This post is the first of a two-part discussion on how abortion services are provided in the United States and how that model might be improved.
The right of abortion in the United States is a 'negative' right: A government's power to prevent a woman from obtaining an abortion is limited. Put another way, the right of abortion in the United States is a right of government non-interference.
It is not, however, a right to abortion: Governments are not required to help women obtain abortions, only stay out of the way. It falls on individual women, civic groups, and the market to determine how easy or difficult it is for women in practice to access abortion services.
Since Roe v. Wade in 1973, pro-choice activists, journalists, and scholars have noted that abortion access has been spotty, in particular for poor women and women who live in rural areas. A long-standing topic of discussion in the pro-choice community is how to improve access.
In recent years one much-discussed solution-- in the U.S., Europe, and third world countries-- has been the provision of "medical" abortions-- abortions that occur after taking one or more drugs that induce miscarriage. Planned Parenthood, for example, has been attempting to provide medical abortion drugs remotely to women in rural areas: The patient goes to a local medical center and talks to a medical professional remotely via a video conference call; the medical professional then pushes a button and a drawer with the appropriate abortion drugs opens for the patient. The woman takes the drugs and the abortion occurs at home.
More recently, a group of doctors and researchers has been discussing moving the provision of "surgical" abortions (vacuum aspiration, etc.) out of abortion clinics and into private doctor's offices.
The United States is unusual in that most abortion services are provided through free-standing clinics rather than in hospitals or doctor's offices. The American clinic model evolved in the early 1970s for a couple of reasons.
First, in states that legalized abortion before Roe v. Wade, like New York, there was a tremendous demand for legal abortions and hospitals were seen as incapable and/or unwilling to meet the needs of women. Clinics were created as the best means to handle all of the requests for abortions.
Second, hospitals were not seen by pro-choice activists as good partners for providing abortion services. In the era before Roe, when some states adopted more liberal abortion laws-- but not abortion on demand-- many hospitals created panels or boards whose responsibility was to determine which requests for abortions were to be approved or denied. These boards were often frustrating obstacles for women wishing to obtain an abortion, as many were a) cautious about approving abortions that might run afoul of the law, b) cautious about approving too many abortions, and c) seen as insensitive to the needs and interests of pregnant women.
Third, in many areas, hospitals are going to be hostile to providing abortion services regardless of its legality. No change in the law, for example, is going to compel a Catholic hospital to provide abortions.
Advocates for access to safe, legal abortions, therefore, turned to a system of clinics that would a) ensure the provision of services in a given area, b) meet demand, c) make the process easier, and d) provide abortion services in a way that was woman-centered and sensitive to the needs of pregnant women.
The clinic model has had several unintended consequences.
First, clinics have been seen by pro-life groups as existing 'only' for abortion, and, especially when an abortion clinic is a for-profit corporation-- as some are-- they are seen as abortion 'mills,' existing solely to make a buck off of exploiting vulnerable women.
Second, clinics are magnets for pro-life activism. It is easier to protest or blockade a clinic than a general practice office or a hospital, because the focus can be on that one office and its primary service.
Third, even when a clinic provides many services for women-- as Planned Parenthood clinics do, for example-- all women who enter the clinic are seen as there for abortions-- especially as pro-life activists figure out on what days of the week abortions are provided. Those women are then targeted by pro-life activists. This makes the experience of women seeking an abortion much more difficult and traumatic.
Fourth, doctors who perform abortion services at free-standing clinics are more easily identified and targeted for pro-life activism.
So that is the state of things. In part II on this topic, I'll discuss plans by doctors, scholars, and activists to lay the groundwork for an alternative to the clinic model.
The right of abortion in the United States is a 'negative' right: A government's power to prevent a woman from obtaining an abortion is limited. Put another way, the right of abortion in the United States is a right of government non-interference.
It is not, however, a right to abortion: Governments are not required to help women obtain abortions, only stay out of the way. It falls on individual women, civic groups, and the market to determine how easy or difficult it is for women in practice to access abortion services.
Since Roe v. Wade in 1973, pro-choice activists, journalists, and scholars have noted that abortion access has been spotty, in particular for poor women and women who live in rural areas. A long-standing topic of discussion in the pro-choice community is how to improve access.
In recent years one much-discussed solution-- in the U.S., Europe, and third world countries-- has been the provision of "medical" abortions-- abortions that occur after taking one or more drugs that induce miscarriage. Planned Parenthood, for example, has been attempting to provide medical abortion drugs remotely to women in rural areas: The patient goes to a local medical center and talks to a medical professional remotely via a video conference call; the medical professional then pushes a button and a drawer with the appropriate abortion drugs opens for the patient. The woman takes the drugs and the abortion occurs at home.
More recently, a group of doctors and researchers has been discussing moving the provision of "surgical" abortions (vacuum aspiration, etc.) out of abortion clinics and into private doctor's offices.
The United States is unusual in that most abortion services are provided through free-standing clinics rather than in hospitals or doctor's offices. The American clinic model evolved in the early 1970s for a couple of reasons.
First, in states that legalized abortion before Roe v. Wade, like New York, there was a tremendous demand for legal abortions and hospitals were seen as incapable and/or unwilling to meet the needs of women. Clinics were created as the best means to handle all of the requests for abortions.
Second, hospitals were not seen by pro-choice activists as good partners for providing abortion services. In the era before Roe, when some states adopted more liberal abortion laws-- but not abortion on demand-- many hospitals created panels or boards whose responsibility was to determine which requests for abortions were to be approved or denied. These boards were often frustrating obstacles for women wishing to obtain an abortion, as many were a) cautious about approving abortions that might run afoul of the law, b) cautious about approving too many abortions, and c) seen as insensitive to the needs and interests of pregnant women.
Third, in many areas, hospitals are going to be hostile to providing abortion services regardless of its legality. No change in the law, for example, is going to compel a Catholic hospital to provide abortions.
Advocates for access to safe, legal abortions, therefore, turned to a system of clinics that would a) ensure the provision of services in a given area, b) meet demand, c) make the process easier, and d) provide abortion services in a way that was woman-centered and sensitive to the needs of pregnant women.
The clinic model has had several unintended consequences.
First, clinics have been seen by pro-life groups as existing 'only' for abortion, and, especially when an abortion clinic is a for-profit corporation-- as some are-- they are seen as abortion 'mills,' existing solely to make a buck off of exploiting vulnerable women.
Second, clinics are magnets for pro-life activism. It is easier to protest or blockade a clinic than a general practice office or a hospital, because the focus can be on that one office and its primary service.
Third, even when a clinic provides many services for women-- as Planned Parenthood clinics do, for example-- all women who enter the clinic are seen as there for abortions-- especially as pro-life activists figure out on what days of the week abortions are provided. Those women are then targeted by pro-life activists. This makes the experience of women seeking an abortion much more difficult and traumatic.
Fourth, doctors who perform abortion services at free-standing clinics are more easily identified and targeted for pro-life activism.
So that is the state of things. In part II on this topic, I'll discuss plans by doctors, scholars, and activists to lay the groundwork for an alternative to the clinic model.
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