See all our coverage of the Kermit Gosnell case here.

Dr. Kermit Gosnell, a Philadelphia physician who performed late abortions mostly on poor and immigrant women, is facing eight counts of murder for his role in the deaths of a woman and seven babies.

According to the Associated Press:

Dr. Kermit Gosnell, 69, made millions of dollars over 30 years, performing as many illegal, late-term abortions as he could, prosecutors said. State regulators ignored complaints about him and failed to inspect his clinic since 1993, but no charges were warranted against them given time limits and existing law, District Attorney Seth Williams said. Nine of Gosnell’s employees also were charged.

Gosnell’s employees included his wife and were not, notes the article, medically trained. According to the Grand Jury report, two called themselves doctors “but neither of them were licensed physicians.” One, a high school student, administered intravenous anesthesia to patients. However, none of the employees aside from Dr. Gosnell had any medical licensing or certification at all. Gosnell and four other employees are charged with third-degree murder, drug violations, drug-delivery resulting in death and the five other employees are charged with drug violations and conspiracy.

The woman at the center of this case, Karnamaya Mongar, suffered cardiac arrest after being given an overdose of a narcotic from one of Gosnell’s employees. The babies, born at term and healthy, in this case were brutally murdered and their deaths essentially covered up by a system which has failed a population of lower-income and immigrant women kept in the dark.

It’s a grisly and devastating story. Gosnell operated “The Women’s Medical Society” in West Philadelphia for over 30 years, providing illegal abortions to unsuspecting women who had nowhere else to turn. With a staff of untrained personnel, Gosnell not only performed abortions beyond the legal limit of 24 weeks, he did so in a “decrepit and unsanitary” clinic, essentially murdering the babies who were born, alive, in the process.

The Grand Jury report offers a stomach-churning description of Gosnell’s practice, difficult to read and near impossible to imagine:

The medical practice by which he carried out this business was a filthy fraud in which he overdosed his patients with dangerous drugs, spread venereal disease among them with infected instruments, perforated their wombs and bowels – and, on at least two occasions, caused their deaths. Over the years, many people came to know that something was going on here. But no one put a stop to it.

Why, if over the years, many people came to know something was wrong, no one stopped it? The AP article notes,

Some women came from across the mid-Atlantic for the illegal late-term abortions, authorities said. White women from the suburbs were ushered into a separate, slightly cleaner area because Gosnell believed they were more likely to file complaints, [District Attorney Seth] Williams said.

“People knew near and far that if you needed a late-term abortion you could go see Dr. Gosnell,” Williams said.

Point blank, the report notes why prosecutors think Dr. Gosnell’s clinic was able to operate for as long as it did, providing dangerous and deadly “care” in squalid surroundings: because the women were poor or were immigrants or both.

But the report notes much more. In fact, both the Department of Health and Pennsylvania Department of State allegedly received numerous complaints about the Women’s Medical Society and Dr. Gosnell. His clinic was reported on numerous occasions. The Philadelphia Department of Public Health (which does not oversee medical centers but is charged with protecting the public’s health) visited the clinic on numerous occasions – citing violations – but there was never any real follow-up to the visits.

The facts of the case will begin to unravel and hopefully revealed in the days and weeks to come. Whether all of the allegations will be substantiated by fact, the stories thus far are, notes the Abortion Care Network, “truly heinous.” But what does this reveal about abortion access and laws nationwide?

When abortion is stigmatized, and access to care blocked for many women in this country, women are forced to turn to “providers” like Dr. Gosnell and his employees. Dr. Gosnell and others like him are offered easy access, in essence, to desperate and vulnerable women simply seeking to end a pregnancy.

But when we stigmatize the decision to have an abortion and keep discussions of this safe, legal option closed, as well as keep abortion care out-of-reach financially or geographically, we are not only telling women not to speak of this issue. We are also telling women they don’t deserve access to safe, legal care and that they won’t get access to a safe, nurturing environment either. Charlotte Taft, the Director of the Abortion Care Network, writes:

We are deeply saddened that our society has created an environment where women must make decisions about their health care based on cost, not quality of care. Until all reproductive health care and abortion services are accessible to all who need them, women will continue to be vulnerable to exploitation and harm by those who offer substandard care. Every day our member clinics receive calls from thousands of women seeking financial help and referrals to safe, legal providers to obtain the abortion services they need.

Most of the women who visited Dr. Gosnell would not have chosen a center like his if they had other options, or if they knew they had other options, of course. It’s why making abortion care more difficult to access – through state laws which prohibit abortion coverage in the new state exchanges to laws which make abortion care illegal for any number of reasons – can be a deadly decision. Women do not stop needing or making the decision to have an abortion because we make abortion increasingly more difficult to access. They just end up at centers like the one run by Dr. Gosnell and his staff.

Vicki Saporta, President of the National Abortion Federation (NAF), understands this well. NAF, she says, “sets the standards for high-quality abortion care” in the United States. NAF provider members care for more than half of the women who access abortion each year and must meet strict guidelines both before they can apply and operate as an existing member. Gosnell had applied on behalf of his practice for membership in NAF and was rejected, “It was clear that the clinic didn’t meet our guidelines,” says Saporta.

Yet Saporta wants to be clear. Most abortion providers provide high-quality care to their patients – Dr. Gosnell’s center was “an outlier of the worst proportion.”

Taft says that restrictive laws surrounding abortion access do not keep women and girls safe but actually contribute to scenarios like this one,

“What this case shows us is that these very strict laws limiting women and girls’ safe access to essential health care did nothing to ensure the safety and health of the most needy of our community.”

Women deserve to receive the highest quality care when they chose to terminate a pregnancy, says Saporta. Of course that’s true – but deserving the care and actually receiving it are very different and sometimes oceans apart.

For Karnamaya Mongar, an immigrant woman who spent “many years as a refugee” in Bhutan, her death tells that story all too well. It’s a story of women who seek safe abortion care but who may not speak English or have access to information necessary to find the care they deserve. And, Vicki Saporta says, “If women come from countries where abortion is illegal, they may not know it’s legal here or expect a certain quality of care. Then they end up in places like Dr. Gosnell’s clinic; sub-standard providers who prey on disadvantaged communities.”