What have health maintenance organization, or HMOs, to do with reducing the number of abortions? Plenty, says Shari Plunkett, the founder of First Resort, a chain of pregnancy help centers in the San Francisco Bay area that operates under a special arrangement with one of the largest HMOs in the country, which she declined to name.
The following is an interview with Mrs. Plunkett.
Q: How did you arrive at this "mainstream medicine" model?
A: It grew out of my frustration in trying to reach women contemplating abortion. It's not like they're all listening to the same radio station or reading the same newspaper. Two years ago, I worked with an ad agency to put together ad spots targeting this group of women, and I learned two things. First, that we were trying to reach half a percent of the population. Second, that a four-month series of ads would cost almost as much as my whole budget for the year. It didn't make sense.
One of my donors said, "You need to have a big HMO to refer all their patients to you." I realized that that is where pregnant women are congregating, and we needed to reach them there. We began talking to physicians, asking if this was a service they would be interested in. One of the first we talked to, a "pro-choice" physician, said, "Absolutely, because I see women like that all the time. I can spend 20 minutes with them, but I can do nothing in comparison with what you do."
Q: How did you describe the service you were offering?
A: We told doctors, "We know that you regularly see women who are pregnant and don't want to be and who are struggling with what to do. We know that you'd love to educate them on their options and hold their hands as they struggle through all their thoughts and fears and circumstances. We also know you don't have that kind of time --but we do. We'd like you to see us as specialists and refer those patients to us. We will provide them unbiased, compassionate, nonjudgmental pregnancy consulting. As soon as that woman makes her decision, whether to carry to term or [have an abortion], she's coming back to you."
Q: How does your relationship work with the HMO?
A: Twenty-four hours after a patient drops off her urine sample, she phones the advice nurse, who tells her if the test is positive. Then the nurse asks, "Is that good news or bad news?" If it's good news, the nurse tells her how to establish prenatal care. If she says "bad news" or that she's not sure, the nurse says, "Let me give you the phone number of the agency we use to do our pregnancy consulting."
If the woman says, "I'm having an abortion," the nurse tells her we will provide pre-abortion counseling for her. All we're doing is spending time with them at the point of their decision, and our hope is that ultimately they will make a decision to carry to term.
Q: How did you get the HMO to agree to this?
A: This HMO did a study of women having repeat abortions and found that the rate declined if women received counseling. One of our volunteer RNs works at this HMO office, and she knew that there was frustration with women having abortion after abortion. It was wearing the staff down. She told them about our organization, and they invited us to do a presentation.
At the end I asked, "If you were to refer patients to us, which would you refer?" I expected they would say the ones that were confused or ambivalent, and that's what one nurse aid right away. But as soon as she said that, the chief of obstetrics said, "But what about the ones that are having abortions? Do they really know what they are doing?"
>From that point on, we prayed for the whole enchilada. We didn't want just the undecided women, but every single one, including the ones that wanted abortions.
Q: Why do you think they agreed to this? If the woman chooses childbirth, it costs an HMO a lot more than an abortion would.
A: Absolutely. When they refer out their first-trimester abortions, it's going to cost $250 or less; for those who carry to term, the HMO has to pay for prenatal care, labor and delivery, and maybe 18 years of pediatrics. So this is not a decision based on money, and that is what gives me hope. I sensed that these health-care providers really wanted their patients to take more time to think through their decisions. They have a real sense that abortion is not a good thing, and if women could make other choices, it would be good for them.
Q: Do the doctors accept that your orientation is pro-life?
A: We've been very honest that our goal is to build the Bay Area into an abortion-free community. One of the first questions people ask us is: "Where do you stand on the issue?" I tell them, "I'm not going to jump into one of the two boxes, because they are political boxes loaded with stereotypes, and I don't know what your stereotypes are." Then I say, "Every day we go to work to reduce the desire for abortion in our community." The minute we say that, they know where we stand, but I've been careful to frame it in a way they've never heard before, and that has made all the difference. ...
Q: What would a woman walking into your clinic receive?
A: Like other crisis-pregnancy staffs, we talk with her about the circumstances in her life, what pressures cause her to be contemplating abortion, who in her life is heading her in that direction, and who is supportive of carrying to term. We ask her, apart from these circumstances, what does her heart tell her to do.
I think every woman's heart is telling her to carry to term, because God has placed truth in her heart, and the truth is that abortion is never the right answer. So our job is to help a woman to see that, during a time of crisis, there's a lot of pressure to make a decision that doesn't align with her values and principles. We try to provide the support structure for her to carry to term.
Besides our screening and referrals from mainstream medicine, we have a full-time registered nurse who can offer ultrasound and has the same training in it as an [obstetrician/gynecologist]. It's amazing to me, but virtually 100 percent of women want to have an ultrasound, even if they plan on abortion. We're very clear with them about what they can expect to see, and tell them they don't have to look at the screen. We let them know that having an ultrasound will merely give them more information, and information is power. It also tells us what her due date is, whether the pregnancy is in the uterus or ectopic, and whether the pregnancy is viable. ... In the process, the patient confronts the reality of another human being that exists.
Q: What are the results?
A: Sixty percent of the women we work with who were seriously contemplating abortion decide to carry to term. Ultrasound plays a big part in this. Some women go into the procedure talking about having an abortion and come out saying, "I'd better start thinking about names."
Over the 14 years I've been doing this, we've seen 15,000 to 20,000 women, and I've never seen one come back and say, "I'm so angry that you helped me carry this baby to term." We've seen fathers and husbands who were pressuring very hard for an abortion. I remember one who said, "You have to have an abortion because I have a car payment to make."
When the baby was born, he brought it back in as proud as he could be.