Abortion on Demand

New York's new "abortion on demand" law, the most liberal in the nation, becomes effective this week. It authorizes the operation in the first months of pregnancy provided only that a woman and her own physician agree upon it. Virtually all the state's general, nonsectarian hospitals have been planning for A-day as elaborately, and with as much foreboding, as they would have for Dday. In one sense their fears may be justified. New York City alone expects 50,000 to 100,000 of its residents to apply for abortions each year and faces the possibility that an invasion from outside the state and city may swell the applicant total to 250,000 or even 500,000. New York's other major cities expect a comparable demand that may well swamp their hospital facilities.

Simple Relief. The only place in the U.S. to which New York can look for experience is Hawaii, which has had a similar law in effect for three months. Doctors and nurses on the obstetrical services, accustomed to bringing live babies into the world, had to make an emotional adjustment in performing abortions, but the law's impact has proved less disturbing than many alarmists had predicted. The patients have reacted, almost without exception, with simple relief because their fears and guilt are less acute now that the operation is both legal and safe.

Because of its 90-day residence requirement, not yet tested in the courts, and its distance from the mainland, Hawaii has not so far become an "abortion capital." Under the new law, 1,002 operations have been performed, 638 of them at Honolulu's Kapiolani Maternity and Gynecological Hospital. Three-fourths of the women aborted have been single, including divorcees and widows; most have been between 20 and 30 years old. On the premise that it is cheaper to help parents control family size than to force them to feed unwanted children, welfare authorities have paid welfare patients' bills. For those who can pay, costs in Honolulu average $300, only half of which is covered by insurance.

New York's law stipulates only that any abortion must be performed within the first 24 weeks of pregnancy. It contains no residence clause and does not require that abortions be performed only in hospitals. But the state department of health has laid down guidelines limiting abortions to hospitals with an obstetric, gynecological or surgical service and to clinics affiliated with such hospitals. The state authorities also recommend that after the twelfth week, women be aborted only as inpatients, with a one-or two-day hospital stay, which would bring the costs to from $400 to $600. Most health insurance plans will soon extend their coverage to keep up with the new law. Leading the way, the Blue Cross of Greater New York announced that its contracts will cover the costs of abortions--even for single women--as long as the operations are performed in a hospital.

Preventive Advice. The crunch comes in New York City. Until a code is promulgated in about three weeks, there will be no local regulations governing abortions. Then, health officials believe that 15 municipal hospitals, plus about 40 voluntary (private but nonprofit) hospitals will be able to handle the cases of local residents. They have no clear idea what will happen to women who flock in from Connecticut and New Jersey--and probably much farther afield --where a legal abortion is still virtually unobtainable.

Last week the city's health authorities strove to work out a set of equitable and uniform rules. Doctors in several individual hospitals were drawing up their own rules, more restrictive than the code. This brought from Lawrence Lader, chairman of the National Association for the Repeal of Abortion Laws, the charge that "the medical establishment is flouting the will of the people and of the legislature." He threatened to take the issue to the courts if the clear intent of the law is not carried out.

The city's advisory committee at first proposed that even outpatient abortions be performed only in hospital clinics to ensure that in case of complications a medical emergency team and full facilities (including blood for transfusion) would be available. Well meant as this obviously was, it brought a cry of anguish from Dr. Alan F. Guttmacher, president of Planned Parenthood-World Population. He proposed a "freestanding" outpatient clinic, which need not be part of a hospital but should be closely connected with one for the patients' protection. Fees would range from $100 to $150 for women able to pay, while hardship cases would be treated free. At week's end the city Board of Health decided to permit clinics of the type that Guttmacher proposed.

Such clinics should go a long way toward driving the illegal abortionist out of his dangerous and dirty business. Like the hospitals, the clinics will also offer patients something that backroom abortionists do not provide: advice on how not to need an abortion in the future.

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