"Legal but Not Safe" by Candace C. Crandall, in The Women's Quarterly (Summer 1996), 21 11 Wilson Blvd., Ste. 550, Arlington, Va. 22201-3057.

With the 1973 Supreme Court ruling in Roe v. Wade, abortion became legal throughout the nation, and that, many believed, also meant that it would be safe. Women would no longer have to venture down back alleys to obtain an abortion; now, abortion would be safe and cheap. Unfortunately, argues Crandall, a free-lance writer who says she sympathizes with the abortion rights movement, Roe v. Wade did not put an end to unsafe abortions.

Some 550,000 deaths that might have been abortion-related-out of 27 million legal abortions induced between 1972 and 1990-were reported to the federal Centers for Disease Control and Prevention (CDC). But officials there, Crandall says, suspect that the actual number of such deaths is much higher. Serious infection and other potential- ly life-threatening complications have occurred in some 250,000 women undergo- ing legal abortions since 1972, according to the CDC.

The clinics responsible for most of these deaths and complications "are not the pris- tine establishments where Radcliffe girls might go for a weekend abortion," Crandall notes, but operations "that advertise in Spanish-language newspapers and neighbor- hood weeklies, pay kickbacks to sleazy phone referral services, and lure women through the doorway with names that echo the politi- cal lingua francaÃ?â??1choice, and 'reproduc- tive health.'" These "abortion mills," she says, prey upon poor and uneducated women, disproportionately black and Hispanic, who do not know how to find a good clinic or how to take legal action against medical malpractice.

Most abortion providers are reasonably competent, Crandall believes, but that was true even before Roe v. Wade, "when Planned Parenthood estimated that nine'out of 10 ille- gal abortions were being performed by quali- fled physicians." The fact that they were often breaking the law kept the number of abortions low (as few as 200,000 annually by some esti- mates), she points out, and also "effectively discouraged most [physicians] from taking unnecessary risks with their patients. Legalization removed these constraints."

To keep abortion costs low today, Crandall says, "abortion providers and abortion rights activists resist health regulation that would require emergency care equipment and bet- ter trained clinic personnel." Federal and state governments, she believes, need to crack down on abortion malpractice. Data on abortion-related deaths and injuries must be systematically gathered, and medical care standards to ensure "a reasonably safe out- come' must be established and enforced.