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Abortion is legal – if you don’t like it, amend the Constitution.

Abortion is not wrong.

Abortion can be sad.

Abortion can be a difficult choice – but not always.

Abortion is a form of killing in that there is something alive in her body and after the abortion it is not alive.

Abortion doctors go to their office every day thinking they are helping women and knowing that they could be killed in an instant. Worse, they may think they are safe going to a church or a social function, but they are not.

Abortions in this country are decreasing.

Abortion is one of the safest medical procedures in the world but, because it is surgery, there is always the possibility that a woman could be harmed or even die.

Abortions cost almost the same as they did when abortion was legalized in 1973.

Abortion doctors are not getting rich and many clinics are closing because the number of patients is decreasing.

Abortion doctors have their personal limits in terms of how far in the pregnancy they will perform the abortion.

Abortion clinic staff believe they are helping woman and they also can be killed or maimed in an instant.

Abortion protestors mean well in that they truly believe they are “saving a life” and they have a right to express those views publicly.

Abortion clinics are for the most part clean and safe but there are some abortion clinics that should be shut down. There are also some abortion doctors who should have their licenses revoked.

Abortion protestors can be particularly ugly to women who are entering clinics but many of them just stand outside of a clinic and pray quietly.

Abortion can be prevented by abstinence, birth control and adoption.

Abortion advocates need to be more candid about the abortion procedure and anti-abortion advocates need to stop exaggerating the facts.

Abortion clinic counselors have different approaches to how much counseling a woman should get.

Regular readers of my award-winning column know that for many years I have been saying that the term “choice” does not cut it anymore. I’ve argued that the term does not resonate with people anymore, especially the younger generation that. And it has been co-opted by numerous banks, telephone companies and the like. Everyone has climbed on the “choice” bandwagon and supporters of legal abortion have suffered as a consequence.

Well, there is finally some movement on this end. But it’s the usual good news, bad news scenario.

According to the New York Times, the term “pro-choice” has “fallen from favor, a victim of changed times and generational preferences,” which is exactly what I’ve been saying. ”This is particularly true of a generation of women who have lived with legal abortion since they were born.” The change “is something that we have been talking about for several years,” said Cecile Richards, the president of Planned Parenthood. “I just think the ‘pro-choice’ language doesn’t really resonate particularly with a lot of young women voters. We’re really trying to focus on, what are the real things you’re going to lose? Sometimes that’s rights. Sometimes that’s economic or access to health care for you or for your kids.” No pithy phrase has yet to replace “pro-choice” but, according to the article, activists are considering “women’s health” and “economic security.”

And that is the bad news.

For about forty years, the most controversial issue of our time has been about whether or not ABORTION should be legal. Numerous groups have been formed for opponents and proponents of abortion rights. Supreme Court decisions, books, movies, and endless columns and opinion pieces have been devoted to ABORTION. But the groups that advocate for this right have for too long cloaked their message under the label “pro-choice.” ABORTION has been this big dead elephant in the middle of the room and our side has run away from it. This has confused or at least failed to influence a new generation to the point where we continue to lose support for the basic right. Not to mention the endless attacks – many successful – on access to this right.

And what is the result of our not talking about ABORTION? It leaves a pretty big vacuum in the public discourse that has been successfully filled by opponents of the procedure. Thus, there remains today a very negative stigma about abortion – and the women who receive them.

So, while I am thrilled that our friends are getting ready to ditch the term “pro-choice,” it looks like they are still not ready to talk about the real issue: ABORTION. And that will only help perpetuate the abortion stigma. And that plain sucks.

In the past, I have made reference to a very helpful website named http://www.abortion.com. I do some consulting for the owners of that site, which is an Internet directory of abortion clinics across the country. Owners pay a monthly fee to be listed, just like the Yellow Pages.

The site has been around for a good ten years, if not more and, over the last few years, I’ve watched as some of the original clinics on the list have dropped off the site. One reason is that the number of abortions is declining (for whatever reason) and these offices are businesses so if they do not have the requisite number of patients to pay their expenses, they try to cut back on the amount of money they are spending. Some just close altogether.

Then there are the clinics that have closed because their state legislature has enacted restrictive regulations (under the totally ridiculous guise of “ensuring the safety of women”) that have forced them to spend hundreds of thousands of dollars to keep their doors open. In Texas alone, I count at least eight clinics that have shut their doors in the last year because of their restrictive laws.

Now, the anti-abortion folks are no doubt applauding these developments. Indeed, I subscribe to LIFENEWS, an anti-abortion electronic newsletter, and every time a clinic closes they shout to the mountain tops (and always give credit to the anti-abortion movement) that another clinic has closed. And the assumption is that when a clinic closes, there are fewer abortions. More babies are saved! Praise the Lord!

Out of curiosity, I spent the last two weeks talking to the owners of those remaining clinics. And guess what’s happening, folks? The remaining clinics in Texas are being – in the words of one doctor – “swamped” with patients. Hmmmm, now ain’t that interesting?

Yep, several clinic doctors and/or owners told me that the number of patients they are seeing has increased since the other clinics shut their doors. And it stands to reason. That’s because the bottom line is that if a woman has an unwanted pregnancy and does not want to carry it to term, then she will seek an abortion. And no matter where she lives, she will get it.

The number of abortion facilities has decreased, no doubt about it, but the ones that are remaining – especially in rural areas like Texas – are seeing the number of abortion patients increase. They also report that more patients are coming from longer distances.

Of course, the anti-abortion advocates – who express their concern about the “safety of women seeking abortions” – don’t give a rat’s ass if a woman has to travel a few extra hundred miles to get to that clinic in western Texas. Who cares if she has to miss two days of work, travel across a state by herself on a bus, pay for someone to watch her kids?

The real strategy is to make it financially impossible for them to get an abortion but at least in Texas I’m not sure the strategy is working. And the irony is that these oh-so-compassionate anti-abortion folks are making it even more dangerous and expensive for women to obtain a legal abortion.

I’ve been writing for this blog for about a year now, and in that time I’ve never written a personal post, instead trying to elucidate some of the medical and legal aspects of abortion. I’ve spent my first two years in medical school learning all I can about abortion in politics and medicine, but it’s only in the last year I’ve begun to personally experience my first brushes with the actual impact of pro-life law, regulation, and thought.

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In that time I have been continually reminded of how large a role healthcare providers play in determining female autonomy, and that goes way beyond abortion. It means pharmacists unwilling to dispense emergency contraception. It means physicians at Catholic institutions forbidden from even discussing birth control, abortion, or physician-assisted suicide for terminally ill patients. It means, from the experience of two OB/GYN residents at the school associated with my hospital, forcing a poor patient who has already spent upwards of $1000 traveling from a nearby state to take off another day of work and purchase three more nights’ stay at a hotel because none of the weekend nurse anesthetists on call are willing to sit in on a surgical abortion.

And the patient interviews I’ve conducted this year have been particularly poignant for me. It is commonplace to ask about gynecological and obstetrical issues as part of a complete history. I’d already built a rapport with the first patient to tell me she’d had an abortion; she was funny and articulate, and the interview was going well. But when I asked about previous pregnancies and she mentioned her abortion, even though I made no sign that I treated it any differently than any other part of her medical history, I could see fear in her eyes. I realized she was afraid I would judge her, maybe even afraid I would say something about the decision. She quickly changed the subject.

The second interview was even more heart-wrenching. She was pro-life, and described an extensive history of physical and sexual abuse. Falling pregnant after one of a long string of rapes by an abuser, her doctor informed her she would not survive the pregnancy if she continued it, because of a severe, possibly life-threatening medical condition he’d diagnosed. She subsequently ended the pregnancy at his recommendation. Crying, she told me her illness had felt like a “blessing in disguise” for occurring when it did, because it allowed her to end a pregnancy that would have tied her forever to her abuser. How terrible have we become, as a society, when a potentially terminal illness is a “blessing” for justifying a choice that should require no moral absolution?

Two of the pro-life physicians I’ve encountered this year have displayed prominently just how important it is to be a vocal advocate. The first I met briefing with ACOG (the American Congress of Obstetricians and Gynecologists) members prior to meeting with state legislators to urge support on several bills, including the Reproductive Parity Act. During the meeting she posed her opinion that she disapproved of “abortions as a form of birth control.”

It’s one thing to hear this carefully coded language from politicians. It’s quite another to hear it from an obstetrician who should know that the majority of women who seek abortion had been using a primary form of birth control the month they became pregnant, much less in a room full of obstetricians that include multiple abortion providers, on a day intended to support a bill that would ensure equal access to reproductive healthcare.

The second was my own (former) OB/GYN in my hometown, who I discovered was the medical director of the local pro-life CPC (crisis pregnancy center), a position he failed to advertise anywhere to the patients in his practice. Giving him the benefit of the doubt, I visited the CPC that week and picked up the brochure materials they normally dispense to patients.

There I found so many medically inaccurate statements presented as fact I cannot see how any legitimate medical professional could possibly support it even tacitly, much less as its medical director. (A sampling: Plan B is an abortifacient; having more than one sexual partner over the course of one’s life reduces or eliminates one’s physiological ability to emotionally bond; abortion increases one’s risk of breast cancer, infertility, and depression; abortion of a pregnancy resulting from rape reduces one’s ability to recover from the psychological trauma of the rape.)

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What about the doctors of tomorrow, my own classmates? Thankfully it seems to me that the vast majority of my entering class was pro-choice, if not actively interested in reproductive health advocacy. Still, there have been a few alarming moments throughout the year. In an ethics case we were asked how to proceed with a woman who refused a Caesarian section, though the baby would die without it. It was a difficult case with no satisfying answer. Still, 5% of the class voted to force the C-section regardless of the woman’s refusal, which would be assault.

On the day of our abortion lecture, our professors played a short video of an interview with Jim Buchy, an Ohio state representative who proposed a “Heartbeat Bill” which would have banned abortion after 4-6 weeks, in which he admits he’s never considered why a woman would seek an abortion. A member of my class spoke up in support of Buchy’s stance: “If you believe a fetus is a person, I mean, it doesn’t even matter.”

I can’t help but feel that’s the overwhelming paternalistic problem with abortion opponents within the medical field: the woman’s concerns, her situation, her health, all of it “doesn’t even matter.” In the pursuit of a single moral absolute, the person most affected by their decisions simply disappears. To people who refuse to consider why a woman would seek an abortion because “it doesn’t even matter,” how can one possibly convey the desperation that would induce women to seek unsafe abortion where legal abortion is unavailable?

So what have my (admittedly few, this far into my career) experiences led me to believe about the future of medicine? It’s crucial now more than ever for pro-choice physicians to be active advocates, even if they don’t provide abortions. I worry about hospital mergers with Catholic institutions that refuse to offer even informed consent to patients, much less actual reproductive care. (In fact, the hospital associated with my medical school is undergoing just such a merger, to the worry of many students, faculty, and healthcare providers.) And while I strongly believe in the right of healthcare providers to consciously object to taking part in procedures they feel are morally wrong, I think hospitals that offer abortions should be required to have at least one member of every position required to perform the procedure on staff at any given time who do not object to helping.

And more than anything else, this last year has made me even more terrified of a future in which the pro-life movement is successful in its quest. What would this future be like for the woman who refused a C-section in our ethics case? Would forced surgery no longer be considered assault? Would it even be legal for her to refuse it? Maybe in that future, possibly terminal illnesses truly will be a “blessing” for women who do not want their pregnancies, providing not moral absolution but legal permission.

 

Sources:

1) 51% of women seeking abortions used a primary form of birth control the month they became pregnant; most either used it inconsistently due to a disruptive life event, or used a less effective method such as condoms: Jones R, Frohwirth L, Moore Ann, “More than poverty: disruptive events among women having abortions in the USA” (http://jfprhc.bmj.com/content/39/1/36.abstract). Summary available here: https://guttmacher.org/media/nr/2012/08/21/index.html

 

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