The beige brick building is nondescript. Every window has its blinds pulled tightly closed, leaving the impression that the interior is barren. There are no signs, other than a bright yellow address — 111 Harvard Street— no trace of protestors, and zero indication that the building is a reproductive health care facility. Upon my arrival at the clinic to meet Dr. Delli-Bovi, the director and founder of Women’s Health Services (WHS), 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 ER, 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 straight out of a procedure and still sporting her blue scrubs. Off the bat, her office provides a window into her life. On the wall hangs her diploma from Harvard University, accompanied by a NARAL certificate, family photos, and paintings; there wasn’t one blank spot. A deranged looking Trump stress ball sits on her dark wooden desk between organized stacks of paper. She sits on a brown leather chair, somehow reclining while simultaneously looking poised and alert. Behind her is an extra desk, this one completely covered by documents.
Dr. 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, Connecticut, to an artist father. “My dad was an artist and a 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 described this exposure to her father’s friends and their varying beliefs as an advantage, as her town was otherwise “fairly conservative.” Following in the footsteps of her father, she majored in visual studies at Harvard with the intention of going to architecture School.
It wasn’t until her senior year of university, when she was writing a thesis on topographical orientation, that Dr. Delli-Bovi discovered she was in the wrong field. She said, “I really wasn’t very into designing buildings, and I thought about what I could do that would be challenging, satisfying, and socially purposeful.” So, Dr. Delli-Bovi found herself in a slight predicament: she wanted to go to medical school but had taken almost no pre-med classes nor had the grades to apply, which made for a very busy senior year. But, after a year and a half in New York, working at New York Hospital and Rockefeller University, she attended Penn State, a relatively new medical school.
Like the decision to attend medical school, deciding to be an OB-GYN was not an obvious choice for Dr. Delli-Bovi. She had loved her elective in plastic surgery, assisting in reconstructive face and neck surgery for cancer patients and people born with congenital disabilities, and thought she had found her medical calling. But the commitment to plastic surgery was fleeting, and despite not actually enjoying her experience during her OB-GYN rotation, she realized it best reflected the type of doctor she wanted to be: one that included an ongoing relationship with patients, preventive medicine, and education.
What happened next in Dr. Delli-Bovi’s journey to becoming the abortion provider she is today, seemed to me, for lack of better words, 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. The Chief of Obstetrics, Dr. Kenneth Ryan believed that abortion should be a part of the training in OB-GYN program. In fact, according to Delli-Bovi, it was the first program in the country that formally incorporated abortion training.
For context, this was merely three years after Roe v. Wade was decided, making abortions a constitutional right (for at least a little while), and two years after Dr. Kenneth Edelin, who had been a chief resident at Boston City Hospital, was charged for manslaughter after performing a legal abortion in 1973. During this tumultuous time for abortion access, Delli-Bovi said, “Most of the older doctors that I'd worked with at the Lying-in 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, when Dr. 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. Delli-Bovi wholeheartedly supported providing abortion in the office and felt it was an option her patients deserved to have access to. Dr. 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,“ she explained. “Most of them [the patients seeking abortions] were women who had had children, which are most women that have abortions. They wanted access to abortion, and they wanted to be discreet about it.”
Over time she noticed that fewer and fewer doctors were performing abortions in their offices, so abortion options were increasingly limited to hospitals. From talking to Delli-Bovi, it became clear that there were a multitude of reasons why clinics were preferable to hospital abortions, even in Massachusetts — financial efficiency, in-depth abortion-specific training, and having a staff that was supportive and not resistant to the concept of abortion.
Delli-Bovi worked in reproductive health care for 16 years in various facilities, including the Crittenton Hastings House, the first fully licensed freestanding clinic to offer abortions in Massachusetts and where Dr. Delli-Bovi was the director before WHS. Nearing the end of her second decade in the field, she came to the conclusion that it was time to set off on her own in 1992. She said, “That's when we started Women's Health Services. We started it with the idea of focusing on the people that weren't getting care.”
Dr. Delli-Bovi explained that patients with health insurance who lived somewhere where abortion services were legal and available were in a generally good spot, but “if you didn’t have health insurance that covered abortion, if you were underinsured because you had a gigantic deductible, if you didn't have insurance at all, or your employer excluded abortion coverage, then you're out of luck,” she said.
In 2008, when Massachusetts added strict legal requirements for clinics providing abortion care, Massachusetts clinics, like Delli-Bovi’s, faced overwhelming challenges. The laws dictated that private practices using general anesthesia had to become ambulatory surgery centers (ASC). According to the federal requirements to be an ASC, clinics must meet the following, among other criteria: ASCs must have available transportation to a hospital in addition to a written agreement with the local hospital. The clinic needed an elevator, fancy HVAC systems, piped-in oxygen and suction, and specific space requirements. Complying with ASC laws requirements are 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 and sell the space to the Children’s Hospital. It became apparent that to become an ASC, the clinic would have to move. Dr. Delli-Bovi and her husband set off to find an open location, a mission that would end up taking four years and a lawsuit.
Delli-Bovi searched for a location for two years, and she said, “A lot of times over that two-year period, we would find a place and 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.” Finally, they were able to get a lease in Brookline, and Dr. Delli-Bovi and her husband put up half the money, about half of $1.5 million, for the ASC renovations.
“And so, then there was a fight,” Dr. Delli-Bovi said. A group of residents tried to prevent the WHS from opening. They claimed that the work Dr. Delli-Bovi was doing was great, but that their neighborhood was not the place for it. People lived there; there were playgrounds, schools, and churches, for God’s sake! Their legal right to object to the clinic’s location came down to the number of parking spots. The clinic had 24 parking spots, but calculations required them to have 32 spots, despite the fact they see no more than 15 patients a day.
“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,” she said. A group of neighbors protested on the basis that the clinic and the protests that would ensue in the neighborhood would scar children for life. Dr. 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. So, our attitude was, if you can't do it here, where can you do it? You know?”
At the time, Dr. Delli-Bovi, mother of two children, had lived in Brookline for 15 years, around the corner from the Planned Parenthood Clinic. She said, “I lived around, originally, the Planned Parenthood clinic…I had little children growing up, we used to walk past it; there would be a scores of protesters, [and] my kids would ask me why they were there. And I would explain it to them.” To Delli-Bovi, the fact that Brookline is a family neighborhood was irrelevant.
After a two-year legal battle, WHS opened in February of 2010. Maintaining the clinic is expensive. The challenge that WHS faces today is that they are neither a nonprofit, nor profitable. Dr. Delli-Bovi said, “We pay for everything.” 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. At a hospital, the out-of-pocket rate for a patient is immensely more than the contracted rate hospitals receive from insurance companies. Patients, who may otherwise have to pay between $3,000 to $12,000 or more at a hospital, can have a procedure for $700 to $3,000 at WHS. “There’s just no comparison,” she said. These are patients who either don't have insurance that covers abortion or have high deductibles to meet before their insurance kicks- in.
The clinic was operating at around a $450,000 deficit per year. “[For] 70% of the people we take care of, we're 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 a 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 explained.
At this point, the clinic had two options: close or raise a whole lot of money. With virtually nothing to lose, the clinic did what in the realm of abortion-providing is the unthinkable: 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 gave small amounts of money, but it added- up quickly. Dr. Delli-Bovi said she would sometimes receive notes along with donations, including one from a woman in her 90’s that said, “I've been fighting for this all my life.”
The Clinic was able to raise enough money to stay open, but the problem remains that the clinic is operating on an immense annual deficit. So, Dr. Delli-Bovi said, “We've been trying to set up a nonprofit, a fundraising arm that is separate from Women's Health Services PC, 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.” Additionally, “there’s discrimination within the insurance world,” Dr. Delli-Bovi said. Because the Center provides abortions, many insurances refuse to provide services or offer prohibitively high rates for for general liability insurance, property insurance, or worker’s compensation.
Allen Bromberger, founding partner of Bromberger Law, is recognized for his work in developing nonprofit and for-profit structures and specifically focuses on the intersection of business and philanthropy. When I spoke to him generally about the abortion clinic’s current situation, he explained that “The biggest issue is whether the clinic will operate as a charity rather than a business. This requires giving up ownership, limits on what people can earn, forgoing political action, and dedicating the assets to charity permanently.”
Qualifying as a nonprofit has two main steps. First is creating the legal entity, which Bromberger describes as easy. The second step, applying and qualifying for the IRS tax exemption, is “complex and takes months to complete. The cost, if you use a lawyer, is $10,000-25,000,” Bromberger said.
I didn’t quite understand how insurance companies could legally have different policies for abortion clinics versus other businesses. Bromberger said, “It is legal because they have different and special risks that are taken into account when setting rates. It is about risk, not politics. This is regulated by state law.”
Despite the many challenges — financial, legal, and personal — Dr. Delli-Bovi said, “we're lucky because it is Massachusetts. Because there are groups like Reproductive Equity Now and Planned Parenthood that have worked to do the advocacy work, to eliminate some of the antiquated laws around abortion, and to make changes in the laws.” Collectively, these groups, along with the Massachusetts government, had a role in eliminating the Shackling Law (which prohibits the unsafe practice of shackling female prisoners during prenatal care, childbirth, and abortions), and the Roe Act (a Massachusetts Act to remove obstacles and expand abortion access), getting protections for physicians after Dobbs (the Supreme Court decision that overturned Roe v. Wade) passed, and, most recently, orchestrating the stockpiling of Methopristone.
“This State is incredible…this is one of the only departments of public health in the country that has a family planning department. It's amazing. And so I think, 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,” Delli-Bovi said.
Despite the challenges still present even 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 coming from the surrounding New England states [because the services they need are unavailable in those states]. They are single mothers; they are women with substance abuse problems. There are women that are homeless, there are women that have mental health problems. You name it,” Dr. Delli-Bovi said.
Delli-Bovi’s observations are mirrored across the U.S. According to the New York Times article “Who Gets Abortions in America” and the data they collected in 2021, the typical abortion patient may already be a mother, is in her late twenties, has attended some college, has a low income, is unmarried, is in her first six weeks of pregnancy, is having her first abortion, and lives in a blue state.
On the day that I met with her, Dr. Delli-Bovi told me she had just met with a patient who had two autistic children. She said, “She was pregnant again, and she just couldn't have, you know, she couldn't have dealt with another child [knowing that another child would be at high risk for autism].” 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 Dr. Delli-Bovi saw who required care at the hospitable, was a married thirty-two-year-old woman with two existing children. Dr. Delli-Bovi said, “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, so she was faced with this terrible decision.”
Dr. Delli-Bovi said that the patient had to ask herself the following questions: “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? Do I want the risk of needing an emergency delivery of a premature infant?” Choosing to continue the pregnancy would most likely lead to a scenario where her husband was left alone to bring up two children and a premature infant, who may very well have all the problems associated with premature babies.
Another couple came to the clinic to terminate a pregnancy due to devastating fetal abnormalities and were met by a crowd of protestors outside. The protestors venomously hurled the typical anti-abortion slurs at them. On the second day, the husband brought his video camera and began to record the protestors. Dr. Delli-Bovi remembers him describing their situation, how they had wanted this baby, and saying to the protestors, “I want you to understand how cruel you're being…this is such a hard thing to do, and you're making it harder.”
Dr. Delli-Bovi emphasized that not all patients who choose abortion have abnormal pregnancies that threaten the life of the fetus or themselves, but “the point is that everybody is looking at their entire situation and deciding what is in their best health interests. That's a decision that only they can make. It shouldn't and can't be made for them,” she said.
Dr. Delli-Bovi is proud of the care she provides, and she never hides it. She said, “It’s always been a question of whether, outside of your work, you discuss the work that you do. 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 Dr. 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.” When she told a woman at a hospital fundraiser what she did and was met with the response, “I just don't agree with it [abortion], when it's purely elective,” Dr. Delli-Bovi said, “It's never purely elective, nobody gets pregnant, so they can have an abortion.”
On Delli-Bovi’s second desk, 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.
“Does this quote have any particular meaning to you?” I asked.
“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 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. And the path is not an easy or safe one. Once on a tollbooth on Mass Pike, there was a message calling Dr. Delli-Bovi a baby killer and giving her home address. The work she does to keep the Clinic open and provide care to patients not only puts herself at risk but also places a risk on her entire family.
Dr. Delli-Bovi finished, “I thought, wow, to me, that exemplifies my choice to do something that was not the road more traveled by. 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, to be able to be provided by the next generation and the generation after that.”