Abortion is Not Always the Only Option

You may be wondering how on earth it's possible to be anti-abortion and pro-choice at the same time. It's like being pro-war but anti-death penalty, right? Not exactly.

Many of the people who are gung-ho pro-choice advocates have never set foot in an abortion clinic. Personally, after working in one for nearly a year has not made me change my pro-choice views; it just raised the question of social and personal responsibility for me. When there are so many methods of contraception available, why do women constantly find excuses to forego using them and opt continually for such an invasive procedure that literally sucks what will be life out of them?

So maybe it's a controversial statement, but I really think some women take their constitutional right to choose for granted. They most likely don't know or just never consider the fact that, in the other countries where abortion is legal, there are still strict guidelines in place to prevent those terminating for no reported reason from having abortions. In these countries, a woman must be seeking an abortion in order to preserve her life, physical/mental health, financial well-being or because the fetus is suffering from severe birth defect(s) or is the product of a sexual assault.

In this clinic where I worked, it is not required that each patient give a detailed explanation as to why she is terminating. All they have to do is come up with the fee for the procedure-which ranges anywhere between about $350 and several thousand dollars for those much further along-and their 'problem' is nothing but a memory that many hope to forget. And, after this ordeal that leaves many emotionally distraught or numb, they still refuse our free gift of oral contraceptives citing some excuse other than health reasons as to why they cannot take them. Many have been led to believe by friends or testimonials from strangers that they will gain weight from the use of contraceptives.

I did see several familiar faces within the year I worked there. In Georgia, it's legal to terminate up to 26 weeks-that's right, 6 months and 2 weeks. A few of these patients also came to us more than once. Coming from other states and countries, they saw this clinic as their last opportunity to be rid of the materialization of a mistake, a sexual assault or, in many instances, to euthanize a very, very sick baby.

I still believe that a woman has the ultimate say in what happens to her body and that no one should be able to either force her to continue with an unwanted pregnancy or terminate a pregnancy she wants to carry to term. While working as a counselor in one of the busiest and oldest abortion clinics in this city, I learned several things that I didn't expect to learn-about my own beliefs.

Inside an Abortion Clinic

The first culture shock was seeing the volume of patients coming through this clinic that performed first trimester (6-14 weeks gestation) and second trimester (15-26 weeks gestation) abortions. On any given surgery day, we processed no less than 20 1^st trimester patients. Even the patients were often astounded by the number of women there with them in the same or similar predicaments. On any day that we admitted 2^nd trimester patients for the more complicated 2-day procedure, we usually processed between 5 and 20 patients.

Georgia state government mandates that each patient's termination be delayed 24 hours from the moment she calls for an appointment under the guise of the Woman's Right to Know Act. This Act requires us to read each potential patient her rights to medical assistance, law-enforced financial assistance from the father of the pregnancy, as well as any possible risks associated with terminating or carrying her pregnancy to term. In addition, she is to receive informational counseling as the last step encountered before being prepped by medical staff for the procedure. A crucial component of the session would be to determine each patient's level of certainty regarding her termination. During my first few months as I was learning the ins and outs of each procedure and how to prepare the patients, I was assured that the procedures were safe and my pro-choice beliefs were solidified by many of the patients' personal stories. They were terminating their pregnancies because they felt they were financially unstable, too young, mentally incapable of raising a child, addicted to drugs or in abusive relationships that made their living situations less than ideal for themselves and even less so for a new baby.

There were quite a few, though, who expressed their unwillingness to have an abortion even though they had been forced to come to the clinic by a boyfriend, husband or parent. I remember a very heart-wrenching case of a teenage girl who'd been tricked into flying here from another state by her boyfriend's parents. As they divulged to the director, their son was a candidate for a very prestigious scholarly award and they felt that parental responsibility would ruin their son's chances of a successful future-and they did not think she was good enough for him. Patients in such circumstances, regardless of how far along they were or whose interests were involved, were rejected and sent home due to the clinic's staunch pro-choice, patient advocacy stance and we made our support of their decision known to the patients as well as the individual(s) who were trying to force them.

In other instances, patients expressed emotional uncertainty even though they had what we deemed rational reasons for terminating, but were advised to seek decisional counseling before being allowed to reschedule.

It was also my responsibility to give each patient a choice to accept a free month's supply of oral contraceptives, a contraceptive vaginal ring or to discuss scheduling a Depo Provera injection for a later date. Most patients, whether taking on proactive attitudes toward preventing more unwanted pregnancies or simply compelled by guilt, accepted the offer emphatically. There were of course those who rejected the offer, unrealistically professing their plans to never have sex again! Many of the objections to taking birth control were surprisingly the parents of our minor patients to whom we promptly countered with reason and reminded them of their presence in an abortion clinic. All of the counselors strongly advised all patients to accept their free 'gift' to prevent repeated visits to our clinic. Rather than expecting patients to abstain, we explained that multiple abortions may compromise or weaken a woman's cervix since it is dilated manually for the procedure. Continually subjecting a cervix to unnatural dilation may make it difficult for a woman who's had several abortions to retain future planned pregnancies.

The Beginning of the End of Nonchalance

It took many more months doing this work before I started to have second thoughts about my involvement in the hundreds of terminations performed each month. Anyone with any knowledge of the rapid growth of pregnancies, especially in the 2^nd trimester, can assume the obvious-the fetuses are growing very rapidly at this point. Since a form that resembles a human being is visible as early as a few weeks into the pregnancy, it became increasingly difficult to refer to a pregnancy at 6 months as a fetus. In order to continue doing my job, I consciously decided to fight the fact that this was becoming a point of contention for me.

"That's murder-when it's that late," a patient said to me once in counseling. I was blind-sided by her comment, but I couldn't find a rational way to explain away her belief. She was terminating in her first trimester, but was appalled by the fact that the clinic also terminated in the second trimester. Because of her comments in the counseling session, I asked her how certain she was that she wanted to have the abortion and she maintained that she needed to terminate this pregnancy because she already had children for which she found it extremely difficult to provide with no assistance from their father or her family. Later on in the evening after her surgery, though, this same patient was sitting on the porch waiting for a ride with her friend and both of them were sobbing uncontrollably, apparently overwhelmed with grief. The image of them crying there is forever etched in my memory.

Even though I know that I did not allow an uncertain woman to be processed through to termination, I realized then that abortion is truly the last resort for some women and they do not always feel a sense of relief once it's done.

Is There Justification for 2^nd Trimester Abortions?

While the majority of those entering through our doors were having abortions for the reasons previously mentioned, a large number of our patients were also advised to terminate their pregnancies in an attempt to preserve their physical or mental well-being.

Many patients were referred to our clinic from other states-even other countries-because we performed late term procedures. Quite a large number of these referrals were due to fetal anomalies, or genetic abnormalities, already hindering or halting normal development in utero and would surely affect development once the baby was delivered if carried to term. As can be expected, these were extremely difficult counseling sessions since the patients were not visiting us due to a personal decision to terminate, but due to a strong medical recommendation. The patient carrying very sick or malformed fetuses wanted to have their babies but were advised not to by their OB/GYN doctor or geneticist.

I remember counseling a woman undergoing a 2^nd trimester termination for the second time. It turned out that this woman AND her husband were both carriers of a degenerative disease that she would only pass onto male children. Her first pregnancy was a boy she delivered prematurely and watched as he suffered for several months before passing away. She'd since given birth to a healthy little girl, but the two subsequent times she'd been pregnant with male children, they both tested positive for the disease. Each time the tests were positive, she'd been advised to terminate. This time, she said, she was going to have a tubal ligation so as not to put either herself, her husband or her daughter through this pain again.

There were quite a few who terminated because the fetal anomaly was Down's syndrome. I know for a fact, however-having two cousins who were born with Down's syndrome-that individuals afflicted with this genetic deficiency can live rather normal lives. Of course it takes a different kind of commitment to raise a child with special needs, but it can be done. I tried not to secretly judge these patients since I have no idea how I'd react in the same situation.

Many of the patients visiting us for 2^nd trimester abortions were young girls who had been hiding their pregnancies for months because of denial or fear of the repercussions once they told a parent or guardian. Several of these young girls were victims of rape and/or incest as well, so it made for a rather difficult situation to handle as a counselor. In one case, a 13-year-old girl had been sexually assaulted by her maternal grandfather but was hiding the pregnancy from her mother by wearing baggy clothing and avoiding her as much as possible. In cases like this, an abortion seemed like the only thing to do when one considers the emotional trauma already imposed on this child and also how carrying the baby to term, giving him/her up for adoption and knowing that this child may want to know someday who his/her parents are. Although an extreme case, it seemed like I was definitely in the right place doing some important work that day.

Is There Such Thing As 'Pro-Choice' Responsibility?

I often caught myself judging other people. Who has good reason and who doesn't? Of course in the 2^nd trimester, a pro-life advocate may try to advise a woman to just continue her pregnancy for the next 10 weeks or so and consider putting the baby up for adoption. But what if she's had no prenatal care since she decided early on in the pregnancy that she was going to terminate as soon as she could come up with the money? What if there are severe abnormalities or developmental problems that haven't been recognized yet? That changes the likelihood of adoption being a viable alternative.

Isn't the bottom line simply that it's still a woman's choice no matter what? I believed this beyond the shadow of a doubt until the day a young man stormed into the clinic 2 months ago demanding to see his girlfriend who, as he put it, was about to abort his child. He pleaded with us to let him talk to her and try to convince her to have their baby-that he was going to do whatever it took to take care of the daughter they'd decided to raise together. He said it was his girlfriend's mother who stepped in, halted their visits to the doctor for prenatal care and convinced her daughter that she was going to ruin her future college and career plans. In counseling this patient, she expressed to me that she'd made up her mind and that she didn't want to see him at all. It was obvious she loved him, but she had made the ultimate decision without him.

Is that fair?

One of the most incredible cases I encountered recently was an East Asian woman who visited us with her husband. She barely spoke any English but was clear that she wanted to terminate her pregnancy because it would be their 4^th daughter-they wanted a son.

So what's so different about choosing not to have a child with Down's syndrome than choosing not to have a child that can't carry on your last name? A woman's right to choose cannot have limits, can it?

I am so grateful for what I've experienced talking with women from so many different backgrounds who are all, in some way, desperate to undo something that may have seemed irreversible until they walk through the doors of an abortion clinic. I will remain a steadfast pro-choice advocate for what should be a woman's irrevocable and uncontested right to choose whether or not to become a mother. All I ask is that women everywhere exercise the rights they've inherited with care. I ask them to think about the women who died or were left infertile at the hands of inept doctors or untrained people using unsterile and horrifically dangerous instruments to end their unwanted pregnancies because it was illegal. I ask women to be socially and personally responsible when they are deciding whether or not to use contraception. If she feels that she can handle the detachment, a woman in this situation could consider putting the baby up for adoption as there are plenty of people who desire to have children but are unable to.

From one pro-choice advocate to others, abortion should be the last resort for unwanted pregnancies and not as a substitute for preventive birth control.