Published in 1996 by the Duvall Project
When abortion was legalized in 1973 with the landmark decision of Roe vs. Wade, the majority of abortion providers, 81 percent, were hospitals. Since then, the number of hospitals that perform abortions has steadily declined. According to the Alan Guttmacher Institute, only 36 percent of hospitals provided abortion services in 1992. Shortly after Roe, many states required that abortions be performed in hospitals. As the safety and simplicity of the procedure was better understood and as advocates for women lobbied, legislators changed state laws to permit abortion procedures in doctors' offices and clinics.
In 1975, the first year the state of Pennsylvania collected abortion data, 33 counties reported more than 5 abortions, and hospitals in all but two of those counties performed abortions. By 1994, abortions were performed in only 20 counties and were available to women without a prior relationship with a physician in only 10 counties. The number of hospital abortions is no longer published, but is estimated to be extremely low—around seven percent.
A 1995 survey by the Clara Bell Duvall Project reveals an even more precipitous decline in the number of hospitals in Pennsylvania that allow abortions to be performed. In conducting the survey, Duvall contacted Pennsylvania's 154 hospitals with OB/GYN services. Out of the 118 that responded, only eight replied that their facility performs induced abortions; 98 hospitals stated they do not allow induced abortions. The remaining 12 hospitals reported that private physicians had the option of performing induced abortions. When asked about their policy toward abortions in emergency situations, an alarming number, 27 percent, stated that their hospital does not perform abortions even in an emergency.
Eighteen of the hospitals that responded to the survey were run by the Catholic Church. Although Catholic hospitals do not allow induced abortions, three stated they would provide abortions in emergency situations, five were unsure, and one leaves it to the discretion of the physician. Just over half of the non-Catholic hospitals reported that they would provide emergency abortions.
Today, well over 90 percent of all abortions in the U.S. are performed in clinics and private physicians' offices. The increase can be attributed to the rise of free-standing clinics that provide less expensive services.
Hospitals are essential for providing safe medical care for women who have special health concerns such as diabetes, heart conditions and HIV. In complicated cases, women may need overnight care and emergency equipment that are unavailable at clinics.
Hospitals are also an important resource for women who receive Medicaid funds for their abortions. A woman in Pennsylvania who is qualified to receive Medicaid can obtain a Medicaid-funded abortion in the case of rape, incest or when her life is in jeopardy. In such devastating situations, hospitals accept Medicaid coverage, unlike most clinics.
Abortions performed in hospitals help to educate medical residents by providing the necessary training for safe, quality care. In 1993 in Pennsylvania, only nine percent of residency programs in obstetrics and gynecology required training in first and second trimester abortions. While abortion is the most frequently performed gynecological procedure in the U.S., few OB/GYN residents must demonstrate competence in the procedure to graduate from their residency programs.
Abortions that are performed in hospitals protect the privacy and safety of both women and their physicians. Harassment by anti-choice demonstrators is a serious and well–founded concern for women seeking abortion services. When abortions are performed in hospitals, it is difficult for anti-choice protestors to identify potential targets.
Many women in rural areas rely on hospitals as their primary source of medical care. Consequently, without a hospital that performs abortions, women must travel to free-standing clinics that are generally concentrated in and around urban environments. Nationally, 84 percent of rural counties have no abortion provider. With its large rural population, Pennsylvania reflects this trend. Since 1975 women from every county in Pennsylvania have had abortions, but the number of counties with abortion services has steadily declined. Because services are sparse, women seeking abortions in Pennsylvania face many obstacles. As a result, some women must delay their abortions, which greatly increases health risks.
Among Pennsylvania's 67 counties, only 10 currently have "accessible abortion services," where a woman who does not have a prior relationship with a physician can call and schedule an abortion (see figure 3). The facilities that offer "accessible abortions" are concentrated in metropolitan areas. This is an alarming reversal from the early days of legalized abortion when 33 of Pennsylvania's counties had abortion services with hospital abortions provided in 31 of those counties.
According to the recorded trends kept by the Pennsylvania State Health Department, approximately 90,000 women in Pennsylvania will become pregnant unintentionally in 1997. Approximately half of these women will probably decide to have abortions. For women in the 57 counties in Pennsylvania without abortion providers, an already complex decision will be even more difficult (see figure 4). Every county in Pennsylvania has a hospital with physicians who could perform abortions. When hospitals fail to provide women with comprehensive health care services, they are restricting a woman's legal right to a safe abortion and threatening her health and well-being.
Related Links
Sources
Commonwealth of Pennsylvania State Health Data Center, 1976-1994.
"Hospitals Abdicate on Abortions," The New York Times, February 27, 1995.
"Factors Hindering Access to Abortion Services," Stanley K. Henshaw, Family Planning Perspectives, March/April 1995.
Shortage of Physicians Trained and Willing to Perform Abortions, Duvall Education Fund, 1994.
Who Will Provide Abortions? National Abortion Federation, 1991.
Wendy Brandes and Amy Surak, working with the Duvall Project, researched and wrote this fact sheet.
Research and production of this fact sheet were supported by individual contributors and grants from the Allen Hilles Fund, Claneil Foundation, Education Foundation of America, Laurel Foundation, Philadelphia Foundation, Samuel S. Fels Fund, Valentine Foundation, the William T. Hillman Foundation, and the Womens Way Discretionary Fund.
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