Beyond Roe

Thoughts on the Roe v. Wade anniversary, 1/22/11.

In the world before Roe, women fronted hundreds of dollars for a perfect stranger (maybe a doctor, maybe not) to terminate their pregnancies.  They risked their lives to secure such a service, never knowing if the provider had proper training, if the abortion would work, or if they would end up bleeding to death in a hotel room.  Some women entered the makeshift "procedure room" only to be raped and left behind, still pregnant and hundreds of dollars poorer.  Still others, those who could not afford even the sketchiest of abortions, took matters into their own hands, ingesting toxic chemicals and using sharp metal instruments such as the now-emblematic coat hanger.  In some areas, groups like the Jane Collective and Judson Memorial Church helped to link women with legitimate (albeit illegal) providers who were known to be safe.  Women who could work it out traveled to Chicago and New York City, respectively, to utilize such services.

The attacks on legal abortion started almost immediately after the procedure was legalized nationwide in 1973, and these attacks continue today.  While we fight with everything we have to preserve Roe, we mustn't forget that the Supreme Court ruling itself never really guaranteed the most important detail: access.

Today, lower income women occupy a complex place: while they are statistically less likely to have access to contraception and are therefore more likely to experience an unintended pregnancy, legislative barriers such as the 1977 Hyde Amendment mean that their access to abortion is severely diminished.  While Medicaid will front the $8000+ bill for basic prenatal care and hospital birth costs, our medical system remains unwilling to offer women the several hundred dollars for an abortion.  These restrictions are upheld by "fiscal conservatives" who ramble on about lower-income women, predominately women of color, being a "drain on society" while simultaneously restricting key prevention options.  Anti-choice groups, inseparable from their "fiscal conservative" friends, claim abortion clinics target women of color specifically as part of some sort of eugenics conspiracy, all the while doing nothing to increase reproductive autonomy in lower-income communities.

Congress reaffirmed the federal ban on abortion funding in last year's "Patient Protection and Affordable Care Act," which, if repealed, will be replaced by even stricter guidelines on abortion coverage.  This does not, of course, curb the rates of abortion in America.  Women will sacrifice groceries, electricity, even rent money to save up for an abortion, and the more time this takes, the more invasive and expensive the procedure will become; reproductive rights advocates refer to this as "chasing the fee."

It's not just financial barriers that limit accessibility.  According to NARAL Pro-Choice America, 87% of U.S. counties currently lack an abortion provider, and with good reason: why would a doctor want to provide a service that could very well lead to attacks by violent anti-choice groups? 88% of US-based abortion clinics have reported at least one form of harassment by anti-choice forces, and nearly one in five clinics has received at least one bomb threat.  And with more restrictive legislative barriers being passed each year, it's no wonder so many clinics are forced to close their doors forever.  Some states, such as North Dakota or Nebraska, have only one or two clinics serving the entire region.  These clinics are generally over-booked, under-funded, and under-staffed, placing very unfortunate compromises on the quality of individual care that a woman may receive.  Many women who have had abortions in these areas compare it to being moved through an assembly line.  Women who must travel great lengths to secure an abortion appointment must take more time off from work and possibly pay high childcare bills for the kids they already have.

There is, then, a whole class of women who will not be able to secure a legal abortion at all, even though they technically have the legal right to do so.  For these women, it's like Roe never happened.  Many procure misoprostol, a drug which, when taken with mifeprex, can terminate an early pregnancy safely, provided the woman is under the care of a physician.  Taken alone and without the supervision of a medical care provider, however, the results can be devastating. 

Still others will not induce abortions with pills received from sketchy international pharmacies.  Some women will indeed find a surgical abortion provider for cheap.  However, if not properly informed they could end up in the hands of someone like Dr. Kermit Gosnell, a man who was recently charged with murder for the deaths of one woman and seven newborn babies at a rogue "clinic" in West Philadelphia.  Gosnell was in fact not a licensed abortion provider, and the stories coming from his now-closed "clinic" are horrific.  Still, women went to him.  And why wouldn't they?  Gosnell was the cheapest game in town, located right in the neighborhood for many lower-income women who needed an affordable abortion.  Indeed, the Gosnell case is a stark reminder that, for many women, the days of back-alley butcheries are for from behind us.

If abortion services were not so stigmatized, if the procedure itself was not so mystified and fraught with silence and shame, and if financial and geographical access were not so profoundly limited, no one would ever visit a place like Gosnell's back-alley butchery.  We cannot simply shun the Gosnell case, recount statistics about the safety practices of licensed abortion facilities, and parade around with images of nicely done-up clinics where private-pay clients receive decent care.  Not, at least, without asking ourselves why Gosnell was in business in the first place.  Monster or not, Gosnell was providing a service that many women obviously needed, and it is up to every one of us to work beyond the limits of Roe to ensure, for each and every woman and girl, complete autonomy over our bodies, our sexualities, and our lives.