WITH INFORMATION AND ACCESS FOR ALL By Ticie Rhodes The essential legal protection for freedom of choice guaranteed under Roe v. Wade was reconfirmed by the Planned Parenthood v. Casey decision this summer. However, the availability of abortion has been seriously wounded over the past two decades and especially in recent years. Obstacles to abortion are increasing in number and severity through state and local restrictions, anti-choice pressure, public confusion, and a shrinking pool of providers. The battle to protect abortion rights now has to be fought on a myriad of fronts, including the Supreme Court, state courts and legislatures, and hospital board rooms. Each of these fronts are under different counter attacks, such as legislative proposals, local statutes, hospital rules, and boycotts. Legality is hollow without access. Tom Glessner, executive director of the anti-choice Christian Action Council, threatens that while abortion may continue to be a right theoretically, in practice restrictions may Òvirtually regulate abortion out of business at the local level.Ó In the Casey decision, the court upheld four of five proposed obstacles to abortion access, effectively allowing states to limit choices drastically. Although Casey introduced the standard of Òundue burden," what may not be an undue burden in Pennsylvania may make abortion prohibitive in more rural areas because of travel requirements and lack of facilities. Too Few Providers Increasingly, the sparse population of abortion providers, especially in the rural South, West and Midwest, undermines womenÕs ability to choose abortion. Between 1977 and 1988, the number of abortion providers in rural areas decreased 51%. Indeed, half of American urban counties and 93% of rural ones offered no known abortion services in 1988. Between 1985 and 1988, hospital abortion services declined 13%; hospitals now perform only 10% of all abortions, with clinics providing 86%. Although 84% of obstetrician/gynecologists favor abortion rights, less than one-third actually perform them. Currently only 12% of American OB/GYN programs include first trimester abortion techniques in the curriculum. An additional 50% offer the training as an option, but an already demanding course or work load often makes it prohibitive for doctors and students. One rationale for not making the time is that so few hospitals require the skillÑas so few offer abortion services. Many physicians are deterred from performing abortions by intense harassment from anti-choice zealots. Dr. Herbert Hodes, a board-certified OB/GYN in Kansas, told Glamour magazine that, ÒYou have not lived until youÕve been at home with your children on a Sunday afternoon and had twenty people out there with bull horns and swastikas.Ó ÒThatÕs how the antis are going to win," he continued. " They are not going to win in the legislatures unless they get lucky. They are going to win by attrition, because fewer and fewer doctors will perform abortions." Geographically sparse abortion services are especially devastating for poor women. Charon Asetoyer of the Native American WomenÕs Health Education Resource Center says, ÒYouÕve got to get the money to pay for the abortion, travel 150 miles to the one abortion clinic in South Dakota, and pay for a hotel room for the night. Some women try to get the money together, but most never make it in time.Ó South Dakota is just one of many states with inadequate abortion services. North Dakota has one abortion provider, in Fargo. Women drive as long as four and five hours for an abortion. Utah has two providers, and Idaho has one Ñwith a six week waiting list, which often forces women to carry their unwanted pregnancies to term or well into their second trimester when health risks dramatically increase. Media coverage of legal and legislative battles often creates the mistaken impression that abortions are illegal or unavailable. For example, on the day that the Louisiana legislature passed an abortion ban, one clinic was forced to turn away five patientsÑjust until the clinicÕs lawyers were sure that the court injunction was in effect. These five patients received enormous media attention; many readers and viewers, however, did not understand that the ban lasted for just a few hours. When women cannot reach providers or believe abortions to be unavailable, they resort to illegal abortions. Statistics on illegal and self-induced abortions are understandably difficult to obtain, but anecdotal evidence suggests a frightening level of self-induced abortions. Alissa Porter reports that her Utah clinic has recently been in contact with one woman who took dog dewormer, one who repeatedly threw herself down a flight of steps, and multiple cases of women who overdosed on birth control pills after a missed periodin efforts to self-induce abortion. With the recent, sweeping pro-choice election victories, anti-choice groups will begin focusing less of their energies on Congress and the courts. Local abortion providers will find themselves more on the front lines than ever. The patchwork of state laws will likely persist, as anti-choice states craft restrictions and erect barriers. Local pro-choice action and support will be needed to encourage reluctant physicians to offer abortions. And every woman has the ability to encourage physicians in her own way. I, for one, plan to ask any potential OB/GYN of my own if he or she offers abortion services, and if the answer is no, then IÕll move on to the next oneÑuntil I find a physician committed to the provision of choice for all women. o