Abortion Services Are Harder To Find For State Women

A few years ago, a woman with an unwanted pregnancy in Chelan County could get a legal abortion close to home, in Wenatchee. Women all over the state, in Kitsap, Clark, Grant, Island, Okanogan and Grays Harbor counties, could find abortion providers nearby.

No longer.

Washington residents have repeatedly voted in favor of liberal abortion laws, recently passing an initiative to keep abortion in the state legal even if federal protections are removed. But because of a variety of factors - including intimidation by anti-abortion groups - the number of doctors and clinics providing abortions has dwindled, leaving almost two-thirds of the state's counties without a single provider.

While the debate on abortion rights continues and the U.S. Supreme Court gears up for oral arguments Wednesday on whether states can restrict access through 24-hour waiting periods and spousal consent, the reality is that access to abortion already has shrunk for thousands of Washington women, forcing them to travel - sometimes hundreds of miles.

Statistics kept by the state since 1970 show that the number of abortion providers performing the procedure in the first three months of pregnancy have decreased dramatically.

In 1982, 97 doctors' offices and clinics, where almost all abortions are performed, reported doing at least one abortion. In 1990, 72 reported doing any abortions - a 26 percent decline.

In 1990, no abortions were performed in 25 of Washington's 39 counties, up 56 percent from 16 counties without abortion eight years before. In four other counties, only one or two abortions were performed.

Many women needing abortions in those counties traveled to other parts of the state, most of them to King County. From Clallam County in 1990, 193 women came to King County. From Chelan County, 121 women; from Skagit, 172; from Whatcom, 143; from Grays Harbor, 94. Nearly 2,000 more from different counties went to Yakima, Pierce and Spokane counties.

In 1990, 31,443 abortions were performed in the state, almost two-thirds in King County. Pierce, Yakima and Spokane counties had most of the rest, primarily in large clinics that specialize in abortion and perform hundreds each year.

Rural areas tend to have the least access. But for abortions after about 13 weeks - about 9 percent of the total - access is extremely limited even for urban women. Only two or three Western Washington clinics and only one east of the Cascades perform them. They're far costlier than first-trimester procedures and they entail an overnight stay.

And getting a second-trimester abortion is even more difficult for low-income women. On March 30, the only place east of the Cascades for women to get such abortions quit performing them on women with Medicaid because the state pays $100 less than the cost. Statewide, there are now only two providers doing second trimester procedures for women with Medicaid.

RURAL AREAS GO WITHOUT

The fact there are fewer doctors willing to do abortions does present a problem, public health officials say.

"Lack of access to care of any kind is a major problem," said Dr. Mimi Fields, Washington state health officer and the deputy secretary of the state Health Department. "It's more pointed in rural areas. Care for women . . . is a very, very difficult problem.

"We ought to be able to take care of people without having them go long distances."

Although the health department is "always looking at access," Fields said, there is no plan to increase access to abortion.

Mary Jo Kahler, executive director of the anti-abortion group Human Life of Washington, views the decline in access to abortion as a good thing.

"We believe abortion harms both the woman and her child," Kahler said. "It's a quick-fix answer that in most instances creates a great deal of pain for all involved. So anything that . . . eliminates the quick-fix solutions that exacerbate the problem has to be a positive response."

DISTANCE IS AN OBSTACLE

Rural women in Washington have a lower abortion rate than women living closer to abortion providers, said Kirsten Holm, a research analyst with the state Department of Health. "Whether that's because there isn't care available, we don't know."

But Beverly Whipple, executive director of the Feminist Women's Health Center in Yakima - where a third of patients live more than 100 miles away - sees a link.

"For some women, they don't make the trip because 200 miles might as well be 2,000 miles," Whipple said. "Others just do what they have to do to get here."

The concentration of care in urban areas is a national trend in abortion, partly because when abortion was legalized, there was an effort to assure most abortions would take place in clinics, where costs would be lower and doctors would be skilled at the procedure. But one result, said Barbara Radford, executive director of the National Abortion Federation in Washington, D.C., was that fewer new doctors felt they needed to learn to do abortions for their own practices.

What's more, fewer residency programs required doctors to learn the procedure. According to a 1991 survey of 225 residency programs, conducted by Dr. Trent MacKay of the University of California at Davis, just 12 percent required doctors to learn how to do first-trimester abortions, down from 23 percent in 1985. Only 7 percent required second-trimester abortion training, down from 23 percent in 1985.

At the University of Washington, residents training to be obstetricians and gynecologists are required to learn the procedure unless they are religiously or morally opposed.

PROVIDERS INTIMIDATED

A growing protest movement has also had its effect.

As clinics became a target for anti-abortion groups, Radford said, fewer doctors wanted to work in them. Intimidation and harassment by anti-abortion groups such as Operation Rescue have also had their effect - not only in states like South Dakota, where only one doctor is left providing abortions, but also in Washington.

According to state health department records, 85 percent of providers said they had been targets.

Probably the most violent attack was on a clinic operated by the Feminist Women's Health Center in Everett in the mid-1980s. "It was firebombed three times," said Whipple, who is with the center's Yakima clinic. "There was daily harassment and attacks on our staff and patients. We could just not operate. It's gone."

That left Snohomish County with only two clinics, both doing only first-trimester abortions.

More subtle pressures have made a difference, too. Across the state, when doctors who did provide abortions retired, often there has been no physician to replace them.

When the only doctor in Kitsap County providing abortions moved on in the early 1980s, for example, no one took his place. Obstetrician Glen Christen came to work about 18 months ago at a large Bremerton clinic, and there was no question about changing the status quo.

"The clinic had no interest in being the only one that did them," Christen said. "I was told at the start I would probably not be able to perform them if I came here."

In Wenatchee, when Dr. Earnest Movius, a staunch believer in abortion rights, retired in 1984, the other doctors who had been providing them at the same clinic stopped.

"There were two doctors that were remaining at the clinic - they said they'd had poison letters left on their windshield wipers and the car," Movius said. "Threatening letters."

Wenatchee women now must go to Spokane, Yakima or the Tri-Cities, where Planned Parenthood recently opened a clinic. If they're into their fourth month, they have to cross the mountains into King County or travel to Portland, Ore.

Movius, like other older doctors who were practicing before abortion was legalized, say access is important in part because he's seen firsthand what he considers the ugly effects of not having abortion available.

"I can recall a case in the early '50s. A young lady came down from the upper valley," Movius said. "She'd tried to abort herself by inserting a lead pencil into her cervix. And of course, she had introduced infection. She was a pretty sick cookie."

BLOCKADING HAS LESSENED

In the late 1980s, anti-abortion groups started "blockading" clinics. It happened all over King County, including an obstetricians' office in Bellevue, where three doctors performed only a few abortions a year for their regular patients.

"The patients were being verbally abused. They were being pushed against the wall. Some patients turned around and went home," said Suzie Parker-Dixon, office manager of the Bell-Grove clinic. "But it affected us in a positive way. There was an outpouring of `Good for you for standing up for women's rights.' "

One of the doctors, Ronald Coe, said he and his colleagues would probably "stiffen their resolve" if it happened again, and would continue providing the service. "Full-service physicians should be doing abortions," he said.

A federal injunction against trespassing on clinic property, issued following a blockade at a Seattle clinic and now being appealed to the 9th Circuit Court, has kept most clinics free from intrusive demonstrations since 1989. Picketers, however, are a regular fixture in front of some clinics, on public rights of way. And most clinics now have elaborate security systems.

"Our locks have been super-glued shut a couple of times so we've been unable to enter the clinic," said Deborah Van Derhei, clinic director of Aurora Medical Services in north King County. "Just six months ago, in fact," she said.

TRAVELING A LONG ROAD

The Aurora clinic, which does abortions up to 16 weeks, gets women from all over the state, Van Derhei said. Many tell stories of difficulties they've had, getting the money together, finding child care and making other arrangements.

"We have a number of women who come from Spokane and drive over the mountains because it's cheaper, because we have more providers here," she said. "We have women that come from Ellensburg and the North Cascades and Northeastern Washington. And a lot of women that come down from Bellingham and Blaine. We get a lot of women that come from the islands and the peninsula. From the San Juans, it takes a whole day. Sometimes they stay overnight."

Diane Hale, administrator of the Cedar River Clinic in Renton, one of the few providers of second-trimester abortion, remembers one woman who did.

She was from Wenatchee. She hadn't known she was pregnant for some weeks, but when she suspected, she went to a clinic in Yakima. They told her she was past the first trimester, the only kind of abortion they performed, one that typically costs $270 or so, and referred her to the Cedar River Clinic. The cost, payable up front, would be $450.

Her husband drove her to Renton, with the couple's four children in tow. The woman asked to use the phone, and a staffer overheard her calling local women's shelters, so she'd have a place to sleep.

"They didn't have a place to stay that night, and the only food they had was a loaf of bread. They had exactly enough money for the procedure and for the gas to get up here," Hales said.

Hale took up a collection among the clinic staff, went out to the parking lot and handed the family $114. "The man started crying," she said. "The family needed to get this done, and they were going to get this done."