly, did not want protesters out in front of their hospitals interfering with their practice of medicine.”

The bill has not yet gone to a vote, but with an anti-choice, Republican House and Senate – and not a whole lot of pro-choice Democrats – it seems likely that it will pass. Governor McCrory pledged not to sign any new anti-abortion legislation; whether he’ll keep his promise remains to be seen. Even if he does refuse to sign the bill, there are sufficient numbers of anti-choice legislators to override his veto – as they did with Governor Perdue’s veto of the original Women’s Right to Know Act in 2011.

If passed, this amendment will force abortion providers in North Carolina to shut their doors. Make no mistake: it is unreasonable, unnecessary, and unacceptable. E-mail or call Governor McCrory and urge him to end SB 308 before it can begin. As of 2008 – there are no more recent numbers – we have only 31 abortion providers in North Carolina. Each of those 31 clinics represents a space for North Carolina women to make the choice to have an abortion, a choice that is guaranteed by Roe v. Wade, not to mention the basic idea that people should be able to have control over their bodies. Those 31 clinics represent real choice for women. We cannot let them close their doors. We need every single one.

Sarah Van Name, a North Carolina native, will graduate from Duke University next month with a degree in Literature. She is a staff writer for Develle Dish and a participant in the WriteHers program at Duke. This blog is cross-posted on DevelleDish.com, and written in collaboration with the WriteHers Project. She tweets @safvn. 

Anti-Choice News Round-Up

Mirroring the situation in Kansas earlier this year, a new law has been proposed in Pennsylvania that would effectively close most, if not all, abortion clinics.  Bill 732 will require clinics remodel their buildings to follow the codes and rules of ambulatory surgical facilities.  At the same time the bill would require a registered nurse to be present in whatever room a patient is in.  According to Pennsylvanians for Choice, these new measures would force most of the 20 clinics in the state to close because they do not have the time or resources to renovate their buildings.

A hearing in North Dakota on the outlawing of drugs used in medical abortions has been put on hold again.  The hearing will not happen until sometime next year.  North Dakota passed a law earlier this year to ban the “off-label” use of drugs which are commonly used in early medical abortions.  This would effectively make medical abortion illegal in North Dakota.  The American College of Obstetricians and Gynecologists as well as the World Health Organization support the use of these drugs for medical abortion.

Ohio’s controversial “heartbeat bill” is currently awaiting a Senate vote.  Supporters of the bill have wasted no time mobilizing their target audience.   TV commercials supporting the bill will air next week  during The O’Reilly Factor and Hannity.

Michigan has introduced legislation that will make physicians screen patients for abortion coercion and domestic violence before they perform abortions.  Physicians will be required to tell victims of domestic violence that coercion is illegal and grounds for civil action, and delay the abortion for 24 hours.  They will also be required to have pamphlets on domestic violence in their office for patients to view.  Unfortunately this bill does not cover reproductive coercion in whole; it only addresses “abortion coercion” and leaves out any redress for women being coerced into pregnancy and motherhood.  While the bill states it will offer “financial compensation” to women who seek civil action over their abuse, it is also unclear how the state will help protect and empower women (and their potential children) from further abuse.