By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
Editor’s note. We’re re-running this post from last year to supplement a new post written today about “independent” abortion clinics. No doubt there have been some changes, beginning with abortion clinic closures, independent or PPFA-affiliated. But what Dr. O’Bannon’s spoke of in his October 2017 article surely reflects a reality still largely present today.
When it comes to abortion clinics, the big name has always been Planned Parenthood, easily the nation’s largest abortion chain, performing 35% of all abortions in the United States. But that still leaves about two thirds of abortions unaccounted for. Who are those other guys who snuff out the lives of hundreds of thousands of babies each year?
Tired of being in Planned Parenthood’s long shadow and obviously not entirely happy that they don’t have the slick marketing or the big budget of the abortion giant, several of the nation’s self-identified “independent abortion clinics” (they call themselves “indies”) have joined together as the “Abortion Care Network” to issue a report on their work titled “Communities Need Clinics: The Role of Independent Abortion Care Providers in Ensuring Meaningful Access to Abortion Care in the United States.”
That report can be found here.
According to the report, “independent abortion care providers” comprise 25% of the abortion facilities in the country but perform 60% of the abortions in the U.S. (Besides the 35% performed by Planned Parenthood, the report says 4% are performed in hospitals and 1% in physician’s offices.) Another way of saying it, they want us to know that “3 in 5 people who have an abortion get care from independent abortion care providers.”
Performing the bulk of America’s later abortions
There is not a whole lot more in the way of statistics. The bulk of the report is devoted to arguing why the “indies” are so important and ought to be appreciated and funded rather than regulated or closed. The authors take pains to point out that “The majority of clinics providing abortion care at every stage of pregnancy are independent abortion clinics.”
What this turn of phrase “at every stage of pregnancy” means is made clear by an accompanying chart. The chart shows that more than half of the abortions performed at 10 weeks gestation or more are performed at the independent clinics. That figure jumps to 68% for abortions 10-16 weeks, 76% for those at 16-19 weeks, 87% of those at 19-22 weeks, and 96% of those at 23 weeks or more. 
In other words, they want to clarify that they are the ones doing the later abortions that your standard Planned Parenthood abortion clinic doesn’t typically do.
There were over a hundred Planned Parenthood clinics doing abortions at 14 weeks or more as recently as 2013, as well as more than a dozen performing abortions at 20 weeks at that time. But that still leaves quite a few others that PPFA does not abort.
Absent the independent clinics, authors of the report say, “access to abortion in a clinic setting after 16 weeks gestation would be diminished by 76 percent, and access after 19 weeks would be nearly non-existent.”
They want more money, funding, insurance coverage
One of the report’s many complaints is that state funding limits keep them from being adequately reimbursed, particularly when it comes to later abortions.
The authors are upset that federal funds can only be used in cases of rape or life endangerment and that 33 different states prohibit state Medicaid funds from covering abortion except in those circumstances. To make things worse, they point out that half the states ban abortion coverage in their Affordable Care Act (ObamaCare) Marketplace plans.
Even in the 15 states that do allow state Medicaid money to cover abortion costs (two other states, Arizona and Illinois, the authors say, legally could, but don’t), “reimbursement rates are low and often do not come close to covering the actual cost of care.”
This is particularly problematic for them when it comes to later abortions:
…there’s a significant disparity in reimbursement amounts between first and second trimester abortion care. While abortion costs increase with gestational age, the reimbursement rates in many states do not increase accordingly, covering significantly less of the cost of second trimester abortion as compared with a first trimester abortion.
They label these insurance reimbursement rates “unjust,” alleging these are just one of the factors making it “nearly impossible” to keep clinic doors open.
Covering States and Patients Planned Parenthood Doesn’t
Authors are determined to make the case that the independent abortion clinic is sometimes the only abortion clinic in the state. This is the case in Kentucky, Mississippi, North Dakota, West Virginia and Wyoming.
In four other states – Arkansas, Oklahoma, Georgia, and Nevada – they are the only ones performing surgical abortions. “Without independent providers,” says the report, “abortion access in those four states would be limited to medication [chemical] abortion within the first 10 weeks of pregnancy.”
The authors also want to make sure the reader realizes what a noble sacrifice this is. These abortionists, they say, endure hostility and face “politically-motivated, medically unnecessary barriers to accessing care.”
“Taking up the Slack”
With the national drop off in pregnancy and abortion rates, the report says that women still seeking abortions are more likely to younger, poorer, and “women of color.” So “independent abortion care providers remain critical when it comes to providing care for those with the fewest resources.”
They also take up the slack from hospitals with regard to abortions after the first trimester. Hospitals “primarily focus of patients with more complex medical needs” when it comes to those later abortions. In other words, the “indies” are the ones, by and large, covering the elective second trimester or later abortions where there is no medical issue involved.
The authors mention again their displeasure that Medicaid or private insurance does not cover these. They characterize this as unreimbursed “care,” ignoring that these are the sort of elective, not health-related procedures, that insurers typically do not cover.
Many clinics are closing
The report notes that 56 independent abortion clinics have closed in just the past two years, 80% of which performed second trimester abortions or later. As a consequence, the authors say, “abortion care becomes increasingly difficult to access as pregnancy progresses.”
Falling in line with a lot of previous abortion industry propaganda, the report tries to claim that a major culprit in these closures is a recent flurry of “TRAP” laws – the Targeted Regulation of Abortion Providers. These laws “place burdensome requirements on abortion care providers – including medically unnecessary building codes and impossible to meet admitting privileges for doctors.”
Texas, as always, is the prime example, critical to abortion supporters. It was the admitting privileges and safety regulations portions of a 2013 Texas law the Supreme Court overturned in its 2016 Whole Woman’s Health v. Hellerstedt decision.
The majority prevailed in that decision, to a large degree, by arguing that the increased travel distances resulting from closed clinics were too burdensome for women in certain parts of Texas.
As we at National Right to Life have pointed out, and at least one justice noted in his dissent, clinics in Texas, like many in the rest of the country, closed for many reasons, several before the Texas law passed or took effect [see here and here].
But the truth is abortionists get old and retire, or exit in scandal, with no one left to replace them. Inspections close a clinic, or the clinic gets so old that it isn’t worth renovating. Consolidation occurs, with business going to a new regional megaclinic.
However the biggest factor, to which the authors only briefly allude, is that demand for abortion is down and there simply aren’t enough abortion patients to sustain the business.
This helps explain why, of the 20 clinics the report says closed in Texas after the passage of the clinic regulations law, only two had reopened as of July 2017.
The Impetus for Pro-Life Legislation
The authors want to attribute the rash of clinic closings to a surge in “anti-abortion legislation” starting in 2010. Two things are worth noting about that date.
First, a lot of pro-life legislation was passed in the preceding decades– parental involvement laws, waiting periods, informed consent or right to know legislation, and a national partial-birth abortion ban, to name a few. Funding limits were also passed, including a law in Texas that pulled state family planning money from abortion clinics in 2011, years before the laws the Supreme Court considered in Hellerstedt.
Second, abortion advocates don’t like to talk about what it was in 2010 that spurred all the clinic regulations – the raid of Kenneth Gosnell’s abortuary in February of 2010. That police raid unearthed appalling unsanitary conditions and horrific patient abuses not to mention hundreds of nearly full-term babies the Grand Jury report says Gosnell delivered alive and then killed. The more it heard, the more the public wanted to make sure that similar abuses could not occur in their states.
That the abortion industry itself failed to police Gosnell’s clinic or expose his abuses made arguments that such laws were “unnecessary” – repeated here – fall on deaf ears.
What the report doesn’t tell you
The authors give the impression that they are speaking out on behalf of a few small operators, valiant public servants just trying to help people and somehow make ends meet. There may be some smaller operations among the three hundred or so independent clinics they represent, but there are also quite a few high volume enterprises in the mix.
There were 926,190 abortions performed in the U.S. in 2014. Of these were about 324,000 were performed at Planned Parenthood. That leaves about six hundred thousand to be performed by other abortionists.
If this report’s 60% figure is correct, that would mean about 555,714 abortions were performed by the 450-470 independent operators the authors say were in existence in 2014.
For 460 clinics, this works out to a caseload of 1,208 per clinic.
Some will do fewer, some will do a lot more. According to previous reports by the Guttmacher Institute for 2008 and 2011, although they represented only 20% of the total providers for that year, “providers” with caseloads of 1,000 to 4,999 accounted for about 64%-65% of those abortions.
And operations with caseloads of 5,000 or more, while only representing 1%-2% of all “providers,” nevertheless accounted for 17% and 13% of abortions for 2008 and 2011, respectively.
The loss of just 36 of the clinics with a volume of 1,000 to 4,999 abortions, and 11 clinics with a caseload of 5,000 or more, appears to have been associated with a drop of 154,440 abortions from 2008 to 2011. That would account for virtually the entire decline from 1,212,400 abortions in 2008 to 1,058,500 abortions in 2011.
Corollaries between caseloads and abortion performed are not yet available for 2014. But the loss since 2011 of 64 clinics with a caseload of 1,000 to 4,999 along with another closure of one clinic with a caseload of 5,000+abortions, are very likely to have constituted the major part of the additional drop of 132,310 abortions recorded from 2011 to 2014.
Who are these “other guys?”
Planned Parenthood megaclinics were some of the major players for sure, but by no means all. Whole Woman’s Health has not only clinics in Texas (Ft Worth, Austin, McAllen and San Antonio), but also in Peoria, Illinois, Minneapolis, Minnesota, and Baltimore. Maryland.
The Women’s Centers has clinics in Atlanta, Cherry Hill, NJ, Philadelphia, Hartford, CT, and Chester, PA.
Dr. Willie Parker is the independent abortionist who performs about 40 abortions a week at the only abortion clinic left in Mississippi, the Jackson Women’s Health Organization (Daily Mail, 10/4/17). If he works fifty weeks a year, he would be performing about 2,000 abortions annually.
Merle Hoffman runs the for-profit Choices Women’s Medical Center in Queens, New York and would qualify as an “independent abortion care provider.” Her precise volume is unknown (her clinic is said to see about 50,000 a year, but not all are abortion patients), but she is known locally as a “Millionaire Abortionist.” In 2016, her clinic saw revenues of about $10 million.
Illustrating both that abuses didn’t stop with Gosnell and that clinics close for reasons other than oppressive clinic regulations, notorious late term abortionist James Pendergraft IV, owner and operator of four independent abortion clinics in Florida was arrested in South Carolina in October of 2015 on drug charges. His clinics closed and he is to stand trial this coming November.
There are many more, but this is enough to see that the field of “independent abortion clinics” isn’t populated by saintly, small time community do-gooders but includes enterprises that perform thousands and thousands of abortions annual.
The Problem is not the image but what is done
The industry still believes that if it their independent abortionists can just get the respect that they deserve, if they can be seen as heroes helping underprivileged women, if they can just get rid of those pesky clinic safety regulations, and if they can get more states to fund their work and more insurance companies to cover their services, they’ll be able to stay in business.
What they fail to see, however, is that the problem isn’t their image, but what they do and to whom. They are not solving women’s problems, just killing their babies and wanting someone to pay for it They are not noble “health care professionals,” but hired assassins, killing, not curing.
 “Gestation” here is measured in terms of weeks since a woman’s last menstrual period, or “LMP.” The baby would be about two weeks younger.