Monday, December 12, 2005

Back into the fray....

This pissed me off.

*deep breath*

*several deep breaths*

As I've mentioned before, I worked at an abortion clinic. I also was a volunteer post-abortion counsellor, and moderated an Internet message board for women who were having emotional problems post-abortion. I'd like to think that the years of doing those things have given me a fairly good handle on the years of pain and suffering and guilt that some women feel after an abortion.

There are a couple of angles I'd like to pursue, here. The first one is the easier one to dissect: that, if you're living in the U.S. and you've had an abortion, you're *expected* to feel guilt, shame, and regret. I don't know what it's like in the U.K. or in Scandanavia, but here there's a constant subtext that women who have abortions regret them, that they wish they could go back and change things, that somehow the procedure has damaged them.

Which isn't true. It's simply not true.

Let's get one thing straight: women whose lives are going fine and dandy generally don't have abortions. Often an unintended pregnancy is the last thing on top of a lot of *other* things, like being broke or in an unstable relationship or immature, that breaks the proverbial camel's back. Having an abortion is not just a response to a crisis pregnancy; it's a response to a whole set of other crises that a pregnancy compounds.

What I saw time and time again was this: women without guilt, women without shame, put their abortion into proper perspective. They took responsibility for the decision and understood the context of the action. They did not (and this is important, so remember it) feel coerced into having an abortion; it was their own choice from the get-go.

Yet they had doubts about themselves because they didn't feel guilty. A friend of mine expressed it well: "I spent two years feeling guilty because I didn't feel guilty."

How much of that guilt and shame that women feel is being brought on by being told, over and over, that there's something shameful and wrong with them for having had an abortion? How many times can a woman see a bumpersticker that says "Real Mothers Don't Have Abortions" or hear someone dismiss women who terminate pregnancies as "sluts" before it starts to take a toll?

The second angle is nastier, darker, and more complex.

There were some women I saw at the clinic--a small minority, maybe one in twenty--who were being browbeaten into terminating their pregnancy. Those women didn't get services. Instead, we called the shelter or the cops (in the case of "my boyfriend/father said he'd hurt me if I didn't do this") and let people who were qualified to deal with the situation handle it.

There were a number of women I encountered in post-abortion counselling, both in the meat world and online, who had guilt. Lots of it. And they had one thing in common: they had had an abortion not because they felt it was best for them, but to please somebody else.

The line that sticks in my head is one from an online correspondent who said this: "My partner wasn't ready for fatherhood and left me when he found out I was pregnant. I had an abortion, but he didn't come back. Now I'm alone, and I don't even have a baby to look forward to."

Some of those women were really, really young when they got pregnant, and their parents basically made the decision for them. Hard enough to be fourteen and pregnant (with all the weirdness that that situation must've come from in the first place) and then have yet another piece of bodily control wrested away from you. If somebody says, "it's for your own good", look at them with slitty eyes...but a girl in that situation has no option.

Just as abortions don't happen in a vacuum, they don't fix everything. I reckon that the majority of women who had real problems dealing with their abortions had the idea going in that somehow life would be roses and cherries afterward; as though solving this one, monumental problem would solve all the others. And, of course, it doesn't work that way. You're still broke, your lover is still gone, you still live in a crappy apartment, your parents are still the sort of wackjobs that would enable your having sex at the age of ten.

I think that, as a culture, we need a reality check. Let me start here:

Even with perfect use, most contraceptive methods have at least a one-percent failure rate. In the U.S., the average failure rate for the most popular birth control method (the Pill) approaches 12%. That means that even with consistent contracepting, some women are going to get pregnant. Some of those women are going to terminate those pregnancies.

Even the most conservative estimates of abortion rates show that more women have abortions than get breast cancer. It's anywhere from one in three (WHO numbers) to one in five (AGI numbers) versus one in seven or eight.

Therefore, abortion is a common experience.

Therefore, we need better systems in place to help women deal with abortion. And not just the procedure itself and the aftereffects, but the whole complex web of situations that lead up to the decision to terminate. At my clinic, the number-one reason for having an abortion was not using birth control. We dealt with that by making contraception cheap and easy to get, even giving a year's worth of pills away to women after they'd had a follow-up exam and their Pap results had come back.

But that's only barely pricking the surface of the problem of unintended pregnancy.

It would be nice if women weren't stuck in situations where they felt that abortion was their only reasonable option. Affordable child-care and decent health programs for children and mothers would go a long way toward solving that particular difficulty. So would wider availability of job-training programs. So would better health care in general for women.

I'll say it again: abortions don't happen in a vacuum. Sometimes it's a simple choice, but it's not ever an *easy* choice--remember the difference. If we as a society deal with the issues that complicate unintended pregnancy rather than sweeping them under the rug, we'll lower the number of abortions performed. If we deal with the issue of abortion openly and honestly and without shame, we'll lower the proportion of women who feel damaged and wounded.

This is not just about the fetuses and women. This is not just about terminating pregnancies. Our societal response to unintended pregnancy is evidence in microcosm of how much or how little we value women, pregnant or not.

And it's not just about guilt, shame, and regret. Getting past those emotions, looking realistically at the whole of a person's life, and finding resources to deal with crises of every sort is what we ought to be doing.


Anonymous said...

Wonderful post, Jo. You really hit the nail on the head, especially regarding the shame of not feeling guilty.

I watched a Sex and the City rerun the other day, and was surprised that the characters didn't show guilt or shame for having had abortions in the past.

Then I realized that I didn't feel it either. I was just shocked that someone was honest enough to admit it.

Yes, it wasn't what I wanted to do, but it was at the time, the right thing to do.

Good luck dealing with the reactions to this post.

Anonymous said...

And then there are the doctors/pharmacists who don't bother to tell women that when they take an antibiotic the failure rate for birth control goes up. So suddenly here's a woman taking birth control and she's pregnant and has to deal with the decision of what to do. And I've encountered a great many who come down on the side of 'well, since I was on birth control and it happened, it must've been meant to be.' Sure wish men could get pregnant -- it'd straighten out some of the convolutions.

shrimplate said...

Excellent post. abortion clinic days has also spoken eloquently to this issue.

Odd this- I recall reading somewhere maybe 20 years ago that it was a myth that women generally "regret" the decision to abort and that "85%," in my recollection, feel relief instead. That figure has stuck with me all these years, but yet the myth continues.


Anonymous said...

This was a great post, thanks.

I have a related question; I hope you don't mind if I ask it.

I hear a fair bit of noise about pharmacists refusing birth control or Plan B (for "moral" reasons). But I never seem to hear news about a physician refusing to write a prescription for birth control or Plan B.

Do doctors not refuse to write such prescriptions, or is there another reason I just don't hear about them in the news?

Thanks, sorry if this is a bit off topic.

Jo said...

Shrimp, I don't know where that 85% figure comes from; I have the feeling that it's as much a chimera as the more recent findings (the article I linked from Shake's Sis has an excellent rundown on the methodological problems of the latest study). The proportion of women who regret abortions will stay the same, but the spin on that percentage will change with the popular concept of what women "should" feel. Which is a good reason, though there are many others, for not using feelings as a benchmark for whether something should be legal.

Anon, there are plenty of doctors out there who won't write prescriptions either for Plan B or for oral contraceptives. They, unlike pharmacists, are protected by real, live conscience clauses and usually make their feelings about artificial contraception known in one way or another before they're in a position to have to refuse. Hell, in my town of 100,000 people, there is an entire physician's group that opposes hormonal contraception (diaphragms are okay; IUDs are not), HRT, and abortion. And they're not Catholic.

There was a whole hooraw about four years ago in the media on this issue. If I recall correctly, the primary fear was this: with the growing number of community hospitals being bought by Catholic hospitals, the number of doctors who would or would be allowed to prescribe hormonal contraception was dropping. I don't know if the most dire predictions of the authors of the article came true. I also don't know if the number of physicians who don't prescribe OC/EC who aren't Catholic is growing. That would be an interesting survey.

Anonymous said...

I have known of a doc in my group who is not comfortable writing for Plan B. I believe he may have religious objections & is also reluctant to write for them for reasons not fully clear. He has some issues with the side effects & rx'ing for patients he doesn't know. I have NEVER had a problem writing for them. I've not had an un-intended pregnancy. In fact, my kids came very expensively. But, hell, if the condom broke, then the condom broke. Get over it. I'd rather prevent the need for an abortion than to write the referral for one. And I agree that a bit more prevention & education on the front end (Just say No works nicely, but isn't applicable to every situation), reduces the need at the back end.

If you really want me to get on my high horse, just ask me about the vaccine against HPV & those that think it wll promote promiscuity & thus are trying to block its release. My daughter is 6 y/o & I'd get in line NOW for a shot that could protect her from a cancer!!!


Anonymous said...

Thanks for the responses. So, if I were to go to a new physician, s/he'd have to tell me up front if s/he wouldn't write a prescription for birth control or Plan B?

(I'm in a new area, so this is going to be an issue at some point, I think.)

Jo said...

Anon, your doc wouldn't *have* to tell you anything. I would simply ask what his/her position is on OC and EC both. Do that as you make your first "interview" appointment.

Me personally, I wouldn't see anybody who doesn't prescribe oral contraceptives, but other people's mileage may vary.

beajerry said...

Amen, sister!
Nicely said.

Anonymous said...

I'm obviously a novice, but... you can make an interview appointment?


I've called 5 different practices in this area and none are taking new patients. I have a couple other calls to make based on friends' suggestions, but given the circumstances, it's hard to imagine asking for an interview.

(I haven't seen a doctor in a long time, can you tell? But I was lucky to be pretty healthy while uninsured for a long time.)

Jo said...

Anon, email me. There's a lot to know about picking a doc and so on, and I don't want to hijack the comments thread with my ramblings.