Abortion in New York

Since New York State's liberalized abortion law became effective on July 1, some 16,000 women have obtained legal abortions. In those two months, however, the new freedom has been marred by widespread confusion about the application of the law, hardship for many women seeking abortions and reluctance on the part of many hospitals to cooperate fully in the program.

For the 57 counties outside New York City, the state board of health has laid down guidelines limiting abortions to well-equipped hospitals and their affiliated clinics. Under these rules, relatively few hospitals are performing relatively few abortions, although far more than under the old law. In New York City, which enjoys medical home rule, health authorities have been unable to agree on a code. As a result, the city's physicians and hospitals are working in a legal vacuum--but most of them are working. More than 10,500 of the state's legal abortions so far have been performed in the city. Almost half of all the abortions took place in municipal hospitals, where 80% of the operations are free. There have been four deaths, but only one that was directly attributable to the abortion; in the other three there were complicating factors.

Poverty Gap. Roman Catholic hospitals and many Catholic and Orthodox Jewish physicians will have nothing to do with abortions. To them the law, like the procedure, is anathema. But a surprising number of nonsectarian "voluntary" hospitals (private but nonprofit) are imposing restrictions that are generally tighter than the law requires. The effect is to shunt many cases to "private" (meaning for profit) hospitals, which are making a financial killing as high-class abortion mills, while the poor, who are most in need of cheap, safe operations, are getting the least benefit from the law.

"The hospitals and the Establishment simply don't want to carry out the spirit of the law," complains Dr. Bernard Nathanson, director of gynecology at Manhattan's Hospital for Joint Diseases and medical consultant to the National Association for Repeal of Abortion Laws. He claims that many hospitals have established arbitrary quotas for the number of abortions of different types (graded according to the length of pregnancy), and how many beds they will allot. Even worse, says Nathanson, is that some hospitals will not take women who are more than twelve weeks pregnant. "These," he adds, "are the women who are really getting desperate, who need it most." It is difficult to get nurses to aid in abortions beyond the twelfth week, because the nurses, and often the doctors, emotionally assume that a large fetus is more human than a small one.

In the first twelve weeks abortion is usually done by "D and C"--dilatation of the cervix and curettage (scraping) of the womb lining. For the next four weeks, most physicians consider abortion too hazardous because of the danger of causing hemorrhage or even puncturing the uterus. Beyond the 16th week, the preferred method is "saline induction," the injection of about half a pint of salt solution into the womb. New York Hospital, which has 112 beds in its women's division, is scheduling eight D and Cs a day, plus 16 salines a week. St. Luke's Medical Center, with 137 beds available, does six D and Cs daily, 18 salines a week; the Hospital for Joint Diseases does three D and Cs a day, and no salines. Most hospitals require patients to stay from one to three nights.

The hospitals' rationale for the quotas is that otherwise some doctors would flood them with abortion cases, leaving little room for other patients. That reasoning, says Nathanson, is hypocritical; he calls it "a vicious method of virtually shutting off abortions and curtailing those doctors who have the most patients from doing what the patients need and have a legal right to."

The hospitals' arbitrary rulings extend to individual cases. Dr. Robert Hall, a professor at Columbia University's College of Physicians and Surgeons, wanted to abort an 18-year-old girl in Presbyterian Hospital. The hospital required that he first get parental permission, although the girl had left home. Hall is now seeking a court order to establish the rights of teenagers. A decision either way in the case, he says, will at least set a precedent. Insists Hall: "A girl who's old enough to get pregnant is old enough to have an abortion."

Ten-Minute Ride. Many otherwise liberal physicians are on the conservative side in believing that abortions should be carried out only in hospitals. To this, Planned Parenthood Federation spokesmen are unalterably opposed. They demand that "freestanding" clinics be approved, provided they are adequately equipped and staffed and are not more than a ten-minute ride from a hospital that can handle any emergency cases.

Manhattan's Dr. Michael Bergman of the Council on Population Balance scoffs at the idea that a clinic needs the $250,000 worth of equipment recommended by proponents of a strict code. In fact, he believes that the commonly used standard equipment is wrong, since it requires a general anaesthetic for dilatation of the cervix and insertion of relatively large metal tools. Instead, Bergman uses only a local anaesthetic, and none at all in most cases, to permit insertion of a specially designed vacuum-suction tube only one-quarter inch in diameter. The instrument, smaller than those in general use, was developed at a Los Angeles abortion clinic and has been used there for a year. Bergman has performed more than 300 abortions in his office since July 1 by this method with, he says, no complications. His charges range from nothing to $100, depending on ability to pay. The operation is over in minutes, and the patient is on her way home after only 21 hours.

Most of the well-to-do women flocking to the private hospitals, where an abortion costs at least $500, have been out-of-towners. A disproportionate number of abortion seekers since July 1 have been, inevitably, those who were pregnant well before that date and are now crowding the legal deadline of 24 weeks of pregnancy. This situation will largely resolve itself by the passage of time and a growing awareness, especially among the poor, that they should seek help early. At the 15 municipal hospitals, which are now doing 120 abortions a day, there have been relatively few black abortion patients.

Last week a Women's Medical Center with a dozen volunteer physicians and 40 counselors opened in mid-Manhattan to perform 60 operations a day at charges of from zero to $50. With a few more such clinics, the city will be able to take care of its own residents. But the city and state will continue to be hard-pressed by the influx of nonresident patients until abortion statutes in other states are liberalized.

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