This article originally appeared in The Nation and is reprinted here with their permission.

In the most recent issue of The New Yorker, Eyal Press, a Nation contributor and the son of an OB/GYN who provided abortions, has a harrowing and important story about the rogue abortionist Steven Brigham, who has owned substandard clinics all around the country. Brigham has been involved in horrifically botched surgical abortions as well as a number of medical abortions that failed because he used methotrexate, a cheaper, less effective and more dangerous drug than the commonly prescribed mifepristone. In some cases, he began a procedure in New Jersey and then had patients driven to Maryland where he would complete it, so as to circumvent New Jersey law governing late-term abortion. One of his patients, an 18-year-old African-American girl who was twenty-one weeks pregnant, had to be airlifted to Johns Hopkins Hospital after her uterus was perforated and bowel damaged.

There have been complaints and investigations about Brigham going back to the 1990s, but somehow he continues to operate, moving from one state to another and opening new clinics when old ones are shut down. On the surface, his case, like that of gruesome Kermit Gosnell, seems like evidence for the anti-abortion movement’s contention that abortion clinics are under-regulated. “The argument about abortion often centers around the morality of killing the unborn,” writes Jillian Kay Melchior in National Review. “But Press’s story really hammers home the impact on the vulnerable women who often find themselves exploited at sketchy abortion clinics.”

The important question, though, is what makes them vulnerable to exploitation. Without a doubt, Brigham’s ability to operate represents a legal and regulatory failure, one aided by official indifference to poor women’s healthcare. But his business, like Gosnell’s, depended on the stigma around abortion and the difficulty many women have in accessing safe procedures. Towards the end of the piece, Press speaks to Katherine Morrison, the director of a clinic in Buffalo, the city both he and I are from. (His father was actually my mother’s doctor.) Long a target of the anti-abortion movement, Buffalo has been plagued by anti-clinic harassment and violence; in 1998, Barnett Slepian, a doctor who worked at Morrison’s clinic, was assassinated by a sniper as he stood in his kitchen. One result of anti-abortion activism is that local hospitals refuse to admit abortion patients, even when women’s lives are at risk.

Morrison tells Press about the case of a 21-year-old African-American woman who came to see her when she was twenty weeks pregnant. Overweight, poor and lacking health insurance, “she had a heart condition that, a doctor told her, made bearing a child potentially lethal,” writes Press.

The woman, who had already undergone two heart transplants, learned that she was pregnant after going to the hospital with chest pain. Because of the woman’s risk of complications from surgery, Morrison felt the only safe place to treat her was a hospital. This would not have been a problem a decade ago, when many hospitals in Buffalo admitted patients like her. Virtually none do so today, owing mainly to pressure from donors opposed to abortion.” After her petition to a hospital failed, Morrison ended up performing the abortion in her clinic. “I was faced with a choice of doing an abortion in a setting that was inappropriate, or forcing a poor girl to continue a pregnancy that could kill her,” she told him. “It’s an example of what happens today to a poor, disenfranchised woman.

Another example comes from an article by Lindsay Beyerstein in The New Republic called “’Miscarriage Management’: The Next Front in the Abortion Wars.” It’s about Dr. Lester Minto, a doctor in Texas’s Rio Grande Valley who has been forced to stop performing abortions because of the state’s sweeping new anti-abortion regulations. With no abortion clinic within hundreds of miles, women have started using drugs—procured in Mexico or on the black market—to induce themselves, and Minto has made a new specialty of managing the aftermath. “While Minto can’t perform an abortion, if you show up at his office bleeding from a miscarriage, he can help you out, no questions asked,” writes Beyerstein. “‘Nothing here is back alley,’ Minto says. ‘We do follow-ups with everybody. We still treat them just like we always did.’”

As I reported in my book about the global battle over reproductive rights, this is how abortion is done in Latin America, which has both the world’s strictest anti-abortion laws and its highest abortion rate. Being treated by a doctor like Minto or Morrison is the best-case scenario for women denied access to the medical care they need. The rest will go to profiteers like Brigham, or worse.