ONE OF THE major questions from the grand jury report on Dr. Kermit Gosnell and the Women's Medical Society is "How could this happen?"

In particular, how, in a state that has led the nation in imposing restrictions on abortion could such atrocities go undetected? Just as puzzling is why the numerous complaints against him were ignored.

The answer is simple: Throughout the 1970s and '80s, when abortion policy was established, the common- wealth's primary goal was to overturn Roe v. Wade and, barring that, impose as many barriers as possible to limit access to abortion. By and large, our policymakers have never viewed abortion as a medical procedure - instead placing it under the Pennsylvania Criminal Code - and therefore haven't nurtured a system of abortion care that is woman-focused, readily accessible and responsive to their medical needs. The commonwealth's focus has been on denying access, not protecting the health and safety of women who need this medical care.

Abortion is one of the most common medical procedures in the U.S. - more than a million American women have abortions yearly and approximately one in three will have an abortion in her lifetime.

History tells us that whether abortion is legal or illegal, women will have them - the only difference is whether they live or die. As in the pre-Roe days, women with resources can usually find quality care, but some without resources will seek out the cheapest care.

The more restrictive and stigmatized abortion becomes, the more women will suffer the indignities of clinics as disreputable and dangerous as Gosnell's is alleged to have been. The direct result of our abortion policy is that the most vulnerable women will have to risk their health and lives to get what should be a completely safe and common procedure.

The grand jury report noted in numerous places that legitimate clinics - those that are part of the National Abortion Federation or Planned Parenthood - adhere to strict, self-imposed standards of quality and provide excellent care that does not endanger women's lives or health. It also noted that their standards are more stringent and more protective of women's safety than are Pennsylvania's abortion regulations.

THERE WERE plenty of opportunities in Pennsylvania - harking back to the days of Gov. Casey's administration - to shut down Gosnell's clinic. But the health and safety of the women who went there - mostly low-income African-American and immigrant women whose health insurance will not pay for abortions - were not prioritized by those charged with protecting them.

What have we learned from this? Precious little, because a state Senate committee just voted out a measure to further limit health insurance for abortion. If the safety, health and lives of vulnerable women were taken seriously, Pennsylvania would be expanding insurance coverage of abortion to ensure all women's ability to safely access this common and necessary medical care.

Carol E. Tracy is executive director and Susan Frietsche senior staff attorney for the Women's Law Project.