NEW YORK - The allegations of murder at a Philadelphia abortion clinic add fuel to already heated national debate over late-term abortions and oversight of providers. One side wants tougher restrictions; the other says women would be safer if they had more options.
Almost in unison, abortion-rights and anti-abortion activists decried the alleged offenses of Dr. Kermit Gosnell, who was arraigned Thursday on eight counts of murder in the deaths of seven babies and one patient. He allegedly provided illegal late-term abortions for up to $3,000 while avoiding a crackdown despite numerous complaints and lawsuits.
"This provider clearly operates outside acceptable quality care standards and is a total outlier," said National Abortion Federation president Vicki Saporta. "The majority of providers offer very high quality care."
The problem with the Gosnell case, Saporta said, is that state and local authorities apparently didn't enforce regulations that were on the books. She noted that Gosnell had been rejected for membership in her federation, which represents about 400 providers accounting for about half the nation's 1.2 million annual abortions.
The federation has a self-policing policy, conducting periodic site visits to ensure that members comply with its guidelines.
Anti-abortion activists say self-policing, as well as existing regulations in many states, are insufficient. They have been pushing for years for tighter oversight of abortion providers, and the Gosnell case is likely to intensify those efforts.
On Thursday, for example, a legislative committee in Virginia endorsed a bill that would subject abortion clinics , which are now regulated like doctors' offices , to the same standards as outpatient surgical centers.
"It's hard to tell the extent of egregious offenders because the abortion industry is almost completely unregulated," said Dr. Donna Harrison of Eau Claire, Mich., president of the American Association of Pro-Life Obstetricians and Gynecologists.
"If a doctor in a hospital did a hysterectomy and had a patient with a complication, he would have to go back and explain why to his colleagues," Harrison said. "With abortion, the doctor has nobody to face , they basically just slide through the accountability process with nobody to hold their feet to the fire."
In general, abortion-rights activists have opposed the state-level efforts to regulate abortion clinics more tightly, depicting these bills as backdoor attempts to shut down the clinics altogether.
Troy Newman of Operation Rescue, a Wichita, Kan.-based anti-abortion group, hailed the prosecution of Gosnell and offered a $25,000 reward to any whistleblower providing information leading to an abortion provider's conviction.
"As shocking as this case is, it is in no way an anomaly," Newman said. "Shoddy and illegal practices characterize the abortion industry in America."
Dr. David Grimes, a North Carolina obstetrician/gynecologist who formerly headed the abortion surveillance branch at the Centers for Disease Control and Prevention, heatedly disputed that premise, contending that abortion was among the safest of medical procedures.
The Gosnell case "is newsworthy because legal abortion has been such a success," Grimes said. "Decades ago, this wouldn't have been a story at all , every city had one of these seedy operations."
Regarding the push for tougher laws, Grimes said, "We don't need more regulations for a non-problem."
According to prosecutors, many of Gosnell's patients were seeking abortions at 24 weeks or more into their pregnancies. Under Pennsylvania law, abortions are illegal after 24 weeks, and many doctors won't perform them after 20 weeks.
Grimes said there has been a broader trend of women seeking late abortions and finding them relatively hard to obtain. In North Carolina, he said, there are now no doctors offering second-trimester abortions , beyond 12 weeks of a pregnancy. Nebraska last year passed a law outlawing abortion after 20 weeks of pregnancy based on the disputed claim that fetuses can feel pain after that point
"The net effect of all this is that more pregnant women will have to travel away," he said. "It creates more risk, because delays of any origin hurt women's health."
According to the latest national data, compiled by the New York-based Guttmacher Institute in a 2006 survey, 88 percent of U.S. abortions occur in the first 12 weeks of pregnancy and only 1.5 percent at 21 weeks or later. With an estimated 1.2 million abortions annually in the U.S., those late abortions would number 18,000.
Most providers have limits on the latest gestations at which they will perform abortions. Guttmacher says 23 percent of surveyed providers offer abortions after 20 weeks, and 11 percent after 24.
Many of the women seeking such late abortions either have serious medical problems of their own or have learned of a serious anomaly in the fetus, Saporta said.
Even as more states seek to limit late abortions, Saporta said most women can find appropriate care if they know how to ask for it. Her federation runs a hotline that provides advice and referrals.
"But a lot of people don't know there's such a resource available," Saporta said. "You might have immigrants who don't speak English and come from a country where abortion is illegal. They try to get a referral by word of mouth and sometimes end out in one of these substandard clinics that prey upon vulnerable women."
Other women, she said, resort to self-induced abortions , often using misoprostol, an inexpensive drug used in the U.S. to treat ulcers but commonly used as an abortifacient in Latin American countries where abortion is banned.
Part of the problem, according to Saporta, is the constant political wrangling over abortion.
"When you stigmatize it to the level we have in this country, it makes it harder for women to access the resources they need," she said.
Dr. Douglas Laube of Madison, Wis., chairman of Physicians for Reproductive Choice and Health, challenged abortion foes' assertions that his field was rife with abuse compared to other medical specialities.
"I'd think we have fewer bad apples," he said. "Practitioners are under tremendous pressure and scrutiny. ... Intuitively I'd say they're operating as squeaky clean as they can."