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The Tufts Daily
Where you read it first | Saturday, April 20, 2024

‘I took the one less traveled by’: An abortion provider’s journey

Dr. Laurent Delli-Bovi discusses abortion access from Roe to Dobbs.

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Protesters rally in Washington Square Park following the Supreme Court decision that overturned Roe v. Wade.

The beige brick building is nondescript. Every window has its blinds pulled tightly closed, leaving the impression that the interior is barren. There is no indication that the building is a reproductive healthcare facility. Upon my arrival at the clinic last spring to interview Dr. Laurent Delli-Bovi, the founder and medical director of Women’s Health Services — which is an ambulatory surgical center specializing in providing abortion care — I was, for a moment, nervous that my Uber driver had dropped me off at the wrong place. But, of course, it dawned on me: Unlike the emergency room, abortion clinics don’t have flashy red signs to announce their presence.

After my identity was verified, I was buzzed into the building with a warm welcome. Dr. Delli-Bovi was coming straight out of a procedure and still sporting her blue scrubs.

Delli-Bovi didn't grow up knowing that she was going to be a doctor; it wasn’t remotely on her radar. She was born in Fairfield County, Conn., to an artist father.

“My dad was an artist and sculptor, and so he had a tremendous number of friends who tended to be very liberal —  if not socialist [or] communist — so the ideas I was exposed to early on were pretty progressive,” she said.

She described this exposure to her father’s friends and their varying beliefs as an advantage, as her town was otherwise “fairly conservative.” She majored in visual and environmental studies at Harvard with the intention of going to architecture school.

It wasn’t until her senior year of university that Delli-Bovi discovered she was in the wrong field.

“I really wasn’t very into designing buildings, and I thought about what I could do that would be challenging and satisfying and socially purposeful,” she said.

So, Delli-Bovi found herself in a slight predicament: She decided she wanted to go to medical school but had taken almost no pre-med classes nor had the grades to apply. After a year and a half in New York, working at a hospital and Rockefeller University, she attended Pennsylvania State University, a relatively new medical school.

What happened next in Delli-Bovi’s journey to becoming the abortion provider she is today, for lack of better words, seemed like fate. After medical school, she returned to Boston for her OB-GYN residency in 1976 at the Boston Lying-In Hospital, which today is known as Brigham and Women’s Hospital. Dr. Kenneth Ryan, the chair of Obstetrics and Gynecology at Boston Lying-In Hospital, believed that abortion should be a part of the training in the OB-GYN program. In fact, according to Delli-Bovi, it was the first program in the country that formally incorporated abortion training.

This was only three years after the Roe v. Wade ruling, which made abortions protected under the Constitution (until it was overturned in 2022), and one year after Dr. Kenneth Edelin, who had been a chief resident at Boston City Hospital, was convicted of manslaughter in 1975 after performing a legal abortion. 

During this tumultuous time for abortion access, Delli-Bovi said, “Most of the older doctors that I’d worked with at the Lying-In [Hospital] were tremendously supportive of legal abortion because so much of what they’d seen during their training, and the years after, had been the really horrible consequences of illegal, unsafe abortions.”

Fresh out of residency, Delli-Bovi was a junior partner in a private practice. She was asked by the senior partner if she was comfortable with the office providing abortion care. Her answer was “yes.”

Delli-Bovi had chosen OB-GYN to meet all the health needs of her patients, and that “included the decision not to have a baby.”

“Most of [the patients seeking abortions] were women who had had children, which is true of most women that have abortions. They wanted access to abortion, and they wanted to be discreet about it,” Delli-Bovi explained.

“It’s never purely elective. Nobody gets pregnant so they can have an abortion,” Dr. Laurent Delli-Bovi said.

Over time, she noticed that fewer and fewer doctors were performing abortions in their offices, so abortion options were increasingly limited to hospitals. In 1992, after almost two decades in the field, Delli-Bovi decided to start Women’s Health Services to address the issue of access.

“We started it with the idea of focusing on the people that weren’t getting care,” she said.

Delli-Bovi explained that patients with health insurance who lived somewhere where abortion services were legal and available were in a generally good spot; however, not all patients seeking an abortion were in this position.

“If you didn’t have health insurance that covered abortion, or if you were underinsured because you had a gigantic deductible, or you didn’t have insurance at all or your employer excluded abortion coverage, then you were out of luck,” she said.

In 2008, Massachusetts added strict legal requirements for clinics providing abortion care. This caused Massachusetts clinics, like WHS, to face overwhelming challenges in providing care.

The new requirements dictated that private practices using general anesthesia had to become ambulatory surgery centers. To meet federal requirements to be an ambulatory surgical center, the clinic needed an elevator, HVAC systems, piped-in oxygen and suction and specific space requirements. Complying with ASC requirements is extraordinarily expensive.  

On top of the new expensive requirements for becoming a licensed ASC, the owner of the building where WHS was located tripled their rent, hoping to push the clinic out. It became apparent that the clinic would have to move, a mission that would take four years and facing a lawsuit. 

Delli-Bovi searched for a location for two years.

“A lot of times over that two-year period, we would find a place and we would research who owned the building. We would contact them, and the minute we told them what we wanted to do, they would be absolutely uninterested in dealing with us,” she said.

Finally, they were able to get a lease in Brookline. Delli-Bovi and her husband put up half the money, about $750,000, for the ASC renovations.

Beyond real estate hurdles, social challenges stood in the way of moving WHS into Brookline. A group of residents tried to prevent the WHS from opening. They weren’t opposed to the work Delli-Bovi was doing but argued that their neighborhood was not the place for it. 

“Basically, all hell broke loose. I mean, it was a three-ring circus with a grim reaper showing up and all the anti-abortion people,” Delli-Bovi said. “They were against it, not because they were against what we did, but because they felt that it was going to be terrible for the community and for children in the community to see the protesters and their signs and things like that. So, our attitude was, ‘If you can’t do it here, where can you do it?’”

After a two-year legal battle, WHS was finally able to open in February of 2010.

The group of people the clinic set out to serve, people who, without affordable options, aren’t able to get any care, pay out of pocket at a discounted rate. Patients, who may otherwise have to pay thousands more at a hospital, can have a procedure for $700 at WHS. 

“There’s no comparison,” Delli-Bovi said.

Devoted to giving abortion access to those in need, WHS was performing procedures and being reimbursed after the fact.

“[For] 70% of the people we take care of, were being reimbursed at a rate that's lower than our cost of care. Which is why in 2019, we ended up almost closing because we were almost half a million dollars in debt. I was like, ‘We just can’t go on this way. It’s all on me; I can’t take any more risks,’ Delli-Bovi said.

At this point, the clinic had two options: close or raise monumental sums. With virtually nothing to lose, the clinic did what is unthinkable in the realm of abortion providing: They actively sought publicity. They got coverage from Boston television stations, the Boston Globe and Bloomberg News. They started getting donations from all over the country. People mostly donated small amounts of money, but the donations added up quickly. Delli-Bovi said she would sometimes receive letters along with donations, including one from a woman in her 90s that said “I’ve been fighting for this all my life.”

The clinic was able to raise enough money to stay open, but the systemic funding problem remains. The clinic is still operating on an immense annual deficit of around $450,000 per year.

“We’ve been trying to set up a nonprofit, a fundraising arm that is separate from Women’s Health Services P.C., that would raise money to help support it and to support the mission of continuing to take care of people whose only option other than hospitals is us,” Delli-Bovi explained.

Because the center provides abortions, many insurance companies refuse to provide general liability insurance, property insurance or worker’s compensation.

“There’s discrimination against abortion in the insurance world,” Delli-Bovi said.

Despite the numerous financial, legal and personal hurdles associated with creating the clinic, Delli-Bovi greatly appreciated the support and work done by organizations within Massachusetts.

“We’re lucky because it is Massachusetts, because there are groups like Reproductive Equity Now and Planned Parenthood that have worked … to eliminate some of the antiquated laws around abortion,” Delli-Bovi said.

In addition to advocacy organizations and movements, Massachusetts itself has additional programs that specialize in resources and education related to sexual and reproductive health.

This state is incredible. … This is one of the only Departments of Public Health in the country that has a family planning department,” Delli-Bovi said. “In some ways, we’re extraordinarily lucky and feel incredibly well supported and in some ways, the challenges are just always going to be there.”

Despite the challenges present in states like Massachusetts where abortion is legal, WHS, with Delli-Bovi at the helm, has been providing safe care to patients for over 30 years. 

“[Patients vary] from patients that have resources to patients that have no resources to patients that are coming from all over the country to get services that aren’t available where they live, or [patients who are] coming from the surrounding New England states,” Delli-Bovi said. “They are single mothers, they are women with substance abuse problems, they’re women that are homeless, they’re women that have mental health problems — you name it.”

Over her career, she has seen countless patients, each with a different story to tell, each that had to face and make a difficult decision. One of the first patients Delli-Bovi saw, who required care at the hospital, was a married 32-year-old woman with two children.

“She started coughing up blood, and she got a workup, and she turned out to have metastatic lung cancer. She wasn’t a smoker. She had a very poor prognosis,” Delli-Bovi said. “And so she was faced with this terrible decision.” 

Delli-Bovi spoke to the types of questions that this patient would have to ask herself.

“Do I try to continue this pregnancy, even though there’s a very good chance that I’m going to die before the end of the pregnancy?” she said. “Do I run the risk of needing an emergency delivery of a premature infant?”

Choosing to continue the pregnancy would have led to a scenario where her husband was left alone to bring up two children and a premature infant with medical issues.

Another couple came to the clinic to terminate a pregnancy due to a “devastating fetal abnormality” and were met by a crowd of protestors outside. Delli-Bovi remembers them explaining that they had wanted this baby. The woman’s husband said to the protesters, “I want you to understand how cruel you’re being. … This is such a hard thing to do, and you’re making it harder.’”

Delli-Bovi emphasized that not all patients who choose abortion have abnormal pregnancies that threaten the life of the fetus or themselves; however, only the patient can make their own health decisions.

“The point is that everybody is looking at their entire situation and deciding what is in [their] best health interests, and that’s a decision that only they can make,” she said. “It shouldn’t and can’t be made for them.”

Delli-Bovi is proud of the care she provides, and she never hides it.

“It’s always been a question of whether, outside of your work, you discuss the work that you do,” she said. “And I’ve always felt that it’s really important to do that, no matter how uncomfortable it might be. And I just put it right out there.”

When Delli-Bovi is confronted by someone who exclaims, “Well, I don’t agree with what you are doing,” she responds with, “Well, I totally understand that, and that’s your right. But if you could see the infinite range of circumstances that lead someone to make this decision, you might feel differently.”

She further explained that sometimes people object to abortions when they are “purely elective.”

“It’s never purely elective. Nobody gets pregnant so they can have an abortion,” she said.  

In Delli-Bovi’s office, there is a large gold disk on a small pedestal with the engraving from Robert Frost’s poem, “The Road Not Taken.”

“Two roads diverged in a yellow wood, / And sorry I could not travel both  / I took the one less traveled by, / And that has made all the difference.”

I asked if the quote had any particular meaning to her.

“I love it because it’s kind of like I took the one less traveled by,”  Delli-Bovi said. 

Throughout Delli-Bovi’s life, just like anyone else’s, she has encountered the so-called places in the woods where the road diverges: architecture or med school? Plastic surgery or obstetrics and gynecology? Hospital or clinic? Trudge along in silence or speak out? Each little decision, even the choice she made to accept my interview, has brought her down the path she is on and paved the way for others.

The path is not an easy or safe one. Delli-Bovi has received threats, including a message on a Mass Pike toll booth calling her a “baby killer” and giving out her home address. 

Delli-Bovi explained the significance of the poem to her career and her hopes for the future.

“To me, [the poem] exemplifies my choice to do something that was not the road more traveled by,” Delli-Bovi said. “I just realized over the years that I do this because I was trained to do it, because I care about doing it well. And because over the last 50 years, there are fewer and fewer people that are doing it. I want to teach people. I want to make sure that it goes on, [that it is] able to be provided by the next generation and the generation after that.”