BY JEFF DEENEY Let me begin by assuring anyone reading this from outside the region that the disbelieving moan of “What the fuuuuuck, Philadelphia?!” that reverberated around the world yesterday is being heard loud and clear here in the evermore ironically nicknamed City of Brotherly Love. Surely, the grand jury report detailing Kermit Gosnell’s filthy West Philly baby abattoir is utterly soul-shattering in and of itself, regardless of your proximity to the events. But many Philadelphians felt an additional, all-too familiar communal nausea watching the story go viral through the Twitterverse, first moving from the local media to national outlets, then later to international ones like the BBC. Here we are, again, we all thought: back in the international spotlight for some stupendously sick piece of inhumanity. Sometimes it seems that our notorious reputation as a city of monsters and hooligans is one we’ll never shake. Sometimes it feels like we totally deserve it.

The nausea was two-fold for Philadelphians who support women’s health, the right to choose and unfettered access to clean and safe abortion facilities. As soon as the enormity of the details became clear, it also became clear what anti-choice Republicans would do with this story. They wasted no time painting Gosnell’s house of horrors as a prime example of a typical big city, liberal-supported abortion provider. Just as quickly you could practically see fists clenching and hear teeth gnashing across the feminist blogosphere as women’s health proponents rushed to forcefully counter argue that Gosnell’s practice was exactly the opposite, an object lesson in what happens to women when access and funding for safe and legal abortions are severely restricted. But we were all thinking, right wing or left, Philadelphian or not, that this is without a doubt the ugliest, most appalling story to have ever come out of a town with no shortage of ugly and appalling stories in its history.

As a social worker I have counseled women not unlike those who live in the poor West Philadelphia neighborhood the Women’s Medical Society targeted for providing unsafe and illegal abortions. I’m talking about TANF moms, young single parents with no income source for supporting their families other than public welfare. The typical TANF mom will get her other health care needs served at one of the city’s health clinics, and it’s worth noting for outsiders that Health Center #4 which serves the same neighborhood is the best in town, providing quality care for the uninsured poor. But Health Centers don’t do abortions, and Medicaid, where a TANF mom’s insurance coverage would come from, if she had any at all, doesn’t pay for them. And for these women the cost of paying for an abortion out of pocket breaks the budget, leaving mom scrambling to make next month’s rent or possibly wind up on the street.

The process of figuring out how to get a TANF mom a safe abortion is painstaking and heart breaking. Philadelphia’s black community is very Christian and very conservative and the women I’ve worked with were under strong pressure from family not to “kill the miracle.” In one specific instance, this familial pressure to keep the child was complicated by the fact that the young woman already had one child she couldn’t afford, and was using her TANF workfare requirement to go to community college. Having the second baby meant dropping out and near certain indefinite condemnation to abject poverty. Terminating the pregnancy meant the chance to complete school, and a chance to make her daughter’s world a better place. Imagine yourself at such a crossroads at the tender age of 19.

Tears were shed during agonized counseling sessions. Anxiety ran high over how to pay for it. Private funding is scarce, and in her case, due to tight time constraints, was impossible to obtain. The very real fear was that the cost of the abortion would so wreck her fixed income budget that eviction would be the ultimate outcome. Most middle class women seeking an abortion don’t have to face down the possibility of winding up in a homeless shelter as a result of it.

So, indeed, lack of access is a very real problem. All the while as mom struggles to make her decision about whether or not to terminate the pregnancy, and scrambles to put the funds together after she’s made it, the clock is ticking. If she can’t get the money in time for an early term procedure, the cost goes up for a more complicated later term procedure, causing yet another scramble for more money she doesn’t have. You can see how a mom might wind up in a situation where getting the money together would take so long she would have no choices left but to seek out a back alley scumbag like Gosnell.

Unfortunately the argument for expanded access, including most importantly public abortion funding sources for women like the TANF moms I’ve worked with, is a non-starter in the here and now. This, like a lot of other policy rememdies on progressive wish lists, is too morally-hazardous to even start an intelligent bipartisan discussion about. Don’t forget that Pennsylvania is a red state now; do you think either Senator Toomey or Governor Corbett support anything in the same universe as public funding sources increasing access to women’s health for the poor?

This leaves us with at least upholding regulatory standards at the facilities we do have. In all the heated early discussion about what the Gosnell case means for the abortion debate, I felt a little too much emphasis was placed on the access issue. I think bloggers making hasty comments on the story didn’t fully read the grand jury report (it’s nearly 300 pages long, so if you were commenting yesterday afternoon right after its release, you either read lightning fast or were going on brief newspaper summaries), and if you are going to comment on this story you really should read the entire report. Because after a full reading of the report the horrors feel less like a result of poor abortion access and much more like a familiar Philadelphia story of institutional failure among the public agencies that are supposed to protect the commonwealth.

In the section of the grand jury report titled, “How Did This Go On So Long?” the jury outlines in great detail the multiple levels of oversight failure that allowed Gosnell to murder viable babies and endanger women in plain sight of the medical and regulatory communities for years. Failure ran across all levels of both state and local agencies; the PA Department of Health, Department of State, Philadelphia Department of Health and other local doctors all share a place in the intersecting lattice of complicity that allowed Gosnell’s illegal activities to continue unabated. Moving forward I think this story is locally better situated next to Danieal Kelly’s, Philadelphia’s other recent international shame story with similar themes. In Kelly’s case, a handicapped girl was intentionally starved to death by her own mother while supposedly under the watchful eye of the state’s child welfare system. In both cases, at those state and local agencies tasked with providing protection multiple levels of institutional failure and incompetence worked in concert to enable maximum human tragedy. In both cases, state and local professionals tasked with protecting the community repeatedly failed at or neglected to even attempt to do their jobs.

The final section of the jury report, “Recommendations of the Grand Jury,” proposes a laundry list of reforms for the agencies and individuals accused of complicity; in fact, the recommendations are so numerous that listing them here is impossible due to space constraints. Hopefully the heads of these city and state agencies and Mayor Nutter, hearing the international howls of disbelief at the sickness and depravity of Gosnell’s illegal abortion practice, will take these recommendations seriously. Hopefully local newspapers will hold the feet of public servants to the fires of accountability for making change happen the same way they did with the child welfare system in the wake of the Danieal Kelly tragedy.

ABOUT THE AUTHOR: Jeff Deeney is a freelance writer whose work has appeared on The Daily Beast, PW, City Paper and the Inquirer. He focuses on issues of urban poverty and drug culture. He is currently working on a book about life in the crossfire of poverty, drugs, guns, and the bureaucracies designed to remedy them, all of which informed his experiences as a social worker in some of the city’s most dire and depleted neighborhoods.