• In my hometown of Buffalo, there are far fewer abortion clinics today than there were in the 1990s. 
• After an abortion provider was shot and killed in Buffalo, doctors are keenly aware of the risks. 
• As long as abortion is demonized and providers have to risk their lives, access will never be what it should be. 
• Lux Alptraum is a writer and podcast host whose smart commentary has been featured in a wide variety of outlets including The New York Times, Cosmopolitan, and Hustler.
• This is an opinion column. The thoughts expressed are those of the author. 

In February 2019, I took a trip to Buffalo, New York. The New York State legislature had just passed the Reproductive Health Act — a sweeping slate of legislation meant to codify liberal access to abortion at a time when Roe v. Wade was more at risk than ever — and I wanted to see what it meant for my former hometown. I expected to hear stories about how getting an abortion in western New York had never been easier. Instead, I heard the exact opposite.

Buffalo isn't the kind of place that people think of when we talk about risks to abortion access. Located on the shore of Lake Erie, in the western end of New York State, the city doesn't face any significant legal barriers to abortion access. There are no six-week abortion bans or onerous licensing requirements, and New York allows same day abortions, with no waiting period between a counseling session and a termination procedure. 

On paper, there's nothing stopping anyone who needs an abortion from accessing one easily — and compared to many places in the United States, Buffalo has enviable abortion access, with two clinics within the city limits, and two additional providers close by in the suburbs. But that pales in comparison to what was available in the late 1990s, when I lived in Buffalo. And the reasons behind that decreased access aren't something that can easily be fixed with some new legislation out of Albany.

Even in the friendliest legal climates, providing abortion requires doctors to face financial and personal challenges that few people are prepared to handle. And when doctors opt out of abortion services, patients wind up suffering.

Providing abortions comes with dangerous risks 

One of the first things you have to understand is that providing abortions is a dangerous business — and in Buffalo, where abortion provider Dr. Barnett Slepian was assassinated by a sniper in 1998, that danger is hard to forget about. Choosing to offer abortions isn't a choice most doctors take lightly. Unlike, say, adding electrolysis to your list of services, or expanding into onsite MRIs, becoming an abortion provider comes with some major risks. 

Anti-abortion activists will add your name to a list and target your office for protests; at a bare minimum, you're opening yourself, your loved ones, and your patients up to harassment and abuse from angry protesters. And providers are deeply aware that it's possible for things to get much, much worse: Dr. Slepian is one of eleven people murdered by anti-abortion zealots between 1993 and 2016. There were also twenty-six attempted murders during that period, along with bombings, arson attacks, death threats, and more.

Because of the risks associated with providing abortion, few providers opt to take on the burden of offering abortion as a solo practitioner. Instead, it's far more likely to see providers working out of a clinic setting, where abortion is the primary offering and security can be a major focus. But in order for the model to be feasible, you need a critical mass of abortions — particularly since, despite what you may have heard, abortion isn't a big profit generator for doctors. 

Setting up an abortion clinic in a rural area just doesn't make sense. Which means that even in an abortion friendly state like New York, many places don't have ready access to an abortion clinic. As of 2017, nearly 40% of New York counties did not have a single abortion provider — and that's not likely to change any time soon. For rural New Yorkers, getting access to an abortion can mean traveling several hours to a city. That's not the kind of trek we think of when we imagine getting an abortion in New York.

And even in Buffalo, there's no guarantee that you'll be able to get your abortion within the city limits. Buffalo's abortion clinics aren't set up to provide abortions past 20 weeks, and the local hospital system isn't particularly friendly to abortion — two of Buffalo's four hospitals are Catholic, and thus refuse to provide abortions entirely. For people in need of complex or late-term abortions, New York City may be the only option. And that's a nearly seven hour drive away.

Limited options, even in New York

Short of mandating that every county have an abortion provider (and fully funding the security and safety needs of said provider), it's hard to see an easy or immediate way out of this problem. The most obvious solution is expanding access to abortion pills: Unlike a surgical abortion, a medication abortion can be safely performed in the comfort of one's own home, with no specialized equipment or medical professionals necessary. Thanks to recent changes to legal restrictions around how abortion pills are dispensed, it's now easier than ever to access abortion pills through a telemedicine provider. 

But abortion pills aren't an appropriate solution for everyone: Some people prefer the experience of a surgical procedure, while others have medical conditions that make abortion pills a less-safe option. Complicating things further, the FDA has only approved abortion pills for early terminations. If you need an abortion past your first trimester, telemedicine abortion isn't going to help you out. You'll still need to go to a physical clinic.

For those people, the best option we have now is supporting the abortion funds that work to remove logistical barriers to abortion (whether that's helping to pay for the abortion itself or funding travel, childcare, and the many other needs that crop up when an abortion isn't readily accessible), and organizations like the Haven Coalition, which provides lodging and escorts to people who travel to New York City to obtain an abortion.

At its core, abortion is healthcare. But as long as it's politicized and demonized, as long as abortion providers are taking their lives into their hands just for providing a medical service, it will never be as accessible as it should be — even, sadly, in abortion friendly states like New York.

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