“Counting fetal parts is not a desirable way to spend the day.”

  women flag

 Yesterday’s Washington Post Magazine featured a thought-provoking article on the making of an abortion provider. Leaving aside the personal safety issues, which are large, the author chose to focus on the reality of performing abortion procedures and caring for the women who request them. It turns out that wanting women to have access to abortion and being personally willing to provide the service are two entirely different things.

According to the Guttmacher Institute, the premier advocacy group devoted to reproductive health and rights, the number of abortion providers remained relatively stable, dropping only 2% between 2000-2005. In contrast, provider numbers dropped 14% from 1992–1996 and 11% in 1996–2000. The primary reason why the number of providers stabilized is because the decrease in providers willing to perform surgical abortions was almost completely offset by the increase in providers offering new medical methods of pregnancy termination like RU-486.

Surgical abortions remain the mainstay of abortion provision, however, and increasing numbers of clinicians simply don’t want to perform them. The WaPo profile of a medical student activist committed to providing abortion procedures who ultimately changes her mind offers a unique insight into the difficulty of recruiting a new generation of providers. Simply put, the reality of providing abortions is far more unpleasant than the reality of supporting abortion rights.

Author Patricia Meisol introduces us to medical student Lesley Wojick:

a 24-year-old second-year medical student at the University of Maryland School of Medicine who had helped organize this regional student-hosted, daylong abortion seminar last year. Lesley respected forthrightness and unconventional thinking…

She had joined Medical Students for Choice, an abortion education group with chapters on 135 U.S. campuses, as soon as she arrived at Maryland. The nation’s abortion doctors were graying, and unless a new generation took their place, the right to abortion might be rendered meaningless. Lesley imagined herself being part of that new generation. But would her support for abortion translate into action?

“I won’t know until I’m faced with doing it, but I think I would absolutely be able to provide [abortions],” she said. “It’s walk the walk, instead of talk the talk. I want my actions to be consistent with my words.”

But Wojick finds that the reality of actually performing abortions is different than talking about them. According to the Guttmacher Institute, 1.2 million abortions were performed in 2005, down slightly from previous years. Although medical abortions are now widely available, they are not popular. Many women show up too late in pregnancy to qualify for medical abortions, and even those that are eligible usually choose surgical abortion because it is quicker and less painful.

Abortions rights supporters often portray abortion as a choice of last resort after contraceptive failure, but the reality is very different. Most women who seek abortions were not using birth control. The typical woman seeking an abortion is an unmarried woman in her 20’s who already has one or more children, and did not want another but took no precautions to prevent pregnancy. The grinding reality of abortion is that it is a method of birth control, not a last ditch effort to deal with a contraceptive failure.

The reality of the surgical procedure itself is even more jarring. At first Lesley feels that she can handle it. After watching a second trimester abortion she reports:

“It was definitely gruesome,” she said. “You could make out what a fetus could look like, tiny feet, lungs, but it didn’t look like a person.” She knew this abortion was an act that her friend … considered tantamount to murder. She herself expected to be very upset. She’d felt that way at her first autopsy, that of a teenage boy who’d shot himself in the head. For weeks, she could not shake the image of the boy. But this was different. She didn’t regard the fetus as a person yet. She said she was happy to help the woman: “I feel like I was giving [her] a new lease” on life.

Over time, though, Lesley begins to feel differently:

As for obstetrics … Lesley hadn’t loved very much about it. Even as she’d shadowed the abortion doctor, Lesley knew in her heart that this would not be the right place for her to make a difference. It was a big disappointment, she said. “I really thought I’d love it.”

The things she cared about — taking care of women, seeing them through the process — hadn’t happened. It was the nurse practitioner who cared for the patient. Vacuuming out a uterus and counting the parts of the fetus did not seem like a desirable way to spend her work days. It took a unique person to do that on a daily basis, she said.

The ongoing decline in abortion providers is a serious problem, threatening the access for women to a service that is entirely legal. On the other hand, the reality of abortion itself, used as a method of birth control, not as a last resort, and the unpleasant nature of the procedure, vacuuming out a uterus and counting the parts of the fetus, lead students like Lesley to change their minds. It’s one thing to support abortion rights; it’s entirely different to actually perform abortions.

  • sara

    How about credentialing issues? Plenty of family docs are capable and willing, and have the advantage of being in a mixed primary care setting that makes them less of a target…but just to get the training in residency, enough numbers to manage complications, and then have an employer credential and approve this – that’s the real roadblock. I finished in a residency class in the double digits and we all trained. How many of us are performing abortions now? One, and she does that exclusively.

  • Arianna Stone

    This article is slightly misleading in the way it describes women who seek abortion for their unintended pregnancy. While it’s true that “most” women were not using a contraceptive method, it’s only “most” by a very slim margin. In fact, 52% of these abortions are among women who were not using birth control. It would be much more fair to say “about half” were not using birth control at the time of their unintended pregnancy. The other half (48%) were using contraceptives, either incorrectly, inconsistently, or experienced a contraceptive failure.

    Moreover, these women are not “using abortion as birth control,” that is to say, not really caring if they become pregnant because they will just get an abortion. Anyone can see the flaw in that logic. Abortions are expensive, invasive, painful, inconvenient and oft times inaccessible. Condoms, on the other hand, are cheap or free, easy to use, pain-free, convenient and available everywhere. There is no logical reason to use abortion “as birth control” when actual birth control is so much better at doing that.

    In reality, these women who were not using contraceptives at the time of their conception overwhelmingly report that they felt that they were “low risk” for becoming pregnant. Some felt that they were infertile, others felt that they were protected from a birth control method they had used earlier in the month (which didn’t count because it wasn’t being used at the moment of conception), they experienced social distress from their (usually long term) partner who did not wish to use condoms, and limited access and education about contraceptive methods among other reasons. One of those reasons was “I just didn’t think about it,” admittedly, but it’s not an overwhelming majority.

    So, while what you’ve said is *technically* true (any number over exactly 50% is “most”, those women weren’t on birth control at the moment of conception, some said they just didn’t think about using contraceptives) I do feel it is a misrepresentation of the data (which I took from a 2008 study to be most comparable to the data available at the time you wrote this, http://www.guttmacher.org/pubs/journals/j.socscimed.2013.10.010.pdf).

  • Abortion is really gross, and no baby not a joyful experience like childbirth. It is a really difficult thin to watch.