Choices


This post was reprinted with my permission at Salon.com on January 21, 2011. I was not compensated for that reprint.

Warning: If you oppose legal abortion, please be aware that I do not share your position on this matter. However, please also be aware that I am using this post to illuminate common ground between the two poles of the abortion debate and I am attempting to be respectful of all points of view in the process. Thoughtful debate is welcomed. Comments that insult me for my opinions will be quietly deleted.

I was prepared to write about reproductive choices in light of the Roe v. Wade anniversary on January 22. Fully prepared. I even had some funny stuff lined up about the groups that come to my town every year to hold a march in opposition to the 1973 Supreme Court decision. While I applaud anyone who is committed enough to march in the freezing cold, I must ask that you NOT clog both sides of the double doors in Union Station so that this mother can get out of the train station to get to daycare to pick up her child. And it’s not like everyone has never seen double doors before. I know you have. You wouldn’t block both sides of the door at Target, right? That’s what I thought.

But I can’t write that kind of post because there was a news story about an abortion provider that was so horrific that even I cannot find a positive to his decades long practice. In summary, a doctor who was not an OB/GYN ran a clinic in Philadelphia that apparently is the last refuge for poor women who wish to end their pregnancies. The news reports indicate that it is unsanitary, staffed by untrained people –  including a teen-ager administering anesthesia – procedures violate medical best practices, staff committed malpractice by lying about stage of pregnancy of patients, viable babies were born alive and killed, and women died of complications. This is a nightmare. Nothing redeems this. Nothing.

I can’t stop thinking about how desperate and scared women must have been to be willing to go to such a place. I can’t stop thinking about how badly they were injured because they were so desperate that they had to seek the option of last resort. I can’t stop thinking about all the crossroads in the months and years that led up to these moments of crisis where these women could have been better served by their communities, by the medical system, by society at large. This didn’t have to happen.

There are those who oppose legal abortion who will likely hold this up as an example of the horrors of a society that allows abortion. I, respectfully and thoughtfully, beg to differ.

First, please know that I understand the idea that abortion ends a life. If you believe that, then I see how no argument will make you feel that there is any moral allowance for abortion. I understand. I disagree, but I understand. I believe that, up to a point, a pregnancy is not a life but the potential for life and that ending that potential is tragic, and a choice I wish no woman ever had to make, but I do not see it as murder. I also believe unshakably that reproductive choice does not begin or end with the abortion debate and we need to deal with the entire spectrum of reproductive health issues in order to prevent scenarios like the one in Philadelphia. The less available other reproductive choices are, the more likely women are to become desperate and the people who prey on their desperation are to run operations that are essentially black-market abortion factories.

We need to start with sex. People have sex. You may wish they wouldn’t and many preach that, without benefit of marriage, people shouldn’t, but people have sex. To give this some perspective, we should understand that the average age of completion of puberty in US youth is 15-17 but the average age of marriage in the US is 25-27. Asking people to be fully sexually mature but not act on that basic urge for a decade or more is a little bit like asking someone to hold in a fart for 10 years. It’s not realistic for the majority of the population. People have sex, they have always had sex, they will always have sex. Societies over the course of human history have tried to put all kinds of different regulations and rules on sex but in the end, pretty much everybody does it. And you do not have the right to impose your personal sexual morals on anyone else. You don’t. It’s rude. So please don’t try.

Since people have sex, we need provide an infrastructure for people to access sexual and reproductive health care. I’ve said for years that if I were reforming the US medical system, one of my top priorities would be to give all women a free visit with a reproductive health care practitioner once a year. The visit would be long enough to encompass a standard gynecological exam as well as a conversation about their sexuality, their contraception needs, preconception counseling, or support for decisions not to have sex. And of course pre-natal care would be paramount for pregnant women. If every woman was getting good reproductive health care and good information…well, I don’t know what the true outcome would be because I’m not a medical researcher or statistician but maybe it would prevent some crisis pregnancies.

You see, we have the technology to make unintended pregnancy incredibly rare. The many types of contraception are, relatively speaking, inexpensive and safe. The hormonal methods available to women are effective and safe. Condoms provide an added layer (pun intended) of protection from pregnancy and disease. Preventing disease protects long-term reproductive health and makes pregnancies safer and easier to achieve. Giving people access to good health care and good contraception is a major public good and I don’t understand why we don’t embrace that policy.

You see, if women can get good care, preventative care, they won’t have to seek crisis care. Right now the waters about sex, sexual health, contraception, pregnancy, and abortion are so muddied with dogma and misinformation that it’s a wonder anyone learns facts anymore. Telling young women that having sex makes them “bad” is a good way to totally undermine their self-esteem if they do have sex and lead them to make poor choices about it. Saying “condoms don’t work” to try and promote abstinence among young people just makes them skip condoms. Waving a picture of a fetus at a woman entering a Planned Parenthood clinic doesn’t make her any more prepared to have a baby she didn’t intend to have – or it might frighten her off if she’s seeking contraception or general health screenings. Putting up barriers to information, to contraception, to reproductive health care, leads women to have sex without protection because they don’t know it exists and don’t think it works or just plain can’t get to it. Whether those barriers be the shocking lack of access to care poor women face because of financial constraints or barriers established by those who think they have the right to police morality, the result is the same: crisis pregnancies.

And a woman who is determined to end a crisis pregnancy will. It’s been true since the dawn of awareness of pregnancy. When there are safe, legal, accessible means to achieve abortion, women will use them. When there are not such means, women die in clinics like the one in Philadelphia.

We can do better by women in America. We can take reproductive health care seriously and make it a policy priority. We can ensure good sexual health information is taught by allowing those in medical fields to write health curriculum rather than allowing arbiters of morality to inject opinion into the dialogue. (Morality and opinion are for parents to teach, the facts of biology are appropriate for schools to offer in my not-so-humble opinion.) We should make gynecologic care accessible even to the poorest of women and we should make the care inclusive of more than just a quick pap smear and a prescription for the Pill or a handful of condoms with no further discussion of a woman’s sexual health status. We should encourage women to choose knowledge and good health practices, we should teach women how to be guardians of their reproductive health. We should encourage good choices all along the spectrum of sexuality and reproduction so that fewer and fewer women need to seek the hard choices that come when a pregnancy is unintended and unwanted.

We should look at the story in Philadelphia and say “It doesn’t have to be like this. We can make it better. How can all of us, on all sides of the debates about sexuality and reproductive choices work together to make it better?”

I think we can work together to make it better. Do you?

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35 comments for “Choices

  1. January 20, 2011 at 11:10 pm

    I’m so so so thankful people like you can beautifully articulate things that happen. While I shed many tears over that news story all I could think about is how people went there because they were desperate and that shouldn’t happen.

    It’s so tragic and these are things we as a society need to address and talk about. And i do think we can make it MUCH better. So thank you.

  2. January 20, 2011 at 11:30 pm

    I’m new to your blogs and I saw you tweet if you should hit publish….well I’m glad you did. I love this post and appreciate all the areas you covered. This is and I think always will be a touchy subject. I personally don’t believe in abortion for myself and believe life starts right away HOWEVER…I do respect and feel all woman have a right to end a pregnancy WITHOUT badgering and belittlement. I also feel abortions should not be out of reach for any1 who can’t afford one and make them feel they must go to a shaddy unsafe makeshift clinic. My heart goes out to those woman.

  3. January 20, 2011 at 11:30 pm

    I agree with you so much. We have and continue to fail the women (and children) of this country. We fail to provide effective education on sex. We continue to breed the fear, guilt, and hysteria surrounding abortion without stepping back to see the entire problem and the ENTIRE solution.

    The tragedies that occured in Philly are sickening. And one of many examples throughout our society. These women (and girls) were obviously scared, and had NOWHERE ELSE TO GO. I feel like we have failed them, and forced this to be their only way out.

    Thank you for being able to see things from more than one perspective and for being unafraid to share your view.

  4. January 20, 2011 at 11:44 pm

    Speak it, sister! Access to reproductive health care is absolutely basic.

    And I was about to go on, but what can I do but say what you’ve already said so beautifully?

    Thank you for this.

  5. January 21, 2011 at 12:04 am

    I don’t know what to say other than…

    I believe the truth of every word you’ve said the way I believe that the world is round.

    Believe it in the “I KNOW this is how the universe works” way.

    The way I know we need to breath.

    You said it perfectly. And I hope your thoughtful and utterly true words reach some people who can hear you.

    I hope it desperately.

  6. January 21, 2011 at 12:22 am

    What a tough topic to write about…you are brave to take it on. I hope that people are honorable in their responses to it. I happen to agree with you and love the angle that you have taken. You are so right about there needing to be better reproductive health options.

    Side note- I wish your link to the news story came with a warning. I had to stop reading. OMG, so horrific.

  7. Joslyn
    January 21, 2011 at 10:34 am

    This is brilliant, thoughtful writing, and your talent deserves a wider audience.

  8. Amy
    January 21, 2011 at 10:41 am

    This would have been exactly what I would have wanted to write iff it was me writing. Extremely well done and succinct.

    Also worthy of note that you took care of important business first by reminding people not to block both sides of the double door. 🙂

  9. January 21, 2011 at 10:58 am

    Beautifully said.

  10. wendy
    January 21, 2011 at 11:13 am

    Beautifully said. There are so many people who need to read this.

  11. January 21, 2011 at 11:16 am

    This country seems to forget that abortion used to be illegal here for a short period of time. During that time, women still had abortions at places just like what was discussed in the article she linked to. A lot of times there were complications, mother and fetus would be killed, lose/lose situation for everyone.

    Me, personally? I believe that women should have choices, even though I’m personally against abortion except in certain circumstances (rape, incest, medical reasons, etc). But I would find it difficult, if not impossible, to legislate those exceptions into law correctly. So you have to defer to the mother and her decision if she feels she wants/can carry the child to term.

    What we should focus on is teaching and promoting the use of birth control and safe sex. Yes, I can only think of a handful of people that actually proclaim of abstaining until their wedding before having sex. Most people don’t give it a thought, now a’days, to have sex out of wedlock. So, to bury our heads into the sand and think that people will wait until their married is idiot.

    Love your post and viewpoint on the world, as usual, love.

  12. January 21, 2011 at 11:17 am

    And I totally wrote a novel. Sorry 🙂

  13. January 21, 2011 at 11:30 am

    Concurred. I debated on writing about this exact story and shied away to keep from getting worked up so thanks for taking the time to express your opinions on the matter.

    I deleted a few people on my personal FB page due to their one-sided, ignorant comments that stated the women deserved what they got and that they should be delivered the same justice as the monster Doctor. While I personally don’t agree with abortion for MY body only, I am also pro-choice and believe that NO ONE should be judged on decisions made regarding their life and the life that they might be creating. Who in the HELL do they think they are to assume they know what those poor women have been through, were thinking or had been told. Who knows what situations led them to that decision and it is not for others to deem acceptable or not.

    Thanks again for posting this!!

    xo
    Jolie

  14. Laura
    January 21, 2011 at 11:37 am

    Perfectly said, on all aspects. A must read for everyone, regardless of pro choice/pro life or where they are politically. Thank you SO much!

  15. Lisa
    January 21, 2011 at 12:21 pm

    All I have to say is “Amen”. You stated perfectly how I feel about this…

  16. January 21, 2011 at 12:55 pm

    This is a wonderful post. You wrote so thoughtfully and respectfully about this difficult subject. I have a 5-year-old daughter and found myself thinking about her and the conversations I will need to have with her. Conversations my mom didn’t have with me (her generation just didn’t talk about those things). Fortunately, I was naive for a long time and was smart about things.

    I hope your post sparks some good, important discussion!

  17. Shannon
    January 21, 2011 at 1:46 pm

    You are a voice of reason, as usual. I applaud your words, and hope they someday help change our world for the better.

  18. January 21, 2011 at 2:46 pm

    **Standing Ovation**

  19. Ashley
    January 21, 2011 at 2:47 pm

    What a well-written, soundly reasoned, and above all, compassionate post. Thank you.

  20. January 21, 2011 at 4:12 pm

    Thank you for your thoughtful post. I cannot help but wonder that one of the reasons that so many late term abortions were done by this “doctor” (butcher is a better word) was because of the costs to the women who could not afford it. They must have had a very difficult time coming up with $3000 or more and as a consequence considerable time past.
    What a tragedy for us all.

  21. Sam
    January 21, 2011 at 4:34 pm

    I discovered this through Salon and I had to pop over here in order to see more about who had written it and, even more importantly, to Thank You directly for doing so.
    I have also discovered links in your version that lead to news stories about this which are not included, for some reason, in the Salon version.
    Pragmatic reality, full of compassion and understanding -and forgiveness, if required- is often lost amongst the finger pointing and accusations of those whose personal beliefs differ, often extremely, about this.
    But the fact remains, as you have so skillfully articulated, that at the center of every decision to end a crisis pregnancy, there is a woman who requires as safe and as reliable and as competent a provider of such services as anyone else would require to resolve their own medical crises of any other kind. And when, for whatever political or social or religious or other reasons, safe and reliable and competent choices are condemned and demonized and castigated -or are legislated into hidden corners underneath mounds of regulation and judicial permission-seeking obstacles- what happened in Philadelphia is, sadly for us all and horrible for those involved, not an unexpected result.
    I look forward to the day when an abortion might be as rare and as unusual as a heart transplant. But, until matters of sexual and reproductive health can be as routine and as ubiquitous and as ongoing as needed for that result to occur, what you have written is as close to a guidebook and map for getting there as anything I have read.
    Once again: Thank You.

  22. LCW
    January 21, 2011 at 4:36 pm

    I think you said it best when you said, we need more education and reproductive health care afforded to women. Period. Very well stated, while may views may differ slightly, I cannot argue with your bottom line.

  23. January 21, 2011 at 5:40 pm

    oh lady… oh oh lady… you have me weeping with gratitude for your words.

    bravo!

  24. January 21, 2011 at 6:09 pm

    A brave and thoughtful post. Jezebel has a similar take: http://jezebel.com/5739884/

    I also immediately thought of this recent Slate story on women wanting to end their pregnancies who resort to “do-it-yourself” methods: http://www.slate.com/id/2281280/

    Whether at home or an inadequately and inappropriately staffed clinic, this is not the way to manage reproductive health.

    (And as a Bitter Infertile (TM), I’m also struck by the sad irony of women so desperate not to be pregnant while there are thousands of women so desperate to be in their shoes. Is there a solution in there somewhere?)

  25. Amy
    January 21, 2011 at 7:00 pm

    THANK YOU!
    I want to meet you someday..in person to hug you.

  26. January 21, 2011 at 8:08 pm

    You did a wonderful job. I only have one thing to say: I thought you were sending links to something that happened in the early 1970s, preabortion. It sickens me that it was just happening!

    Thank you.

    xo Susie

  27. boballab
    January 22, 2011 at 1:50 am

    I read your post with great interest and noticed something: Not once did you state that you read the actual Grand Jury Report which is online.(http://www.phila.gov/districtattorney/PDFs/GrandJuryWomensMedical.pdf)

    The reason I bring that up is because the majority of what you posted has nothing to do with this case. This man did what he did for one reason and one reason alone: To make lots of money. He was not in anyway trying to help the “poor” or “disadvantaged”.

    “Section III: Gosnell’s Illegal Practice

    Gosnell’s “medical practice” was not set up to treat or help patients. His aim was not to give women control over their bodies and their lives. He was not serving his community. Gosnell ran a criminal enterprise, motivated by greed.

    Some 40,000 abortions are performed across the Commonwealth each year. Abortion is normally one of the simplest and safest medical procedures. But not in Gosnell’s clinic. Employing unlicensed, untrained workers in a facility that was grossly inadequate and unsanitary, his operation made a pretext of providing health care. In the absence of any regulatory oversight, Gosnell recklessly cut corners, allowed patients to choose their medication based on ability to pay, and provided abysmal care – all to maximize his profit.

    We estimate that Gosnell took in as much as $10,000 to $15,000 a night, mostly in cash, for a few hours of work performing abortions. And this amount does not include the money he made as one of the top Oxycontin prescribers in the state. The Women’s Medical Society stands as a monument to an absolute disdain for the health and safety of women, and in many cases of babies who were born alive in this filthy clinic.”
    from page 23 of the Report

    “Even using conservative estimates, the amount of money that Gosnell took in every procedure night is staggering. If he did 20 first-trimester abortions at $330 a piece, and five 19- to 20-week abortions at $950, he would take in $11,350 a night. Similarly, in
    the later years, if he performed 10 first-trimester and 5 late-second-trimester (23 to 24 weeks) abortions a night, Gosnell would still take in $11,425. And that does not include any of the illegal abortions past 24 weeks for which he charged much more, or the profits he made by selling additional anesthesia a la carte to first-trimester patients.

    This amounts to nearly $1.8 million a year – almost all of it in cash – assuming just three procedure nights a week. (Testimony indicated that he performed abortions from about 8:00 p.m. to 1:00 a.m., three nights a week – for a total of 15 hours.) In light of the testimony we heard that Gosnell performed the really late third-trimester abortions on Sundays, his take was likely much higher. And none of this includes his income from writing prescriptions – according to one law enforcement agent, Gosnell was one of the
    top three Oxycontin prescribers in the state of Pennsylvania.”
    from page 88 of the Report

    And the reason he got away with it? Well it is stated right in the report:

    “Most importantly, the abortion regulations include no requirement for DOH ever to inspect or monitor abortion providers. The Grand Jury was astonished to discover that abortion clinics in Pennsylvania, unlike any other health care facility, are apparently
    supposed to operate on the honor system.

    Many abortion clinics deliver quality care because that is their mission. But what if a particular doctor’s mission is to maximize profits by cutting corners? He may hire unqualified staff, reuse instruments, administer expired drugs, tolerate unsanitary facilities, and use obsolete and broken equipment – until one or more of his patients dies. Then, after law enforcement gets involved, DOH might take action.

    This is what happened in Gosnell’s case. It is not a workable system for regulating health care facilities that perform one of the most common surgical procedures, or for assuring safe medical care for the women of Pennsylvania.”
    from page 167 of the report.

    As shown there is no regulations blocking any type of abortion clinic, be it well run or hack jobs like Gosnell. Why? Because there is no requirement for the state to inspect or monitor them in Pennsylvania. However that wasn’t always the case as also shown in the report. No you must ask why the state’s Department of Health (DOH) stopped inspecting clinics like Gosnell (Even though the report shows those inspections were farcial at best). The reson being: Politics. No not from Pro Life advocates but from Pro Choice Advocates.

    “Under Governor Robert Casey, she said, the department inspected abortion facilities annually. Yet, when Governor Tom Ridge came in, the attorneys interpreted the same regulations that had permitted annual inspections for years to no longer authorize those inspections. Then, only complaintdriven inspections supposedly were authorized. Staloski said that DOH’s policy during Governor Ridge’s administration was motivated by a desire not to be “putting a barrier up to women” seeking abortions.”
    from page 147 of the Report.

    For those that don’t know Gov Casey was a Pro-Life Dem and Gov Ridge a Pro-Rep. Strange to most but true and can be verified here:
    http://en.wikipedia.org/wiki/Tom_Ridge
    http://en.wikipedia.org/wiki/Robert_P._Casey

    So how high did the pressure come from to not inspect abortion clinics?

    “Brody confirmed some of what Staloski told the Grand Jury. He described a meeting of high-level government officials in 1999 at which a decision was made not to accept a recommendation to reinstitute regular inspections of abortion clinics. The reasoning, as Brody recalled, was: “there was a concern that if they did routine
    inspections, that they may find a lot of these facilities didn’t meet [the standards for getting patients out by stretcher or wheelchair in an emergency], and then there would be less abortion facilities, less access to women to have an abortion.” ”
    from page 147 of the Report.

    As shown the Pro Choice Governors administration was afraid that if the Department of Health inspected these clinics they would have to close some of them down, thus reducing access. They decided to turn a blind eye. This continued under the next Governors administration of Ed Rendell, also shown in the report.

    As can be seen the reason for this horror wasn’t lack of access, it was lack of regulation and proper oversight. The cost in human life? Lets run the numbers from the report. Doctor Gosnell started in 1979 and the he did:

    “By these estimates, Gosnell performed at least four or five illegal abortions every week.”
    from page 79 of the Report.

    So take 5 per week, multiply by 52 weeks in a year = 260 babies murdered each year, multiply that by 30 years = 7,800 murdered babies.

    Gosnell makes Dahlmer, Bundy and Gacy look like chumps and the most chilling thing is, is that the later 3 did what they did because they are sociopaths. Gosnell was just greedy.

    My recommendation to anyone that wants to try and comment on this case (Either for or against Abortion), should read the full report and not just news blurbs and sound bites. This isn’t about access to care, this isn’t about sex ed or contraceptives. This case is about a Greedy callous man, that hired people that became just as greedy and callous as he was. This case is about state agencies having political pressure on them by Pro-Choice politicians not to rock their political boat by doing their job and possibly shutting down an abortion clinic. The Grand Jury report says it best:

    “See no evil

    Pennsylvania is not a third-world country. There were several oversight agencies that stumbled upon and should have shut down Kermit Gosnell long ago. But none of them did, not even after Karnamaya Mongar’s death. In the end, Gosnell was only caught by accident, when police raided his offices to seize evidence of his illegal prescription selling. Once law enforcement agents went in, they couldn’t help noticing the disgusting conditions, the dazed patients, the discarded fetuses. That is why the complete regulatory collapse that occurred here is so inexcusable. It should have taken only one look.”
    from page 8 of the Report.

    “We discovered that Pennsylvania’s Department of Health has deliberately chosen not to enforce laws that should afford patients at abortion clinics the same safeguards and assurances of quality health care as patients of other medical service providers. Even nail
    salons in Pennsylvania are monitored more closely for client safety.

    The State Legislature has charged the Department of Health (DOH) with responsibility for writing and enforcing regulations to protect health and safety in abortion clinics as well as in hospitals and other health care facilities. Yet a significant difference exists between how DOH monitors abortion clinics and how it monitors facilities where other medical procedures are performed.

    Indeed, the department has shown an utter disregard both for the safety of women who seek treatment at abortion clinics and for the health of fetuses after they have become viable. State health officials have also shown a disregard for the laws the department is supposed to enforce. Most appalling of all, the Department of Health’s neglect of abortion patients’ safety and of Pennsylvania laws is clearly not inadvertent: It is by design.
    from pages 137 and 138 of the Report (Note: in the report the words It is by design is emphasized by having it in italics)

    Warning: If you do read the report I recommend you do not do so after eating nor just before going to bed. The Report is that horrifying, not just in the photographs of the murdered babies but in the descriptions themselves and the testimony given. Example is this testimony by a staffer about how another staffer murdered a baby:

    “Cross saw Williams slit the neck of a baby (“Baby C”) who had been moving and breathing for approximately twenty minutes.
    Gosnell had delivered the baby and put it on a counter while he suctioned the placenta from the mother. Williams called Cross over to look at the baby because it was breathing and moving its arms when Williams pulled on them. After playing with the baby, Williams slit its neck.

    When asked why Williams had killed the baby, Cross answered:

    Because the baby, I guess, because the baby was moving and breathing. And she see Dr. Gosnell do it so many times, I guess she felt, you know, she can do it. It’s okay.”
    from page 104 of the Report.

  28. Anonymous
    January 22, 2011 at 3:23 pm

    I agree with you, but I didn’t always. I had a pregnancy scare in college and don’t know what I would have done if I had actually been carrying a baby. I said abortion was wrong.

    And then I got pregnant for the first time last year. I was SO excited; I’d wanted a baby for a long time. My husband and i were looking forward to changing diapers, guiding our baby through her first steps, helping with homework, planning her wedding …

    … and then we got TERRIBLE news. Our child had an extremely rare genetic disorder, mosaic trisomy 6. What does this mean? Unfortunately, nobody really knows. Half of children with this disorder are FINE — about four kids in the world. The other half — again, four children — are *not* fine. They have misshapen limbs. They’re blind and deaf. They have heart problems. They are mentally retarded.

    Our daughter, unfortunately, would’ve been in the second group. She had a heart defect and extremely short femurs. Her nuchal cord was very large.

    It was difficult to decide to terminate the pregnancy, but I did. At 23 weeks I had a D&E (because of other medical problems which meant that being induced was dangerous for me). I begged the doctor to please get our baby out in one piece; I desperately wanted to hold her.

    And she did. That half hour I spent with my daughter was both the best and the worst thirty minutes of my life.

    I was torn about whether I’d done the right thing or not until somebody at a Compassionate Friends meeting said this to me: “My son was four when I decided to shut down life support. People have said that they disagree with my decision, which both upsets me and baffles me. He’d suffered enough. You made the same decision for your Annie — BEFORE she could feel pain.”

    I’m grateful for the doctors that gave me the option to end my pregnancy. I’m resentful that politicians feel the need to try to stop it.

    P.S. I’m expecting in April! This time, a very healthy baby.

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