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Although organized opposition to abortion is now largely associated with the fundamentalist evangelical Christian movement, it was the American Medical Association that led the late-19th-century charge against abortion in the U.S. Until then, it had been an openly advertised procedure. By century's end, most states had anti-abortion laws on their books.
The sexist tone of the AMA campaign provides the context for Roe vs. Wade's legacy as a feminist, rather than medical, landmark. A woman seeking abortion "becomes unmindful of the course marked out for her by Providence, she overlooks the duties imposed on her by the marriage contract. She yields to the pleasures -- but shrinks from the pains and responsibilities of maternity," was the AMA's 1871 assessment of the procedure, according to a document quoted in the book The Abortion Movement and the AMA.
Organized medicine remains uncomfortable with abortion to this day. Every year, fewer medical schools train doctors to perform the procedure. The portion of medical schools offering abortion training as part of their curriculum has gone from 22.6 percent in 1985 to 12.4 percent in 1991, according to the latest available figures from the National Abortion Federation.
This elimination of training programs has coincided with a ghettoization of the specialty. As abortion techniques become increasingly safe and simple, an ever greater portion of them are performed in free-standing clinics, rather than in more expensive hospitals. As a result, what was already perhaps medicine's least prestigious specialty has become increasingly isolated.
And because abortion is vanishing from doctors' palette of skills, more and more abortion clinics are forced to fly physicians in from other cities weekly to perform the procedure. Some 85 percent of U.S. counties don't have clinics, or doctors who can perform abortions.
Managed Care Manages Fewer Abortions
The spread of managed medical care has also impeded abortion access, in part because of abortion's uniqueness among surgeries: It becomes dramatically more dangerous and costly if postponed, yet it is rarely considered an emergency procedure. The prior approvals, difficult-to-get appointments, and other hassles that have become the hallmark of modern managed care programs can lead to extended postponement of abortions.
And the longer abortion is delayed, the less likely it is to be performed.
Medi-Cal, the California version of the government-funded Medicare program, has turned increasingly to managed care providers in recent years. The resulting restriction on abortion access is clear; the poor women who are beneficiaries of Medi-Cal are the women who are statistically most likely to want an abortion. Abortions are sometimes delayed so long they are no longer legally possible under Roe vs. Wade, which creates a right to abortion, but only before the fetus is able to survive outside the womb. (In California, viability is legally deemed to begin 24 weeks after conception.)
"I had an intern spend all week arguing with a managed care medical program in Sacramento County. It was delayed so long that the woman couldn't get an abortion," says Brenda Cummings, director of Access Pro Choice Information and Referral, a San Francisco organization that aids women seeking abortion and childbirth services. "It has become harder and harder to find a provider, find insurance that covers abortion, or find a doctor who will give a referral. Managed care has caused a lot of problems with getting an abortion. It's safest when soonest. And with managed care, we get delays, and we are finding fewer and fewer providers who accept Medi-Cal as payment. That's made access dwindle."
It has also dwindled because anti-abortion activists have been more numerous, committed, and inventive than their feminist counterparts. Pro-choice groups celebrate every Jan. 22; anti-abortion advocates work year round.
Crisis Pregnancy, No Abortion
Abortion opponents have set up hundreds of "crisis pregnancy clinics" that advertise in the abortion section of the telephone directory, then offer descriptions of maimed fetuses to women who take the bait. According to Betsy Powell, Bay Area director for the California Pro Life Council, there are now more such "crisis" clinics than actual abortion clinics.
"We believe strongly that women need to make a fully informed decision. Even though it's very difficult to hear descriptions of abortion methodology, or see an ultrasound, as a woman, I believe I'm going to make a better decision if I know all the facts. We provide that kind of environment," says Shari Plunkett, CEO of First Resort, a $700,000-per-year organization that has crisis pregnancy centers in Oakland and Pinole, and is now scouting for a location in the San Francisco Financial District. Plunkett says her staff manages to talk two-thirds of the women who walk through their doors out of getting an abortion.
First Resort is still advertised in the 1997-1998 Pacific Bell telephone directory under its old name, Crisis Pregnancy Services, a term now widely associated with anti-abortion counseling. "We're not a crisis pregnancy center," Plunkett says. "Please make sure you use the name First Resort."
Other right-to-life measures have been similarly subtle and effective. The right-to-life movement has toned down its fight to have abortion outlawed, and instead focused on making abortion more difficult to obtain in certain, specific circumstances. President Clinton recently vetoed a bill that would have outlawed a rare abortion technique used for late-term fetuses. Abortion opponents hope to gain the votes to override a veto this year.
The fact that the procedure, called dilation and extraction, now shows up regularly in news headlines as "partial birth abortion" is fortuitous for the right-to-life movement because it is singularly macabre. Used only in certain, rare, mid-to-late-term pregnancies, it involves partly delivering most of the fetus breech first, then removing part of its brain before the head is taken from the woman's body. Even some liberal Democratic politicians have taken a stand against the procedure, and it has served as a rhetorical jumping-off point for right-to-life arguments.
According to Dr. Smith, the procedure was developed in 1978 to replace a situation that was similarly ghoulish. "In the old days, after 16 weeks, we put a needle in the abdomen, put a solution into the water sack around the fetus. That would put the woman into labor, and she would be in labor overnight. Within 24 hours everything would come out," Smith explains. "The problem was, there were so many of these girls -- 14, 15 years old -- that we'd have a medical ward where there were 30 people screaming their lungs out all night. It was something out of an Elizabethan madhouse."
