[Ed. The book described was written in 1986. If these concerns were prevalent just 13 years after abortion was legalized nationwide, it becomes chilling to wonder how the level of indifference to the clients must have escalated since then…]
Pro-choice author Carole Joffe interviewed abortion industry workers for her book The Regulation of Sexuality: Experiences of Family-Planning Workers.
Although many of the clinic workers Joffe interviewed genuinely seemed to want to help the women, the book reveals many disturbing things about what went on in the abortion facility. According to the workers’ own words and the author’s observations, women were rushed through the facility to maximize profits – and abortionists often treated them badly.
Joffe observes that the abortion facility regularly overbooked patients to maximize revenue. A significant portion of women, she observed, didn’t show up for their appointments and overbooking guarded against lost business. Joffe says:
Like many other nonprofit clinics, Urban [the name Joffe gave to the clinic] typically overbooked clients, especially at peak hours, to guard against the loss of revenues that would result from too many no shows. This meant, for counselors, a never-ending stream of clients in the waiting room…The clinic had to make the most efficient use of medical personnel, the highest-paid workers in the clinic, for financial reasons and for courtesy. (83)
One thing to take away from this quote is that many women change their minds after making the initial abortion appointment. We don’t know how many of the women the book speaks of chose life on account of pro-life intervention, but their minds were changed by something. Not all women who make their appointments already have their minds made up. Abortion seeking women are often still reachable.
But the facility’s overbooking also had the result that workers were forced to rush women through the abortion process one after another to fit them all in. They did not have time to counsel women as thoroughly as they would’ve liked. As Joffe says:
… As the clinic director was fond of pointing out, counseling did not generate revenue for the clinic; being seen in the medical room did. Perhaps the greatest problem with slowdowns [counseling sessions that took longer than average] was the risk of annoying doctors.(89)
There was no doubt that the overbooking was done mainly to maximize profits:
Besides ongoing frustration over salaries, the [abortion] counselors felt that there was no real understanding of the pressures and demands of their work. They believed, for example, that the agency director and board were always devising ways to increase the patient load (and hence generate more revenues) without considering that more patients applied a need for additional staff. (57)
Obviously, counseling fell by the wayside. There was little care or respect for each woman as an individual. Even though many of the workers wanted to give more support, they were under intense pressure.
The facility’s owners and management always wanted to increase revenues. This caused tension between workers who wanted to help a woman make the best choice for her and management which simply wanted more abortions done:
At Urban, as in other family planning clinics that provide abortion services, these services are the major source of revenue; hence, there are constant pressures from management to increase the total number of abortions performed. During the period of my observations, abortions were performed four days a week, and there were ongoing discussions about whether they should be increased to five. (112-113)
One abortion counselor talks about trying to console upset women despite the pressure to rush them out of her office quickly:
I’ve taken up to one hour and a half if the patient needs it – the people at the front desk don’t love it if I do that too often, but if I have to, I do. I just had a patient today that took a really long time. It was a post abortion – she was crying, feeling really guilty. The doctor really scared her; I had to act as her advocate. (86)
This is not the only time a worker had to protect a patient from the words and actions of the facility’s abortionists.
As Joffe says:
Another counselor grievance concerned doctors’ interpersonal style with patients. Certain doctors were accused of being too abrupt or “insensitive” with patients… Bernice [a clinic worker] recalls that when “Dr. Stuart first came, he did a very racist number on a couple of patients. I called him on it, and he has changed.” Some specific accusations of insensitivity were related to the rejection of obese women for clinic abortions.… [These patients pose “special difficulties” in an emergency] Counselors felt that some doctors handled this admittedly difficult situation in a particularly mortifying way. (106)
Also, abortion workers were forced to try and intervene for women when they were on the abortion table and wanted to change their minds, or became so agitated it seemed clear they did not want the abortion.
Abortionists often did not want to stop the process, even if they could do so safely:
Infrequently it happened that a patient became so upset during the procedure that the counselor felt that it should be stopped.… For the Urban physicians, on the other hand, the ruling premise was that any procedure, once started, should continue – as long as it was medically safe to do so… For some doctors at Urban, “starting” meant any contact with the patient, including the preabortion pelvic examination.… The doctors at Urban did not routinely proceed with the abortion in the face of immense distress. As one put it, “if she’s crying a little, you still go ahead… If she jumps a foot off the table during a pelvic, that is a different story.” The point is that the doctors have far more tolerance of emotional distress than the counselors did. And the ultimate decision to continue or discontinue past a certain point is with the doctors. (106)
The workers complained about the insensitivity some doctors showed towards patients.
Some doctors tended to initiate small talk with the counselors and essentially ignore the patients: most counselors felt that this was insensitive: “she’s lying on the table having an abortion… She doesn’t want to hear what you did with your boyfriend last weekend. (97)
And, of course, there was only so much the abortion workers could do to protect women from shoddy medical care and poor surgical skills. One worker says:
At Gino’s, quality of a hamburger depends on who’s working the grill that day. It’s the same with abortions. If Dr. Benjamin is on that day, I know there’ll be few complaints. If it’s Dr. Thomas, I know there will be a lot of pain. (105)
Even though many of the workers Joffe interviewed went into the abortion business hoping to help women, they all had to face the reality that the doctors and facility administration were not in the abortion business to serve the women, but to make money. Sadly, most workers adjusted to this reality and continued working there. However, the author notes that during the time she was interviewing and observing at the facility, one worker decided she’d had enough. She announced that she had become pro-life and quit her job in the abortion business, never to return.
Source: Carole Joffe, The Regulation of Sexuality: Experiences of Family-Planning Workers (Philadelphia: Temple University Press, 1986)