With the historical passage of federal health care reform, more Americans are paying attention to questions of access than perhaps ever before - and certainly since Roe legalized abortion 37 years ago.  However, looking critically at the fraught discourse leading up to passage of reform, arguments that one might reasonably expect to hear principally from the right about one of the most common medical procedures in this country - abortion - took position on the center stage of the debate:  most notably the notion that government has greater responsibility to protect taxpayers from supporting a procedure they oppose than it has to support women's health and fundamental human rights.  How has it come to be that essential progressive answers to questions about the right to health care and the role of government can be so different when it comes to abortion? 

Looking toward the health care system itself provides one clue: the isolation and exclusion of abortion within federal policy mirrors the isolation and exclusion of abortion from mainstream medical practice.  Since 1982 a steadily increasing number of abortions are provided by specialized clinics in urban areas.  This isolates not only the abortion procedure, but the women who are having abortions, cutting off both women and providers of abortion care from the millions of other patients and health care professionals who are invested in the current health care reform debate. 

AAP and several of our colleague organizations are working toward a different vision for abortion care, guided by our conviction that a strong system of care is a diverse system that does not isolate abortion or place sole responsibility on a single type of provider setting. We believe that the broader engagement of health and social service providers will not only lead to more equitable and sustainable access, but that it has political implications as well.  Service delivery engages people at the level of the woman and her story - an essential lens through which to view the ‘abortion debate' but one that is difficult to achieve in political discourse. 

Colleague organizations within and outside of the reproductive health, rights and justice movement deserve accolades for their hard work to pass health care reform, seeking to improve and expand access to health care without diminishing reproductive decision making and women's dignity and autonomy.  Nevertheless, sacrifices weigh heavily as we applaud the passage of reform.   It is time that we revisit the intersections between access/service delivery and politics/policy and look not only at the impact of policy on practice, but at how practice has shaped  - and could help change - contemporary political realities.