Philadelphia abortion provider Dr. Kermit Gosnell is accused of running a clinic straight out of the Saw horror franchise: standard practices allegedly included snipping the spines of live newborns with rusty equipment, storing feces in cat-food containers and fetus feet in jars, and overdosing patients, particularly those who were poor women of color. Make no mistake: if these charges are correct, Gosnell is a monster. But his business was able to thrive because of limited access to reproductive choice, not because of reproductive choice itself.

From the pages of the grisly grand jury report detailing the case against 72-year-old Dr. Kermit Gosnell, accused of murdering one woman and seven infants (Here's a good chronological recap from Philadelphia Weekly's Tara Murtha if you want more background):

This case is about a doctor who killed babies and endangered women. What we mean is that he regularly and illegally delivered live, viable, babies in the third trimester of pregnancy – and then murdered these newborns by severing their spinal cords with scissors. The medical practice by which he carried out this business was a filthy fraud in which he overdosed his patients with dangerous drugs, spread venereal disease among them with infected instruments, perforated their wombs and bowels – and, on at least two occasions, caused their deaths. Over the years, many people came to know that something was going on here. But no one put a stop to it.


Anti-abortion advocates, naturally, are thrilled that Gosnell is on trial. Horrified along with the rest of us, but thrilled at a chance to argue that this case illustrates how unspeakably disgusting abortion is using the most visceral evidence imaginable. "This is not about being 'pro-choice' or 'pro-life,'" Kristen Powers argues in a USA Today op-ed that seems to have drawn significant national attention to the case for the first time since Gosnell's "Women's Medical Society" was raided in early 2010. "It's about basic human rights."

But this case is all about the difference between supporting and blocking reproductive choice.




First, it's important to remember no one (besides his lawyer) is on Gosnell's side. Infanticide is illegal in all 50 states, and Pennsylvania law prohibits abortions after 24 weeks; Gosnell told the authorities that at least 10 to 20 percent of the fetuses found in his clinic were probably older than 24 weeks in gestation. Prosecutors believe Gosnell killed live babies because he wasn't giving women the correct drugs that would have terminated them in the womb. His assistants were often unlicensed and untrained. He was was not a certified obstetrician or gynecologist. No one thinks the Women's Medical Society was a shining bastion of women's health care. We all want him behind bars.

But Gosnell doesn't represent or stand for abortion care in any way. Abortion, done right, is a safe medical procedure; according to the Guttmacher Institute, fewer than 0.3% of abortion patients ever experience a complication that requires hospitalization. The Gosnell Grand Jury Indictment notes that legitimate providers like Planned Parenthood and members of the National Abortion Federation follow the law and standard medical procedures. Here's how Women's Medical Society is described in the report:

The clinic reeked of animal urine, courtesy of the cats that were allowed to roam (and defecate) freely. Furniture and blankets were stained with blood. Instruments were not properly sterilized. Disposable medical supplies were not disposed of; they were reused, over and over again. Medical equipment – such as the defibrillator, the EKG, the pulse oximeter, the blood pressure cuff – was generally broken; even when it worked, it wasn’t used. The emergency exit was padlocked shut. And scattered throughout, in cabinets, in the basement, in a freezer, in jars and bags and plastic jugs, were fetal remains. It was a baby charnel house. The people who ran this sham medical practice included no doctors other than Gosnell himself, and not even a single nurse. Two of his employees had been to medical school, but neither of them were licensed phys icians. They just pretended to be. Everyone called them “Doctor,” even though they, and Gosnell, knew they weren’t. Among the rest of the staff, there was no one with any medical licensing or relevant certification at all. But that didn’t stop them from making diagnoses, performing procedures, administering drugs.


Gosnell is not your typical abortion provider; these brave, caring people are your typical abortion providers. Women were hurt by Gosnell because he broke the laws and they had nowhere else to go. This is what happens when states restrict access to abortion: women seek out illegal and dangerous options. In Pennsylvania, there are zero abortion clinics in the hundreds of miles between Pittsburgh and Harrisburg. History proves that women will always find a way to access abortion when in need. Is this the type of experience we want them to have?

Kate Michelman, the former president of NARAL Pro-Choice America, puts it well in Huffington Post:

The answer is simple: Throughout the 1970s and 1980s, when abortion policy was established, the Commonwealth of Pennsylvania's primary goal was to overturn Roe v. Wade and, barring that, impose as many barriers as possible to limit access to abortion. By and large, our policymakers have never viewed abortion as a medical procedure - instead placing it under the Pennsylvania Crimes Code — and therefore have not nurtured a system of abortion care that is woman-focused, readily accessible, and responsive to their medical needs. The Commonwealth's focus has been on denying access, not protecting the health and safety of women who need this medical care. If the charges against Gosnell prove true, Gosnell was an outlaw who repeatedly violated numerous laws and should have been shut down years ago, but the state did not hold him accountable to its own laws and policies.


and

Evidence suggests that a number of factors influenced a woman's decision to seek care at Gosnell's clinic: Medicaid's refusal to provide insurance coverage for most abortions; the scarcity of abortion providers in Pennsylvania (and across the nation); the fear of violence perpetrated by protestors at clinics, and the right-wing culture that has so stigmatized abortion that many think it is still illegal 40 years after Roe v. Wade.


Gosnell patient Davida Johnson told the AP that she wanted to go to Planned Parenthood but the anti-abortion protesters there made her nervous. A friend suggested Gosnell instead.

Why didn't most people know about Gosnell until recently, even though both local and feminist outlets (we covered the case back in 2011; Salon's Irin Carmon has a good roundup of other outlets) were on the case? Not because of some dastardly pro-choice master plan, but because most of the women affected by Gosnell were poor women of color, and stories about marginalized women don't always make it into mainstream news. From an interview with Tina Baldwin, a 15-year-old intern at the clinic:

Like if a girl - the black population was - African population was big here. So he didn't mind you medicating your African American girls, your Indian girl, but if you had a white girl from the suburbs, oh, you better not medicate her. You better wait until he go in and talk to her first. And one day I said something to him and he was like, that's the way of the world. Huh? And he brushed it off and that was it.

Abortion providers and patients are also marginalized, which is almost surely another reason why this story flew relatively under the radar until recently. The Atlantic expands on this point:

For this isn't solely a story about babies having their heads severed, though it is that. It is also a story about a place where, according to the grand jury, women were sent to give birth into toilets; where a doctor casually spread gonorrhea and chlamydiae to unsuspecting women through the reuse of cheap, disposable instruments; an office where a 15-year-old administered anesthesia; an office where former workers admit to playing games when giving patients powerful narcotics; an office where white women were attended to by a doctor and black women were pawned off on clueless untrained staffers. Any single one of those things would itself make for a blockbuster news story. Is it even conceivable that an optometrist who attended to his white patients in a clean office while an intern took care of the black patients in a filthy room wouldn't make national headlines?


We need to talk about Gosnell — even though the charges against him are worse than nightmarish, even though the story is ammunition for antis, even though it's Friday afternoon and we'd rather be giggling over puppy photos — because this is what happens when it's next-to-impossible for women in low-income areas to get a legal abortion.