Community Pressure Has Made Rural Abortionists Few and Far Between : Health: Some estimates say 83% of U.S. counties lack either a clinic or doctor to perform the procedure. For poor women, long drives and high costs are prohibitive.

If the U.S. Supreme Court retreats from its Roe vs. Wade decision that legalized abortion, many rural women won’t notice much of a change. As it is, they can’t get abortions now.

Anti-abortion protests that have shut clinics and intimidated doctors have left a severe shortage of abortion providers, particularly in the South and the Dakotas.

“If Roe were in good shape, we still would have this crisis,” said Barbara Radford, executive director of the National Abortion Federation. “We think it’s the most critical problem facing women.”

According to the Alan Guttmacher Institute in New York, 83% of counties in the United States lack a clinic or doctor that performs abortions. In rural areas, women must drive an average of 100 miles for an abortion.

Only one doctor in South Dakota performs abortions; Mississippi has only five, and Kentucky nine.

And in predominantly rural Alabama, Arkansas, Louisiana, Mississippi and Kentucky, no rural women can get abortions in the county in which they live.

Doctors say the lack of abortion providers means babies are being born only to die almost immediately.

In rural areas, most women are poor. They can’t afford both an abortion, which costs between $200 and $600, and a long trip, said Dr. Joseph Mitchell, who performs abortions in Gulfport, Miss.

“They don’t want the baby so they don’t take care of themselves and the baby dies of low birth weight, or it’s abused or neglected,” he said.

Abortion-rights advocates say that Macon, Ga., a city of 106,000 people whose doctors serve patients in 18 rural counties, illustrates the situation.

Massive protests shut the city’s last abortion clinic in 1981. State health records show 1,000 women from the Macon area drove 100 miles to Atlanta for abortions in 1989.

Sandra, a woman from Crawford County, adjoining Macon, was one of them.

“I really resented that I had to go all that way, and I had to get a friend to drive me, so she had to take a whole day off work,” said Sandra, who asked that her last name not be used.

“It was painful and somewhat frightening to have an operation and then get in a car, all sore, and drive 100 miles away from the doctor you would need if there was a problem,” she added. “I was lucky--nothing happened. But I’m still mad. Having an abortion is traumatic and people down here are intent on making it more so.”

Lynne Randall, director of the Feminist Women’s Health Center in Atlanta, is trying to open an office in Macon, with doctors who commute from Atlanta. But she’s being stalled by anti-abortionists who picketed one potential site and quickly bought another--with cash--before she could sign a lease.

Local doctors won’t staff the clinic, primarily because of a requirement that says doctors must notify the city if they plan to perform an abortion.

“It’s fine for the women in Macon to come to Atlanta for abortions, but not to have the service available in their own community when it’s safer . . . not to have to travel,” Randall said.

One doctor in Macon said he does not perform abortions because of intimidation.

“As soon as the pro-lifers see you’ve told the city, they promise they’ll picket your house,” said the obstetrician and gynecologist, who asked that his name not be used.

“Doctors are very frightened. They don’t want to be thrust into a war,” said Nancy Terrill, one of 900 women from the Macon area who pledged to pressure their doctors to help Randall.

Abortion-rights advocates say anti-abortion pressure that is particularly strong in the Bible Belt is responsible for the lack of providers.

Anti-abortionists get strong support from the Southern Baptist Convention, the largest denomination in the South, and from the Roman Catholic Church.

“Churches are a big help,” said Terry Michaels of New Orleans, who travels around the South picketing clinics with Operation Rescue and other groups. “Doctors don’t want to oppose the teachings of their congregations.”

In Georgia, where 80% of rural women must drive at least 50 miles for an abortion, a state study showed that the longer the trip, the less likely the abortion.

Anti-abortionists say that proves they’re on target.

“The fewer clinics there are, the fewer doctors who will provide abortions, the fewer abortions there will be,” said Mary Boyert, executive director of Georgia Right to Life.

But doctors say it only hurts the women who get an abortion anyway.

Bleeding is a common complication of abortion. In Mississippi, Mitchell has had patients travel hundreds of miles for an abortion and then go to a local doctor for bleeding, only to be told they were being punished for their abortion.

“Distances cause delay of treatment,” he said. “There are physicians who say, ‘You deserve this.’ There are doctors who don’t want the anti-abortionists to know they’ve helped a patient.”

Anti-abortionists also try to persuade doctors and medical students not to perform abortions, said Boyert of Georgia’s Right to Life.

A survey performed by Dr. Trent MacKay, a professor at UC Davis, of the nation’s top 225 obstetrics-gynecology residency programs found that the number that provided no abortion training increased from 28% in 1985 to 31% last year; only 12% required abortion training, down from 23%, and 56% made training optional, up from 50%.

“The most common reason given was community pressure,” MacKay said.