The XX Factor

Why Did Women Go to Kermit Gosnell Instead of Reputable Abortion Providers?

Poverty and intimidation drove women to Kermit Gosnell’s allegedly macabre practice

Photo by Alex Wong/Getty Images

The allegedly murderous abortion doctor Kermit Gosnell, who was operating illegally in Philadelphia, has been on trial since mid-March for killing seven babies and one woman in his clinic, which has rightly been described as a house of horrors. (I covered the case here at XX Factor when it first broke two years ago.) The case, which has been going on for weeks now, received a flurry of media attention late last week and over the weekend, driven by a conservative press eager to use the existence of a clinic offering illegal abortions to score points against supporters of legal abortion by dishonestly conflating the two

The trial has made it clear that the prosecution has a strong case against Gosnell. He appears to have run an operation staffed by people with no real medical training and to have told women they weren’t as far along as they were so that he could lure them into delivering live babies, which he then killed with scissors to the neck. We’ll leave it to the true crime writers in the years to come to make sense of his motivations. The question we have to grapple with right now is why patients were willing to go into a clinic that feminist journalist Tara Murtha of Philadelphia Weekly describes as a hellhole: “Blood was splattered all over the dirty floor. It stank of urine, cat feces and the fetid turtle tank kept in the waiting room.” Why go to Gosnell when Philadelphia has other reputable clinics that offer quality care?

The reason is simple: poverty, plus lack of access due to anti-choice activism. One of Gosnell’s patient-victims told reporters that she had scheduled an abortion at Planned Parenthood but balked when she approached the clinic: “The picketers out there, they just scared me half to death.” Gosnell didn’t pay real nurses, have real equipment, or bother with the expense of cleaning up very much, making it easy for him to undercut the prices of reputable providers, as Carole Joffe reported for RH Reality Check in 2011.

As numerous abortion clinic managers have told me over the years, for very poor women—who are way over-represented among abortion patients—differences of even five or ten dollars can be the deciding factor of where to go. The price list at Women’s Medical Society, listed in the Grand jury report, shows that in 2005, a first trimester procedure was $330.00, while the average price nationally then was about one hundred dollars higher. For a 23-24 week procedure, Gosnell charged $1,625.00, while the relatively few other facilities in the Northeast offering such abortions would have charged at least one thousand more.

In addition, Gosnell is alleged to have done abortions much later than legal providers will do under circumstances that don’t threaten the mother’s health or indicate a problem with fetal development. Poor women are far more likely to seek later abortions, because it takes so much time to save the money to get an abortion. 

Jeff Deeney, a social worker in Philadelphia, published a piece in the Atlantic Monday morning about the kinds of women that Gosnell exploited: women who needed abortions to escape poverty but didn’t have the money to afford them. He described one young woman he counseled, who was on food stamps, TANF, and WIC—and who knew that carrying another baby to term would ruin her plans to complete her education and secure a real middle-class job:

What’s worse is that the cost of the abortion, $300, would break Ashley’s budget. There was no such thing as an extra $300 in Ashley’s world. If she was going to go through with it, could she raise the money, and could she do it in time? I was concerned that if she paid for the abortion she would get behind on rent, and wind up back on the streets. If welfare medical assistance provided funds for women to have abortions, she could have very quickly and safely had the procedure done. Instead, the clock was quickly ticking as she explored every avenue for getting the money together. The longer it ticked, the more expensive the procedure would become, until ultimately it would become illegal and she would have to bring the baby to term. Or, if she was that desperate, she might have turned to Kermit Gosnell, who allegedly exploited exactly this scenario of poor women past the term limit for a legal abortion, maybe because while they were struggling to get the money together for it the clock ticked too long, maybe because they were ignorant of other, better resources for the service.”

What makes this all so frustrating is that it would be easy enough to prevent. If there was no Hyde Amendment blocking women from using Medicaid to fund abortions, they could get timely, safe abortions and not resort to desperate measures. If low-income women had better access to contraception, it would reduce the need for abortion. Unfortunately, the trend lines are running in the opposite direction, with safe abortion clinics disappearing under a flurry of irrelevant regulations aimed at depriving women of safe care rather than ensuring health and safety standards. (Pro-choicers support relevant regulations, as I explain here.) Unintended pregnancy rates are going up for low-income women, a trend that could get worse in states where Republicans are trying to slash contraception subsidies. This means the demand for abortion for those who can least afford it is going up, too, making it all the more lucrative for men like Gosnell to offer black-market abortions that don’t meet any of the legal standards for safe medical care. The government has nabbed this particular butcher, but nothing is being done to prevent future Gosnells from exploiting poor women’s inability to get safe, legal abortions.