In the years preceding the discovery that would fuel nightmares -- that the aging, harmless-appearing Dr. Kermit Gosnell had been running more of a slaughterhouse than a women's health clinic from his office on the corner of 38th Street and Lancaster Avenue in Philadelphia -- I was working with a family homelessness program that put mostly single mothers with children into permanent housing in the same community.
Chronic individual street homelessness is often driven by severe mental health disorders like schizophrenia, frequently co-occurring with a substance use problem, but family homelessness is more likely a purely economic problem. A single mom with little income can't absorb much budget shock; one prolonged illness, one lost job or one disruption in TANF money can quickly land mom in a homeless shelter with her children or uncomfortably doubled up with family members. Once out of the housing market, she begins the monumental task of saving the first, last and security deposit that the private housing market demands. Subsidies are few and far between and can take longer to materialize than they're worth.
In getting to what family homelessness has to with Kermit Gosnell and his baby butcher shop; let me share with you on woman's story.
When I met Ashley she was 19 and homeless, living in ad hoc arrangements on sofas around North Philadelphia along with her mother and her new born child. Her mother, a long time crack addict recently out of jail after a botched armed robbery attempt, was looking for help finding a place to live. While Ashley's mom was doing time, Ashley had lived with her grandmother, who was also an addict. After Ashley's mom was released, staying clean and struggling to find work and a place to live, Ashley decided to join her on the streets. Her grandmother's condition had been deteriorating, her household sinking into chaos as she strung together late night binges, strange men coming and going. Better to tough it out with her mom, Ashley figured, who for the first time was looking like the more stable and reliable parent.
Ashley's boyfriend was still in the picture as well. He didn't provide much help, but he did no harm. Like most kids who come up on the streets in North Philly, his skill set revolved around low level drug hustles. There the drug economy provides most of the jobs for unskilled, uneducated kids. When he wasn't hustling, he would dip his toe into what remained of the city's industrial economy, working part time minimum wage factory and warehouse jobs. He didn't seem like bad news to me. Mostly he just looked like a kid who was lost and confused and had no idea how he was going to make it in the world. When he and Ashley had their first baby, he found a new role as a child care provider, freeing up time for Ashley to start community college classes, which she excitedly did. She planned to train in health services and maybe some day go to nursing school.
My agency decided that the wisest thing to do would to be to split this family unit into two, providing Ashley's mom a place of her own where she could focus on her recovery from addiction. Ashley moved, with her boyfriend and her baby, into a studio apartment in North Philly and we figured out a razor tight budget where government programs covered the bases: WIC money fed the baby, SNAP put food on the shelves and TANF paid the subsidized rent. It was possibly the first stable housing experience Ashley ever had in her life. Sure, she was living off the dole, but she was also working hard to break a three-generation cycle of poverty.
Ashley came to me unexpectedly in tears one day. She was pregnant again. She didn't want to have another baby because it would wreck everything she was working for. If she had another baby, she would have to drop out of school. With a second baby, she couldn't hold a job. It might be years before she could make another try at furthering her education. She was close to escaping the gravitational pull of generational poverty, but this second baby could be the weight that would pull her back down.
Talking to poor women like those who sadly found themselves on Kermit Gosnell's doorstep about choosing to terminate a pregnancy or bring another baby into the world is something I've done a number of times a social worker. The decision is often complicated by issues of substance use, mental illness, and general ability to provide for another mouth; there's a real question as to whether or not bringing another child into such an unpredictable world is the right thing to do. Money for the procedure is always an issue. I provide information about where to find safe, affordable service should she choose to get an abortion but never try to influence the ultimate decision.
Ashely's decision was complicated by her mother's pleas for her not to terminate the pregnancy. Abortion among the often Biblically-literalist and very conservative black churches of Philadelphia is heresy; black genocide narratives like the one suffusing 3801 Lancaster, a recently-released documentary about Gosnell, take hold in this fervent religious culture. "Don't kill your miracle!" Ashley's mother begged her. Watching Ashley struggle with a decision that on one hand could ruin her own future but on the other ruin her relationship with her mother and her church was heart rending.
What's worse is that the cost of the abortion, $300, would break Ashley's budget. There was no such thing as an extra $300 in Ashley's world. If she was going to go through with it, could she raise the money, and could she do it in time? I was concerned that if she paid for the abortion she would get behind on rent, and wind up back on the streets. If welfare medical assistance provided funds for women to have abortions, she could have very quickly and safely had the procedure done. Instead, the clock was quickly ticking as she explored every avenue for getting the money together. The longer it ticked, the more expensive the procedure would become, until ultimately it would become illegal and she would have to bring the baby to term. Or, if she was that desperate, she might have turned to Kermit Gosnell, who allegedly exploited exactly this scenario of poor women past the term limit for a legal abortion, maybe because while they were struggling to get the money together for it the clock ticked to long, maybe because they were ignorant of other, better resources for the service.
In retrospect, it seems to me almost inevitable that if a Kermit Gosnell were to exist, he would exist in Philadelphia. The poorest of America's largest cities, saddled with a dysfunctional system of institutions that serve the poorest communities, a state level bureaucracy hostile towards us because we're so poor and need so much, with a frequently broken system of oversight that has produced scandal after scandal, tragedy after tragedy in our child welfare system, our schools and our health services. Of course Gosnell, operating in plain sight for years, should have been stopped long before he was. However, I would further argue that if access to safe and legal abortions were expanded, and public funds used to provide them, there wouldn't have been a Kermit Gosnell. The poor women upon whom Gosnell preyed would not be shunted into the black market if earlier on there had been safe, free services available to everyone in need.