O NE OF THE fundamental values of democratic societies is that institutions ought to be responsive to popular preferences. A great deal of social science research has focused on the problem of institutional responsiveness: Are institutions responsive to popular preferences? What institutional mechanisms facilitate a linkage between public policy and popular preferences? Under what circumstances do popular preferences influence policy formation and implementation? The abortion issue presents a curious problem in the study of responsiveness. The 1973 Supreme Court abortion decision (Roe v. Wade, 1973) established a national policy recognizing the right of a woman to terminate an unwanted pregnancy, and restricting the power of government to prohibit abortions during the first two trimesters of pregnancy. However, the implementation of the policy in local communities rests not with government, but with medical organizations such as hospitals. Although hospitals are now free to respond to community preferences on the abortion issue, they lack most of the institutional mechanisms that create an incentive to be responsive. Moreover, because previous health policy research finds that hospitals are closed systems, one would expect decisions about the provision of abortion services to be determined more by internal, professional preferences than by community needs or consumer demands (Krause, 1977; Alford, 1972, 1975; Reinhardt, 1973; Rayack, 1967). Nonetheless, the substantial variation in the provision of abortion services across communities suggests that some hospitals may be responsive to community preferences. This paper seeks to contribute to a better understanding of the linkage between policy implementation and community preferences by analyzing hospital abortion policies after Roe v. Wade (1973). Two questions guide the study: (1) To what extent are hospital abortion policies responsive to community preferences? (2) What community and organizational variables influence hospital responsiveness to community preferences on this health issue?