What 1,000 Abortions Have Taught Me

My first anniversary as a health worker here at Cedar River Clinic, one of the Feminist Women’s Health Centers in Washington, has just passed and the event has me thinking about the rewards and challenges of the past year. I have learned much. In that busy year, I figure I have born witness to about a thousand abortions, and learned much from the women we serve...

...For many women, the circumstances surrounding an unintended pregnancy make deciding whether to have an abortion a difficult task. For these women, the decision usually entails weighing out more than simply the options of parenthood, abortion or adoption. They struggle with the other parameters of their lives: jobs, money, living situation, and relationship status, among others. For some women, an abortion is the lesser of two evils, the choice they can live with most easily when confronted with the difficult dilemma of an unintended pregnancy. The anti-choice folks seem to think legalized abortion invites women to terminate, as if women would line up around the block to end their pregnancies just for the fun of it. They don't realize that many women, if it were possible to change some other life circumstances to make having a baby a realistic option, would choose to carry to term. Nor do they see the genuine regret these women feel because having a baby is not possible.

...For other women, the choice to have an abortion is more clear. Some simply do not want to be pregnant or have a(nother) baby. Others find those other circumstances of their lives, such as career and finances, much less easily changed than being pregnant and so, for these women, the decision can be very straightforward. I suspect some of these women would not choose abortion, if they were able change any of these other life parameters. The women who make the decision with clarity are not heartless, selfish, inhumane, un-womanly, devoid of "maternal instincts" or anything else. They are women who are clear about their options and the choice they make. More often than not, these women have a strong support network behind them and they appear to me to have a good sense of their own capabilities and limitations. I support their clarity as I do the ambivalence of other women.

...The biggest problem facing women wanting or needing abortion services is accessibility. Before I started working here, I could have told you that over 87% of all U.S. counties do not have a known abortion provider, but I didn't know what that statistic looks like. Now I know it looks like exhausted women who travel from Idaho, Alaska, Montana, Colorado, Oregon, even Canada, in search of services. It looks like desperate women who must sell precious and needed belongings, borrow and beg from friends and family to finance their journeys and procedure costs. It looks like frightened women who must travel alone to have their abortions among strangers and away from loved ones who support and nurture them. It also looks like the invisible faces of the women who couldn't borrow, beg or sell enough to travel here and won't be able to have an abortion.

...Women choosing abortions later in pregnancy are just like women who choose abortion earlier. They are no more irresponsible, selfish, victimized or immature than any other women, pregnant or not.

...The abortion debate is framed here in the U.S. in black and white, either/or terms which rarely speak to the reality of the abortion experience. Some pro-choice people have reservations about abortion in some circumstances and most anti-abortion people do allow for abortion in some situations. Intuitively, I think most of us realize that matters of sex, consent, age, family, death and money are never easy and abortion is or can be about all of these. I think because the debate is framed as it is (indeed, a "debate"!) people are discouraged from discussing their feelings about abortion. Some pro-choice people are hesitant to discuss their reservations and I believe most anti-choice people are afraid to voice any pro-choice tendencies they may have. Both sides, then, perpetuate the either/or view of abortion. In the end, it means most of us try not to think about abortion, except perhaps, in abstract terms, until we become involved--we ourselves become pregnant, or a lover or friend or sister or daughter or mother becomes pregnant. I have counseled women who hadn't thought much about abortion except that, "I'd never have one," until the day they discovered they were pregnant, and now learn their partners are on opposite sides of the debate. This reluctance to explore the gray areas of abortion can heighten the crisis an unintended pregnancy can create.

At this point, there are no absolute answers - science and law cannot tell us when life begins. It is up to each woman to decide for herself what she believes in, how she will live out those beliefs, and who she will involve in her decision. To discuss it with significant others seems crucial.

...Work in the abortion field is often misunderstood, maligned, even attacked. Not only are doctors being shot and workers harassed, there are more subtle ways even self-described pro-choice people show their lack of support. "All you do at your clinic is abortions?" I am asked. Does anyone ever ask the dermatologist, "What, you only do skin?" I am proud of the work that I do. I am grateful to every vocal pro-choice person I know, but women need to receive services, not just talk about them. (By the way, we offer a range of other gynecological services at our clinics.)

...Women frequently ask questions like, "Can you tell what sex it is?" "How big is it?" "Does the doctor cut the cord?" "What happens to the fetus once the abortion is finished?" These questions are normal. Most women have a mental image of the fetus; they want to compare their image to reality. In a few cases, women have asked to see the tissue. My experience with this has been very positive -- the women's mental image is almost always scarier and more disturbing than reality. For some women, the motivation is curiosity; for others, I believe it is a way to say good-bye to this pregnancy. Women often ask these more graphic questions in an apologetic tone, afraid their questions are morbid or strange. I see these questions as part of the process and hope all providers meet these questions with respect and an affirming attitude.

...Pregnancy is not a punishment, nor a failure. Many women feel stupid, guilty or angry at themselves for not using birth control consistently, for not obtaining an abortion sooner, or for having sex in the first place. We all take risks in our lives, everyday. Only a very small percentage of people use birth control every time they have sex. It is in our natures to take chances. That doesn't make us stupid, selfish, irresponsible or hedonistic. That makes us human.

...At the same time, the options available for birth control are highly inadequate. With options that can cause uncomfortable side effects, can be unsafe, are expensive or difficult to obtain, have to be hidden from parents or partners, are difficult to use or ineffective...well, no wonder we take chances!

...Most women voice their fear of pain as their greatest anxiety around the abortion experience. For years, the anti-choice folks have tried to scare women out of having abortions by portraying it as violent, bloody and oh, so painful (as if childbirth isn't any of those!) In fact, most women comment that it was far less painful than they feared and was finished much sooner that they expected. My dentist recently had to fill a cavity in my molar. I was crying from fear and pain as she injected the anesthetic. She commented that she could imagine a lot of things a lot worse, including "what you do at your job." My announcement that I would rather have an abortion than a cavity filled shocked her into silence.

...Some women experience abortion as painful. How much so depends on factors such as gestational age of the pregnancy, type of procedure (suction or extraction), sedation used during surgery, available support, and mental preparedness. As a health worker I try to help clients become as calm as possible in order to diminish the fear which I believe increases physical pain. But the fact that abortion is sometimes painful is not reason enough to say a woman shouldn't have one. Undoubtedly, giving birth hurts more.

...While lots of women involve loved ones in their decision and some even bring partners, parents or friends to the clinic, lots of women don't. For most of these women, I think its about self-preservation. They don’t tell because they expect their parents or partner to be unsupportive, perhaps even try to prevent them from having an abortion. I think the majority probably tell them later, when the fear that the unsupportive loved one can block their choice is gone. These women sometimes express guilt for not telling, but it strikes me as smart. It makes sense to call only on people one can expect support from. It only makes me mad that some women can't rely on their closest family and friends to support them, no matter what.

I work with a group of courageous and special people. From their experience and sharing, I have learned much. I'm grateful for the new skills they have helped me develop and the lessons they've taught me. I'm looking forward to many more.

At the end of her first year of working at Cedar River Clinics in Renton, Lynne V. wrote this article in 1993. At the time Lynne had Bachelor Degrees in Human Sexuality Education and Counseling and Women’s Studies from the University of Massachusetts at Amherst. Lynne worked at Cedar River Clinics for four years, then went to Medical School and is now a doctor.

We have to change the culture of America from a place where women's judgment is not trusted and valued to a place where it is trusted.

Feminist Women's Health Center