Month: January 2011

He does tell us a few things about abortion. They just aren’t what William Saletan thinks.

The Gosnell case shows us the worst of what happens when abortion isn’t accessible. Gosnell’s “clinic” was nothing short of a house of horrors, and he preyed upon women who couldn’t get abortions anywhere else or who were unfamiliar with the American medical system — poor women, immigrants, minors. Michelle Goldberg writes:

No woman would subject herself to such a place if she thought she had somewhere else to go. Forty-one-year-old Karnamaya Mongar, who died after being given an overdose of sedatives at the clinic, was a refugee who had recently arrived in the U.S. from a resettlement camp in Nepal. She couldn’t read English and may not have had any idea how to find a decent clinic. Minors went to Gosnell’s clinic—it was the one place they could skirt state law and get abortions without parental consent. Gosnell performed illegal late-term abortions on women who should have been cared for months earlier.

As Florence pointed out in a comment on the previous Gosnell post, “It also says quite a bit about how important it is to give laws teeth. The laws were in place to prevent this from happening, but despite numerous complaints the state couldn’t or didn’t intervene.”

Gosnell’s clinic hadn’t been reviewed by the Department of Health in 15 years. Members of his staff were unlicensed and not properly trained. And Gosnell knew that he could get away with offering sub-par care to women who he thought were less likely to complain — young women, immigrants, poor women and women of color. As Lori Adelman details:

As you may have witnessed, media coverage of these charges against Dr. Gosnell and nine staff members of his clinic has been rife with gruesome details like this one, which have understandably generated public reactions of horror and disgust. But buried deep in articles describing “bloodstained furniture” and ” jars packed with severed baby feet,” is a less gory but equally as horrifying insight that, at Dr. Gosnell’s clinic, “white women from the suburbs were ushered into a separate, slightly cleaner area” than Gosnell’s regular clientele, which was comprised primarily of poor minority women, including many immigrants. Gosnell reportedly treated these white suburban clients to a more pleasant and sanitary experience because he believed they were “more likely to file complaints” about substandard care.

He was right about that for a long, long time. Lori continues:

The crimes of which Gosnell is accused are exceedingly serious; he must be prosecuted for them to the fullest extent of the law. But the undeniably racialized elements of his practice reflect a need to explore the bigger picture of this story, beyond Gosnell’s presumed guilt or innocence: why Gosnell’s clinic was allowed to continue for so long, and why Dr. Gosnell’s patients, who were overwhelmingly poor minority women, had come to expect their health care needs to be met with such inadequacy that they were forced to accept Gosnell’s “care”.

Gosnell tells us quite a bit about the state of health care in the United States — and especially about abortion care. His clinic was by all accounts a disgusting, flea-infested mess. It doesn’t sound like the kind of place that women would go if they felt like they had any other options. Obviously anti-choice advocates are latching onto this story as an illustration of the horrors of abortion, even though most abortion clinics don’t look like Gosnell’s and are in fact subject to must stricter rules than other medical facilities — but there are more than a few health clinics, abortion-related or not, that are decrepit and run by incompetent practitioners. Those sub-par centers almost exclusively serve communities that are poor, of-color, immigrant, or non-English-speaking. It is absolutely a crisis.

But that’s not the story that you’re going to hear from anti-choicers and conservatives. You’ll hear “abortion is bad” without any recognition that outlawing abortion would have done absolutely nothing to help the women and babies who died or suffered in Gosnell’s care. You won’t hear about how affordable and accessible health care for everyone could have alleviated this situation, or how greater government oversight and enforcement of health care laws could have shut down Gosnell’s operation years ago. To prevent this from happening again — to stop other predatory clinics that offer a variety of health care services, not just abortion — we’d have to get into the hard stuff of recognizing the socioeconomic and racial inequalities in our current health care system. We’d have to admit that for many Americans, decent health care is inaccessible, and reproductive health care is especially poor. There’s a reason we have one of the highest infant death rates in the developed world. There’s a reason that in Washington D.C. the infant death rate is 14.1 per 1,000 live births, while in Connecticut it’s 5.5.

If we want to actually help women and babies (and men and children too), we can increase access to health care and increase government oversight of health care facilities and practices. We can give government entities greater ability to enforce existing laws, and we can push for new laws across the spectrum of consumer safety — in health care, in food regulation and in consumer goods. But those are tough, across-the-board changes. They take (yikes) taxes and government involvement. They require recognizing that we have a problem, and that the USA is not #1 where health care is concerned.

Which is to say that enacting those changes is almost certainly a pipe dream. But that would be a whole lot more life-affirming (and life-saving) than simply using the Gosnell atrocity to fall back on the same old “make abortion illegal” position in the abortion debates. Illegality doesn’t end abortion. Demonizing abortion doesn’t end abortion. Using the Gosnell case as an example of why abortion is bad doesn’t end abortion. But affordable and accessible health care, including abortion care, for everyone regardless of socioeconomic status or location or immigration status or race or English language skills? That saves lives. That decreases the abortion rate. And that’s how we make sure that women aren’t forced to accept inadequate and dangerous “care” because they have no other options.