Legality vs. Reality: Why Laws Aren’t Enough to Ensure Abortion Access in Vermont

by Mary Elizabeth Fratini

The second line is faint but unmistakable, and it shows the one outcome of home pregnancy tests not celebrated on television commercials: unhappily expecting. I’m a sixteen-year-old victim of incest and rape. I’m twenty-three and in law school. I’m thirty, married with three children. I’m forty with grown children. I’m your mother, your sister, your daughter, niece, cousin, neighbor — and I want to terminate this pregnancy. What now?

Vermont women have had unrestricted legal access to abortion regardless of age or marital status since 1972, when the state Supreme Court ruled an 1846 law criminalizing the procedure unconstitutional in Beecham v. Leahy. You do not need to notify or get permission from a parent, guardian, or spouse prior to the procedure, and abortions are covered under the state Medicaid program.

Abortion is the most common surgical procedure in the United States — more than forty percent of women in the United States under age fifty have had one. But access to abortion is often limited by economics, geographic location, and a community’s attitude towards reproductive services. Legal rights to services become a moot point if they are simply not available. According to NARAL Pro-Choice America, more than forty percent of Vermont counties have no abortion providers at all. There is nowhere in Vermont to receive an elective abortion in the second trimester. And Fletcher Allen Health Center (FAHC), the largest of the state’s fourteen hospitals, refuses to perform elective abortions at any stage, even in cases of incest and rape.

A Culture of Secrecy and Shame

Fletcher Allen’s policy was originally adopted in 1972, several years after the original hospital merger of Mary Fletcher and Bishop DeGoesbriand — a Catholic hospital. The policy was reconfirmed in 1984 with some additional language [see sidebar for text of policy]. Medically indicated terminations — in which a medical condition poses a specific threat to the mother’s health in pregnancy — are available up to twenty-two weeks. FAHC does not perform elective abortions under any circumstances, or require resident OB-GYN’s to learn how to perform them. “Residents have the opportunity to rotate through Planned Parenthood and most do, but realistically there are people who are strongly opposed to abortion,” said Dr. Ira Bernstein, director of maternal fetal medicine and vice-chair for obstetrics at FAHC. “An OB-GYN should be able to provide referrals if they can’t perform the service themselves, but it is unreasonable to expect that someone should participate in abortion training if that is not something that they want to do.”

“I find it unconscionable that we are sending girls who are victims of incest and rape out of state for abortions,” states Crea Lintilhac, who has been involved with FAHC for more than twenty years through a family foundation. The birthing center at FAHC is named in honor of her mother-in-law, who was a nurse midwife in China for decades. “The argument I hear is that there are so few of them it isn’t worth rocking the boat, but that’s like saying it is just one or two lynchings,” she added. “It’s one too many and represents a culture of discrimination and bigotry that has been going on for a long time.”

Lintilhac’s statement became painfully clear when I called the Rutland Regional Medical Center for more information on its access policies and was mistakenly transferred to the emergency room. When I asked the nurse who answered what abortion services were available at the hospital she answered without pause, “Well, I don’t know, but I certainly hope that there aren’t any.”

Brattleboro Hospital referred me to the two OB-GYN practices in town, only one of which performs abortions. Personnel from the practice that offers only referrals refused to explain their policy, saying repeatedly, “We just don’t do them.” A representative from the clinic that provides abortions was willing to share details on cost and procedures, but asked to remain anonymous. They operate on a cash-only basis: “We have had people cancel credit cards and set up payment plans using a false address, so that we never get reimbursed,” she said. “We will help people file for insurance coverage on their own behalf, but we have to require cash.”

The Time and Funding Crunch

Elective abortions in Vermont range from $250 to $1500 depending on the method used, and the stage of pregnancy. Eighty-five percent of all abortions in this state are performed by Planned Parenthood of Northern New England (PPNNE) at four of its fifteen Vermont sites. Its patients are eligible for financial assistance through the tri-state Laura Fund, but PPNNE cannot provide abortions beyond fifteen weeks, or for women with certain pre-existing medical conditions that preclude an outpatient procedure. Those women must travel out of state, often as far as Boston or New York, for service. “Anecdotally, we probably send fifteen to twenty people out of state from Burlington every year and we don’t know how many never get to a health center in the first place,” said Jessica Oski, director of public affairs for PPNNE-VT.

For low-income women whose Medicaid funds are useless once they cross state lines, the financial pressures often become nearly insurmountable; the procedure alone can cost up to $2,000 without including transportation, lodging, or childcare. The Laura Fund can only offer $500 for women leaving Vermont for service. In 2003, a second group began distributing financial aid — the Vermont Access to Reproductive Freedom (VARF). The average household income of VARF’s recipients is less than $10,000. “If the abortion cost $1,000, that’s ten percent of their average income — and in some cases that is more than these women earned in an entire year,” said Selene Colburn, chair of VARF’s board.

There are a number of reasons why women wait until the second trimester to seek termination, Colburn added, citing two recent clients: one woman had a medical condition that prevented her from realizing she was pregnant until she was seventeen weeks along and therefore ineligible for services in-state. A second woman had an abusive partner who prevented her from going to scheduled medical appointments and had to wait for a restraining order to be in place to seek service. In less than two years, VARF has distributed approximately $24,000 to over 120 women.

“We see many things preventing access to abortion, and have tried to provide solutions to one of them: financial means,” Colburn said. “It’s a myth that legality is enough — women are still throwing themselves down stairs, overdosing on birth control, ingesting toxic chemicals, or being repeatedly punched in the stomach.”

The Next Steps

“Women seeking abortions shouldn’t be forced to walk in the shadows of a don’t ask/don’t tell policy,” Lintilhac asserts, and that’s why she is participating in LEAD International’s Hospital Access Campaign in Vermont. The goal of the campaign, which is based on the Abortion Access Project, is ensuring access to abortion for all women by increasing abortion services, training new abortion providers, and raising awareness about the critical importance of abortion access to women’s lives. “There are no legal restrictions in the state of Vermont to Roe v. Wade, and I expect the hospital to take responsibility for providing service to people who need it,” Lintilhac said. She is urging FAHC to change its policies and allow stimulant drug users to be seen in the hospital; to perform elective abortions in the second trimester; and to offer dilation and evacuation procedures after sixteen weeks.

“This is a cycle of violence that is perpetrated in the mentality of people running our hospitals and institutions, allowing the violence and tyranny of anti-choice agendas to destroy people’s lives,” Lintilhac said. “It has ruined a lot of lives, but they don’t want to count them.” Lintilhac will continue to work with board members at FAHC to address the policy and added, “I think it is important for me to step forward because I’m not going to lose my job.

Mary Fratini is a freelance writer and photographer living in Montpelier. She can be reached at 229-6178 or maryfrat@yahoo.com