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Originally posted by Cow Poke
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The thing that I wish were better appreciated is that abortion is healthcare ― and any attempt by policymakers to separate it from the rest of medicine is artificial. Women are more sure of their decision to have an abortion than are patients who go through other comparable medical procedures. In terms of safety, abortion is at least as safe or safer than similar clinic-based procedures that are not regulated as stringently as abortion. Like other healthcare, health insurance, including Medicaid, should cover abortion care, as is done in most other countries where abortion is legal. And finally, abortion training needs to be a part of medical and nursing education everywhere ― because it’s healthcare.
The public approaches the decision of abortion with sympathy and sadness regardless of the situation. Women chose abortion in order to improve the lives of themselves and those they care about. Instead of shaming women, intentionally or unintentionally, we should be empowering and celebrating all women who make decisions that are right for themselves and their families.
I want policymakers to know that abortions remain safe in this country due to evidence-based practices based on rigorous and robust research. Abortion will only continue to remain safe in this country when there is protection of the access that women have to safe abortion services. People need to know that abortion providers, whether they are specialists, OB-GYNs, Family Medicine providers or advanced practice providers, do not “have fun” or “enjoy” performing abortions ― we perform abortions because it is a fundamental human right to make decisions about one’s reproductive health. We are passionate about defending that right.
My biggest frustration about the abortion debate in today’s political climate is that so many incorrectly think that abortions are a one-size-fits-all experience for women. Not only are actual abortions quite varied ― they range from medications to surgical procedures ― but most importantly, the reasons that a woman chooses to have an abortion couldn’t be more diverse. In my career, I’ve cared for women who became pregnant as a result of rape, women with serious medical problems for whom pregnancy would be life-threatening, and women who discovered late in pregnancy that their baby could not survive after birth. Some of these women decide to end their pregnancies and some do not, but the point is that they have the right to decide. For all of these women, and for all women, abortion must remain a safe and legal option.
I wish that policy makers understood that poor women are thinking of their current children when they have an abortion. Many of the women I see are living day-to-day to get food for their families. They work hard to ensure their children have food/clothes/a place to live. When Medicaid and other insurance companies don’t pay for women to have abortions, children go without necessities. If we want to lift families out of poverty, we should cover their healthcare needs, including abortion care.
Less than 1.5 percent of abortions are performed after 20 weeks gestation in the United States. Many women seek these later abortions for fetal structural abnormalities. These malformations of the brain, heart and other organs are very often not compatible with life and cannot be diagnosed until the “anatomy ultrasound,” which is performed at 18-20 weeks gestation. Women who live in the 15 states with 20 and 22 week abortion bans are unfairly burdened by the increased cost of travel, time away from work and family, child care and stigma.
Women are referred to another city an hour and 15 minutes away by car. Women who have only bus for transportation, who have small children to bring with them, whose two-day procedures will require an overnight stay in a hotel they do not have money for. Most of these women are forced to carry to term and have a baby they do not want, cannot care for, know will drain already limited family resources. Law does not mean access.
I think one thing to know is that the majority of women present for abortion care are nervous and have guilt about talking to a doctor about abortion, but that a majority of them feel relief once the abortion is over. There are a lot of misconceptions (as evident in the debate) about what abortion is, the risks, and how it will feel for a women going through it. This creates a lot of stigma around the procedure and the care they get (often I’m told “you are much nicer to me than I thought you would be” because these women expect to be treated poorly). I would want policymakers to know that it is important to understand that laws restricting abortion develop a stigma that hurt women.
My greatest frustration about discussion of abortion in the public sphere is the lack of diversity of women’s perspectives and experiences. Anti-choice advocates have a very simple narrative: every pregnancy is a blessing, and every abortion is bad. My patients’ lives are so complex, and women end pregnancies for so many reasons, from the heartbreaking to the mundane. I wish that policymakers understood that legal and financial barriers to abortion do not end abortion, but only make it more burdensome and dangerous.
My role as a reproductive psychiatrist is to treat women who are suffering from conditions like depression during pregnancy. I also see those who have to make a difficult termination decision due to fetal anomalies, for example.
My biggest frustration is that the debate centers around this one small procedure, and yet we have not nearly enough debate on how to treat those who continue their pregnancies and struggle postpartum, [as well as] the families who suffer with so many different psycho-social issues.
As a physician who provides abortions, I have observed that every single woman who comes to me for this care wishes things were different. That there weren’t a lethal fetal anomaly affecting her pregnancy, or that there were still a heartbeat. That she did not have to live with the memory of a sexual assault. That she had the time, energy, and resources to be the best parent she could be at this very moment, because that would change everything. She alone walks in those shoes, and I trust her to decide.
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