The restoration of abortion services at Cook County Hospital. (SPECIAL REPORT).

On the evening of September 16, 1992, Six women obtained abortions at Chicago's Cook County Hospital, a massive public institution that is the primary source of medical care for the city's large indigent population. The procedures went smoothly, but the situation was anything but routine: It marked the reversal of a 12-year ban on abortions at the facility. It also appears to be the first instance in which a public hospital has banned and then restored abortion services. In the year that followed, approximately 1,500 low-income women had first trimester abortions at Cook County Hospital--a remarkable event in view of the opposition to the reinstatement of abortion services among a majority of the Cook County Board of Commissioners, which operates the hospital.

The number of procedures is only part of the story, however. Since services were restored, the hospital has received nearly 7,000 calls a month(1) from women seeking information and abortions--a powerful testament to the need for subsidized services among low-income women, especially in the 37 states, including Illinois, that do not pay for abortions under their Medicaid program. (2) The response "has outstripped everything we expected, ("3) declares Richard J. Phelan, president of the Cook County Board of Commissioners, who issued the executive order directing the hospital to resume abortion services. Hospital officials were also taken aback by the response. "We didn't expect the number of calls we've received, ("4) acknowledges Assistant Administrator Laurie Thomson.

Hospital officials do not know how many individuals have called the clinic during the past year-since some of the 80,000-plus calls have been repeat calls made by women attempting to reach a staff person rather than the clinic's answering machine. Officials have no doubt, however, that the demand for abortions is far greater than the hospital can accommodate. The hospital is the only public provider of abortion services in Cook County, where close to half a million women of reproductive age have family incomes below 250% of the federal poverty level. (5)

The restoration of abortion services at Cook County Hospital is also noteworthy because it occurred at a time when few public hospitals, especially county hospitals, are offering abortion services, (6) and when nearly half of all hospital providers perform fewer than 30 procedures a year. (7) Moreover, most hospitals that provide 1,000 or more abortions annually are located in the states where Medicaid pays for abortions. (8) Cook County Hospital, by contrast, appears to perform more abortions than any other county hospital in the country (*) and is located in a state where only seven abortions were funded under Medicaid in 1992, all by the federal government. (9)

The issue of public funding of abortions for poor women is receiving renewed attention in the wake of the election of a prochoice president and the growing sense that the legal right to abortion is considerably more secure than it was during the Reagan and Bush administrations. In midJuly, for example, a coalition of 130 organizations launched the national Campaign for Abortion and Reproductive Equity aimed at restoring federal coverage of abortion services for poor women and others who rely on the government for their health care.

Furthermore, support for the Freedom of Choice Act, which would codify in federal law the parameters of the Supreme Court's 1973 ruling legalizing abortion, has eroded because it leaves the issue of abortion funding to the discretion of individual states and therefore, in the words of U. S. Senator Carol Moseley-Braun, "discriminates against...poor women. ("10) The focus on abortion funding is likely to become even more intense in the coming months during debate on health reform and whether abortion services will be included in the basic benefit package.

The experience at Cook County Hospital over the past 12 months provides compelling evidence of the importance of public funding for poor women seeking to exercise their right to terminate an unwanted pregnancy. Through interviews with nearly two dozen local political leaders, hospital officials and prochoice activists conducted during the spring and early summer of 1993, (+) this report explores the political and legal events that led to the imposition of the ban on abortions in 1980 and its reversal 12 years later. It also touches on other issues that surrounded the resumption of services and concerns about how the program is currently operating.