Samantha had already lost custody of her two older children, and she had been bringing her one-year-old daughter to Dr. Linda Prine's New York office with marks "that looked suspiciously like burns." Then, said Prine in a speech Monday accepting an award from the group Physicians for Reproductive Choice and Health, Samantha became pregnant and wanted an abortion. Prine scheduled the procedure at a nearby Planned Parenthood, but Samantha never showed up. The reason: "she just couldn’t go to an abortion clinic." Providers say it's a common phenomenon: women who want abortions, but can't face the environment of a standalone abortion clinic. Some of them, like Samantha, don't end up getting abortions at all.
In 2000, 93 percent of abortions in the US took place in standalone clinics — while that percentage may have edged down since then, it's still the vast majority. And abortion clinics, as the group Advancing New Standards in Reproductive Health (ANSIRH) puts it, "have a PR problem." A 2011 study by ANSIRH notes that pop culture often portrays them as "lonely, depressing places devoid of compassion or human contact."
And of course, patients who visit abortion clinics face very real concerns. Of 41 women interviewed in the study, 8 cited the presence of protesters as negative or traumatic — one called them “the most disturbing part of the whole experience" and said she was afraid they would become violent. Prine's patient Samantha also said the fear of protesters was what kept her away from the Planned Parenthood clinic.
Women in the ANSIRH study also said that some procedures clinics took to ensure their safety and privacy ended up making them feel worse about the procedure. One said that being buzzed in through a secure door made her uncomfortable: “I know they're trying to protect your rights and to keep everybody safe but it just made it even seem all the more like a secretive, shameful thing.” Another was afraid of the metal detectors at the clinic, saying, it felt “like someone's going to come in and rob you.”
Dr. Margaret Kini, a Texas abortion provider honored by Physicians for Reproductive Choice and Health Monday night, told BuzzFeed she sees patients who are afraid to go to abortion clinics "all the time." She said that in addition to fear of protesters, patients worry that clinics may be unsafe or illegitimate — being "sent out" to a location away from their regular doctors feels "secretive" and scary to them. She mentioned a physician friend whose fetus had an abnormality and who sought abortion at a local clinic — immediately afterwards, she said she had a good experience. A year later, though, she had a non-viable pregnancy and was able to have a termination at her ob-gyn's office. She told Kini, "thank God I don't have to go back to that terrible place." Even though she felt she'd gotten good care at the first clinic, "the thought of going to an abortion clinic again" was unbearable to her.
For providers, women's fear of standalone clinics is a key argument for integrating abortion into ob-gyn and family medicine practices. In her acceptance speech Monday, Kini said, "integrating abortion into general practice allows patients to escape the marginalization and vilification imposed by anti-choice groups." She also noted that having their regular doctor present can make patients feel better about the experience, describing a patient who "was so relieved to know that I could be there for her, whether she continued the pregnancy or had an abortion."
Lisa Maldonado, the executive director of the Reproductive Health Access Project, adds that training family medicine doctors and ob-gyns in abortion care would make abortions available to women in places where clinics are scarce. But it won't be easy. Because of restrictions on federal funding for abortions, facilities that provide them along with other services have to go through complex steps, like keeping abortion funds separated from other money and purchasing special malpractice insurance to cover abortion care. And it's hard for ob-gyn or family medicine residents to get trained to perform abortions — of 400 to 500 such residencies in the country, only about 30 offer abortion training.
Maldonado says things are improving — she cited programs that offer funding to to ob-gyn and family medicine residencies to help them teach abortion care. "We've made a lot of progress in the last ten years," she says, but abortion is still largely "marginalized and segregated" from all other healthcare.
Those who advocate for the integration of abortion into family medicine or ob-gyn practices aren't critical of standalone clinics themselves — the ANSIRH study, for instance, found that despite the sometimes intimidating nature of safety precautions, the women who visited clinics were in general very satisfied with the actual care they got. Instead, they argue that some women need an additional option that's more comfortable for them — an abortion at their doctor's office, with their regular doctor. Prine said she'd asked her patient Samantha, "if I had been able to do her abortion in my office, would she have had wanted it?" Her answer: “Of course.”