The Loneliness of the Abortion Patient

By Carole Joffe and Kate Cosby, AlterNet. Posted May 26, 2007.

"I think that people should be held accountable for their actions and a lot of times it's the convenience of the situation that makes it easy ... to get an abortion, and if I wasn't the person that I was, I mean this would be real easy for me, just real simple. ..."

Jessie is a 23-year-old woman, the mother of two children, having her third abortion. Her comments are drawn from a small interview study (16 women interviewed thus far) we are conducting to understand the impact of state-imposed regulations on women having abortions in two highly regulated states. In our talks with Jessie and other women, we uncovered a striking sense of isolation among many abortion patients. Rather than expressing solidarity with others experiencing unwanted pregnancies, nearly all our respondents took pains to distinguish themselves as different from other women getting abortions.

Though there were some expressions of sympathy, we also heard disparaging remarks about women who were too careless about contraception and were obtaining abortions too "easily." "I am a Christian; I am not doing this casually," one woman said, with the clear suggestion that others in the waiting room were not so thoughtful or moral. Perhaps the starkest example of isolation came in one woman's response to the question of whether she would "ever consider being part of a group that supports people who get abortions?" Her answer was an emphatic "no!" As she put it, "I wouldn't support them (other abortion recipients) because ... it [might become] a habit for everyone." The speaker was a 20-year-old mother of one, who was about to have her second abortion.

The situation we describe is very different from the one that existed in the United States in the 1970s, around the time of legalization of abortion. Then, many women seeking abortions felt part of a larger movement. "Second wave" feminism was flourishing and women's health issues were a central focus of the movement. People still had fresh memories of when abortion was illegal, and thousands of women died and many more were injured from unsafe abortions. Rather than being ashamed, many abortion patients of the pre-Roe v. Wade era recall feeling entitled to having this once dangerous procedure done in a professional and women-centered setting.

The new occupation of "abortion counselor" was established in this period -- someone who explained the procedure to the patient and accompanied her throughout her stay at the clinic. Feminist health activists pressured the newly established clinics to keep prices low and to make sure doctors were sufficiently respectful to their patients. In short, for many patients in the early years of legal abortion, the experience was both "personal and political," in that there were constant reminders that this medical procedure was tied to a larger movement. In contrast, in many of today's clinics, the staff is so busy complying with state-imposed "informed consent" requirements, which often involve telling patients downright lies -- for example, the supposed link between abortion and breast cancer and other distortions of risks of the procedure -- that there is rarely the opportunity to impart a positive political message about reproductive justice.

We are not suggesting that there no longer exists a movement for abortion rights. Today, there continues to be an extremely hardworking, multifaceted "reproductive justice" movement, as it is often now referred to. There are dedicated healthcare providers who resolutely go forth each day to provide abortion care, often risking their personal safety. There are lawyers who work tirelessly to stem the tide against the various restrictions imposed by anti-abortion politicians and by the Supreme Court ( as in the recent egregious case, Gonzales v. Carhart, which banned a type of abortion that is sometimes medically necessary to care for women in the second trimester of pregnancy, and which imposes stiff criminal and civil penalties for providers who perform the procedure). There are advocates who engage in crucial activities, ranging from raising money to help low-income women obtain abortions, to organizing political campaigns, such as the recently successful one in South Dakota, in which voters defeated a measure to ban nearly all abortions.

Yet a clear gap -- of class, income and education -- exists between those who work in this increasingly professionalized reproductive justice movement and those women who now form the majority of abortion patients. A recent study from the Guttmacher Institute, the leading research organization on reproductive health issues, paints a dramatic picture of the divide between nonpoor and poor women: "The abortion rate among women living below the federal poverty level is more than four times that of women living above 300 percent of the poverty level." Not surprisingly, there is a similar gap in access to contraception, leading the Institute to speak of "Two Americas" for American women with respect to the ability to control their reproductive lives. (http://www.guttmacher.org/media/nr/2006/05/05/index.html)

The women we encountered in the waiting rooms of three abortion clinics, located in the South and Midwest, have little experience with the contemporary reproductive justice movement, or indeed of politics in general. But they are highly aware of the shame and stigma surrounding abortion. Some spoke of their fears of being recognized in the waiting room by acquaintances. Others, when asked if they would have preferred to have their abortions performed by their own doctors, in their home towns, rather than undertaking a drive of several hours to a clinic, recoiled at the thought. "I don't think that I would be comfortable going to my ob-gyn for an abortion, knowing that's the same man that delivered my children. ... I would think he would think of me differently. ... I mean, he sees me in one light, and that's the way I want him to see me."

None of the women interviewed said they thought abortion should be illegal. But many expressed ambivalence about their decision to have one. An unmistakable sense of sadness hovered around our conversations. Ultimately, these women made the decision to have an abortion for the same reasons women always have: Their recognition that they could not adequately care for a child at this moment in their lives. This seemed especially true for the more than half of our interviewees who already have children.

Most of all, the abortions sought by our interviewees seemed to symbolize for them their personal failures to achieve the lives they wish they had. As Linda (who already had two children) said wistfully, when asked if there were circumstances under which she would not have had the abortion, "If my old boyfriend would still be with me, not caring I was pregnant ... or, if I had the money and my own house, my own car, maybe I wouldn't care about having a man beside me, and I could just move on with my kids."

The stories of the women we met in the clinics are so grim -- with tales of unreliable male partners, minimum-wage jobs that don't allow them to properly care for the children they already have, broken-down cars and inadequate social support -- that it becomes clearer than ever that "reproductive justice" means far more than accessible contraception and abortion. Affordable housing, living wages, better child care, intimate partner violence programs and universal health care are things the movement must fight for in order to give these women and their children a shot at a decent life. And if that weren't enough, a challenge of a different nature is to make the lonely women in the waiting rooms feel part of that struggle.

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Carole Joffe and Kate Cosby are both researchers with the Advancing New Standards for Reproductive Health (ANSIRH) program at the Bixby Center for Reproductive Health Research and Policy at the University of California, San Francisco.

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