Who would go to Kermit Gosnell to get an abortion? Someone who didn't have any other choice, that's who.
Kermit Gosnell faces murder charges in the deaths of four babies and also of a 41-year-old mother who died in his care at his West Philadelphia Philadelphia abortion clinic. His offices there were strewn with aborted fetuses and their severed body parts.
Proclaiming Gosnell's innocence, his lawyer says he's being judged unfairly because he's African-American. But the real victims of prejudice in this grisly tale are Gosnell's patients, who were all members of minority groups themselves. For more than a century, women of color have been denied equal access to safe abortions. So they have often resorted dangerous self-induced procedures or to fly-by-night operators like Kermit Gosnell.
From the colonial era into the mid-nineteenth century, abortion was legal until "quickening"—that is, until a woman could feel her baby moving. It was usually self-induced or performed by midwives and folk healers, who caught the ire of the country's male-dominated medical profession. "The female practitioners are less educated, being chiefly negresses or mulatesses, or foreigners without anatomical, physiological, and obstetrical education," wrote one doctor in 1855, condemning abortionists.
Two years later, the American Medical Association called for outlawing all abortions except when a physician had certified that the mother's life was in danger. Over the next four decades, nearly every state instituted bans or restrictions on the procedure.
But it continued, of course. Well-to-do white women found expensive doctors willing to perform abortions, adding to fears of "race suicide" among the country's eugenically-minded elites. If white Protestants continued to limit the size of their families, the argument went, they'd be overwhelmed by immigrants and African-Americans.
These populations were having abortions, too. They patronized less skilled practitioners or tried to induce miscarriages themselves, using knitting needles, hairpins, and scissors. Others ingested folk remedies like slippery elm or the wide array of commercially available abortifacients, which were advertised to women who were "Stomach Sick" or had "Missed Menses."
Countless women died or suffered permanent injury, particularly in poor and minority communities. A 1917 study in St. Louis found that half of white women who received an abortion were induced by a physician or midwife. Lacking access to these services, African-American women "pinned their faith on drugs," as the study dryly noted. In the 1930s, Harlem Hospital opened a separate ward to treat the mostly black patients requiring emergency care after botched abortions.
Abortion laws would become even more restrictive in the 1950s, leading to another spike in injuries and deaths. In New York City, where the total number of abortion-related deaths doubled between 1951 and 1962, nearly four times as many women of color as white women died because of the procedure. Abortion accounted for half of the maternal deaths among minority women, but only one-quarter of white women's deaths.
In part, these statistics demonstrated the poor overall quality of medical care in minority communities. But they also reflected the fact that white women could more readily find a physician who would certify a "therapeutic" abortion—that is, an abortion for medical reasons. In New York, over three times as many therapeutic abortions were performed in hospitals' private services—where customers paid out of pocket—than in the public wards.
Abortions became easier to obtain after the Supreme Court's Roe v. Wade decision in 1973. But they were always harder for women of color, who were more likely to be on Medicaid and other forms of public assistance. And Medicaid won't pay for abortions.
So what would you do, if you were a poor woman who needed to terminate a pregnancy? You'd go to the cheapest place available. According to the grand jury investigation of Kermit Gosnell, he charged about 25 percent less than the average national price for a first-trimester abortion. And for a second-trimester procedure, his fee was at least a thousand dollars less than the handful of other facilities that will perform one.
So we shouldn't be surprised that all of Gosnell's alleged victims were minorities, who had nowhere else to go. But when the occasional white patient showed up, bringing the promise of higher payment, Gosnell escorted them into the only clean office in the clinic.
When an employee confronted Gosnell about his racial double standard, according to the grand jury report, he was unmoved. "That's the way of the world," the doctor said. In this sad and revolting tale, that might be the only thing Kermit Gosnell got right.
Jonathan Zimmerman is a professor of history and education at New York University. He is the author of “Small Wonder: The Little Red Schoolhouse in History and Memory” (Yale University Press).