The conviction of Kermit Gosnell on three counts of first degree murder, one count of involuntary manslaughter, and hundreds of lesser charges should make it very clear that the horrors he committed in his squalid West Philadelphia clinic were illegal. This should be crushingly obvious, but it’s been ignored by the right-wing pundits who have tried to turn this deeply disturbing case into an argument against legal abortion.
This has always been a story about illegal abortion, a phrase that appears over and over in the Gosnell Grand Jury report. It’s about what women will subject themselves to when they see no other option for ending an unwanted pregnancy. It’s about the appalling lack of health care for poor women in this country, especially when it comes to abortion, which, thanks to the Hyde Amendment, isn’t covered by Medicaid. It’s about murdered babies from pregnancies that never should have gone as far as they did.
The Grand Jury report is clear about why women went to his grotesque facility, a place with bloodstained furniture that reeked of cat urine. Gosnell performed abortions on minors who felt they couldn’t get parental consent and on those who didn’t want to comply with Pennsylvania’s 24-hour-waiting period. “Too young? No problem. Didn’t want to wait? Gosnell provided same-day service,” the report says. He preyed on poor women who were willing to accept terrible treatment because they couldn’t afford anything better. “He treated his patients with condescension—slapping them, providing abysmal care, and often refusing even to see or talk to them—unless they were Caucasian, or had money,” says the report.
And, of course, Gosnell did illegal late-term abortions. “The real key to the business model, though, was this: Gosnell catered to the women who couldn’t get abortions elsewhere— because they were too pregnant,” the Grand Jury report says. “Most doctors won’t perform late second-trimester abortions, from approximately the 20th week of pregnancy, because of the risks involved. And late-term abortions after the 24th week of pregnancy are flatly illegal. But for Dr. Gosnell, they were an opportunity.”
All of this raises the question: Why did women go to him? The daughter of Karnamaya Mongar, the 41-year-old grandmother whom Gosnell has been convicted of killing, testified that she’d been turned away from two abortion clinics in Virginia, where she lived, as well as one in Washington, D.C., because none of them did second trimester abortions. She was 15 weeks pregnant when she started seeking an abortion, and 19 weeks by the time she died. Someone with more social capital would have known how to find a decent clinic, but Mongar had just arrived in the United States after 20 years in a Nepalese refugee camp. It is women like her who suffer most from the barriers to safe procedures that the anti-abortion movement is forever throwing up.
Less is known about the mothers of the babies Gosnell has now been convicted of murdering. We know that the mother of Baby Boy A, who was born alive at around 30 weeks—well past the point of viability, as well as the point where he could experience pain—was 17 years old. Young women are significantly more likely to seek late abortions than older women, both because it takes them longer to recognize or admit that they’re pregnant, and because they are more likely to be waylaid by logistical hurdles. Diana Foster Greene, an associate professor at the University of California, San Francisco, is a co-author of a forthcoming paper looking at 200 women across the United States who had abortions after 20 weeks. These women were twice as likely as those seeking first trimester abortions to be under 25. “If you’re young, or you didn’t realize you were pregnant, and you lack money, it can really slow you down,” she says. Indeed, two thirds of the women in her study were delayed while they tried to raise money to pay for their abortions.
To be clear, I am not arguing that abortion at 30 weeks should be legal. I am arguing that late abortion—including illegal late abortion—is part of what happens when earlier abortion is inaccessible. For decades now, reproductive rights advocates have warned of the return of the unsafe, clandestine procedures prevalent before Roe v. Wade. Well, after a multi-decade assault on reproductive rights, they’re here.
Consider the recent case of Jennie Linn McCormack, an Idaho woman arrested for inducing her own abortion with drugs she’d bought online. “She joins an increasing number of women who get the so-called abortion pill off the internet,” NPR reported. Young women are especially likely to resort to underground abortion; in a 2010 paper in Reproductive Health Matters looking at 30 American women who’d tried to self-induce, the median age was 19. “Reasons to self-induce included a desire to avoid abortion clinics, obstacles to accessing clinical services, especially due to young age and financial barriers, and a preference for self-induction,” the study’s authors found.
When you restrict abortion, this is what happens. Gosnell is what happens. We know this from the days before Roe v. Wade, and we know it from around the world. Banning abortion doesn’t stop it: Latin America, the region with the globe’s strictest anti-abortion laws, also has its highest abortion rate. But make it hard to end an unwanted pregnancy as safely and as early as possible, and women will resort to hideous, desperate measures. That’s the lesson of Kermit Gosnell, who profited from the misery of people who fell through the cracks of our broken health care system. How grotesque that the anti-abortion movement is using his crimes as a pretext to make those cracks even wider.