A reader has asked an important question: Why do we need abortion CLINICS, why not just go to a hospital or your doctor's office?
Here's the historical development. Abortion was illegal until it was nationally legalized by the Supreme Court in Roe v. Wade January 22nd, 1973. It was legal in three states prior to that, New York, California, and Colorado. There were always some doctors who did abortions on the sly, or who did a D&C for their patients (oops, I guess they were pregnant!). But it was risky and in the medical community there was a stigma both about the procedure and who got abortions, but also about breaking the law and risking losing your license or a jail term. There is a wonderful movie called "Dear Dr. Spencer" about a doc in a small town in Pennsylvania who operated an office for abortions openly, under cover, so to speak, but mostly it was really cloak and dagger stuff. Some doctors gave their patients an antibiotic and referred them to an abortionist, who might be a midwife, or an ex Army medic, or a funeral home director. Frequently the Mafia controlled access to abortion services.
When abortion became legal in NY, clinics were set up over night and they sometimes worked 7 days a week, 24 hours a day just to keep up with the demand as people travelled from all over the US. Early clinics were an interesting hybrid of medicine and politics. Some of the early advocates of legal abortion were feminists, clergy, and doctors, so they inserted some of that desire to let people talk about their sistuation into mandatory counseling. They also introduced an informed consent process, which meant that everyone needed to be told what was going to happen, what the risks were, what the alternatives were. This was an innovation at the time.
When the rest of the country started to provide abortion services, a mix of the same people, with some entrepreneurs, founded clinics based on the same strategy as any other specialty business: VOLUME. At that time there were still many doctors who performed abortions for their own patients, perhaps one or two a week, or even up to 10 a week, but there was that stigma attached to it, and most doctors realize that getting along in the community is very important to survival. But some people hate to go to hospitals because they can so easily lose their confidentiality or run into a hostile nurse or someone else who knows someone they know, for instance. Also, as larger practices started to form, for reasons of on call coverage, economy, and other factors, it was inevitable that one person in the practice would object to abortions. In larger cities it is still possible to find a private doctor who will do an abortion. (Like on ER the other night Dr. Coburn said, "Abby, I will help you whatever you decide.")
But that is rare, in large part due to the anti's. In the 80's anti abortion activists would call each doctor in town and pose as a patient, ask about ob care, and then ask about abortion. If they said they did that, they would start yelling and screaming at the nurse/receptionist. They picketed doctor's offices and hospitals and mostly it was just not worth it to do abortions in your office. If you wanted to continue to offer it, it was easier to work in a local clinic. More often, especially in smaller cities, you had to bring doctors in from out of town because no one locally would offer the service.
There are a lot of good things about the clinic model however, in spite of the isolation from mainstream medicine that many clinic experience. One is that people who work at clinics really get that pregnancy decisions are very complex and are usually good at understanding what their clients need. (Not always true, some clinics seem to adopt the stigma we are trying to change. I don't get why they are still in business...) Unfortunately, this frees people who just do obstetrics or birth control to miss part of the picture. Like every sub specialty, though, you can assemble a staff that really knows what they are doing, medically and emotionally. I remember talking to one doctor who worked in a hospital setting who said that it was nightmarish having to work with different nurses in the hospital who hated what he was doing or who would inadvertently hand him the wrong medicine because they were inexperienced.
And of course, there is the business part of the story. There is great economy of scale if you can bring all the right staff, resources, patients, and medical people to one session. Some Planned Parenthoods, for instance, schedule several visits for the convenience of staff and patients complain that they have to take off work or school, or find child care twice or three times.
I have given you the long answer. The short answer is stigma. Abortion clinics exist because those in the regular practice of medicine cannot withstand the heat or the stigma of providing abortions. In a society so divided about a subject, and with so much heat about the issue, you need people whose job it is to withstand the pressures, the negative attention, and who are not beholden to referral pressures in the medical community. If that same facility can evolve as an understanding place to go with a pregnancy crisis, then that's turning lemons into lemonade.
Thanks for the question.