Posted on 6.06.2012 by Chantal
This week I've been thinking about late term abortion* and late term providers. I went back and forth for a while about whether to join my fellow aborto-bloggers in celebrating the life and work of Dr. George Tiller, who was murdered on May 31, 2009. I'll admit that I don't remember where I was or just how I reacted to the news of Dr. Tiller's death. Although I was certainly outraged, I don't think I truly grasped the ramifications of the event until I myself became a member of the abortion providing community. Only then did I begin to understand what it meant on a deeper level. Having worked in a clinic that provides abortion services up to 21 weeks and 6 days of pregnancy (the farthest in my state), I've had a lot of time to think about second trimester abortion. I've heard the fear, the desperation, and above all the shame that so many women facing a second trimester procedure express. I've been the person who has to break the news to a woman younger than myself that she is too far along and that her next best option is a clinic hundreds of miles away. Through all of these experiences, my feelings toward second trimester abortion have been and continue to be complex. But not for the reasons you might think.
I've always been a firm believer that abortion should be available on demand with little to no restriction. And while I consider myself a staunch advocate for greater access to abortion services, I find myself consistently frustrated with the way in which access has been framed by the larger pro-choice community. As Amy alluded to in an earlier post, much of the pro-choice community has been quick to minimize the importance of late term abortion. As most of us have heard by now, the vast majority of abortions in the US, 88% in 2006, occur in the first trimester. But just because second and third trimester abortions are less frequent, doesn't mean they're any less important or in any way less worth fighting for. If we're really pro-choice, I mean, if we really really believe that abortion is one of many acceptable options for a woman faced with an undesired/unplanned pregnancy, then why is it so hard for us to say that out loud? I think we're afraid to tell the truth about late term abortion (It exists! And we support it!) because we're afraid that, if we do, somehow the antis will win. Well, guess what! They're already winning. Because we're letting them.
What comes to mind immediately when thinking about late term abortion is actually something else that's rarely mentioned: cost. In fact, cost is what I think of most when I think of any type of abortion procedure, be it at 8 weeks of pregnancy or 18. In the interest of full disclosure, I believe that abortion should be free. Or at the very least, as close to free as possible. It's the only way to begin to bridge the gaps in access, so many of which are socioeconomic in nature. For those of you who may not be familiar, first trimester abortions are expensive. Second and third trimester abortions are just absurd. According to the Guttmacher Institute, the average cost of a first trimester surgical abortion is $451. Having seen it so many times before, I'm already somewhat desensitized to that number. But then I ask myself, at any given point in the month do I have an extra $500 lying around? I wish. And then I remember the countless women I've talked to who were forced to reschedule their appointments over and over again because they could barely raise the $75 needed just to have an ultrasound. I remember the women who hadn't even thought about the cost because they were still trying to figure out how to get a ride to the clinic or who was going to watch their other children for the duration of their 4-5 hour appointment. Abortion should be free.
It's hard to even find reliable data on the average cost of abortion after the first trimester. When I first entertained the idea of writing this post, I wondered to myself, how much did Dr. Tiller charge for a second trimester procedure? Three years after his death, I haven't been able to find a clear answer. Lily directed me to an NYT article from 2009 that estimates Tiller's average fee to be about $6,000. But the author doesn't specify the cost based on gestational age.
In my experience, the few late term providers who practice in this country get away with charging pretty much whatever they want. I've heard estimates as low (relatively) as $3,000 and as high as $10,000! This is the point at which my blood starts to boil. I no way mean to minimize the important work that late term providers do. We don't have nearly enough of them and part of me understands the impulse to want to defend and sometimes even worship them. The 3-year anniversary of Dr. Tiller's murder only reminds me that people actually do give up their lives for this work. I don't for a second believe that anyone would sacrifice so much for something they don't deeply believe in.
At the same time, I feel that we should be asking more of our abortion providers, late term providers in particular. After all, for the millions of American women who are uninsured and living in poverty, the Dr. Tillers of the world might as well not exist. In fact, working in a clinic in the Northeast in a state where medicaid does not cover abortion and where most of our patients were low-income, it sometimes seemed as though there weren't any late term providers at all. I never once saw a woman who was comforted by my telling her that there's a clinic in Maryland, Nebraska, or Colorado that might be able to see her at 26 weeks for upwards of $3,000 (plus travel and lodging).
As someone who is planning a career in medicine, mainly so that I can one day provide abortions myself, I would like to believe that the act of providing abortions is in and of itself a radical act. I would like to believe this. But the more I think about it, the less it holds true. There's nothing revolutionary to me about providing a $10,000 abortion, or $6,000 one for that matter. In fact, it's almost disgusting. While I don't entirely blame doctors for charging for their services (we do live in a capitalist system in which we expect to be paid for providing a service), I think it's important to recognize that doctors and clinics do have some autonomy when it comes to setting their fees. But in a capitalist system in which an abortion clinic is first and foremost a business, there's little incentive to charge the lowest possible fee.
In the interest of clarity, what I'm asking for is free abortion. I don't mean financial assistance. I don't mean better insurance benefits. I don't mean charity. (Although, I'm generally okay with most of those things.)
In many accounts of Dr. Tiller's life, I've read about his willingness to negotiate with women in dire financial straits. As I said before, I don't claim to know what his policies were when it came to payment. I'd like to think that he wasn't the type to turn a woman away for lack of funds. Even if that were the case, he would be the exception, not the rule. Ultimately, what I'm asking for is not greater leniency for the few women who are especially good at advocating for themselves. I know for a fact that for every one of these women there are countless others who won't raise a fuss, who won't call and call, who won't demand help when they need it, who won't end up having an abortion because they can't afford to, even though they deserve to as much as anyone else.
My goal is not to demean Dr. Tiller's legacy. Like it or not, he has become a symbol for the reproductive justice movement in this country. I only hope that in the next generation we can begin to critique the way that we imagine abortion care and start to create alternative models that exist outside of a profit-driven system. It's time for the pro-choice movement to stop reacting defensively to what we don't want and start being proactive about what we do want.
*I feel like I should mention that, even though I'm not too fond of the phrase, I use "late term" abortion to refer to any abortion procedure that takes place after the first trimester of pregnancy. Simply for ease and for lack of a better phrase.