Four thousand years ago, around the time that Stonehenge was completed and horses were tamed, some woman somewhere had an abortion, and someone else had a problem with it. We know this because as early as the Code of Hammurabi, abortion politics were brewing. The penalty for causing a miscarriage through assault (which is understood to mean helping someone abort) was costly, with fines varying according to whose fetus you double-crossed (10 shekels for punching a noble girl’s uterus and so forth).
Several thousand years later, we are still engaged in a political debate about abortion. You may have asked yourself recently: “Hey, is that another abortion bill I’m hearing about in the news?” In the first several months of 2015 alone, U.S. legislators have introduced more than 300 anti-abortion bills. More surprising than this, however, is the fact that every day, in clinics all across the country, a fellowship of cautious caregivers endures. Today’s abortion providers practice medicine while tiptoeing around a minefield of absurd restrictions.
Consider for a moment the following situations: My colleague and I both provide abortions, he in a red state, I in a blue. On the same given day we are both at work, taking care of women on what may be one of the worst days of their lives. Sitting across from our mirrored patients, we each take a deep breath and then start out on two completely different counseling processes.
I tell my patient that she has options—that she can have her abortion through medication at home or through a brief in-clinic procedure. I tell her that both options are extremely safe and effective, and that the overall side effects are minimal. She makes up her mind to have the clinic procedure, and even though she is 17 years old, we proceed that day and she goes home two hours later, safe and relieved.
Several hundreds of miles away, the same encounter is happening in my colleague’s office in a drastically different way. He unwillingly gives his patient a more mixed message. He tells her about both options but then is required by law to also tell her that abortion increases her chances of developing breast cancer, a statement that is contradicted by the medical literature. She is 17 and wants an in-clinic procedure that day. He tells her he can’t actually perform the abortion for another 24 hours due to a mandatory waiting period, and that furthermore she’ll first need written consent from both of her parents, or she can stand before a judge to obtain a court waiver from parental consent. She doesn’t feel safe talking to her parents, so she’ll have to figure out how to navigate the court system.
Prior to her procedure, he’s also required to perform an ultrasound and make her listen to the fetus’s heartbeat. She then has to sign a form saying that he didn’t purposely leave this last part out. She is 100 percent sure of her decision to terminate the pregnancy, so this step seems beyond cruel, to both of them.
Here we are—21st-century gynecologists, practicing in the same country, performing the same legal procedure, and fighting completely different ethical battles. I counsel my patients that abortion is actually much safer than carrying a pregnancy to term and delivering (because, in fact, it is), while he on the other hand is legally forced to lie. Can he then insert his own countering piece of medical wisdom afterward? Yes, but imagine how confusing that would be to hear: Abortion causes breast cancer, and in some states: Medical abortion can be reversed, or abortion leads to irreversible depression and mental health illness. Followed by: “No, no, and no it doesn’t.”
To equate the politician-physician relationship with that of a puppeteer and his doll seems drastic, but in some states and some clinics, that is the unfortunate truth. In what other field of medicine is a physician required by law to give false medical information or to be purposefully cruel in the hopes of changing someone’s mind about a medical procedure? This is not what our physician predecessors had in mind when they pushed so hard to legalize abortion in 1973. What is legality anyway if what you’re doing is so socially chastised and legally harassed that no provider wants to do it anymore?
This brings us to probably the biggest dilemma aside from access: providers, or lack thereof. After decades of school and hundreds of thousands of dollars of debt, not many people are willing to put up with the constant external bullying in this field. Imagine a kid who doesn’t want to go to school because every day she is threatened on the playground. Now imagine those bullies are grown adults, that kid is a respected physician, and those threats are threats on her life and the lives of her family members. Only an idiot would keep going back to school, right?
This is often what it’s like to practice legal and necessary medicine in this field. And this is why it’s all worth it. Last month, I received an email from a friend of a friend asking for help. She described a situation her family was going through that immediately put a knot in my stomach. Her niece, let’s call her Jane, is a minor who just found out she was pregnant and is not yet ready to be a mother. Scared and alone, Jane decided to take up smoking in the hopes that tobacco would end her unwanted pregnancy. She also arranged for kids at school to “jump her” in the hopes that the blows to her abdomen would stop the fetus from growing. Never mind the impact of tobacco or physical assault on her personal health—Jane is so terrified (and in her state, so restricted in her options) that she’ll do anything to end an unwanted pregnancy. How have we as a society allowed this?
We propagate this message every day when we endorse the following: It’s not OK to have an abortion, it’s not OK to say abortion, and it’s definitely not OK to become abortion providers. To that I can only propagate a different message: that abortion is safe, that anti-abortion laws and rhetoric are dangerous, and that despite bullying, we will keep on providing.