What have HMOs to do with reducing the number of abortions in a given community? Plenty, says Shari Plunkett. She has begun a chain of pregnancy-help centers (called First Resort) in the San Francisco Bay area that operate under a special arrangement with one of the largest HMOs in the country: When the health-care providers of this health maintenance organization have patients who are ambivalent or negative about their pregnancies, they refer them to First Resort for counseling. More than 40 percent of First Resort's clients come from those referrals, says Plunkett. "We're a medical and counseling service for women who are at the point of making a decision about carrying to term or having an abortion. About 70 percent of our patients fall into that category, while for most pregnancy care services, it's 20 to 35 percent." Plunkett spoke with CT columnist Frederica Mathewes-Green about this "mainstream medical" approach to abortion intervention—a model Plunkett hopes will be used across the country. (Plunkett may be reached at sp1rst@dnai.com)

It grew out of my frustration in trying to reach women contemplating abortion. It's not like they're all listening to the same radio station or reading the same newspaper. Two years ago I worked with an ad agency to put together radio spots targeting this group of women, and I learned two things. First, that we were trying to reach half a percent of the population. Second, that a four-month series of ads would cost almost as much as my whole budget for the year. It didn't make sense.

One of my donors said, "You need to have a big HMO to refer all their patients to you." I realized that that is where pregnant women are congregating, ...