Secrecy, Stigma: Roots of Substandard Abortion Care

I am the director of the Abortion Care Network, a non-profit organization that supports independent abortion providers and challenges the stigma associated with abortion. I have worked with independent abortion providers for more than 30 years. I don’t have firsthand knowledge of Dr. Kermit Gosnell’s practice in Philadelphia, so my comments are not directed to the particulars of his clinic. But when I read media accounts of women coming forward to report terrible experiences with their abortions, I feel sad and scared that these women may have settled for far less than they deserve.

One of the many prices women pay for the stigma attached to abortion is that they don’t realize they have a right to medical skill, kindness, and a clean attractive abortion facility, just as they do with any other health care. If they are keeping secrets, they may not tell even other women about bad experiences—or good experiences. So each woman who is thinking about abortion is on her own. And they may not report substandard care to health authorities because they don’t want to jeopardize their own confidentiality. Or they may not even realize that they deserve better.

As with any kind of service, some abortion facilities are better than others. Ironically the anti-choice movement with its righteous judgment creates an atmosphere of secrecy where a bad clinic could thrive. Sometimes it actually seems as though the angry picketers target the better clinics. If abortion were talked about as the normal, common, experience that it is, bad abortion providers would go out of business the same way bad restaurants do—because people would tell each other not to go there. Abortion is still treated as such a shameful secret that many women don’t even know that their sister or cousin or aunt may have been to a clinic herself, and have information to share. In a room with 10 women, at least three of them have had an abortion—and all of them have known and loved someone who has. What would it be like if we reached out to each other so that this important life decision wasn’t such a lonely one?

My organization, the Abortion Care Network has a section on its website called “Considering Abortion.” This and “How to choose a Quality Clinic” gives you very important information about what you should expect from an abortion provider. As you are reading this, someone you care about needs this information, so please pass it on.

One thing that good abortion providers have in common is that they truly care about the women they serve. You may not realize that before abortion became legal there really were no outpatient clinics. Independent Abortion Providers pioneered the model of offering excellent outpatient medical care so that it could be more economical and much less time consuming than in a hospital. Outpatient care also guarantees a supportive staff, which can be quite a challenge in a hospital where staff may not be dedicated to providing excellent abortion care.

Abortion providers pioneered the idea of including counseling with medical care, and the opportunity to talk about feelings that many clinics offer is still very special. We were among the first to develop the idea of informed consent in which a patient had the right to full information about the procedure she was choosing and possible risks. In the past 30 years the anti-choice movement has brainwashed our society so relentlessly that it could be easy to forget that an early abortion (90 percent of abortions are done under 12 weeks) is many times safer than continuing a pregnancy to term. More than 50 million women in this country have had an abortion. Women know that they have both the right and the responsibility to make the best choices they can about when and whether to bring new life into the world through their bodies. Legal abortion has allowed many women to care better for the children they already have, to complete their educations, and to delay parenthood until they are truly ready.

For the past 37 years Independent Abortion Providers have been partners with women giving kindness, excellent medical care, and support. We trust that our patients are good women doing the best they can. There are many other things you may not know about those who provide abortion care. Come visit at and see the wonderful resources we have for patients and their families.

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  • mark2

    Charlotte – thanks so much for saying what needs to be said.  I loved the piece and agree with you.  The only quibble I have is with this statement: before abortion became legal there really were no outpatient clinics. This is largely true, but it discounts an important community – the brave men and women who provided excellent outpatient care in violation of the law before abortion was decriminalized throughout the country.  Carol Joffe documents some of these amazing individuals in her book Doctors of Conscience.  I’d hate for their dedication and commitment to be overlooked.  There was some outstanding care before Roe v. Wade, although not enough. These providers, like those in the Abortion Care Network, demonstrate that individual providers ultimately addressed women’s needs and innovated in this area.  Other than that, this is a great piece.

  • carole-joffe

    Excellent piece, Charlotte! Mark2, I appreciate very much the shout-out to my book, Doctors of Conscience, where I describe those heroes and heroines who provided abortion before legalization.  But these doctors, by definition, had to provide abortions secretly–it was not until NY and DC legalized abortion in the early 70s, that the *clinic* model, with all the innovations that Charlotte mentioned, was developed. carole

  • kate-ranieri

    Charlotte, a much needed, timely and highly articulate article. A million thanks.


    I’d add a shout out to the brave women of the Jane Group who provided countless abortions in a caring, compassionate yet secret circle of women.