By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
Abortion clinics are closing all across the U.S., and the number of abortions are down. A lot of the long-time abortionists are getting older and the industry is struggling to find replacements.
Yet the number of chemical abortions performed in the U.S. continue to rise and more clinics are adding them to their offerings every year. How are all these developments connected?
Clinics close for many reasons. We’ve discussed this elsewhere, but they can close because of scandal, because new regulations expose deficiencies, because there just isn’t sufficient demand to keep it open, or because it is part of a consolidation move by two or more affiliates of a national abortion group. Planned Parenthood is the primary example of the latter—of pruning operations, cutting costs, and perhaps preparing the way for some larger regional abortion mega-clinic hub.
It may be a combination of several of those elements. Often, though, one of the significant factors is that some aging abortionist, who got into the business back in abortion’s heyday just after Roe, has simply gotten tired of riding the circuit between several clinics where he may work a day or two at a time before flying to the next town. As more and more of this generation of abortionists die or retire, the ones who remain are spread thinner and thinner, shuttling back and forth between cities, dealing with exhaustion, the infirmities of age, and the never ending parade of human misery.
The industry has long been aware of the problem and has tried to take steps to shore up their ranks in several ways. For example, nearly twenty years ago, they tried to get the nation’s official medical graduate school accreditation body to mandate abortion training as the part of any ob-gyn’s medical education, forcing those who would consider going into the obstetrical and gynecological field to bloody their hands along with the nation’s abortionists if not to join them.
That was neutralized, through, thanks to pro-life congressional watchdogs who crafted legislation to essentially nullify the new abortion training criteria. But the industry was not deterred.
Planned Parenthood initiated its own training program in New York City, while on the west coast, abortion research and training giant University of California – San Francisco (UCSF) not only bulked up their training program, but also started a national abortion training fellowship to pay for the education of abortionists at other medical schools across the country.
There have been some takers, but apparently not enough. Limited schedules (performing abortions one or two days per week) and circuit riding abortionists are still common and the industry still complains about a shortage. That is why there is a persistent effort to expand the categories of non-physicians who can perform abortions.
Just a year or so ago, California passed a measure to allow physicians assistants and nurses to perform abortions (fueled in part by a convenient study from UCSF claiming, sketchily, that complication rates for Physician Assistants and nurses were similar to those of doctors).
The connection to chemical abortions
In the midst of this push, chemical abortions came on the scene, highlighted by the September 2000 U.S. Food and Drug Administration approval of RU-486. The abortion industry’s talk was all about providing women with new, safe, simpler options (though the reality was neither safe nor simple). Insiders understood what was really involved, but few outside the industry grasped how dramatically this could change the abortion trade.
The industry fought hard to ensure that surgical training (to treat failures and complications) was not required in the FDA protocols. They kept ultrasound from being mandatory. They fought, unsuccessfully, to have the FDA drop the second visit from the three visit protocol. It was on that second visit the woman was to return to the abortionist’s office to have a prostaglandin (misoprostol) administered to stimulate powerful contractions to expel the tiny corpse of the child starved earlier by the RU-486.
But that has not stopped them. Citing off-label studies performed by the industry, they have largely ignored this requirement of the second visit, instead allowing women to vaginally self-administer the misoprostol at home. Concerns have been raised that this vaginal self administration may be linked to several of the infection deaths associated with use of these abortion drugs. Several states have passed laws requiring abortionists to follow the FDA protocol and these have been challenged in court. (See, most recently, nrlc.cc/1pTRo9X and nrlc.cc/1pTRuy7.)
They have also exploited language in the FDA protocol indicating that the drugs are to be administered “under the supervision of a physician.” Many people reading that might assume that this requires that a physician [abortionist] be present, conduct a physical exam, directly hand the pills to the patient, observe her taking them, monitor her for signs of problems, and be available to confirm her abortion or to see her if she has any problems. .
In practice, the abortion industry interprets this as only requiring that the physician somehow distantly oversee the process. It is this sort of thinking which gave birth to the “web-cam” abortion, practiced by Planned Parenthood’s large Midwestern Heartland affiliate and copied elsewhere. Typically, an abortionist in a large central facility in a big city connects by web-cam to a small, lightly staffed branch office, perhaps in a small town. After reviewing some records, chatting with the pregnant woman, the abortionist clicks a computer mouse which opens a drawer containing the abortifacient pills.
The abortionist never physically examines the patient, nor is he ever in the same room. If she has problems, she calls a hotline, where she may be referred to her local Emergency Room, however close or far that might be.
Iowa’s official medical board, seeing how fraught with danger the method is, drafted rules that would have effectively ended the practice. Predictably, the industry has fought back in the courts and the final outcome is still uncertain.
This concern has also been the impetus behind many “physician presence” laws which have been advanced in other states, requiring that the abortionist at least be in the room with the patient to whom he is administering the pills.
Beyond the impact on web-cam abortions, there are other reasons why the industry would oppose this legislation.
Under their application of the “physician supervision” mandate, the supervising physician could be one circuit-riding abortionist who is responsible for patients at several different abortion clinics. He may leave a stack of signed prescriptions in the office of each clinic (or sign orders later), but have nurses or physician assistants or perhaps even just some lightly trained assistants do the patient interviews and pass out the pills, web-cam or not.
These chemical methods change how abortions are delivered and they expose women to a whole new set of risks. (Pro-abortionists always seem to largely avoid mention of the deaths associated with chemical abortions and the thousands of “adverse” reactions.) But it is also worth noting the payoff for the abortion industry.
If one abortionist can manage the caseload at half a dozen clinics or more simultaneously, it not only cuts down on travel and time, but it also enables abortion clinics to get by with fewer abortionists and fewer medically trained other personnel. This goes a long ways towards alleviating the “shortage” of abortionists.
It also means that the industry does not need so many large abortion clinics. It may be possible that perhaps one large central mega-clinic functioning as the hub for several smaller, lightly staffed satellite offices will do. The mega-clinic with the on-site abortionist can handle most of the surgical abortions, as well as any major complications, while the satellite clinics can pass out abortion pills in the abortionist’s name.
A few smaller, older clinics will close, staffing will be reduced, and those old abortionists who don’t retire can cut back on their travel without cutting back their “caseloads” or their profits.
It explains why the industry has fought so hard against “web-cam abortion” restrictions and “physician presence” laws. It explains why chemical abortions are increasing while abortions overall are decreasing.
By 2012, overall abortions actually dropped by 13%, now at just over a million when they were 1.6 million just over twenty years before. At the same time chemical abortion increased by 20% from 2008 to 2011, from 199,000 to 239,400, now accounting for nearly a quarter (23%) of all abortions in the U.S. Why? For all the reasons explained above: convenience; the capacity to reach new “markets” (rural areas); less costly physical structures; a similar, if not higher, “caseload” for the circuit-riding abortionists who can “supervise” the abortions of many women literally hundreds of miles away, perhaps via web-cam, and the like.
This is why we can’t afford to rest on our laurels and think the battle over when we see a few clinics closing, abortionists retiring, or a drop in the abortion numbers. The abortion industry will continue to try and make the most of the resources they have left and we can do no less.
Please send your comments to firstname.lastname@example.org