Finding a Reputable Abortion Clinic

Disclaimer: Throughout this article, we will be using the term “woman” to describe biological females who can become pregnant. We understand that sex and gender are separate, but for the sake of simplicity and consistency, these are the terms we will be using. If you would like to learn more about gender identity, visit our Sexual Orientation Gender Identity article.

If you or someone you know is seeking an abortion, there are several factors to consider when choosing a clinic. Namely, it is important to ensure that the health care provider is medically certified to provide an abortion, the clinic does not have any hidden moral agenda, and the facility is a sterile environment suitable for medical practice. Although abortion is both a safe and legal way to terminate pregnancy in all American states, the availability of abortion services varies widely across the nation. When searching for a clinic, you need to be aware that not all abortion facilities are equally accommodating, and you may need to travel some distance to receive the best, most affordable care. Generally, a good abortion clinic is one that provides dignified and professional physical, mental, and emotional care.1

 

Medical Certification

Perhaps the most important criterion for choosing an abortion clinic is verifying that it employs licensed physicians and nurses who are certified to perform abortion procedures. In the United States, this means an abortion practitioner must have a standard physician’s license per regulation (at the state and federal levels) and any assisting nurses must also have the required state licensing. In the United States, the abortion practitioner should be a licensed doctor and any assisting staff should be Licensed Vocational Nurses (LVNs), Registered Nurses (RNs) or Physician Assistants (PAs). Licensing may vary by state, so more information can be found in the public records for each state’s Department of Health Services (or their equivalent department).

In 1994, the Accreditation Council for Graduate Medical Education (ACGME) started to require obstetrics and gynecology residency programs to at least allow residents to access training to perform induced abortions. In a statement updating the requirements on residency training released in June 2017, ACGME clarified that the previous requirements must be upheld and that residents must also be trained to manage any complications from abortion procedures.2 Only 61% of residency programs reported that the required abortion procedure training was routinely provided and 32% reported that it was available or optional for the residents.3 The number of abortion clinics nationwide has declined over recent years due to the dwindling number of abortion-practicing physicians and the general rise in cost of abortion procedures. This, in addition to varying legislative restrictions4, has led to an overall decrease in licensed abortion procedures by about 8%.5

Perhaps the most influential reason for the decline in legal abortion rates is the shrinking number of clinics and health care providers available to those seeking abortion. It is believed by women’s health experts that the actual number of abortions performed each year is unknown due to the decrease of professional practicing clinics and increase in unsafe, non-clinical abortions. Many laws which are introduced to improve the quality of care are actually aimed at shutting down clinics and make it harder to keep them open and accessible. Historically, many women in regions where abortions were unavailable (because they were illegal or highly stigmatized) sought abortions from non-licensed persons in whatever conditions the procedure was available.5

In areas of the world where abortions are unavailable in medical facilities, as many as 20 million unsafe abortions are performed on a yearly basis. The results of unsafe abortion practices are clear: each year, approximately 68,000 women die, and millions more experience complications that compromise their health temporarily or permanently.5

 

Hidden Moral Agendas

Although a majority of Americans polled in 2017 believe abortions should be legal in all or most circumstances (57%), there is still a large portion of Americans who believe abortions should be illegal in all or most circumstances (40%).6 Recently, there has been a growing trend towards “conditional acceptance” in which abortions are considered acceptable in cases of rape, incest, endangered maternal or fetal health, or strong indications of defects in the developing fetus. Most importantly, when given the freedom to choose on a continuum of the abortion debate, a vast majority of Americans fall somewhere in the middle of the two extremes.6

Those who identify as unconditional pro-life supporters typically do not follow such trends and fall on the extreme end of believing abortions should be illegal under all circumstances. They believe life begins at the moment of conception and that removing a developing fetus from the womb is equivalent to murder. Some groups and organizations who oppose abortion pose as willing providers to lure women seeking information on abortion into conversations with the goal to sway the women away from obtaining an abortion. Due to pro-lifers’ extreme opinion and the fact that they have been violent, some doctors who are willing to and capable of performing abortions refuse to do so out of fear of harassment or violence. However, some states have protections for the doctors and clinics. These protection laws prohibit obstruction, threat or damage of the clinic and its staff and can also create a zone around the clinic in which it is illegal to protest.7 

Women seeking a reputable clinic, for information or a procedure, should be cautious of facilities where clinicians do the following:

  • Refuse to give out complete contraceptive information.

  • Falsely advertise health services that they do not provide.

  • Give free pregnancy tests and ambiguous answers to any questions about the clinic.

  • Show shocking films and handouts designed to scare women away from abortion.

  • Attempt to induce guilt by performing ultrasounds and personifying the fetus.

  • Preach their personal religious beliefs.

Clinics that actively support a woman’s right to terminate her pregnancy do not participate in any of the above activities. Reputable abortion clinics are respected, trustworthy, established facilities that encourage women, without bias, to be well-informed of all their options. Such establishments support the physical and mental health of all women, regardless of their beliefs or decisions. Certified, dignified, and professional practices will do the following:

  • Have strong, established reputations.

  • Meet all certifications for the procedures they offer.

  • Offer contraception and complete information about birth control.

  • Have sterile facilities and practice cleanliness.

  • Provide information on all types of abortion procedures and discuss alternative solutions without bias.

  • Employ licensed nurses and physicians.

  • Respect the patient’s wishes and do not subject them to unwanted procedures. 

 

Sterile Medical Environment 

First impressions matter. Upon entering any medical facility, you should have the impression that it is a clean, sterile, and organized environment. If the facility seems chaotic, unclean, or unkept, you reserve the right to leave and choose another facility. Any facility that provides medical procedures is required to abide by state and federal laws regarding the regulation of sanitation and health practices.

If you choose a facility upon a satisfying first impression but find the conditions in which your abortion procedure is being performed unsatisfactory (e.g., unclean rooms, tools, etc.), you may leave the facility at any time. If you suspect medical malpractice or unsanitary conditions, it is wise to choose another facility in which you feel more comfortable, and report the previous facility to the state’s Department of Health (or their equivalent department). Medical practices in the United States are held to strict standards regarding their cleanliness and sterility and can lose their licenses in the event of unsatisfactory inspections.

Availability by Region in the United States

The availability of abortion services across the United States varies by location. Unfortunately, one-third of all American women still live in counties without a single abortion provider, despite the fact that abortion is legal in all 50 states. Large cities typically contain plenty of abortion providers, and women are typically able to find competitively priced procedures in such areas. 

In more rural areas and the middle and southern states, it is often extremely difficult for most women to find reputable abortion providers, if they find any at all. Women residing in some of these states are limited to one provider within the entire state because anti-abortionists dominate the state’s political spheres. These states often only have abortion providers in the largest city in the state.11 Many women may have to travel more than 30 miles each way or even out of state to find such a provider.8 This makes it painfully difficult for these women to find legitimate providers who support their right to choose, and oftentimes women must seek quality providers outside of their city, county or even state.

However, time and cost of travel can make it nearly impossible for women in these areas to receive a safe procedure and the proper care before and after. Many states also have requirements about a waiting period, meaning that the women would either have to stay where they travelled to for 24-72 hours and therefore take time off work and pay for a hotel, or travel back home after the first appointment and then travel to the provider a second time for the procedure or post-operation check-up.9 This poses a considerable burden for those who do not have the financial resources for either option, cannot take time off work, find childcare, pay for housing near the clinic location, or even obtain access to the transportation.10 There are many other factors which impact women in these largely rural, poor, and low-income environments.10  Additionally, the stigma associated with abortion in such areas can sometimes be enough to turn women away from the possibility of even considering the procedure.

 

Legality of Abortion in The United States

Under federal protection from the historic Roe v. Wade decision, abortion is currently a legal way to terminate a pregnancy in the United States. However, individual states are permitted to impose restrictions limiting the availability of the procedure. Therefore, access to abortion services may be restricted depending on one’s state of residence. Consult your state’s abortion laws to find out if it enforces any restrictions on the procedure. Examples of popular restrictions are listed below:

  • Age: Many states require the individual obtaining an abortion be over 18 years of age.

  • Parental consent: Many states require parental consent or involvement in a minors’ decision to have an abortion. 

  • Trimester of pregnancy: Many states prohibit abortion in cases with the gestational period over 20 weeks or at viability, unless medically necessary to protect the mother’s health.

  • Notification of marital spouse: While not required, many states and clinics will deny abortion access if the spouse, partner or parent of the fetus is not previously notified.

  • A waiting period: Many states require a 24-72 hour waiting period between the first check-up in which the woman decides abortion is the right option and the actual procedure. 

While abortion is federally legal under the ruling of Roe v. Wade, the restrictions put on women who would like to obtain access to abortions can severely impact the reality of obtaining a legal abortion.

In closing, abortion in the United States is both a legal and safe option for women who do not wish to carry a pregnancy to term. Although women from different regions of the country may encounter more difficulty than others in receiving an abortion, any clinic that provides abortion services should provide high quality unbiased physical and mental care, and treat all patients in a dignified manner.

To see what availabilities and restrictions there are on abortion procedures in your state of residence (U.S only), please visit the Guttmacher Institute and the Safe Place Project webpages or click the links below to see a comparison chart and map.

Restrictions by state (as of October 1, 2017).

Availability by state (as of April 14, 2017).

 

Canada

Abortion is legal in all provinces of Canada since 1988.12 Currently, there are some provinces which impose regulations that may make it more difficult to obtain access to an abortion. A woman can go to either a hospital or a clinic for the procedure; however, hospital procedures may require a referral from an OB/GYN. Additionally, procedures done in clinics may not be covered by insurance, depending on the province and whether the clinic is privately owned. Procedures done in hospitals will be fully covered, the same as any other medical expense. In the 1989 case Tremblay v Daigle, the Canadian Supreme Court decided that the father of the fetus may not prevent a woman from obtaining an abortion.13

 

Many provinces’ health insurance will fully cover an abortion pill. This is a viable alternative option for those who, for any reason, cannot access physicians who will perform an abortion. In 2017, Health Canada approved Mifegymiso, an abortion-inducing pill which can be used at up to 9 weeks gestation.14 Manitoba, Ontario, Alberta, New Brunswick, and Quebec have all ruled to allow the Mifegymiso pill to be distributed by doctors to patients fully covered under the national health insurance.15 If the pill is not covered in the province, it will cost about C$ 300 to 350 for the two-step treatment.

 

Links to Find Abortion Availability in the Provinces:

Access Canada for Sexual Health and Rights  

Canadian Health Coalition

Abortion Rights Coalition of Canada

 

United Kingdom

Abortion became legal in the United Kingdom under the Abortion Act of 1967. The current gestational limit is 24 weeks and all abortion services are typically fully covered under NHS. This Act only legalizes abortion under certain conditions. These include but are not limited to: that continuing the pregnancy is more harmful for the mother’s mental or physical health, if the fetus when born would suffer serious or mental handicaps, or if continuing the pregnancy severely affects the existing family.16 Abortions after 24 weeks are allowed if there are potentially seriously harmful mental or physical risks to the woman or fatal fetal anomalies. Abortions can be obtained in any NHS hospital with the prior verification from two doctors that the terms of the 1967 Act are met.17

 

The Act does not extend to Northern Ireland; thus, women must often travel to Great Britain to access abortion services under NHS.18 In Northern Ireland, the restrictions are much more limiting in that an abortion is only legal in the case where the pregnancy will result in a non-viable fetus or that the mother will die or suffer long-term harm to her physical or mental health.19 A woman in Northern Ireland may provide proof that the abortion is necessary under the current legal standings or may legally travel to Great Britain. In 2017 it was announced that the government would cover the costs of abortion for any woman travelling to England.20

 

References

1. Abortion Care Network

2. Accredidation Council of Graduate Medical Education. Clarification on Requirements Regading Family Planning and Contraception. ACGME, June 2017.  

3. Steinauer, Jody MD, MAS; et al. “Abortion Training in U.S. Obstetrics and Gynecology Residency Programs.” Obstetrics and Gynecology, vol. 130, no. 4, Oct. 2017, pp. 44S-45S.

4. “Targeted Regulation of Abortion Provider.” Guttmacher Institute, 1 Oct. 2017.

5. Hyde, Janet and John D. Delamater. Understanding Human Sexuality, 11th Ed. McGraw-Hill Companies, Inc., 2011.

6. “Public Opinion on Abortion” Pew Research Center, Washington, D.C. 7 July 2017.

7. “Protecting Access to Clinics” Guttmacher Institute, 1 Oct. 2017.

8. Bearak J et al., Disparities and change over time in distance needed to travel to access an abortion in the USA: a spatial analysis, The Lancet Public Health, 2017.

9. “An Overview of Abortion Laws” Guttmacher Institute, 1 Oct. 2017.

10. “Although Many U.S. Women of Reproductive Age Live Close to an Abortion Clinic, A Substantial Minority Would Need to Travel Far to Access Services” Guttmacher Institute, 3 Oct. 2017.

11. The Safe Place Project.

12. The Society of Obstetricians and Gynaecologists of Canada. Unintended Pregnancy. SOGC, 2017.

13. Supreme Court of Canada. Tremblay v. Daigle. 16 November 1989.

14. The Society of Obstetricians and Gynaecologists of Canada. Health Canada updates Mifegymiso Product Monograph and Risk Management Plan. 7 November 2017.

15. Bellemare, Andrea. “Quebec to Offer Abortion Pill for Free by Early Fall” CBC News Montreal. 6 July 2017.

16. BBC News UK. Q&A: Abortion Law. 21 May 2008.

17. Home Health UK. Abortion. 2017.

18. Birchard, Karen. “Northern Ireland Resists Extending Abortion Act.” The Lancet, vol. 356, issue 9223. 1 July 2000, pp. 52.

19. Her Majesty’s Court of Appeal in Northern Ireland. Family Planning Association of Northern Ireland v. Minister for Health, Social Services and Public Safety. 8 October 2004.

20. Marie Stopes UK. Joint Statement on Funding for Women from Northern Ireland. 23 October 2017. 

 

Last Updated: 8 December 2017.