Gosnell case fuels bitter US abortion debate

PHILADELPHIA - May 16, 2013

But the woman happened to be six months pregnant, and nearly waddled to the stand. If the jury had any doubts about the second- or third-trimester abortions Gosnell performed at his west Philadelphia clinic, she offered a stark visual.

So, too, did the cellphone photographs staff took of a nearly 30-week baby so large that Gosnell callously joked it could "walk to the bus."

That boy, Baby A, is the first of three babies Gosnell stands convicted of killing after Monday's verdict. The 72-year-old Gosnell waived any appeals to avoid the death penalty on Wednesday, and will spend the rest of his life in prison.

The high-profile murder trial of a high-volume abortion provider reignited one of the nation's most intractable debates.

People on all sides of the abortion debate - from proponents to clergy and lawmakers - were quick to attack Gosnell, whose methods were unorthodox even when they weren't criminal.

"Gosnell's conviction is proof that he ignored not only state and federal laws, but standards that are set by the medical profession on best practices in reproductive health care, including safe abortion care," said Dr. Nancy Stanwood, the chair-elect for the New York City-based Physicians for Reproductive Health.

"Some abortionists may have cleaner sheets than Gosnell, and better sterilized equipment and better trained accomplices, but what they do - what Gosnell did - kill babies and hurt women - is the same," said U.S. Rep. Chris Smith, who co-chairs the House Bipartisan Congressional Pro-Life Caucus.

Opponents of abortion were joined by proponents in calling Gosnell's conviction appropriate, but they remained divided over what it may portend.

"Justice was served to Kermit Gosnell and he will pay the price for the atrocities he committed," NARAL Pro-Choice America president Ilyse G. Hogue said this week. "We hope that the lessons of the trial do not fade with the verdict. Anti-choice politicians, and their unrelenting efforts to deny women access to safe and legal abortion care, will only drive more women to back-alley butchers like Kermit Gosnell."

The Gosnell case could serve as a fulcrum for more dialogue about abortion, said O. Carter Snead, a University of Notre Dame bioethicist and law professor.

"I would hope that people on both sides of the abortion debate, after this Gosnell atrocity ... would sit down and say we have to find a way to talk about this," Snead said.

Gosnell's clinic went more than 15 years without a state inspection, a span that saw the practice become reckless and the doctor rich.

According to staff members, Gosnell had once performed mostly first-trimester abortions, but that proportion changed as first-trimester patients found other options than his chaotic, dirty clinic, and second-trimester patients increasingly had fewer options.

Gosnell came to rely on untrained staff, unsterile equipment and unorthodox abortion methods that included women delivering babies that were then "snipped" with scissors after they were born alive, the jury found.

Gosnell was also convicted of involuntary manslaughter in the 2009 drug overdose of a patient, a 41-year-old refugee from Bhutan.

"The fact that we've got such a paralyzed political system when it comes to this question leads to attorneys general, governors and others not doing anything in the face of obvious harm to the public," Snead said. "This is a grotesque wakeup call for us to sit down and have a hard conversation about a very difficult question."

Relatively few women seek second-term abortions, and only a fraction of them wait until after 20 weeks. Abortions at 21 weeks or more make up only 1.5 percent of the total performed in the U.S. each year, according to the nonprofit Guttmacher Institute, a research group that supports abortion rights.

That group might include teens in denial, the poor trying to raise money for the fee, or women trying to get several days off of work or family responsibilities in states with waiting periods.

Stanwood said that what she described as "arbitrary" restrictions on abortions in some states could drive some women to use clinics such as Gosnell's.

"He was preying on women who were on the social margins, who didn't have ready access to health care," she said.

The desperate, uninsured poor made up a considerable portion of Gosnell's cash-only practice. The mother of Baby A testified that she was 17 at the time, and didn't know how far along she was. She guessed she might be 4 1/2 months along when her aunt brought her to Gosnell's clinic in Delaware.

Gosnell manipulated the ultrasound wand to make the baby appear smaller, and listed the fetal age at 24.5 weeks, according to staff testimony. He then told her to return the next day to Philadelphia, where abortions could be performed until 24 weeks, four weeks later than in Delaware.

The aunt raised $2,500 in cash, some of it from an ATM after they arrived in Philadelphia. The aunt thought the abortion was in the girl's best interest, although the teen ended up with sepsis from the abortion, and spent two weeks in the hospital.

Staff cell phone photos showed what one clinic worker called the largest aborted baby she had ever seen. A prosecution expert said it was nearly 30 weeks. The photo was shown repeatedly during the trial, in part to prove the prosecution's theory that Gosnell regularly aborted babies past the state limit. The jury convicted him on 21 or 24 counts of performing illegal third-term abortions.

"Somewhere around 90 percent, 88 percent, (of women) have an abortion in the first trimester," said Elizabeth Nash, a public policy associate at the Guttmacher Institute.

The Buhtanese refugee who died at Gosnell's clinic, Karnamaya Mongar, had sought an abortion closer to her Virginia home when she was 15 weeks pregnant, and went to three clinics before she found Gosnell a month later.

Her case exemplifies one of the many reasons women delay getting an abortion, especially as states adopt more and more restrictions, Nash said.

"It's so heartbreaking," Nash said. "If we were able to provide health care to these women, who are so in a sense displaced because they don't have a connection to the health care system, either because of financial reasons, or fear, or lack of knowledge ... we could really make a huge dent in the unintended pregnancy rate."

Half of all pregnancies are unplanned, she said.

"If you could work on that issue, you could really reduce everything that's going on around abortions. The decibel level could be reduced. And potentially, we could have a real conversation about abortion."

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