Politicians continue to make it harder for women to get safe abortions. Pennsylvania lawmakers are not alone in developing strategies to regulate abortion care right out of existence. In fact, state legislatures have enacted 135 abortion restrictions in just the last two years, according to the Guttmacher Institute. It's important that women know that abortion is a legal, safe medical procedure.

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Originally posted at the Philadelphia Inquirer on March 25, 2013.  (Co-authored by Carol E. Tracy, executive director of the Women's Law Project and a cochair of WomenVote PA.)

With Kermit Gosnell's criminal trial under way in Philadelphia, public outrage at the physician accused of murdering one woman and seven infants increases with each grisly revelation. In a state that has led the nation in imposing restrictions on abortion, how could such atrocities go undetected?

The answer goes back to the 1970s and '80s, when abortion policy was established. In the wake of Roe v. Wade, Pennsylvania moved to impose as many barriers as possible to abortion access. By and large, our policymakers have never treated abortion as a medical procedure, and they therefore have not nurtured a system of abortion care that is focused on women, readily accessible, and responsive to medical needs.

If the charges against Gosnell prove true, he was an outlaw whose practice should have been shut down years earlier. So why did women go to him instead of a more reputable provider?

One former patient at the clinic told a state Senate committee that women in her neighborhood knew Gosnell offered the cheapest abortions available. Another Gosnell patient told the Associated Press that she had intended to go to a Planned Parenthood clinic but was scared away by antiabortion protesters. An acquaintance suggested Gosnell's clinic, where protesters - ironically - were not an issue.

The evidence suggests a number of factors led women to Gosnell: Medicaid's refusal to cover most abortions; the scarcity of providers in Pennsylvania; fear of violent protesters; and a right-wing culture that has stigmatized abortion.

It's important that the women of Pennsylvania know that abortion is a legal, safe medical procedure. As set forth in the Gosnell indictment, legitimate providers like Planned Parenthood and members of the National Abortion Federation follow standard medical procedures and the law.

Unfortunately, politicians continue to make it harder for women to get safe abortions. Every year since 1976, Congress has reauthorized the Hyde Amendment, which bans federal Medicaid coverage of abortion except in cases of rape, incest, or danger to the pregnant woman's life. Pennsylvania likewise restricts state Medicaid money from funding the procedure except in those rare circumstances. So low-income Pennsylvania women are as a rule responsible for the entire cost. That typically equals or exceeds an entire month of Temporary Assistance for Needy Families benefits.Bills in the state legislature would also ban coverage of abortion by policies sold on the health-care exchange to be established under the Patient Protection and Affordable Care Act.

Moreover, reputable providers of abortion care are under attack. As a result of an orchestrated campaign of harassment, intimidation, and violence, the number of abortion providers in the United States declined 38 percent between 1982 and 2005. In Pennsylvania, there is not a single free-standing abortion provider between Pittsburgh and Harrisburg.

Compounding this shortage, the Pennsylvania legislature passed a law in 2011 mandating that the remaining handful of abortion providers comply with volumes of costly regulations designed for ambulatory surgical facilities, where much more complex surgeries take place. Today, there are just 13 free-standing providers of surgical abortion care in Pennsylvania, down from 22 two years ago.

Pennsylvania lawmakers are not alone in developing strategies to regulate abortion care right out of existence. In fact, state legislatures have enacted 135 abortion restrictions in just the last two years, according to the Guttmacher Institute.

History tells us that whether abortion is legal or illegal, women will have abortions - the only difference being whether more women will die. Today, as in the pre-Roe days, women with ample resources can usually find high-quality care. But those without resources will often seek out the cheapest possible care. The long-term impact of burdening and stigmatizing abortion care could be that the most vulnerable women will once again have to risk their health and lives to get what should be a completely safe and common medical procedure.

Authors Bio:
Kate Michelman is one of the most respected and influential women leaders in America today.

For nearly 20 years, she served as President of NARAL Pro-Choice America, catapulting the organization to prominence as the nation's premier reproductive rights group--an achievement that has earned her a reputation as a nationally recognized expert not only on women's issues but also on grassroots organizing and strategic organizational development. Under Kate's leadership, NARAL Pro-Choice America transformed the political debate and positioned a woman's right to choose as a fundamental American liberty. She has also been an academic, consultant and author.

Since retiring from NARAL, Kate has written her well received memoir -- With Liberty and Justice for All, published by Penguin Books -- authored op-eds that have appeared in major national publications including The New York Times and the Washington Post, lectured at universities and other venues nationwide and been a sought-after consultant and campaigner for advocacy organizations as well as candidates at all levels of government, from Congress to President. In 2004, she directed the Democratic National Committee's "Campaign to Save the Court." In 2008, she served as senior advisor on women's issues for John Edwards' presidential campaign, after which she endorsed and campaigned nationwide for Barack Obama. She has consulted for candidates for Congress and United States Senate as well. Kate assisted Advocates for Youth on a project to use her personal story to inspire young people to act on their beliefs. Currently she is a senior advisor on women's health policy for the Women's Law Project in Philadelphia.

During her time at NARAL, Kate was a frequent advisor to former President Bill Clinton. She worked closely with -- and her counsel has been sought by -- many of the most powerful leaders in America, from Senators to Cabinet Secretaries.

Vanity Fair Magazine named Kate one of America's 200 Women Legends, Leaders. Washingtonian magazine named Michelman--a seasoned lobbyist and skilled political strategist--one of the capital's 100 most powerful women and The Hill named her one of the top grassroots/non-profit lobbyists. While serving as NARAL's President, Kate pursued a legislative agenda to keep abortion legal while making it less necessary and built NARAL Pro-Choice America into a dominant force in electoral politics at the state and federal levels. Fortune Magazine has described NARAL Pro-Choice America as "one of the top 10 advocacy groups in America." 

Early in her professional career, Michelman was a specialist in early childhood development, with a discipline in developmental disabilities. Building on her work with special-needs children in rural Pennsylvania on the edge of Appalachia, she developed a model multi-disciplinary diagnostic treatment program for developmentally disabled preschool children and their families.

Michelman, who first honed her organizing skills in the civil-rights movement, dedicated her life to women's equality and health with a focus on reproductive freedom after her own humiliating experience with a pre-Roe v. Wade abortion in 1969 when abortion was largely illegal. In order to obtain a hospital "therapeutic" abortion to avoid injury and possible death in a back alley procedure she was required by law to obtain the consent of the husband who had deserted their family as well as a hospital panel comprised entirely of men.

Prior to joining NARAL Pro-Choice America in 1985, Michelman was executive director of Planned Parenthood in Harrisburg, Pennsylvania, where she expanded the range of reproductive health services available in the area. She also trained medical students and residents in child development as a Clinical Assistant Professor in the Department of Psychiatry at Pennsylvania State University School of Medicine. She has also been a Fellow at the Institute of Politics at Harvard University.

Michelman was married for nearly 40 years to the late Fred Michelman. She has three daughters and six grandchildren.