By Randall K. O’Bannon, Ph.D., NRL Director Education & Research
Editor’s note. This excellent analysis appears in the September digital edition of National Right to Life News. The entire 38-page edition can be read at www.nrlc.org/uploads/NRLNews/NRLNewsSeptember2014.pdf
By now, you’ve heard that a federal judge at the end of August struck down regulations that Texas passed in 2013 requiring that abortion clinics meet the same building standards as ambulatory surgical centers. Texas has appealed Judge Lee Yeakel’s 21-page decision and a three-judge panel of the 5th U.S. Circuit Court of Appeals has already heard oral arguments.
Abortionists have fought other aspects of Texas’ HB 2, including the provision that abortionists have admitting privileges in a local hospital.
Individually or in tandem, the abortion industry insists these common sense requirements would shut down abortion clinics all over the state. (Worth noting is they did not challenge the Pain-Capable Unborn Child Protection Act which prohibits killing unborn children who have reached the developmental milestone of being able to feel pain, which substantial medical evidence places at 20 weeks, if not earlier.)
Whether they ultimately win the legal battle against these regulations in Texas or in many of the other states where they have passed, the abortion industry is both making as much as possible of the fight and preparing to deal with the potential closure of a significant number of substandard clinics.
Strategy #1: Fight in the Courts and the Media
They have fought the regulations in the legislatures, in the courts, and in the media, of course. They have trotted out stories of women “denied” abortions, arguing that the measures, such as admitting privileges for abortionists, are unnecessary and only intended as obstacles.
Don’t expect the facts to get in their way.
This ignores an official declaration by 32 medical groups, including the American Medical Association, the American College of Obstetricians and Gynecologists, and the Association of Reproductive Medicine, that “Physicians performing office-based surgery must have admitting privileges at a nearby hospital, a transfer agreement with another physician who has admitting privileges at a nearby hospital, or maintain an emergency transfer agreement with a nearby hospital” (American College of Surgeons, “Statement on Patient Safety Principles for Office-Based Surgery Utilizing Moderate Sedation/Analgesia, Deep Sedation/Analgesia, or General Anesthesia,” April 1, 2004 at www.facs.org/about-acs/statements/46-office-based-surgery). Resisting these requirements also ignores the all too common troubling stories of abuse, injury, and death of patients that have taken place at old, cramped, and/or unsanitary clinics like those run by notorious abortionists such as Kermit Gosnell.
Some clinics did indeed shut down even before the law was scheduled to take effect. Perhaps they anticipated (and thereby avoided) the embarrassment of a state investigation exposing unsafe conditions and practices.
This surely means that, at least in the immediate future, both pregnant mothers and the babies they carry should be safer. If Gosnell showed us anything, it is that concerns about callous, irresponsible abortionists and dangers to patients are well founded.
Even if common sense prevails and these regulations ultimately endure in some form, the evidence shows us an industry that is adapting.
Strategy #2: Opening New Central Mega-Clinics That Are Up to Code
Abortion giants like Planned Parenthood may close a clinic or two here or there, but they take the opportunity to play the victim, raise funds, and build giant new code-compliant abortion megaclinics. Within months of announcing the closure of a few clinics in Texas, Planned Parenthood affiliates there announced plans to build huge new abortion performing facilities in San Antonio and Dallas with construction and refurbishing costs totaling $13 million (Mother Jones, 8/28/14).
Texas is not the only place where this is happening. When another clinic closed in Asheville, North Carolina, Planned Parenthood came along to pick up the slack. They said they would take care of abortion patients at their newly opening center and assured the public they would be compliant with new clinic regulations passed by the North Carolina legislature.
“We are going to build to that standard so that we are prepared and ready to provide care for our patients no matter what,” Melissa Reed, a spokesperson for the regional Planned Parenthood affiliate told a reporter for the Asheville Citizen Times (3/18/14).
Planned Parenthood has been building large, modern, abortion megaclinics all across the country over the past several years. Megaclinics in places like Aurora, IL, Houston, and Denver have garnered a lot of press, but there are new abortion super-centers in places like Oregon, California, Nebraska, Minnesota, Michigan, Florida, Virginia, New York and elsewhere.
Smaller centers in the area can simply drop surgical services (and the need for surgically trained abortionists, of which there is an increasing shortage) from their offerings and refer patients seeking surgical abortions to the megaclinic.  Lower level clinic personnel can continue to provide abortion pills to patients wanting chemical abortions, letting patients consult with an abortionist back at the megacenter over a webcam.
Where laws or practical limitations keep clinics from offering at least chemical abortions, the industry pushes forward nevertheless.
Strategy #3: Push Chemical Abortions
It is not coincidental that while discussions of clinic regulations and their impact on abortion availability are taking place, the New York Times would run a story on Rebecca Gomperts and “The Dawn of the Post-Clinic Abortion” (8/28/14).
Gomperts is the Dutch general-practice physician behind the so-called “Abortion Ship” that attempted to perform chemical abortions in international waters just outside the boundaries of Ireland, Poland, and Portugal in the early 2000s.
While that venture largely failed to pan out, using the publicity the stunt generated, Gomperts began telling women how they could use drugs women could readily obtain from their local pharmacies to perform their own abortions.
At first, this was through “hotlines” that Gomperts promoted in several countries where abortion was not legal. Gompert’s group, Women on Waves, told women how they could get and use misoprostol, a widely available prostaglandin that helps patients who take a lot of non-steroidal anti-inflammatory drugs avoid ulcers, to self-initiate abortions.
Eventually Gomperts decided to start a website where women in countries with laws protecting unborn children could answer a few medical questions and then order abortion drugs shipped from India. Her website, Women on Web, is only one of several places where women can order mifepristone (RU-486) or misoprostol on line.
There is already a black market in place in many parts of the U.S., and has been for a number of years, where women can get misoprostol to self-abort. Among those places, many recent news stories tell us, are border town flea markets in Texas, which many of those stories tie directly to the Texas push for abortion clinic regulations.
Lester Minto is one of the Texas abortionists getting out of the business and complaining about the new requirements. He shared with Slate magazine (11/20/13) what he tells women who came to him.
“I tell them that I know that there are other things that people do… they go over the border to Mexico and go to a pharmacy and buy misoprostol at a pharmacy. It is an ulcer drug, but it works as an abortifacient. It is not as effective [as] mifepristone, which is the on-label medicine used in the U.S. But in these ladies’ situations, misoprostol can be a good choice.”
Though misoprostol is currently legally used in conjunction with mifepristone for abortion here in America, it is not licensed separately for abortion and is only supposed to be used with a doctor’s prescription. But there are those in the pro-abortion movement now pressing for over the counter status for misoprostol and hope to make mifepristone available that way as well.
There is some resistance to such a move. Some medical professionals have argued there continues to be a need for a doctor’s direct supervision. And at least one state medical board (Iowa’s) put in place rules to end a webcam abortion program on safety concerns. Legal appeals, of course, are ongoing.
The U.S. Food and Drug Administration (FDA) has not yet given any indication that it is willing to go as far as making the abortifacients available over the counter. But who knows what it will do under the pressure of pro-abortion administration and a heavily financed campaign by the abortion lobby?
Continuing Abortion By Whatever Means Necessary
All these things taken together make the abortion industry’s strategy with regard to clinic regulations clear.
They will fight even the most common sense health and safety regulations, just as they have fought right to know and ultrasound laws that make certain vulnerable women know what abortion would do to her and her baby and know about realistic alternatives to the destructive procedure.
They will win some times and lose some times in the legislatures and in the courts, with the final outcome yet unknown. A critical part of their campaign, no matter what happens in the courts, is to try to counter the exposure of the reality abortion industry’s greedy, seamy underside with diversionary tactics
At the same time, they will be retooling the industry, shifting most of their surgical work to big, shiny, centralized, code-compliant mega-centers. They’ll try to move as many women as possible to earlier chemical abortions that can be managed at smaller satellite clinics, if possible by minimally trained (cheaper) personnel or by webcam where the abortionist is never in the same room as the pregnant woman.
The “true believers” of the movement will encourage and aid women in chemically self-aborting, obtaining pills ordered over the internet, picked up at a flea market, or, if they ultimately have their way, over the counter.
Lest anyone forget, women have died after taking these powerful abortion pills. Women have bled to death, others have contracted rare bacterial infections that seem to show up inordinately among women having drug induced abortions, while still others with undetected ectopic pregnancies have experienced deadly ruptures. And even when the mothers do survive, the whole process is still bloody, arduous, extremely painful, and dangerous.
Clinic regulations may slow them down for a while and bring some needed attention to the callous and deplorable way that the abortion industry not only treats unborn babies, but too often, their mothers. But don’t believe any of the hype about them closing their doors and giving up the cause.
 In California, which doesn’t have the same legal limits but apparently still sees a “shortage” of abortionists, the abortion industry has succeeding in allowing physician assistants, nurse practitioners, and nurse midwives to perform some first-trimester surgical abortions (NRL News Today, 5/29/13).