As a resident of Philadelphia and an abortion provider, I can tell you that the Gosnell case has gotten media coverage. But no one is talking about poor, under-insured, and under-served women.

A hospital buy-out means that Green Bay's only abortion clinic—one of five in the whole state—will no longer be allowed to provide abortion care.

High cost for good healthcare service via Shutterstock

Some reporters and media critics have claimed that not enough is being written about the trial of Dr. Kermit Gosnell, an illegal abortion provider who operated far outside the bounds of legitimate medical practice. In a recent column for USA Today, for example, Kirsten Powers claimed that the case is not receiving the attention that it deserves.

As a resident of Philadelphia and an abortion provider, I beg to differ. Gosnell’s atrocities have been covered widely. But what haven’t been covered as much as they should be are the reasons why the women who turned to Gosnell for abortion care were disproportionately low-income women of color who felt they had no other place to turn.

Whether you are a supporter or opponent of women’s health rights, or just interested in things related to reproductive justice, you should know that the Gosnell case has been written about steadily since February 2010, when Gosnell’s clinic was raided by the Drug Enforcement Administration and his license was suspended. The story was widely covered in the national mainstream media and by women’s health advocates in 2011 when the case’s Grand Jury report came out. So while the trial is news, there is little to no information that has not already been reported about Gosnell up to this point.

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Indeed, when Google renders about 9,000 hits in 0.15 sec using the search term “Kermit Gosnell,” it’s hard to say this story lacks attention.

But this case is about more than just a practitioner who did bad things. His case embodies the “off-the-grid” abortions we can expect to see in states like Mississippi and North Dakota, where anti-choice harassment and regulations purposefully pass to close all clinics providing legal, safe abortion care mean only one clinic is left in each state, and even those are under threat of being shut down.

Gosnell’s “Women’s Medical Society” was not an unknown entity. In fact, it was surrounded by well-known and respected hospitals and clinics. But because they adhere to safe abortion care practices and because health care is expensive generally, the cost of care at these clinics was often out of reach to women who, without public assistance, don’t have and cannot afford regular health care of any kind.

Gosnell’s operation bears no resemblance to safe abortion care. His entire “practice” was illegal: There were untrained medical “assistants” and abortions performed at viability without medical cause. His “clinic” was unsanitary and unsafe and what Carole Joffe has referred to as a “chamber of horrors.”

Moreover, in a gruesome quid pro quo, Gosnell charged on a “sliding scale” for anesthesia; you got more anesthesia the more money you paid, so the poorer you were, the more pain you suffered. Women who went to Gosnell may have known of other places to receive abortion care, but they were either beyond the legal time limit when they could get an abortion in the state, or they could not afford safe abortion care.

What this case reveals is that the cost of dignity in health care has risen, and the attack on poor women intensified.

These realities underscore the real missing headline. In 2011, the Grand Jury report stated, “We think the reason no one acted is because the women in question were poor and of color.” Almost all of Gosnell’s patients are identified as poor women of color. Still, the mainstream media is largely not paying attention to the issues of race and class inherent in this story, which contribute to the reasons why Gosnell could thrive. Poor, under-insured women are not getting acceptable health care of any kind, but because this story is about abortion, these usually invisible women are suddenly the subject of public pity by anti-choice activists. They were made to suffer until many lives were taken.

In an age of rising stigma, discrimination, widespread misinformation, and violence against providers, facts get trampled. What Gosnell underscores is a point that women’s health and rights advocates have long asserted: Women who need to terminate a pregnancy will go to desperate lengths to do so, and by isolating abortion care, we drive women to back-alley providers.

Anti-choice conservatives know this but seem not to care. Mississippi state Rep. Lester “Bubba” Carpenter (R-Burnsville) put it bluntly at an Alcorn County GOP meeting:

[Y]ou have the other side. They’re like, ‘Well, the poor pitiful women that can’t afford to go out of state are just going to start doing them [abortions] at home with a coat hanger.’ That’s what we’ve heard over and over and over. But hey, you have to have moral values. You have to start somewhere, and that’s what we’ve decided to do. (via the Maddow Blog)

These are the aspects of the story that Kirsten Powers and a handful of others in the media are missing completely. Powers claims that there’s a “deafening silence” in the media surrounding this story. Try coming to live in Pennsylvania—trust me, it is not quiet here. The real deafening silence is on the part of the Powers and other pundits and their inability to see or report on the effects of restrictions such as the Hyde Amendment.

Right now there are 13 freestanding providers of surgical abortion in Pennsylvania, down from 22 two years ago. Legitimate clinics have closed because of new regulations that have nothing to do with providing safe services. Act 122, first presented as HB 574 and SB 732, is the Department of Health Abortion Facility Oversight Act. Under Act 122, clinics that would have passed a routine inspection are now required to adhere to policies as an Ambulatory Surgical Facility. As a result, clinics in Pennsylvania saw more architectural changes than critique of patient advocacy.

Kristen Powers is clearly not in touch with what has been the reality of Pennsylvania abortion access since the Gosnell story broke. There is not one clinic in the 205-mile span between Harrisburg and Pittsburgh. In the 2013-14 session of the Pennsylvania legislature, SB 3 has been proposed to prohibit abortion from being placed for purchase on Pennsylvania’s health insurance exchange, which is a portion of the Affordable Care Act.

As a young Black Philadelphian, and a worker for an independent abortion provider, I feel confident in saying that a certain type of conversation has been sparked. Now, instead of people who morally oppose what I do just being outside my door on Thursdays, Fridays, and Saturdays, they are emboldened on the state Senate floor to “save women’s lives.” Yet, nothing has been done to provide low-income women with dignified health care, including safe abortion care. If the case of Gosnell, it is not clear to the average reader that there are other “doctors” just like him seeing women who are not accounted for.

This is the gray area of abortion that no one wants to talk about: the women we cannot see for services, the women who we have never seen for services, and the women who are receiving abortions that are not counted by anyone. There is a deafening silence alright: A silence that ignores the daily plight of under-insured, and under-served women living in poverty.