A day at the Philadelphia Women’s Center: How staff navigate state restrictions to provide compassionate abortion care

By Julie Zaebst, Senior Policy Advocate, ACLU of Pennsylvania

On a recent day in March, a group of our staff was glued to our phones in anticipation of the Georgia state House vote on a draconian anti-abortion bill. The bill would ban abortion at six weeks gestation — a stage before most people even know they are pregnant. But as this circus was unfolding in Georgia, we were also preparing to spend the day at the Philadelphia Women’s Center, getting an inside look at what it actually means to provide abortion care under the current regime of restrictions and red tape in Pennsylvania.

The Philadelphia Women’s Center is an independent abortion provider that has been providing first- and second-trimester care for more than 45 years. Every day, their staff arrives at work prepared to navigate byzantine laws and regulations that were designed to make their jobs of providing safe, compassionate, and timely abortion care difficult. But despite the politically motivated restrictions, they’ve developed systems to make the experience as seamless as possible for patients.

By the time patients arrive for their appointment, they have already cleared countless hurdles. First, they must locate a provider and get themselves to the office. With more than 85% of counties in Pennsylvania lacking an abortion provider, this is no small feat. The number and locations of abortion providers is not a reflection of the need for care; rather, it is a reflection of the challenges of opening and operating a clinic, a task made more difficult by restrictions the state imposes only on abortion providers and not on other similar healthcare providers.

Of course, patients must arrange time off from school or work for their appointment. For low-income folks, this may mean a day without pay that their family counts on for survival. The majority of patients are already parents, so securing affordable childcare is often another obstacle that they face.

State law imposes a mandatory delay on patients: at least 24 hours before their procedure, they must receive state-directed counseling from a provider. The Philadelphia Women’s Center offers a couple of options to make this process as least burdensome as possible to patients. But if a patient misses their counseling session and they can’t reschedule quickly enough to satisfy the waiting period, they have to cancel their procedure and restart the scheduling process.

Perhaps the biggest barrier of all is the ban on insurance coverage of abortion care. During our visit, we had the chance to read patients’ entries in journals that the center provides in their waiting room. Many of them shared that their decision to get an abortion was driven by financial circumstances — they simply couldn’t afford to raise a child (or, in many cases, another child). According to a study by Guttmacher Institute, 75 percent of the people who received abortion care in 2014 were low-income.

Still, PWC staff must break the news to most of their patients that their insurance will not cover their procedure because state and federal law prohibit Medicaid from covering abortion care in most circumstances.*

Because most patients who are insured through Medicaid must pay out of pocket, some may wind up “chasing the fee,” as one staff member explained to us. A patient may take a few weeks to scrape together the money needed, only to find out that the cost of care has increased because they are now further along in their pregnancy — so they have to go back to the drawing board.

A patient must navigate all these barriers before they even arrive at the center for their procedure. And for some patients, the hurdles are even higher: for incarcerated folks, for instance, or for young people, who must obtain consent from a parent or get a judicial bypass.

When they arrive, patients will likely be greeted by anti-abortion protesters outside the clinic — but also by escorts, who help them make their way inside safely. There, staff will welcome them and prepare them for their procedure.

What we observed during our visit were dedicated, compassionate medical providers doing what they were trained and committed to doing: providing healthcare. The only difference we saw between the Philadelphia Women’s Center and any other healthcare facility? Doctors and patients — those who know best — face politically motivated restrictions and interference.

Replacing Medical Judgment with Political Will: PA Pushing Extreme Anti-Abortion Bill, Again

By Amanda Cappelletti, Larry Frankel Legislative Fellow, ACLU of Pennsylvania

Gov. Wolf announces his intention to veto SB3 at a press conference in Philadelphia (credit: Ben Bowens)

The legislative session has barely begun, and we’re already seeing some of the most extreme bills being introduced and pushed through. In that collective is Senate Bill 3, a bill that would ban abortion after 20 weeks and would ban a medically proven, safe method of abortion. This type of legislation puts women’s health at risk by preventing doctors from making decisions based on their professional medical judgment, in consultation with their patients.

In addition to replacing medical expertise with political will, this bill provides the narrowest of exceptions for abortions after 20 weeks: to prevent death of the mother and substantial and irreversible impairment of a major bodily function of the mother. But with no definition of “major bodily function,” it is unclear when this exception applies. There are no exceptions for pregnancies that result from rape or incest. There are no exceptions for fetal anomalies. Every woman’s circumstance is different, and this bill takes away her ability to decide what is best for her.

Abortion bans punish women. Not only do they strip a woman of ability to make a personal medical decision, but they can force her to go through severe mental and physical trauma. A Texas woman was forced to wait for her fetus to die in utero and endure a stillbirth because of a similar law, something no one should have to experience.

Doctors are at risk of punishment, too. SB 3 bans a medically proven, safe method of abortion — anyone who performs that method is guilty of a third degree felony. Our lawmakers are criminalizing doctors for following their professional training and conscience. This is one of the many reasons why the American Congress of Obstetricians and Gynecologists opposes these types of restrictions.

Extreme legislation like SB 3 has been enacted, challenged, and temporarily blocked or not allowed to go into effect while litigation proceeds in four states because of the serious constitutional issues these types of laws raise. It would seem that Pennsylvania lawmakers would like to add us to the list of states being sued for extreme abortion bans.

While we may not agree about abortion, we can all agree that physicians and not politicians should be a part of the medical decision-making process. We cannot stand by while politicians push their agenda into our doctor’s offices, with no regard for the health and well-being of women. A woman’s health, not politics, should drive important medical decisions. Contact your legislators and remind them — they’re not medical experts and shouldn’t be meddling.

Senate Bill 3 passed the state Senate on February 8 and is now under consideration in the state House of Representatives. Call your state representative today to tell them to vote “NO” on SB 3. To find your state representative, use our “find your legislator” tool, enter your zip code, and look for your representative under “governor and state legislators.”

PA House Rushes to Vote on Extreme Anti-Abortion Bill

By Julie Zaebst, Director, Clara Bell Duvall Reproductive Freedom Project

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Update: June 21, 2016

Soon after this post was originally published in early April, HB 1948 stalled in the House. Now, the House is poised to take a final vote on the bill as early as this afternoon, Tuesday, June 21st. A companion bill, SB 888, has also been introduced in the Senate and has been referred to the Judiciary Committee.

April 6, 2016

Yesterday, the House Health Committee moved with breath-taking speed to vote on an extreme anti-abortion bill that would make it illegal to provide abortion care to some of the most vulnerable women in some of the most difficult circumstances. House Bill 1948 would ban abortion after 20 weeks and would ban the safest and most common method of second trimester abortion, preventing doctors from making decisions based on medical science and putting women’s health at risk.

The bill contains only a very narrow exception of the health and life of the woman – one that could force doctors to wait until the woman’s health deteriorates before providing her with the abortion care she desperately needs. And the bill includes no exception for rape, incest or fetal anomalies, which often aren’t discovered until a woman’s 20-week ultrasound.

Make no mistake – this is one of the most extreme abortion bans we’ve seen in any state legislature. Only two other states – Kansas and Oklahoma – have enacted this type of “method ban,” and both of these laws have been put on hold by the courts because they raise serious constitutional issues. Method bans substitute a political agenda for a doctor’s expert opinion about which procedure is best for their patient – and threaten doctors with criminal charges if they follow their professional training and conscience and perform an abortion using this method.

But the House Health Committee didn’t pause to consider the expert opinions of doctors or to ask themselves whether this bill would pass constitutional muster. The committee voted to advance HB 1948 just one business day after the legislation was introduced and after just an hour of debate. Members voted against holding a public hearing that would have provided an opportunity for the real experts – medical professionals and families who have sought later abortion care – to share their knowledge and experience with lawmakers.

Anti-choice lawmakers claim that abortion restrictions don’t “punish women,” as Donald Trump recently suggested they should. It’s true that HB 1948 wouldn’t impose criminal penalties on women – only on the medical professionals who are addressing women’s medical needs using evidence-based protocols that are the standard of care for their profession.

But let’s be clear, these types of restrictions do punish women. Just last week, we heard the story of a woman in Texas who was forced to wait for her fetus to die in utero and endure a stillbirth because of a similar type of restriction on later abortion care. When women and their families are confronted with complex medical issues like this, they deserve compassionate care guided by the best medical science – not political interference.

We can’t stand by while lawmakers ram through a dangerous bill with callous disregard for the health and well-being of women seeking later abortion care or for the medical expertise of the doctors who are doing their best to serve them. Contact your lawmaker today and let them know you believe a woman’s health, not politics, should drive important medical decisions.

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Julie Julie Zaebst has served as director of the Clara Bell Duvall Reproductive Freedom Project since 2014, bringing more than 10 years of experience as a program manager and advocate. A social worker by training, she previously worked in child welfare and as the associate director of the civic engagement Office at Bryn Mawr College.

Thank You, Abortion Providers!

By Marah Lange, MSW, former Duvall Project intern

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Last Wednesday was an important day in the fight to protect abortion access.

As the justices gathered to hear arguments in Whole Woman’s Health v. Hellerstedt, thousands came together outside the U.S. Supreme Court to have our voices heard: stop the sham. While Texas’s HB2 and similar laws are engineered to appear to be focused on protecting women’s health, they do just the opposite. In fact, they restrict access to safe abortion by placing medically unnecessary restrictions on providers and causing clinics to close. For patients, this creates an obstacle course of barriers to having an abortion. If I have to travel hundreds of miles for my procedure, who can watch my children? Will my employer allow me the time off I need to travel for my appointment? How will I afford the cost of travel in addition to the cost of my procedure?

This is something we need to be shouting about. And on March 2nd, we shouted! I was one of 60 people who took a 5 a.m. bus from Philadelphia to Washington, DC, to join the Rally to Protect Abortion Access that day. Once on board the bus, I sensed excitement, adventure and, with some bus mates who had been in the fight since Roe, camaraderie. I also felt some trepidation. This was my first large-scale abortion rally, and I did not know what to expect from the opposition. After some coffee, chanting, and eventually a sunrise, we arrived and joined over a thousand other advocates who came together to defend access to abortion (and to show off some fantastic posters).

The Rally to Protect Abortion Access was also a platform for celebration. Women gathered to share their abortion stories, leaders of the fight spoke of their mission to protect access, and abortion providers were met with cheers of gratitude for their dedication to caring for patients with respect and dignity. It was electric.

While advocates await the court’s decision in June, today marks the National Day of Appreciation for Abortion Providers. We observe this day each year on the anniversary of the death of Dr. David Gunn, one of several abortion providers and clinic workers murdered by an anti-choice extremists. It is a day to show our gratitude for the courageous medical professionals who provide abortion care despite political interference and often threats of violence. Each day, providers stand in solidarity with patients who have chosen abortion for themselves and their families. Today we stand with those same providers and say “thank you.”

Thank you, Providers!

THANK YOU to the providers who work hard every day to make sure that people across Pennsylvania have access to the abortion care they need! We appreciate all you do to make reproductive rights a reality. #AppreciateProviders #NDAAPPlanned Parenthood Southeastern Pennsylvania, Planned Parenthood Keystone, PPWP–Planned Parenthood of Western PA, Philadelphia Women's Center, Allentown Women's Center, Delaware County Women's Center, Allegheny Reproductive Health Center Physicians for Reproductive Health

Posted by ACLU of Pennsylvania on Thursday, March 10, 2016

“Save Roe”

By Julie Zaebst, Project Manager, Duvall Reproductive Freedom Project

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It has been 42 years since the Supreme Court decision Roe v. Wade legalized abortion, but somehow, on this cold, slushy Thursday, I found myself standing in the middle of Broad Street holding a sign that said “Save Roe.”

Some days, I wonder how we got to the point where it doesn’t seem far-fetched to say that Roe needs saving. Today, though, I was grateful to stand with a small crowd in Center City Philadelphia and remind passersby what safe, legal abortion means for women and their families. Of course, it’s about the ability to decide when and under what circumstances to take on the incredible responsibility of having a child. But it’s also about access to basic health care for women. It’s about financial stability. It’s about opportunities and dreams. It’s about respect and equality.

A lot of people on Broad Street today understood that. We got honks of support and thumbs-up. People rolled down their car windows to cheer and say thank you. The only counter-protestor who dared to join us kept her headphones in the whole time.

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(This rally was organized by Planned Parenthood Southeastern pennsylvania)

I wish I could have brought members of Congress out today to see that the American people get it – and that we’re paying attention. Late last night, the House of Representatives dropped plans to vote on a bill that would have banned abortion after the 20th week of pregnancy, amid concerns about the “optics” of the issue. This sounds like a victory, but instead, the House approved a bill that targets abortion access for low-income women: HR 7 would ban federal insurance coverage of abortion, including in insurance policies sold on the state exchanges.

I’m afraid I’ll be back on Broad Street at this time next year, still holding my “Save Roe” sign. I hope you’ll be there to join me.

ACLU ACTION >> Protect Women’s Reproductive Decisions

Julie Julie Zaebst joined the ACLU-PA in July 2014, bringing more than 10 years of experience as a program manager and advocate.

Abortion: Breaking the Silence

By Lisa Wildman, Clara Bell Duvall Reproductive Freedom Project Intern

Clara Bell Duvall

Clara Bell Duvall

Why are we re-fighting abortion forty years after Roe v. Wade? State legislators across the country are putting forth regulations that target abortion at an increasing rate. Alarmingly, many of these have become law. Why have these laws succeeded in eroding abortion rights?

A big part of the answer lies in the stigma surrounding abortion, which has helped keep abortion hidden. The movement working against abortion has shamed and intimidated people who seek abortions and those who provide abortion care. Look and listen to the condemning, demonizing language they use outside of clinics. When I volunteered as a clinic escort, why did protesters call me a whore? And who can forget Rush Limbaugh’s vicious slander of Sandra Fluke just for seeking birth control? American society is uncomfortable with abortion in part because it is uncomfortable with female sexuality. The war over abortion is a war over who controls women’s bodies. If we use our reproductive rights, we frighten those who would control our bodies for us.

A woman considering abortion care likely feels very alone and frightened. I know I did. Many Americans may think that they do not know anyone who has chosen to have an abortion. But one woman in three has an abortion by age 45. We all know someone who has had had an abortion. She is our coworker, our friend, our neighbor, our sister, our mother. In fact, most women who choose abortion are already mothers.

Silence perpetuates the stigma surrounding abortion. We can help remove the stigma surrounding abortion by breaking the silence. Empower yourself by beginning to talk about abortion. If a family member of yours died from an abortion in pre-Roe days, tell that story. (Mitt Romney did.) If you are pro-choice, say so. If you had an abortion, say so. Tell anyone who will listen.

Studies have found that how we talk about abortion does make a difference. Talk about how abortion is a personal and private decision. Talk about how abortion is a right under the U.S. Constitution, not something that should vary state by state. Talk about how politicians should not be allowed to interfere in what is a decision a woman makes with her own doctor and her own family.

But most importantly, keep on talking.

Learn more about the Clara Bell Duvall Reproductive Freedom Project.

Lisa WildmanLisa Wildman interned at the ACLU-PA’s Duvall Project while completing a master’s degree in social work at Temple University.