potrero view

February 2009

Center Offers Options to Women

By Deia de Brito

Nineteen years ago Eleanor Drey was teaching English to high school students. Today, she’s an associate clinical professor of obstetrics-gynecology (OB/GYN) at the University of California, San Francisco (UCSF), performing caesarean sections, hysterectomies, Pap smears and abortions.  Dr. Drey has also served as the Medical Director of San Francisco General Hospital’s (SFGH) Women’s Options Center for the past half-decade.

In 1990, at the age of 30, Drey quit teaching English to attend Harvard Medical School.  She went on to complete her OB/GYN residency at UCSF.  “I was an urban public school teacher for the same reasons I went to medical school. I care about people who are most vulnerable,” said Dr. Drey.

Abortion services have been available at SFGH since 1976, originally as part of the outpatient women’s clinic.  But with increasing demand for services, roughly 10 years ago the clinic acquired its own space and its current name. There’s a second Women’s Options Center at Mt. Zion Hospital.

Women’s Options Center accepts Medi-Cal, private insurance, and self-pay.  Self-pay abortion costs are relatively low, said Drey, and most of the center’s patients are covered by Medi-Cal. “What’s wonderful in California is that Medi-Cal will fund your pregnancy services whether you get prenatal care or decide to end the pregnancy. Medi-Cal will help fund abortions. That includes pregnancy and abortion services for undocumented immigrants,” she said.

But Medi-Cal provides low reimbursements, said Drey, which impacts the clinics’ willingness to accept Medi-Cal patients.  According to Access, an Oakland-based abortion services referral center, roughly three-quarters of the 205 abortion clinics in California accept Medi-Cal patients.  However, only a handful of these clinics provide abortions late in the second trimester of pregnancy.  “A lot of clinics that accept Medi-Cal go to the first trimester, but fewer go to the second trimester. But that doesn’t mean they’ll see someone that is high-risk,” said an Access representative.

Women’s Options Center is among the less than a dozen high-risk abortion clinics in the state.  As a result, many of the center’s patients come from northern or central California towns and cities that don’t provide the reproductive services offered at the center.  Occasionally women seeking abortions travel to the center from other states or countries.  “We’re one of the safety nets for women who need our services,”  Drey said.

Measures regularly appear in the state legislature, or on the state ballot, to cut Medi-Cal funding for abortions, or limit the number of abortions covered per person each year. According to Planned Parenthood, “Each year, a number of bills designed to create barriers or limit access to abortion services are introduced. Areas this legislation has covered include ‘informed consent’, abortion reporting, insurance coverage, student fees, pathology reports, ‘fetal pain’, fetal license plates, sex selection, fetal tissue research, late term abortions.”  Last year’s state ballot measure, Proposition 4, which lost by a four percent margin, would have amended the California Constitution to require parental notification for teenagers seeking abortions. If a parent wasn’t present, it would have required patients to write an abuse report about the absent parent, which doctors – as mandated reporters – would be forced to submit to Child Protection Services, the police, and to the substitute adult. Patients would be allowed to obtain an abortion only 48 hours after the doctor submitted the report. The only way the patient could have avoided this process would have been to get a waiver from a judge. This proposition could have greatly complicated teens’ ability to get abortion services promptly, which could have increased their medical risks.

Drey is concerned about the needs of politically vulnerable women, such as immigrants and those with low-incomes, who need second trimester abortions, and who frequently face challenges accessing care.  Eighty-eight percent of abortions in the United States occur during a pregnancy’s first trimester, through 13 weeks.  But the Women’s Options Center provides a large number of second trimester abortions. According to Dr. Drey, it’s much harder to find a provider to terminate a pregnancy during the second trimester, which is why many of those patients come to Women’s Options Center.   “The majority of second trimester patients didn’t learn they were pregnant until they were in their second trimester. Some of them never missed a period or had morning sickness. It’s harder to find childcare or get days off work [for a two-day procedure].  All of the logistical aspects of accessing healthcare are harder for women without much money,”  she said.

Abortion after the second trimester is illegal in most states.  California law limits abortion to fetuses before viability, or the ability of the fetus to survive outside of the uterus, which has been capped at approximately five months.

Because of its location in SFGH’s trauma center, Women’s Options Center sees a significant number of high-risk patients.  “We are able to take care of the highest risk, sickest women. We have a lot more support for them medically,”  Drey said.  Many clinics across northern and central California refer patients with a high-risk for bleeding to the center.  High-risk problems that can contribute to bleeding include diabetes, high blood pressure, and thyroid problems, as well as patients who have used so many needles that no veins are visible to place an IV.  Drey also attributes some of the high-risk factors to an increase in caesarian sections, which significantly raises the likelihood of increased bleeding later on during an abortion or future childbirth.

“We see a really diverse patient population,” Drey said.  Women’s Options Center staff reflect the cultural and racial diversity of its patients:  one-third Latina, one quarter African- or European-American, and 10 percent Asian-American. With 14 supervising physicians, resident physicians – who can perform only under the direct supervision of physicians – nurses, counselors, multi-lingual medical interpreters, and phone receptionists, the center may be the largest and best-equipped abortion clinic in the Bay Area.

And if an abortion patient wants to pray with a clergyperson, SFGH provides a chaplaincy service. “Our counselors are excellent at pregnancy options counseling,” Drey said. Patients who decide to proceed with their pregnancies can get referrals to prenatal care; patients who end their pregnancy can leave the clinic with the contraceptive method of their choice. Most patients having abortions had been using contraception that failed and are looking for a reliable method.

It’s very much about the woman’s choice, according Drey. “We’ve had parents bring in their teenage daughter only to find out that she doesn’t want an abortion, but we only provide services to women who want them, free of coercion.  No one wants to come to an abortion clinic.  Most women we see already have children and they feel they just can’t have another baby.  They feel they have to do it for their families, even if they don’t believe in it.”

Last month UnitedHealth Group and PacifiCare awarded the center $164,360 to support reproductive health services, health training programs and technology upgrades.

However the latest threat to abortion access is Mayor Gavin Newsom’s proposed 25 percent cut to the City’s public health expenditures.  “We don’t know how the budget cuts will impact the clinic,” Drey said. “But we are trying to be as cost-effective as we can be.”

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