Availability Of Abortion Dwindling Providers Decline In Past 10 Years
A North Idaho gynecologist walked out to his receptionists a few years ago and told them to stop scheduling abortions. He was tired of the protests, tired of the harassment, tired of bearing the entire burden of providing the community with abortions.
Within days, he received letters from anti-abortion protesters who had picketed his office. They congratulated him on “seeing the light.”
“Nobody, absolutely nobody who’s for choice called up and said, ‘What a shame,”’ he said.
Not one of the dozens of North Idaho doctors who had referred desperate patients to him, no one from the local chapter of the National Abortion Rights Action League, no one from Spokane’s Planned Parenthood clinic where women from North Idaho were going by the hundreds to get abortions.
The doctor didn’t want his name used to avoid being dragged back into the political fracas he had endured for most of his career.
Twenty-five years ago today, the U.S. Supreme Court declared that a woman’s right to privacy guarantees her the ability to choose an abortion up until the point her fetus is independently viable. But abortions now are harder to obtain than at any other time since the ruling.
In the last decade, the number of abortion providers - including hospitals, clinics and doctor’s offices - has dropped by 18 percent nationwide, according to the Alan Guttmacher Institute for reproductive research in New York City.
Fewer medical schools provide abortion training, fewer young doctors are opting to learn the procedure on their own, fewer facilities want to provide abortions even as a minuscule portion of their overall services.
While the victories for anti-abortion activists have been small in the courts and legislatures, their impact on the actual practice of abortion has been extensive.
Spokane and the surrounding area are a classic example of the dynamics at work.
The number of abortions performed annually in Spokane has remained steady (roughly 2,000 according to state figures, 2,800 according to the Guttmacher Institute, which compiles voluntary reports from doctors). But the number of women from out of the county and out of the state coming to Spokane to get abortions has more than doubled over the last five years.
In short, Spokane has become a regional mecca for people looking to end unwanted pregnancies.
“Let’s see, nobody up north, nobody in Tri-Cities, nobody in Coeur d’Alene,” said John Nugent, director of Planned Parenthood of Spokane and Whitman Counties. “For a lot of people, they think that because the Supreme Court said it’s legal, it will always be there.”
At times, Planned Parenthood has had to fly doctors from the West Side to Spokane to meet the abortion demand. Nugent said he hopes the worst of the doctor shortage is over.
“We have some prospective trainees,” he said.
But his optimism may be misplaced. Most doctors, even those committed to legal abortion, refuse to do the relatively simple procedure.
“No one wants to be identified as an abortion provider,” said Dr. Thomas Easterling, a University of Washington professor of obstetrics and gynecology.
It’s not just the intimidation by abortion opponents, although that is a big factor, especially when it extends to spouses and children, he said.
Doctors also fear being ostracized by their colleagues, being denied credentials at a Catholic hospital and losing patients.
“And then there’s the very real fear that maybe someone will take out a gun and shoot me,” Easterling said. Five doctors or clinic workers involved in providing abortions have been murdered since 1993 in the United States.
When the University of Washington Medical School announced an optional course on abortion for fourth-year students in 1996, it was the target of protests and pickets.
The course doesn’t actually teach the procedure. Rather, it provides students with the moral, cultural and medical framework for addressing patients who seek abortions.
“Our goal is to educate people about the issue so they can make their own informed decisions,” Easterling said.
Since the course was announced, Easterling has been very cautious when discussing it with outsiders.
“Pardon me if I’m slightly paranoid,” he told a reporter last week while he verified her credentials. “My wife doesn’t like me to talk about this at all.”
Officials at the school said the course is still available, but refused to say if any students were currently enrolled or how many had taken the course.
In big cities like Seattle, there are many private doctors still willing to do abortions.
“But pretty much if you live anywhere outside of Seattle in this state you have to search to find a private provider,” he said.
Even in Spokane, several hundred women travel to Yakima or Seattle every year - mostly to obtain second trimester abortions. Planned Parenthood in Spokane provides abortions up to 14.6 weeks.
“In a city the size of Spokane, I think it’s unfortunate that women have to travel five, six hours to get a second-trimester abortion,” Easterling said. “If you knew the quality of the reasons for second-trimester abortions, your heart would go out to those women.”
Such abortions are often done after the mother learns that her fetus has neurological damage that will kill the baby within weeks after birth, if not before. Such tests, which are part of routine prenatal care, cannot be performed until the mother is 16-18 weeks pregnant, he said.
Other second-trimester abortions often involve drug addicts, homeless women and others living in extreme poverty - conditions so severe they didn’t even notice their pregnancy until they were beyond the first trimester.
The dwindling number of facilities is a reality bemoaned by many in the medical field, but cheered by the anti-abortion movement.
“We’ve basically got an attrition of the industry,” said Jim Anderson, founder of the Spokane-based Lifeline Ministry, an organization dedicated to preventing abortions.
He says by praying and protesting, he and his followers have affected the public conscience.
While praying outside of Planned Parenthood in Spokane, he said he can sense the stress and the level of sadness inside.
“I believe that courage and moral sanity is transferrable,” he said. “Our work gives people courage on a personal level. That’s why you see a great amount of ambivalence among doctors in general.”
That ambivalence was the very reason the North Idaho doctor got out of the business.
“There’s five obstetricians in this community and all are very strongly pro-choice. But none of them were doing abortions,” he said. “They were just dumping on me. It was a case where I was not going to do other people’s dirty work.”
Many people hope the prospect of oral medication to induce abortions is the answer to the dilemma over obtaining a surgical abortion.
It is more likely that the anti-abortion pressure will simply spread from doctors and clinics to drug companies and pharmacists.
Eventually, Americans themselves are going to have to sort out the conflict.
The Gallup organization has been polling Americans about abortions since the Roe vs. Wade decision. At no point since then has the poll indicated more than 25 percent of the country favors making the procedure illegal again. But the most-recent poll reveals a shift in opinions.
When asked about a woman’s freedom to determine the course of her life, the public still supports abortion rights. When asked when life begins or if a fetus should die, public opinion swings toward restrictions.
Dozens of court and legislative decisions have drawn boundaries around the right to an abortion: waiting periods, parental consent, bans on public financing.
But the most conservative Supreme Court and Congress in decades seem unwilling to go further.
“There’s a lot of people out there who think abortion was their mother or father’s issue,” Nugent said. “They don’t want to talk about it because they are numb from 25 years of screaming about it.”
, DataTimes ILLUSTRATION: Color photo Graphic: Abortion 25 years after Roe vs. Wade