News & Politics » Feature

No Choice

Access to abortions is shrinking at an alarming rate. For many low-income women, the prohibition against public funding is equivalent to a prohibition against the procedure itself.



Cook County commissioner Maria Pappas says Cook County Board president Richard Phelan "isn't man enough" to ask the board to reinstate abortions at County Hospital. And they're on the same side of the issue. People who disagree about abortion can be less friendly about it. The board's proreinstatement members are not very cohesive, or numerous for that matter. Yet if public funding of abortions for low-income women is reinstated here anytime soon, it will be at County Hospital.

Prochoice advocates insist that the current public-funding moratorium is the single largest obstacle to abortion access. That's not likely to change on the federal level. Prochoice groups are fighting just to keep abortion legal; they expect the Supreme Court to effectively overturn Roe v. Wade when it rules on a highly restrictive Pennsylvania abortion law it will hear on April 22. Nor is it likely to change at the state level. Illinois is considered "high risk" by the National Abortion Rights Action League (NARAL) because of its closely divided general assembly, though Illinois prochoice groups are working hard to elect prochoice candidates in November. Pam Sutherland, executive director of the Illinois Planned Parenthood Council, thinks the elections could make a big difference in the assembly's prochoice-prolife balance. That leaves Cook County.

But the lack of public funding isn't the only factor blocking abortions for many women. The prochoice and prolife communities might agree on one point: it's harder than ever to obtain an abortion in this country and harder than ever to obtain information about getting one. Well-educated women with adequate incomes remain largely unaffected, for now. Not so women with fewer resources, particularly teenagers and low-income women, who are mainly black and Hispanic.

These women face numerous obstacles. Fewer places now perform abortions, the number of new doctors training in abortion procedures has decreased, and many more experienced doctors have quit due to the harassment of antiabortionists. The Bush administration's "gag rule" is already operating at the Chicago Department of Health public family-planning clinics, while organizations such as Planned Parenthood are preparing to lose federal funding rather than refrain from telling patients about their options. There are also what prochoicers call "bogus clinics"--places that look and advertise like abortion clinics, but pressure women not to have abortions.

Let's start with the money. In Chicago there are basically two places where low-income women seeking abortions can go. Planned Parenthood's Midwest Health Center has a private grant to discount first-trimester abortions for low-income clients, about 25 percent of its patients. Uncounted thousands more women, including those who need second-trimester abortions, turn to the Chicago Abortion Fund (CAF), a small nonprofit group trying to help them on a tiny budget--last year it totaled $65,106.

Some background on why these are the only options would probably be useful. The Hyde Amendment, sponsored by Illinois' own U.S. representative Henry Hyde, cut off federal medicaid funding in 1977 for all abortions except when a pregnancy endangers the mother's life or is the result of rape or incest. Since then all but 12 states have restricted state medicaid funds. Illinois and 29 other states took advantage of a law signed by President Jimmy Carter on October 1, 1980, allowing states to restrict funding even more than the federal government. The Illinois law provides medicaid funding only when a mother's life is in danger, leaving rape and incest victims to their own devices. Two days after Carter signed the law, Illinois welfare officials announced that it would go into effect by October 22. On October 9 then-Cook County board president George Dunne unilaterally banned all abortions at Cook County Hospital, with or without county public funds, except to save a mother's life.

Dunne called County Hospital an "abortion mill," asserting that of the 3,600 women who had abortions at County each year from 1973 to October 1980, 1,769 had had more than one and some had had as many as six. Dunne's disapproval put a misleading spin on those numbers: the total number of abortions performed in the years he cited was 28,800, and repeat abortions were a mere 6 percent of them. In other words, 94 percent of the women who came to County had only one abortion there. Yet Dunne's ban went into effect the next day.

Eighteen women showed up at the hospital on October 10 for previously scheduled abortions and were referred to three clinics. The Tribune interviewed two teenagers and their mothers. One mother, a widow on public aid, said that "after getting through all the nervousness of what was going to happen today, we come here and wait for a half hour before they announce that we can't get an abortion. It took me 20 minutes to stop this child from crying and shaking." "How am I going to raise a child?" her daughter asked rhetorically. "I'm trying to go to school, and my momma is still taking care of me. I can't add to her burden with a grandchild."

Then-hospital associate director Charles Jervis said that at the time County was performing 3,500 abortions a year, about 75 percent of which were subsidized. There are no exact numbers on how many poor women have since sought and failed to obtain an abortion. A 1976-1978 study by the Chicago Reporter, done when medicaid funding for abortion was already widely unavailable due to confusion over medicaid reimbursement, found that 13.5 percent of the women who would have sought publicly funded abortions gave birth instead. A 1990 national study by the Alan Guttmacher Institute, a nonprofit research organization, found that 20 to 25 percent of women who sought an abortion have been forced to carry to term since the Hyde Amendment was passed. The Illinois Department of Public Health says its records of state-funded abortions prior to 1984 are no longer available, but between 1984 and 1990 it recorded a total of 19 state-funded abortions.

We also don't know how many women have suffered complications or died from illegal or self-induced abortions since public funding was cut off. No one anywhere keeps records of such cases. The Centers for Disease Control made one attempt to measure the increase by monitoring 24 hospital emergency rooms immediately after the Hyde Amendment was passed, and linked four deaths from illegal or self-induced abortions to lack of medicaid funding.

Back in 1980 Jervis pointed out that before abortions were widely available County Hospital devoted an entire ward to women suffering complications from illegal abortions. "That is our greatest concern. That these women will turn to something else," he said. "The problem will still be there, and people are going to take care of the problem one way or another."

Dr. Kathy Fagan, then head of County's House Staff Association, said that the hospital had seen almost no cases of illegal or self-induced abortions since abortion became available, but she predicted an increase. Less than a week after Dunne's abortion ban, two women were admitted to the hospital's emergency room after attempting to induce abortions themselves. Nonetheless the Cook County board unanimously approved Dunne's ban a few weeks later.

One County doctor says the hospital doesn't often see such cases now, "but enough to make it an issue. If you have even one Rosie Jimenez, that's too much." Jimenez, a 27-year-old Texan who was about to graduate from college, is thought to have been the first to die from an illegal abortion after the Hyde Amendment passed.

The Chicago Abortion Fund was started to prevent cases like Jimenez's in the Chicago area. In 1984 members of Women Organized for Reproductive Choice began recruiting from groups such as NARAL, the Chicago Women's Health Center, and the now- defunct Health Evaluation Referral Service (HERS), and together they started raising money to help low-income women pay for abortions. By October 1986 they had raised enough to set up an office, hire a part-time director, and start distributing loans and grants.

Only a handful of groups like CAF exist in the country. Last year it helped 1,241 women with $40,000 in direct grants and the equivalent of an estimated $150,000 in reduced fees at the small pool of clinics that lower prices for CAF clients. Individual contributions made up 64 percent of the budget; the rest came from foundations.

Even with yearly budget increases, the CAF office answers client phone calls only 12 hours a week because there aren't enough funds to help even the women who get through in that short period. "At one point we received 100 calls a month that we actually talked to, and another, say, 40 on the answering machine that we could never get back to," says executive director M. Jeanne Wirpsa, who has an extensive background working with homeless women and children and is finishing a doctorate in theology at the University of Chicago. "I get women who have the operator interrupt because the lines are continually busy and they can't get through." At most CAF can partially fund an abortion, seldom paying more than $200 in a direct grant. When the budget periodically runs dry, it provides only reduced-fee referrals, advice, and sympathy.

CAF also took over an abortion-clinic-evaluation project from HERS when it folded in 1989. "The safe legal aspect is important," says Wirpsa. "Low-income women historically have resorted to less-than-safe abortion providers because they advertise lower prices, and the information is not out there for them. Planned Parenthood used to do evaluations, but they stopped. They in part rely on our findings. We just finished the latest round of evaluations, and the status of the project is up in the air. We don't know if we can continue it."

Abortions are not cheap. "Think about the cost of a first-trimester abortion--$200 or $250," says Wirpsa. "And most of the women we deal with are facing higher costs. Think about a woman who is getting $367 a month for three children, the average from AFDC. That's the money she has to work with. The average rent in Chicago for a family of four was $540 the last figure I saw. They have no resources at all. Their family and friends are usually in the same circumstances.

"Then you have women who really fall through the cracks--working part-time, at minimum wage, who are making only $500 a month, who don't get food stamps, who don't get any public assistance because they're 'working,' and they have even less access to resources than public-aid recipients. I had one woman the other day who got her $200 toward a $500 abortion, and I asked how she got it. And she said, 'We didn't pay half of our bills.'"

Wirpsa says a disproportionate number of low-income women need second-trimester abortions because they have to spend weeks saving up for them. Of course the medical risks increase substantially in the second trimester, and the costs skyrocket. "At 13 or 14 weeks, if you can get transportation outside the city, it's $280 to $300. One clinic in the city will do it for $400. Most places it goes up to $500 to $600 as soon as you enter the second trimester--up to 16 weeks. Some places increase it week by week, some places by chunks." By 20 weeks a clinic abortion runs $1,200 to $1,500.

"That's an astronomical amount for the women we work with," Wirpsa says. "I get women calling who are 16, 18, 20 weeks pregnant who say, 'I saved the $200--it took two or three months to get the money.' They don't know the cost goes up."

Diana Lammon, clinic manager of Family Planning Associates Medical Group (FPA), agreed to work with CAF when her clinic opened four years ago. "People don't realize--they think the only calls we get of cases needing discounts are from the abortion fund. But it's gotten to the point where we get a good many calls during the week, some weeks more than we can handle. First it's someone living out of the garbage, then the 14-year-old who's been raped by her father. I mean, it goes on a roll, where by Friday you're going, 'OK, we'll do this one for very little money, and this, and this.' And you think that's it--and the next call's still worse than the last.

"The worst thing was dealing with no way to help these people that have no money. I've had people bring things into the clinic--jewelry, they'll give you anything. They'll have a TV set in the car that they'll want to give you because they don't have any money."

Other factors also prevent low-income women from seeking early abortions. "It makes a huge difference in how soon women realize they're pregnant," says Wirpsa. "For example--and this surprised me when I first started here--many women spot during their first few months, so they think they're getting their period. So until they start to recognize other symptoms, they don't realize they're pregnant. So you can be three months pregnant before you realize it and start to act on it--make a decision, try to find funds, get information on clinics. And then there are the young women who are in denial, especially if you're 13 or 14 years old." Lammon concurs and points out that other women need second-trimester abortions simply because amniocentesis results showing fetal abnormalities don't come in until they're 17 or 18 weeks pregnant.

Lack of information on good clinics can cause further delays. Many women who call CAF have already gone to a clinic that includes blood and ultrasound tests in the abortion cost and have paid up front, only to find that their pregnancy is, say, 13 weeks along and the clinic only does abortions up to 12 weeks. Or the pregnancy is late enough that it crosses into a more expensive fee range the patient can't afford. Either way, their money isn't refunded. Wirpsa describes a downtown clinic she prefers not to name. "They confuse women enough so that they think they're going to be able to get the abortion done there. But then if they don't do the abortion, they wind up keeping her $185. So there's $200 lost that they could have used to go to a reputable clinic."

Many CAF clients have accidentally visited one of the bogus clinics, says Wirpsa. "We have a lot of clients who wind up going to those because they do false advertising--and our low-income women are looking for the best deal they can get, and they can't discern from the Yellow Pages which are good clinics and which aren't. That's one of the things that causes me the most anger, when I hear from a client who wasted a couple of weeks because she contacted one of those clinics and it delayed her. Not because they changed her mind--which is very interesting--but because it took her another week or two to get going again. They're usually very angry when they call, because they recognize the delay in time. It happens very often."

CAF works out of a one-room office the size of a large bedroom. The window looks out over a liquor-store parking lot across the street, and the el rattles by next door. The room is sparsely furnished with gray industrial carpeting and a large metal desk that holds a jumble of files and notebooks. Two smaller desks, one filing cabinet, and one bookcase line the white walls. Overhead are a dropped ceiling of acoustic tiles and one fluorescent light. In February a large space heater is turned up, but it's still chilly.

On a typical day Wirpsa works alone or with one or two volunteers during phone hours, from 1 to 4 PM four days a week. Often the phone rings at exactly 1 PM; after that, a five-minute interval between calls is a long one. Callers are referred by clinics, hospitals, and social-service agencies, which do the initial screening to determine financial need. Wirpsa and the volunteers take down information on each caller--age, income, number of children, medical problems. First-trimester women are referred to Planned Parenthood's Midwest Health Center; the others get financial counseling.

The CAF staffers try to ascertain how much money each woman can contribute herself and whether she has exhausted all of her resources. They'll ask if she can borrow from family or friends, whether anyone she knows may have a credit card she could use, whether she has anything she can sell. Each client needs to put a fair amount toward the abortion, since CAF can't afford to give more than a maximum of $200 to $250 to any one person. Depending on how far along the pregnancy is, they may ask women to look for money for a few more days or a week before calling back. When possible, CAF sets up an interest-free payback plan, but since CAF clients have little or no income, only 5 or 6 percent of the loans are repaid. CAF doesn't really push for the rest.

On a recent afternoon Wirpsa is joined by two volunteers who prefer not to have their real names used. Beth is planning to start law school next fall; she recently quit her job to live on her savings and work at CAF as a part-time unpaid intern. Lauren is a UIC undergraduate psychology major doing an internship for a class.

The calls on this day range from an 18-year-old with one child and a public-aid income of $268 a month to a 16-year-old who was raped and lives with her grandmother. Beth takes this call, announcing as she hangs up, "Her grandmother knows and is trying to prevent anyone from helping her, because she says if she hadn't been outside this wouldn't have happened--and a woman's place is in the home." "Her grandmother knows and won't help?" Lauren coughs in disbelief.

The day's last call is from a homeless woman living in a Springfield mission shelter. The mission has just kicked her out after learning she is contemplating an abortion.

"I come home from this job sometimes completely overwhelmed and feeling quite hopeless about the situation," says Wirpsa. Lauren voices the same thoughts. "For like the first two weeks I used to just sit on the train on the way home and wonder if this girl or that girl was OK, for instance. It was like seeing a car accident for the first time, how you're shocked. These women are very real. It's just been a personal eye-opener."

Wirpsa is talking on the phone to a woman I'll call Sharon. "She's 21, she has five kids under five years old, and she's been trying to get this abortion for two months. But she hasn't been able to get the money." Wirpsa always speaks in a calm, soft voice, but whenever she becomes especially concerned her voice drops. She practically whispers to some CAF clients. "Now she needs $850," she says, barely audible. "We may or may not be able to help her, but I found her story particularly compelling, so we're going to try our hardest. Just between you and me, we're going to do our damnedest." Wirpsa has asked Sharon to see what she can find over the weekend.

Later Sharon tells her story in a voice that alternates between toneless despair and spurts of optimism. "Right now really I've got two four-year-olds, because the one just turned four and the other isn't five yet. And I just don't think I'd be able to deal with another, because me and my husband aren't together right now. And they all being so young, I don't think it's fair to them. They're not getting all the baby time they should. And then other things that come along in family life. I didn't want to go through an adoption, because there's no telling if somebody else would treat it right, and that wouldn't make me feel any better. I've been trying to have an abortion since the early part of January." She calls gently to one of the children, who are playing in the background. "Honey, put that down. Put that thing back there. Bring that to me. Bring me the bottle."

With one baby settled down, she continues. "I looked through the phone book, and I called a lot of abortion places. I was just looking through the book trying to find one, because I'd been calling since the beginning of my pregnancy. But since I'm on AFDC, I get $540 a month. And my rent is $470, so when I get my check the first thing I do is pay my rent. When I first moved here I had $100, and I called this one place and they said it'd be $180. I said I had $100 in my hand, could I just make some kind of payment plan? And they said no, you have to have the whole thing. And I knew I couldn't come up with 80 more dollars, so . . . " Her voice trails off. "And I haven't come in contact with any more money since then, so . . . "

Sharon says she had no idea how high the price would get as her pregnancy advanced. "When I was calling places, in the beginning they was saying 200 something or 300 something, and I thought that was high. Now I'm farther, and they're like $800, $1,200. I mean God." She breaks off and starts imitating someone at a clinic she called recently. "'Oh, if you're on public aid you get a discount. If it's $1,200 we'll knock it down to $1,000.'" She snorts. "I'm like, wow. I mean, that's not really any help to me. Because I'm on public aid. Where am I supposed to get that amount of money from? There's no way I can get it being on public aid. I'm on it for a reason." She can't help giggling at the situation.

Sharon wanted to have an abortion the last time she was pregnant, but she inadvertently went to a bogus clinic. She still sounds disgusted when she remembers it. "When I called--I found it through the phone book--I thought they'd help get an abortion. They showed me a film and all about an abortion. And then I said I didn't want to go through with it," she says tiredly. "I just went to places and got maternity clothes and brought the baby home. And me and my husband were together then, so it was like 'We're gonna work this out.' But now we're not, and there's no way I'm gonna bring another baby home. I mean, I'm having a hard enough time as it is. I mean, I have kids comin' out of the woodwork. It's not like I just don't want the baby, because I wouldn't have five now if that was the case. I love kids, but I don't think it's fair to them either to keep every year bringing a baby home, and we all in a one-bedroom apartment. But that's all I can afford. Maybe if I moved into the city, but I wouldn't want to bring my kids into that kind of environment. So my whole check goes for rent, and then I worry about the other bills later. It's something that, being a parent, you have to do."

"It's so easy for me to get pregnant," she sighs. "I could have had my tubes tied, but I didn't because I might want to have more kids later on. And it turns out I got pregnant again. No matter what protection I use, most of the time I still get pregnant." She contemplates her mission for the weekend, scaring up close to $850. "I don't have any family that's financially fit to lend me money or give me money. But I'm gonna try to think of some way, someone who can help me or something--even though I don't know how that's possible. But I really want to do this, so I'm gonna try. Never stop trying."

For many low-income women, prohibiting public funding is equivalent to prohibiting the abortion itself. The ACLU filed suit last year on behalf of a 16-year-old Chicago girl pregnant from a rape. She and her unemployed mother lived on public aid. The girl was unable to get medicaid funding for an abortion, though her ACLU attorney, Colleen Connell, says it was recommended by two doctors and a psychiatrist. The girl--much like the 14-year-old Irish rape victim who was initially barred from traveling to England for an abortion--threatened to commit suicide rather than give birth. But the state didn't agree that her life was endangered. Patricia Dougherty, executive director of NARAL's Chicago office, recalls that when she worked at an abortion clinic she saw a patient who had already attempted suicide. "She had a public-aid card, but the attempted suicide was not enough to prove that the pregnancy was putting her life in danger."

The 16-year-old's case got a lot of publicity, and private funds were donated so that she could have an abortion. "The problem is that if people can get that kind of publicity, they can get the funding," says Dougherty. "But for every one person who gets that kind of publicity, there's thousands that don't." So the ACLU is pursuing the lawsuit in the hope of ensuring that medicaid funds can be used when a woman's mental and physical health are jeopardized. The suit claims that the existing law violates the right to privacy in the Illinois constitution as well as due process of law and equal- protection obligations--men who are eligible for medicaid are not denied medical care that's necessary to protect or preserve their health. This is the first time the Illinois law has been challenged at the state level; the ACLU challenged the federal law and lost in the U.S. Supreme Court in 1980. A Michigan appeals court ruled in a similar suit--now pending before the Michigan Supreme Court--that its state constitution provides a wider right to privacy than the U.S. constitution. If upheld, that ruling would protect public funding of abortion as long as the state funded pregnancy and childbirth costs.

Obtaining approval for a medicaid-funded abortion because a pregnancy threatens the life of the mother is never an easy process, according to abortion providers. "It's impossible," says the FPA's Diana Lammon. "I've never seen one be able to do that in four years, no matter what the case. Usually we'll just do it at a discounted price."

At County Hospital, Connell says, it was "very difficult to get administration approval for a termination" before Ruth M. Rothstein took over as hospital director from Terrence Hansen in December 1990. One woman who contacted Connell about being included in a class-action suit was admitted to the County emergency room with two serious conditions--high blood pressure and asthma--when doctors discovered she was also pregnant. "Her attending physicians recommended terminating the pregnancy immediately. Well, the administration refused the request for an abortion, finding that the threat to her life wasn't immediate enough--although certainly there were immediate threats to her health. The consequences were that the woman carried the pregnancy for another three months, was admitted again to the emergency room in her sixth or seventh month--and at that point her life was immediately in peril. And what that woman had to endure was an induction--they tried to induce premature labor, and after several days of excruciating labor she gave birth to a stillborn. And her health was seriously jeopardized by carrying that pregnancy another three months. The medical complications that ensued from the induced labor and other medical complications kept her in the hospital another several weeks. So what we see oftentimes is a policy that has resulted in women being forced to delay the inevitable termination until what was a threat to health becomes a threat to life."

"The state's idea of what's truly life-threatening is probably an extremely strict one," says a County Hospital doctor we'll call Jones. "Really kind of literal life-threatening, like you might die pretty soon as opposed to suffer." Jones is involved in the approval process for medical terminations of pregnancy, which begins with a written medical justification, then the approval of a physician's committee, and finally the approval of the administration. Jones calls the process "more straightforward" under Rothstein's administration. "When Hansen was there, there was a strong feeling in the hospital that he had the direct power to stop them." Now, says Jones, a written medical justification that makes it through the committee is usually approved by the administration. But, Jones cautions, "it's a lengthy, difficult process. Since this whole process takes weeks to do, it may not be something that a person who's feeling up against a wall as far as their urgent need to end the pregnancy is going to be able to completely follow through on. I'm not sure it's clear how they even enter the system."

To start the process, Jones explains, a woman needs to begin at the hospital's high-risk-prenatal clinic, "which is not a clinic one just finds one's way to off the street. They'd have to be seen by somebody and referred to the clinic and make the appointment and be talked to. I think a lot of women, if they have access to any fund or medical care, probably go and see if they can do it on a more immediate basis."

In testimony before the Cook County Board of Commissioners last November, CAF's Wirpsa told the board about a CAF client, a public-aid recipient with cervical cancer. "Medicaid would pay for the surgery required to remove the cancer, but not for the abortion that was necessary before surgery could be performed," she testified. "That's not unusual," she says. "This past summer we had calls from three women with cervical cancer who needed abortions." At least one was a County patient.

Jones notes that cervical cancer is considered unlikely to change significantly within six months. "On the other hand, you or I, if somebody told us we had cervical cancer, we'd want to start treatment yesterday. No one could really be expected to feel comfortable being told that they had to postpone their treatment in a way that was different than other people because of these financial barriers."

Deciding whether a pregnancy is life-threatening, says Jones, is usually "a numbers game. There are very few medical conditions that are 100 percent fatal to pregnancy, but there are conditions where you can say the chances of dying are 25 percent or 10 percent, which, considering that the maternal mortality in this country is something like six in 100,000, is an unacceptable odd. If we expect not to see a pregnant woman die almost ever, except by an accident, then saying she has a one in four chance of dying is not acceptable."

Sharon spends the weekend searching for any amount of money. "Man, it's been terrible," she reports on Sunday afternoon. "I've got all of $30, but I'm still trying. She told me if I could come up with a reasonable amount I could maybe get an appointment. I don't really know anyone with money, so . . . I called people, but nobody seems to have any money. I didn't tell 'em what I wanted it for, but I been trying everybody I know, everybody I can ask for money, 'cause you can't ask just anybody."

On Monday Wirpsa talks to Sharon on the phone. "I just told her we have never in our history made a loan of $800," Wirpsa says. "We once made a loan of $600 to a 13-year-old rape victim. I really can't loan her that much, though I'm really tempted. So I told her if she can get some more together, to call back."

"I'm trying to get up the money," Sharon explains that Friday. "I didn't even get my check this week and I was supposed to. I could have paid my rent and used the rest of it. I called the welfare people, and they said it was an error they made." She lets out a deep sigh. "I wish they'd get it together, because this is keepin' me from doing a lot of stuff. I can't even pay my rent, and the landlord is really bugging me. He's having a fit, even though this is the first time I've been late. If I can't get it together in time I'm really gonna be a mess. It's a lot of stress on me mentally because I'm not ready to go through this again. That's all I been thinking about."

Illinois is nothing like North Dakota. There one abortion clinic under constant seige by antiabortion protesters serves all the women in the entire state. The doctor has to fly in from Minnesota after dodging protesters in her driveway and at the airport.

Then again, maybe Illinois is a little bit like North Dakota.

In Illinois 69 percent of urban counties and 99 percent of rural counties had no abortion services at all in 1988, according to a Guttmacher Institute study. Cook County wasn't one of these, but it has followed the study's documented trends: nationally, hospitals offering abortions dropped from 1,654 in 1977 to 1,040 in 1988, and 86 percent of all abortion services were provided in clinics. In Chicago hospital abortion clinics have dwindled to one. In addition, second-trimester abortion services, especially critical for low-income women, are scarce, and many in the prochoice community believe clinic numbers are declining.

Both Illinois Masonic and Michael Reese have discontinued services, Illinois Masonic so that it could buy adjoining land owned by the Chicago archdiocese. That left Northwestern's Prentice Women's Hospital, which performs abortions up until 16 weeks. After that, the FPA's Diana Lammon says, a woman whose health requires a hospital abortion has "nowhere to go. We'd have to do it here with backup. You can't send them to a clinic in another state, because they won't do it either. There's only been one that we had to turn away--because we know if we send them away, there's no place for them to go."

Few Chicago clinics do abortions up to 16 or 17 weeks, and only the FPA goes to 23 weeks. Until the FPA opened and began working with CAF, many second-trimester CAF clients had to travel to Rockford, Saint Louis, Milwaukee, or Dayton. But non-CAF clients may not find out about the FPA's second-trimester service. According to Lammon some Chicago first-trimester providers won't refer patients there. "They will refer them 300 or 400 miles out of state. I've met with them, and they'll remain nameless, but they will not do it because they don't want to take the business away from themselves. Because what they say is, a big referral source is word of mouth. Friends. So if they get a patient at 17 weeks and they send her to us and she likes our facilities better, she'll tell her friends about us. They're afraid of losing first-trimester clients that way. It's very, very sad, because if you give a 14-, 15-year-old kid an address four, five hours away, they'll never get there."

Existing clinics are also threatened by a decrease in trained doctors willing to provide abortions, which is related to the hostile climate produced by prolife demonstrators. In 1985 almost 25 percent of obstetrics-gynecology residency programs required first- and second-trimester abortion training. By 1990 that number had dropped to 13 percent requiring first-trimester training and only 7 percent requiring second-trimester.

"We have a tremendous problem attracting physicians, in our case to do first-trimester abortions," says Bryan Howard, associate director of Chicago's Planned Parenthood. "There are physicians occasionally who contact us who would be willing to do abortions, but we have very high standards, including requirements for the experience they must have had. Part of what they have to evidence is the number of procedures they have done previously. And because it has become such a rare service, there are very few physicians who are already at that point. When necessary, we're able to train. We'll allow the physician to perform the procedure with a more experienced physician attending to get them up to the threshold. But that makes it an enormously expensive process."

"A couple of clinics have closed, and one other well-known clinic has lessened its service considerably," says Eileen Adams, former administrator of Park Medical Center, which closed in late 1990 after 13 years. "Basically I think one of the reasons clinics are closing is because of the doctors. You cannot get a good doctor. That's one of the reasons we closed Park. We had superb doctors, and then our main doctor said he wasn't going to deal with the antiabortionists anymore. I hate to have that in the paper, so the antiabortionists will say they've won, but they did. Young doctors don't want to touch it. Older and middle-aged doctors are concerned about picketing of their businesses and homes. The only ones willing to go through all that are the older ones who remember when women didn't have a right to choose, and they're retiring now. Doctors don't want to be picketed. They don't want their kids followed to school. The only ones I think that will continue are the clinics owned by doctors. That wasn't the case with Park."

Compared to cities such as Wichita that have undergone prolonged demonstrations by the prolife group Operation Rescue, Chicago abortion providers agree that Chicago is relatively unscathed--but not unaffected. Dr. Aleksander Jakubowski gained much unwelcome publicity last year when prolife demonstrators chained themselves to his car and his Aurora clinic suffered about $150,000 in vandalism damage. Jakubowski moved the Aurora clinic last year when his lease was not renewed due to the protests. He also closed his Milwaukee clinic, where CAF used to refer clients in that city, after he tried to relocate and couldn't get a lease. In Chicago many clinics are picketed every Saturday. American Women's Medical Center was blockaded twice last year. Planned Parenthood clinics, says Bryan Howard, have been largely spared, probably because their sites "don't lend themselves to news coverage," since they are usually in multiunit buildings.

Eileen Adams says the demonstrations at Park were almost constant. "That's because Park is a freestanding building on a wide boulevard across from a park. As far as the antis were concerned, that was wonderful for the media. And of course they do pick a clinic that's well-known, and they do pick the good clinics. We had picketers every Saturday. In terms of Operation Rescue or the Illinois Pro-Life Alliance, I mean really big demonstrations, hundreds of people. Those always happened on the Saturday before Mother's Day, generally on Christmas, and once or twice more during the year when we weren't expecting it."

Cook County state's attorney Jack O'Malley isn't prosecuting antiabortion protesters aggressively enough, says Susan Valentine, a Chicago lawyer who represented American Women's Medical Center against protesters arrested for blockading the clinic last year. "They were charged with criminal trespass, mob action, and resisting arrest," she says. "The course Jack O'Malley took is that they would all, regardless of criminal records, get court supervision, which is not a conviction of record. They can get back their fingerprints, mug shots, everything. So in effect Jack O'Malley was telling these people, 'You didn't do anything wrong.' Especially because a lot of them had been arrested before and convicted, and a couple had even spent time in jail. To give them court supervision is no deterrent. In fact, as we were leaving the court, they were saying to the center's doctor, 'We'll be doing the same thing next Saturday, doctor.' They only had to pay a $10 fine."

The National Organization for Women is charging that demonstrations organized nationwide in the last decade by some antiabortion activists and groups, including Joseph Scheidler's Illinois Pro-Life Action League, constitute terrorism and are a conspiracy to close legal businesses. The NOW suit is currently being considered by the U.S. Court of Appeals for the Seventh Circuit in Chicago. NOW charges that the demonstrations--including 33 firebombings or attempted firebombings, 73 clinic invasions, and 311 blockades--violate the federal Racketeer Influenced and Corrupt Organizations Act usually used on mobsters.

The NOW suit is still under consideration, and two weeks ago a motion by one of the defendants for sanctions against NOW was denied. NOW had charged that the defendents "have links to arsonists and have not condemned such violence nor have they taken any steps to discourage further acts of violence." The judge ruled in NOW's favor, citing letters written by Joseph Scheidler, one of which read, "Thanks so much for sending the photographs of our gang in front of the bombed out abortuary--great scene. Appreciate your help. Keep up the good work."

Adams also calls the antiabortion tactics terrorism. "We never knew when the doors would be glued shut with Krazy Glue--or blocked by some moron with a Kryptonite lock around his neck," she says. "[Since Park closed] the death threats have stopped--that's a good thing, I can tell you. I'm not looking over my shoulder anymore."

A week after Sharon's first call to CAF, she still has only $30. She calls back anyway, just in case. "We were sitting here talking about her after she called, and we were in tears," says Wirpsa. "In my mind so much of this is about economic justice, not abortion, and that just really came to me so powerfully with her. Everything is against them. One of the things we talked about is that we do make exceptions in some cases, and Sharon is one. A woman who is 21, with five kids and no resources--that needs to be seen as important a case as a medical condition."

Wirpsa calls the FPA, and Diana Lammon agrees to even further reduce the CAF-client price. CAF pledges $600, and Sharon's appointment is set.

Sharon grew up on the west side, the second of nine children. She's moved her family to a tiny but well-maintained one-bedroom apartment in a tidy west-suburban complex. The living room is filled by two older plain couches, and a set of shelves holds a small TV and portable radio-tape player.

A few days before her scheduled abortion--a three-day procedure during which her husband will take care of the children--Sharon describes her life. She has a pretty moon-shaped face, almond-shaped eyes, and she pulls her long hair back in one thick braid. Her arms and legs are thin, and her pregnancy, which she says has just begun to show, is completely hidden by her large blouse. Her youngest son, who's eight months old, teeters around the room for a while before climbing on the couch to lean on her, clutching his bottle.

"The baby's real attached to me, so he's really gonna go crazy when I'm in the hospital," she says, smiling. "I hope I don't have to stay there the whole three days. I gotta get back to my family. My husband can do things, but I usually have to tell him what to do. I'm like Mother Hubbard. I'm never away, even when I had the babies. I never stayed overnight when I had a baby. The last one I delivered myself at home," she says matter-of-factly. "I didn't have a choice. I was at home alone.

"You know, I just got [CAF's] number by luck. I just called every number in the book. You know, every birth-control method don't work for everybody, because I tried everything. It's not like I haven't tried. I was on the pill and got pregnant. Ever since I started taking the pill I got pregnant every year, no matter what I tried. Believe me, after this I'm gonna use two things at once.

"Lately it seems like I'm always pregnant, so when I have periods I'm not even used to it anymore. I don't want to go through it at least one year. Hopefully this'll be the first summer I don't have to go through bringing a new baby home.

"How am I ever gonna be able to go out and take care of myself if I always have a baby? 'Cause I used to--I didn't go on public aid until my third child. And then I was giving my whole check to the baby-sitter and didn't have nothin' left over, so I had to quit.

"Usually every month with that little bit that's left, I'll pay $30 here and $30 there. As long as you pay 'em something it might be OK. I still don't know what I'm gonna do about Pampers and the other stuff I'll need this month. Most of the time I'll come out OK with the food stamps, but the money. I pay the rent, and the little bit that's left I'll use for the bill they're talking about turning off. But this month I won't even be able to do that because of the abortion. That landlord, he knocked on the door eight times yesterday. Eight separate times. I told him, when I get the money I'll pay you."

Women who look through the Yellow Pages for an abortion clinic will find reputable clinics that perform abortions, clinics that organizations like Planned Parenthood and CAF will not recommend to their clients, and bogus clinics. From the listings, many women will not be able to tell the difference. And according to abortion providers, the Yellow Pages are their single largest referral source.

The Yellow Pages are a crucial information source in large part because of the "gag rule," a federal regulation issued in 1988 prohibiting clinics that receive federal funding from discussing abortion with patients. The Supreme Court upheld the rule last year. Congress then passed a bill to overturn it, but failed to override Bush's veto. New bills to challenge it are now working their way through Congress, with the support of major medical groups, including the American Medical Association, who oppose the rule.

So far the gag rule hasn't been enforced, pending guidelines from the Health and Human Services Department. But those guidelines were issued March 20. The Bush administration claims they settle the most controversial issue by allowing doctors in federally funded clinics to discuss abortion. Nurses, counselors, and other health-care workers still may not. But at a March 30 hearing of the House Subcommittee on Health and the Environment, experts agreed that exempting doctors contradicts the gag-rule regulation, giving that part of the guidelines no legal weight--which leaves doctors who discuss abortion open to prosecution. Even if doctors could be exempted from the gag rule, the guidelines still do not allow them to refer patients to abortion clinics--which of course account for 86 percent of all abortion facilities. Moreover, according to Amy Coen, executive director of Planned Parenthood in Chicago, "the vast majority of patients [in public clinics] never see a doctor." They see nurses and other health-care workers.

However, the gag rule went into effect at the Chicago Department of Health's family-planning clinics right after it was issued. "If a young woman comes in and wants to know all her options, we'll give her a list of four providers," says spokesman Tim Hadac. They are Planned Parenthood, the Illinois Department of Public Health's Families With a Future, Catholic Charities, and United Charities. Of these, only Planned Parenthood provides abortions, abortion information, or referrals.

Organizations such as Planned Parenthood are nervously waiting to see if the new guidelines go into effect. "We're talking with the state about how this will be implemented," says Coen. "It's soon, in the next two or three months. I'm hoping Congress will take that as a compelling reason to really hustle with this." Otherwise Planned Parenthood will forfeit the federal funds it receives. In Chicago that comes to about $400,000 a year--about 10 percent of its basic operating budget and 25 percent of its family- planning budget. "It's going to cut back on the volume of care we provide, there's no question," says Bryan Howard. For the first time, Planned Parenthood would be forced to institute a minimum fee for clients, who now pay according to a sliding scale and therefore may pay nothing at all. "It's absolutely going to be much harder for women to get quality information about quality options," Howard insists. "At best they're going to be able to open the phone book--and advertising doesn't tell the whole story. There will be confusion because of the fact that in the Yellow Pages there are antichoice clinics as well as actual abortion providers. It's going to become a much more confused and difficult path to negotiate."

Actual abortion services are listed under the heading "Abortion Services" in the 1992 Chicago Yellow Pages. But a woman opening the book first sees the heading "Abortion Alternatives," with 16 listings and two and a half pages of display ads. None of the places listed here offer abortions or information about obtaining one. U.S. representative Ron Wyden of Oregon--chairman of the House Small Business Subcommittee on Regulation, Business Opportunities and Energy--held hearings last September about these clinics, accusing them of consumer fraud. The subcommittee staff found more than 2,000 bogus clinics in the country.

"Abortion or abortion-referral services are neither given nor contemplated by the operator," said the subcommittee staff report. "Instead, these facilities are by design venues for hard-sell and often abusive anti-abortion arguments and tactics aimed at unsuspecting and vulnerable consumers." Women who accidentally went to such clinics testified that they were forced to watch films of discarded fetuses, physically prevented from leaving, and called names like "baby killer." Staff investigators had already visited clinics themselves to verify such claims and found a guidebook explaining how to set up and operate a fake abortion clinic, from using neutral, misleading names like "Pregnancy Problem Center" to decorating the waiting room like a real abortion clinic.

The hearings resulted in new guidelines by the Yellow Pages Publishers Association (YPPA) for its members. The guidelines, which are voluntary, recommend making sure the two categories "Abortion Alternatives" and "Abortion Services" are mutually exclusive, including notifications above headings explaining what services the listed organizations provide, keeping a "sufficient" physical separation between the display ads for the two categories, and paying "special attention" to the use of deceptive or misleading phrases in ads such as "crisis pregnancy center," "free pregnancy test," "birthright," and "postabortion counseling."

The 1992 Chicago Yellow Pages, for instance, includes the following notice under "Abortion Alternatives": "Organizations listed at this heading provide assistance, counseling, and/or information on abortion alternatives. They do not provide abortion services, nor do they provide counseling or information on the attainment of abortions, or birth control services." Assuming a woman reads the small-print notice, she would then be confused by the next heading, "Abortion Information," under which the notice reads: "See Physicians and Surgeons Headings; also Clinics; also Hospitals . . . also Abortion Alternatives."

Clearly the misleading phrases specifically cited by the YPPA have not yet been eliminated. Some of the misleading phrases are part of the clinics' names. There are three branch clinics called "Crisis Pregnancy Center," plus the "Northside Crisis Pregnancy Center" and "Birthright of Chicago." Three of the display ads use the phrase "Free Pregnancy Test," and one uses "Post-Abortion Counseling." In addition, display ads for "Abortion Alternatives" and "Abortion Services" are on facing pages, a physical separation that is technical at best. The page headings on the pages for both categories read simply "Abortion."

"I think any of these ads are misleading. Look at the Women's Center ad," snorts Nancy Kohn, director of the Illinois Pro Choice Alliance. "'Considering Abortion? It's Your Choice.' It's as if to say that they're going to provide the service. I'd say that's misleading. It's your choice--until we make it for you. It falls far short of addressing the problem."

Bryan Howard agrees. "Women and couples who are considering abortion, faced with an unintended pregnancy--they're at a very difficult point in their lives, and they're having to consider a tremendous amount of information. Sometimes their thoughts aren't very well formed at the outset, and I think disclaimers in small print help. But they're not the perfect remedy for women and couples becoming confused about who provides exactly what."

Representative Wyden believes the Yellow Pages guidelines will clear up most of the confusion, says Graydon Forer, counsel to Wyden's subcommittee. "There's only so much government can do," he explains. "Ultimately both sides want to use the A word, both sides want to use the word 'abortion.' So it's a question of how that's placed, so abortion alternatives and abortion services have a certain amount of clarification. We probably haven't made all the prochoice people happy. God knows we haven't made the prolife people happy."

Indeed, prolife organizations are not pleased at all. None were invited to testify at the subcommittee hearings, and outside them Thomas A. Glessner, president of Christian Action Council, claimed abortion clinics fear losing business to the prolife clinics. Nancy Watson, executive director of the Loop Crisis Pregnancy Center, sent a letter to the center's supporters describing 1991 center activities that read in part: "When we tried to renew our Yellow Pages ad to list (as it has for years) the services we offer under the 'Abortion Alternatives' heading, the Donnelley directory's 'ethics committee' told us that our ad was misleading. When I pressed (up to the CEO's office) to find out what was misleading about the ad I could get no straight reply. . . . Well, I thought as hard as I could for as long as I could to get them to print our ad in the manner that would honestly serve our clients, and in the end I lost to the printing deadline. I had to agree to their version of our ad or not run the ad at all. As so many of our clients are referred by the Yellow Pages, I had to acquiesce. (I talked to Dennis Byrne of the Chicago Sun-Times right after this and he wrote a great column.) But as if to remind me of Who it is that really runs this ministry--listen to this: When we received the ad copy back for a final proof from the publishing house in Indiana, the ads had been switched! Our ad is the one that will appear in the Yellow Pages. Divine legerdemain!" The center's nearly half-page display ad in the 1992 book is in fact identical to last year's--with the addition of the headline, "Considering Abortion? Make an Informed Choice."

Dennis Byrne's column stated: "If you went to buy a new car but instead found yourself in a used car lot because you had mistakenly looked under the heading 'Used Cars' in the Yellow Pages, would you: A. Say, 'Oops, I'd better go back and look in the phone book's "new car" section'? B. Demand that the word 'car' be deleted from used car phone ads?" He called Yellow Pages publisher DonTech's decision to delete the phrases "information on abortion" and "postabortion counseling" from the ad "incredible" because the "ads for these centers are in a section clearly marked 'abortion alternatives'--as opposed to 'abortion services.'"

Yet the congressional subcommittee found that women often believe "abortion alternatives" means alternative types of abortion services. As CAF's Wirpsa notes, the confusion can delay women seeking abortions, pushing them into riskier, more expensive second-trimester abortions. The extra delay may even push them beyond the legal limit for an abortion; for low-income women the extra expense can have the same effect. All are repercussions slightly more serious than ending up at the used-car side of the lot instead of the new-car side.

The American Law Division of the Congressional Research Service found that bogus clinics cannot be prosecuted on the federal level because the Federal Trade Commission doesn't have jurisdiction over nonprofit corporations--and bogus clinics seldom charge fees. But prosecution at the state level under false-advertising or consumer-protection statutes, it said, was possible. The report quoted U.S. Supreme Court and federal-court opinions dismissing First Amendment claims as a defense for false advertising, concluding, "There is no constitutional right to disseminate false or misleading advertisements."

The Illinois attorney general is investigating the issue and should make a statement in a few weeks on possible action, says Lisa B. Cohen, executive assistant to the attorney general's chief of staff. Until then phoning first won't help. A recent call to the Loop Crisis Pregnancy Center found the receptionist carefully admitting that the clinic "isn't a medical facility, so we don't perform abortions," then adding, "We give information on different types of abortion and free pregnancy tests."

Before Sharon leaves for her first abortion appointment, she finishes cooking breaded pork chops for the kids and her husband, who's staying with the children while she's gone. The baby sits on his knee, silently watching Sharon. "The baby's gonna go crazy when you leave," her husband warns. When Sharon moves toward her coat, the baby's face begins to screw up in preparation to wail. He progresses to full-fledged crying as she puts on her coat and zips it up.

On the way to the clinic Sharon talks about her husband. "He can't keep a job," she says, shrugging. "Him and his brothers, they just always want to be playing basketball. I say, that's not the real world. You playin' basketball isn't gonna get the baby Pampers. But he just ain't ready to grow up. He'll say, 'I'm only 24. I haven't done this, I haven't done that.' And then he'll go out. Well, I'm only 21, and I got five kids. I never did anything. I didn't go to no high school games, I didn't have no prom, no homecoming. But he just isn't ready to grow up."

It's a little mysterious how Cook County Board president Richard Phelan intends to reinstate abortions at County Hospital. He was elected promising to do it, but almost surely without the necessary board votes. And public funding for abortions won't be coming from the state or federal governments anytime soon.

Phelan postponed the abortion battle when County Hospital lost its reaccreditation. The issue was resuscitated after the hospital was reaccredited in February, and on March 5 Phelan announced the formation of a task force to "develop a plan for the orderly restoration of abortion services." The task force, appointed by hospital director Ruth Rothstein, will report back by June 1.

Phelan won't say whether he will ultimately call a board vote or issue an executive order. Opinions diverge widely on whether such an order would stand. Commissioner Maria Pappas, who is prochoice but whose feud with Phelan is well publicized, asked the Cook County state's attorney whether an executive order was possible. The answer came back no, with some room for bickering. The opinion said that Cook County "statutory, regulatory and bylaws provisions" gave that power to the board as the hospital's governing body. But it noted that there were only two major case-law precedents on executive orders from the Illinois Supreme Court, neither of them "germane to the question presented." Phelan spokesperson Pam Smith says the president considers the opinion "advisory."

Board members differ on whether an executive order would need board approval, requiring 9 votes out of 16. If legal action didn't overturn such an order, the only recourse abortion opponents would have would be an override, requiring 14 votes.

Prospects for board approval are dim, though prochoice forces are hopeful. In recent interviews five suburban Republicans and Chicago Democrats Frank Damato and Ted Lechowicz confirmed their unyielding opposition. The remaining Republican, Richard Siebel, would not return repeated phone calls but has been opposed in the past. Of the eight other Chicago Democrats, four (Danny Davis, Irene Hernandez, Maria Pappas, and Bobbie Steele) are for reinstatement, though some question Pappas's commitment; Jerry Butler is prochoice but won't commit his vote; three (John Daley, Marco Domico, and John Stroger) are wild cards with antichoice records.

Domico, whose wife was in intensive care during the board poll, did not return phone calls, but in the past he has been considered a likely no vote. He can't be counted out entirely though, since Hernandez was also against reinstatement and has changed her mind. "I had to think it over for many years," she says. "I have seven children, so you see why. And I just decided I couldn't tell a woman what to do, even my daughters. So I'm prochoice. A mother can give a daughter advice, but that's it."

Daley recently replaced the resigning Chicago Democrat Charles Bernardini, who favored reinstatement. Spokesman Gus Lorenzini said Daley would wait for the task-force report before taking a position, but his Springfield record is entirely antichoice. There is also much speculation about mayoral influence. Mayor Daley's Springfield record was antichoice, but he has called himself prochoice in his two mayoral campaigns. In an amusing interview with Sun-Times City Hall reporter Fran Spielman after Phelan's task-force announcement, the mayor dodged questions on publicly funded abortions at County by repeating variations of "I think it's a decision between a doctor and a patient dealing with the health of an individual."

John Stroger was on the board in 1980 and voted to approve Dunne's ban. He was also quoted in December 1990 saying that "elective abortions should not be the order of the day at the hospital." Still, some prochoice activists consider him capable of changing his stance. Stroger says he favors a woman's right to abortion, though he would not say whether Cook County should fund that right. "I have an open mind," he says. "I'll see what the report says. I think the report should come out to an open discussion, and I want a chance to evaluate it and see what the total impact will be on services in the entire county health-care system." Though Phelan's disastrous first move as board president was a failed attempt to replace him as finance committee chairman, Stroger has since generally supported Phelan initiatives, including the controversial proposed county sales tax.

There are still questions about Pappas's actions among commissioners on the proreinstatement side and prochoice activists. They approve of Phelan's postponement of the issue during the hospital's reaccreditation and of his current task force; Pappas fiercely criticizes both. The Pappas-Phelan feud has been colorful, with Phelan reportedly singing "Maria" from West Side Story to Pappas, not in the original spirit, and Pappas accusing Phelan of disconnecting her microphone before a board meeting.

Pappas's official statement on the task force was considerably more vitriolic than the portions that made it into the Sun-Times and Tribune. She called the task force a delaying tactic and claimed, "Mr. Phelan is not man enough to ask the County Board to approve an ordinance restoring abortions at Cook County hospital. President Phelan controls the votes to approve the reinstatement by ordinance. He doesn't seem to have a problem getting lop-sided votes when he wants to raise property taxes or give his campaign contributors sweetheart deals."

Pappas is still fuming. "He gets these people together--they pass three tax increases this year! They were like ducks in a pond! He hid out under accreditation for a year and three months, and now we've got a task force. He needs to talk to the board members and get them to vote for this, just the way they vote for everything else he wants." Asked if the antiabortion stance of many board members might hinder their voting with Phelan on this issue, she said, "Listen, they were all antitax too before he came in office. It's not an excuse."

Asked whether Phelan could force a favorable board vote if he really wanted to, Danny Davis chuckles and says, "Well, I think Commissioner Pappas has a very creative mind."

"There's a question why she's not supportive," says NARAL's Patricia Dougherty. "I just don't understand it, unless it's a political reason. I would encourage Maria Pappas, who ran as a prochoice candidate, to line up the votes of prochoice commissioners and work with President Phelan to make sure poor women in Cook County have access to safe and legal abortions."

Terry Cosgrove, director of Personal PAC, a bipartisan organization backing prochoice candidates, agrees that Pappas has not worked with the pro-choice community. "I'll give you the sterling example. She just went to state's attorney O'Malley, without consulting anyone in the prochoice community, and asked if Phelan could [reinstate abortions] by executive order. And it put him in the position where he had to issue an opinion because a commissioner asked him to. I couldn't believe she did that. I still don't understand to this day her rationale. She says that she is prochoice, and I believe her. But what we're interested in is seeing a commitment to the issue, and that means in a constructive way by helping us get abortion restored at County Hospital."

Dougherty and Cosgrove are guardedly optimistic about a board vote, citing a trend in which some local officials with antichoice records have changed their minds since the Supreme Court's Webster ruling threw abortion restrictions back to the states and made local votes count. "We have seen this happen on more than one occasion," says Dougherty, "that local legislators are understanding that the reproductive lives of women in their states or county are their responsibility because we don't have a Supreme Court that's going to protect this choice anymore. So on the one hand we can look at an old voting record. On the other hand responsible local elected officials are rethinking their positions on reproductive rights and public policy."

Another factor is the imminent move to single-member districts for county commissioners in 1994 rather than at-large elections. "They're going to be held accountable in a way that in the past they have not been," says Dougherty. "And I think that will absolutely make a difference. I base that on what we've seen in our state senate and house legislative races."

Some commissioners are less sanguine about a board vote. "Maybe he has the votes," says Bobbie Steele. "I doubt it. But there are other methods of legal pursuants we can do. It's not a lost cause." Jerry Butler states flatly, "I think it would fail."

Danny Davis voices a common position for reinstatement. "The primary reason I'm in favor of reinstating abortions at County Hospital is because they are available to certain segments of our population--the segments that can afford to pay. And I think it would be discriminatory not to provide the same options to all people."

Some board members who oppose reinstatement are altogether antiabortion, including Robert Gooley. "You're talking to one of the leading Catholics, and that's me," he says. "I don't know when murder occurs, but I think a fetus is something alive, and I will vote against it." Others, including Mary McDonald, think public funds shouldn't be used for abortion. "I've gotten thousands of letters from people against it for tax purposes," she says. "And if some people don't want their money spent on what they consider murder, it shouldn't be. The state and federal government don't pay for it, and there's no reason the county should. Especially when we're 150 nurses short and pregnancy isn't a disease. And women who want to keep their babies get their first prenatal visit at three months. This would push it to six months, because they're going to have to take money and doctors away from that."

Frank Damato thinks that the number of costly malpractice suits "would be tremendous," though he admits he knows of no studies that support his conclusion. But, he claims, "It's gonna run into millions of dollars. Nobody can tell me it isn't."

Phelan is waiting for accurate figures from his task report, but according to his spokesperson Pam Smith, reinstatement would cost roughly $250,000 to $400,000 a year. Smith denies that money would come out of other health services. "Prior to this year, Mr. Phelan's administration, the hospital was not collecting for outpatient services," she says. "In other words it wasn't billing state medicaid. The hospital is doing that now, and that's additional revenue to the tune of $2 million a month. Now compare that additional revenue of $24 million a year to $250,000 to reinstate, and you see money is not the issue here. The issue is equity, and Mr. Phelan thinks low-income women have a right to the same services."

Whether or not money should be an issue, it will be--particularly since Phelan projects a $555 million deficit by 1997. That deficit was estimated by the county's finance bureau, which predicted the county's health-care costs will increase from $482 million to $924 million. Phelan, who proposed a 0.75 percent county sales tax last month to finance the deficit, has also said he wants to build a new Cook County Hospital at an estimated cost of $500 million or possibly rent a new building from a private developer.

Prochoice activists argue that abortion costs pale compared to the cost of prenatal care, delivery, and subsequent medicaid and welfare payments for the child. A 1986 Guttmacher Institute study based on a state-by-state analysis found that for every dollar spent on abortions, four dollars would have been spent in a child's first two years. The Illinois medicaid reimbursement for vaginal delivery alone, now $522.50, is more than twice the cost of a first-trimester abortion.

A new proposal in the state legislature makes reinstatement of abortions at County Hospital an even more urgent issue for low-income women in the Chicago area. State senator Frank Watson proposes denying additional benefits to mothers who give birth while on public assistance, and the General Assembly will consider that idea this spring. If the bill passes, welfare mothers won't receive public funding for abortions--or for the new children they bear if they fail to finance an abortion themselves.

At the FPA clinic Sharon stands nervously at the reception counter. She's wearing an electric blue sweat suit with a pink turtleneck collar and sleeve insets, one pink sock, one blue sock, and white sneakers--the dainty cheerleader kind. "I'm nervous," she says. "I know when it was," she adds, referring to her last period. "But I know they have to do the ultrasound to make sure."

The receptionist gives her a medical-history survey to fill out, along with information sheets on the abortion procedure and the risks of second-trimester abortions. She fills out the form and snorts when she gets to "Children, Ages." "Look at this," she says, pointing ruefully to where she's written "5,4,3,2,8 months." Her name is called, and she's ushered into an examining room for her ultrasound, the first step.

Sharon pulls herself up on the table, and a nurse spreads a clear salve on her stomach and begins waving the ultrasound device over it. A few minutes later she switches off the machine and announces, "Twenty-nine and a half weeks."

Sharon looks confused. "Twenty-nine and a half? No. I had my period September 21."

"I don't care when was your last period," says the nurse. "You can have your period and be pregnant. You can have your period the whole nine months."

"I know that, but I have five kids, and I never had that before." Sharon is sitting up now, mechanically wiping the salve off her stomach with some tissue. Her eyes are wide, staring blankly at the floor.

"It's right here," the nurse tells her, holding up the ultrasound copy, an incomprehensible black square with a circular pattern of white lines. Sharon takes it reluctantly and looks at it, still sitting on the table. "Twenty-nine?" she asks in a small voice.

While Sharon waits at the front desk to check out, clinic manager Diana Lammon walks up. She takes one look at Sharon and asks worriedly, "What's wrong?"

The nurse hands her the ultrasound. "Ohhhhhh. No, this is . . . No, sweetie," she gently tells Sharon. "This is a perfect picture. There's no way. Maybe a place in Kansas . . . No, not even Kansas."

Sharon walks out in a daze, plops down in the car, and stares at the ultrasound copy clutched in her hands. "I feel sick. I can't believe this. It's impossible. I can't have another baby," she moans. "I can't go through that again. What'd she say, something about Kansas? Texas? How would I get to Texas?

"I was hoping this summer I could maybe start takin' 'em places. They can't even go out, 'cause I can't take 'em out all by myself. They never been to the zoo, they never been anywhere." She stares at the ultrasound as she talks. "If things weren't so rough right now, I coulda taken care of this early on. But I didn't have the money. And I didn't find out about that abortion fund . . . "

At one point she pulls out her medicaid card and looks at it. "I'm just lookin' at my medical card. Look at all those eligible names on there. Six. And now there's gonna be one more? Too many people. Just too many."

She lies back in her seat and closes her eyes. "I feel terrible. I have never felt this terrible before in my life. When she said 29 weeks, I just about dropped on the floor."

Art accompanying story in printed newspaper (not available in this archive): illustration/H. Ario Mashayekhi.

Add a comment