Gosnell case not about abortion, it’s about how the desperate and disadvantaged get care

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Dr. Jen Gunter

Dr. Jennifer Gunter is a nationally and internationally renowned obstetrician/gynecologist.

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April 24th, 2013 11:42 AM

Gosnell case not about abortion, it’s about how the desperate and disadvantaged get care

Kermit Gosnell is on trial for providing grossly negligent care to many women culminating in the death of at least one. He is also accused of performing late term abortions past the point of legality. The pictures in the press look like most of his patients (or the economically disadvantaged ones anyway) were seen is what looks like a garbage dump. The story has not seen a lot of front page news and some have postulated this is because of a liberal pro-choice bias in the press.

I can’t comment on what motivates journalists, but to say that the Gosnell case is an abortion horror story and it is being ignored by a supposedly pro-choice media completely misses the point. It’s a medical horror story.

State legislators like to boast that abortion laws protect women, but laws or even legal abortion for that matter don’t prevent the unscrupulous from preying upon the disadvantaged. TRAP (targeted regulation of abortion providers) laws drive up the cost of high-quality care forcing the desperate to turn to cheaper options and charlatans. I’ve seen women maimed by legal abortion, but not because the procedure is unsafe because untrained providers in unsafe settings maim patients. If you haven’t read my post, Anatomy of an Unsafe Abortion, read it. I’ve also seen women maimed by poorly done or unindicated hysterectomies, but I don’t see any hysterectomy legislation aimed at making the procedure safer for women.

When you have no money, are afraid to ask for advice, don’t speak the language, are a victim of domestic violence, or are afraid of immigration officials (to name a few reason why a pregnant woman seeking an abortion might be medically disadvantaged) a cheaper procedure from a clinic that is flexible about providing identification and doesn’t require a contact person might seem like the only option. Well-trained providers who have done residencies and comply with the ever growing number of bizarre state laws are too expensive for many women and also require more personal information that some are able to provide.

The desperate overlook or don’t know about obvious warning signs that scream, This does not look like a safe place. How many women do you think go to their abortion alone? Abortion is so marginalized in America that having a friend or family member looking out for you is a luxury. And not everyone has a friend or family member who knows what to look out for.

However, we must not forget that bad and unsafe medical care is not an abortion-exclusive phenomenon. Didn’t we just hear about a dental shop of horrors in Oklahoma where the instruments were not sterilized, exposing potentially thousands to HIV and hepatitis? Most of those patients were economically disadvantaged. Then there was the endoscopy clinic in Las Vegas that re-used medical vials exposing patients to hepatitis C. One man died from the hepatitis C he contracted (and by the way, the news coverage has been pretty scarce). If you read enough news stories you will find plenty of accounts of bad outcomes by suspect surgeons or less than reputable surgery centers. There is also case after case of counterfeit Botox, often with disastrous and deadly outcomes.

While lack of health insurance and other economic disadvantages clearly increase the risk of bad care, even those with money are not immune. Priscilla Presley had her face injected with industrial silicone instead of cosmetic grade by an unlicensed provider.

More laws won’t prevent the Gosnells of America from taking advantage of people, just like they won’t stop plastic surgeons from buying cheap, unsafe botulinum toxin from Mexico and passing it off as the more expensive Botox. Legal abortion doesn’t guarantee safe abortion any more than legal root canals guarantees safe root canals.

I agree that we need to focus more on the Gosnell case, but not because he provided abortions. We need to talk about this case because it highlights how despite regulations providers somehow manage to game the system in state after state and that this atrocious care disproportionately affects the desperate and disadvantaged. We should also not forget that in America women who seek abortion will almost always be the most disadvantaged of all.