I have known Dr. E for the better part of 20 years and, while I was aware he practiced abortions, we never discussed what motivated him to do it; until now. When I approached him about doing a piece on a physician’s view on abortion, the first words out of my mouth were: “I would not mention your name, nor the state where you practice.” He agreed to talk to me, mainly on the record.
To anyone reading us from outside the U.S., such precautions may make little sense but, since the Supreme Court, in the landmark Roe vs. Wade decision, legalized abortion in 1973, the conservative movement has worked hard to chip away at the legality of abortion. Although there is at least one clinic per state that offers it, some states place such limitations to make abortion virtually unobtainable.
Sofagirl and I have always been pro-choice. Meaning just that: we respect the right of every woman to decide what is best for her life, including having a baby under difficult circumstances if her beliefs consider life to begin at conception.
Being the one living in the U.S., I find it particularly troubling that more and more restrictions are placed on what I consider a right that seemed settled four decades ago.
Since 1993, 8 people have been killed for the sole reason they helped women get rid of unwanted pregnancies or worked at abortion clinics (4 doctors, 2 employees, one security guard and one clinic escort – one of the doctors, Dr. George Tiller, was killed while serving as an usher during the Sunday morning service at his church in Wichita, Kansas, in 2009).
Seventeen attempted murders have taken place since 1977, not to mention the hundreds who have been harassed and threatened.
The most fascinating part of a conversation that took place over two sessions, which I tried to condense here, is not just the medical perspective, but the male one on a fraught issue that is typically the domain of women.
Over to Dr. E.
I was still a medical resident when, one night, a doctor was wheeled into the trauma center in dire conditions. He had been shot by an anti-abortion zealot.
I have always been pro-choice. In college, I started a pro-choice group that was criticized and protested. My view is that if it were men getting pregnant, birth control and abortion would be freely available and easy to get. As a man, I can walk into a drugstore and purchase, for a few dollars, a perfectly acceptable form of birth control without being judged. I can even buy Viagra on-line, without interacting with a health care provider. But a woman, let’s say a woman without health insurance, to get access to the pill has to make an appointment at a clinic, get checked up, maybe tests are ordered and, before she knows it, she owes hundreds of dollars just for her refills. If this is not gender discrimination, what is?
The violent death of a physician I witnessed all those years ago, even if I wasn’t on the team that tried to resuscitate him, struck an emotional chord in me. Here I was, a pro-choice doctor in words only, in a community where suddenly all options for a woman had gone dark. Despite the personal dangers it presented, I decided to get trained and offer my services. And I never looked back.
The technical details of abortion are not that difficult to master. It’s more about learning to manage the complications, and that comes with time and experience, and a good mentor.
Once a week, I get picked up off-site by an off-duty police officer – I wear a mask and I am escorted into the clinic where I perform abortions. I see between a dozen to thirty women in a day, from all walks of life and income status. From inner cities women to religious girls accompanied by their mothers to suburban housewives (half of all abortions are sought by women who already have children, shattering the myth that it’s mostly young girls in trouble). Most people who are not pro-choice have two firm beliefs on who should get an abortion: victims of rape and incest – until they are confronted with their own unplanned pregnancy. Many times I have heard: “I am not pro-choice but I can’t have this baby.” You are pro-choice then.
As a physician, I don’t judge anyone and ask of my patients they do not judge anyone else in that waiting room. At the beginning I would get upset when I would see someone come in for their third abortion but, really, what do I know of her situation? Is there someone getting rid of her birth control, is violence involved? Nobody can know what circumstances lead a woman to an abortion clinic: the little girl raped by her father while her mom was in prison; the medical resident who felt she couldn’t interrupt her studies to care for an unplanned baby. No woman wants to be there, each and one of them is prey to circumstances or life or bad decisions and trying to do the best they can. What I do know is that no woman gets pregnant because she can have an abortion.
As things stand in 2014, unfortunately for women in the U.S., abortion has been taken out of the primary ob-gyn venue and marginalized to clinics. Until recently, most women with an unwanted pregnancy would talk to their health care providers who, in turn, would refer them to a gynecologist within their medical group who would quietly perform abortions as part of his/her medical practice.
Today, though, what used to be a procedure that was standard in most ob-gyn offices, has been ghettoized, and most doctors intimidated into not performing it. And this is happening in a country where 1/3 of the women of reproductive age will experience an unplanned pregnancy (50% of all the pregnancies in the US are not planned).
By the time a woman walks into a clinic her mind is pretty made up and, often, the only counseling that is done is perfunctory or legally mandated. I still talk to every woman I see, to make sure this is really what they want, that they haven’t been coerced. If a woman comes in and is unsure – maybe her partner or her family are pressuring her – I will send her home pregnant every time. “Think about it and decide what is right for you” – I will tell her – “It has to be done for your reasons, and nobody else’s. If you want to keep it, there are ways you can do it.”
The procedure in itself lasts only a few minutes and it’s performed either under local anesthesia or minimal to moderate sedation (either sedation does not knock the patient unconscious). It does cause a fair bit of discomfort: a tenaculum (surgical instrument with long handles and a clamp at the end) is used to hold the cervix in place for the cervix to be dilated. When the cervix is wide enough, a cannula, which is a long plastic tube connected to a suction device, is inserted into the uterus to suction out the fetus and placenta. After the procedure, the uterus quickly returns to its pre-pregnancy condition, causing strong cramps. Most women recover in a matter of hours, and are back to their usual lives within a day or two.
I have three daughters and we talk often about the perils of unwanted pregnancy and unprotected sex. But the truth is that, should one of them find herself with a baby she wouldn’t or couldn’t have, regardless of restrictions, I would find a way to help her. But what of those girls who live in states where there is only one clinic and it may be too far for them to travel to? Or they live in a state where public funding for abortion has been banned and they can’t afford the cost?
Abortion cannot be willed away by legislation. It will always take place. In 1962, when it was still illegal, Chicago’s Cook County hospitals would admit a bleeding woman, the victim of a botched abortion, every 100 minutes. Desperate women will seek desperate measures. Why not make it safe for them? In many European countries, surgical abortion is rarely practiced anymore. The so-called abortion pill, the precursor of which was the unjustly infamous RU486, is administered at a clinic, followed by other medications taken at home to induce menstrual cramps. It can all be managed safely at home and it is effective in 98% of pregnancies up to 18 weeks. The Federal Drug Administration, however, has approved it only up to 7 weeks (a follow-up check up is required after a fortnight to ensure the fetus has been expelled in its entirety).
Why do I do it? I am certainly not in it for the money. I get paid a small fee for each procedure. If anything, the drawbacks can be considerable. I lost a teaching position at a conservative university because my outspoken support for abortion was more than frowned upon, even if it represents a tiny portion of my medical practice.
My personal belief is that there is no sentient life until there is viability, which is generally accepted to be at 24 weeks. Every time I walk into the clinic, the protesters outside scream at me “Save the babies! Use your talent to save the babies!” My standard response is I am saving the mommy today. Would these same people be willing to adopt a crack baby born at 28 weeks? Or the baby of an alcoholic? And these are the same folks who will deny children in need social services such as food stamps, early childhood education, healthcare. What are we supposed to do with these babies exactly? Are they willing to house them, school them, clothe them and feed them? There is so much passion involved in other’s people uteruses, it doesn’t make any sense.
When I tell a woman it’s all over and she did great, invariably I get a heartfelt thank you. That thank you makes me feel as if I have taken away a huge weight off her shoulders, a problem that, until the day before, maybe seemed insurmountable. As a doctor, it is my duty to try to make a difference. In the case of the women I see, I am able to help them rebalance the course of their lives. That is why I do it.
To read more about how individual states handle abortion and on the subject in general, you can consult Naral – Pro-choice America
For additional facts and figures, Guttmacher Institute is a wonderful resource
An insightful read on the so-called “abortion wars” is the non-fiction book “Absolute Convictions by Eyal Press