"The New Abortion Providers" and the Old Political Dilemmas

By Christine Cupaiuolo — July 16, 2010

The New York Times has published online an extensive article about “The New Abortion Providers” (it will appear in print in Sunday’s Magazine), which I highly recommend reading. Such detailed reporting from a mainstream publication on the struggles of individual medical students and doctors to make abortion an accepted, integrated part of healthcare is quite welcomed.

The story provides both a historical and personal context for understanding the challenges — and the courageous dedication — of women’s health advocates on the frontlines of reproductive health for the past four decades.

Unfortunately, this ground-breaking journalism appears the same week in which we learned the Obama administration is denying abortion coverage for women whose pre-existing conditions will place them in “high risk pools” that have been established through the recent health care reform legislation.

More on that lack of courage in a moment.

But it’s worth pausing on Emily Bazelon’s story. She first outlines the depressing marginalization of abortion providers in the United States that occurred in the decades after Roe v. Wade. In 1973, hospitals made up 80 percent of abortion facilities. Fifteen years later, 90 percent of abortions were performed in clinics. At the same time, medical schools increasingly refused to make abortion training part of their curriculum. By 1995, “the number of OB-GYN residencies offering abortion training fell to a low of 12 percent.”

Even though it was the hard work of the feminist movement that made abortion widely available through clinics, those clinics were never intended to replace the key role of hospitals. And as we’ve seen all too often, clinics are ground zero for harassing patients and abortion providers.

As Bazelon notes, “This was never the feminist plan.”

This is a story, though, with an encouraging ending. While anti-abortion forces forced this marginalization through very public protests and acts of violence, a quieter, grassroots movement has taken hold that is starting to reverse these trends:

Over the last decade, abortion-rights advocates have quietly worked to reverse the marginalization encouraged by activists like Randall Terry. Abortion-rights proponents are fighting back on precisely the same turf that Terry demarcated: the place of abortion within mainstream medicine. This abortion-rights campaign, led by physicians themselves, is trying to recast doctors, changing them from a weak link of abortion to a strong one.

Its leaders have built residency programs and fellowships at university hospitals, with the hope that, eventually, more and more doctors will use their training to bring abortion into their practices. The bold idea at the heart of this effort is to integrate abortion so that it’s a seamless part of health care for women — embraced rather than shunned.

The article goes on to tell many compelling stories and reveal complex personal negotiations and sacrifices.

The comments section of the article is also an essential read, as it provides some key corrective points and additional context. “sadpatient” points out that the article, despite its “sympathetic” stance, still participates in the demonization of second trimester abortions, even though “many women are driven to terminate a dearly wanted pregnancy due to poor prenatal diagnosis.”

“Jenny K,” a member of Nursing Students for Choice, was “disappointed” that the article didn’t mention the role of nurse practitioners and physician assistants. And “CM,” through a personal anecdote, discusses the continuing difficulties of terminating a pregnancy in hospitals that are unwilling to provide separate, specialized facilities.

But the gains noted in the article are undeniable. Unfortunately, the Obama administration’s decision this week to prohibit abortion coverage in Pre-Existing Condition Insurance Pools (PCIPs) — also known as high-risk pools — is a disheartening setback for all those fighting to make abortion accessible and affordable.

The Hill reports that the decision “came as the National Right to Life Committee and others argued the pools being set up in Pennsylvania and New Mexico would cover elective abortions — something that wasn’t prohibited by the healthcare reform law or the president’s executive order on abortion.”

Jessica Aron, in her enlightening breakdown of the political machinations behind the decision, explains why denying coverage to women in this group is particularly devastating:

Women entering these plans are, by definition, those who have experienced serious medical conditions — so serious that insurers are unwilling to sell them insurance. In other words, those who get pregnant are already at a heightened risk for needing an abortion for health reasons when compared to the general population.

Aron also explains in detail why, even with the executive order that Obama signed as a compromise with anti-abortion Democrats like Bart Stupak, “nothing in the law requires such action” restricting abortion in PCIPs.

It is understandable that the Administration might now feel the need to honor the “spirit” of the compromise that resulted in the Executive Order.  But the whole point of the compromise was to preserve the status quo, which included both restricted and unrestricted spheres of abortion funding.  Moreover, the terms of the agreement were carefully negotiated.  Abortion opponents who participated in the bargaining did not raise concerns about high risk pools or other specific potential sources of federal funding, and they should be able to live with the deal they made.

The worst of it is that the Administration could have at the very least set up something akin to the Hyde Amendment and the PPACA by giving states the option of using state or private money to cover abortion care costs.  Instead, the Administration cited the Federal Employees Health Benefits Plan specifically as the controlling precedent for the PCIPs.

The reaction from women’s health advocates has been swift. Judith L. Lichtman, senior advisor of the National Partnership for Women and Families, released this statement:

For the next few years, temporary insurance plans for those with pre-existing conditions will be the best and only way that millions of Americans — including many women of child-bearing age — can get health insurance coverage. It is unnecessary and punitive for the Obama Administration to adopt rules that prevent women from using their own private resources to purchase coverage for abortion services in these plans.

Cecile Richards, president of the Planned Parenthood Federation of America, stated:

The very women who need to purchase private health insurance in the new high-risk pools are likely to be more vulnerable to medically complicated pregnancies. It is truly harmful to these women that the administration may impose limits on how they use their own private dollars, limiting their health care options at a time when they need them most. This decision has no basis in the law and flies in the face of the intent of the high-risk pools that were meant to meet the medical needs of some of the most vulnerable women in this country.

Raising Women’s Voices and the National Women’s Health Network are providing avenues for action and key talking points to use when contacting the White House (202-456-1111) and Health and Human Services Secretary Kathleen Sebelius (877-696-6775).

One response to ““The New Abortion Providers” and the Old Political Dilemmas”

  1. Disturbing and interesting. Started to read it and stopped reading it because I felt it was the same as a recent Ms Magazine Cover Article more then anything else. As for me I found that I’m in the middle of this. Haven’t really done any serious learning and researching on this

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