Tuesday, June 16, 2009

Things That Piss Me Right the Fuck Off

I realize I rant about the western medical industry a lot - about how it's profit-driven and averse to evidence-based practice, about its profound and subtle patriarchal values and views, etc. But since the assassination of Dr. Tiller I've been slowly cooking up a new beef with western medicine.

It seems to me that much of the stigma and violence surrounding abortion would be impossible if abortion was simply integrated into normal medical practice. Any ob-gyn can perform an abortion. In fact, in the case of medical abortions (the pill), all it takes is a nurse practitioner, or anyone who's qualified to administer a pregnancy test and write a prescription. And if you don't believe that OBs perform the exact same procedures as surgical abortions all the time, ask most women who have had a miscarriage - it's common for a procedure very similar to the most common methods of surgical abortion to be performed on women who have miscarried but whose uterus doesn't seem to have discharged all the tissue. So it's not as if performing abortions is some mysterious thing that requires a whole other set of skills. Of course, some medical professionals may not feel comfortable providing abortion services, but for the majority of medical professionals, this doesn't seem to be the case, as is evidenced by the plethora of tests they push on you during pregnancy, which often result in a recommendation to abort if the results are positive.

By refusing to perform abortions in OB clinics and hospitals, the practice of abortion becomes segregated and ghettoized to clinics that are highly visible and easy targets. The patients who visit these clinics are much more likely to be seeking an abortion, so they're vulnerable to the hateful harassment of anti-choice protesters. And the medical professionals who work there are vulnerable to violence. Much of this would be resolved if abortion services were seamlessly integrated into other women's health services at clinics and hospitals. Nobody would know who to harass or target with violence if the same clinic served women who were carrying pregnancies to term and those who were just there for a pap smear and those who were there for a new BC prescription or IUD and those who had chosen to terminate a pregnancy... So maybe some doctors and nurses would opt out of providing abortion services, but most clinics have more than one doctor and more than one nurse, so this should be a relatively minor issue.

A few months ago I had an unplanned pregnancy at a very inconvenient time. Although we're technically open to the idea of having another baby (sort of), we simply couldn't handle it (in a number of ways) at the time. I was irritated with myself for allowing it to happen, and a little sad that the timing was so bad. After gliding through my twenties and early thirties with nary a single birth control slip-up, I find myself experiencing two unplanned pregnancies in my mid-thirties. Whatever happened to the biological clock and the it's-so-darn-hard-to-conceive-after-the-age-of-35 shtick so often used to scare women into early marriage and motherhood?

As I investigated my options (it was very early, so a medical abortion was an option for me), I discovered that in my state, there were none. And for no apparent reason. Abortion is not illegal here, but there are no providers. And there are no women's clinics here that will even prescribe the pills for a medical abortion, which requires no work on the part of the physician to bring about the abortion. And nobody seems to have a good explanation for this. Nobody knows why there's no access to abortion here, there just isn't. And if you ask your primary provider if they couldn't just prescribe the pills for you, you are met with a polite but conversation-stopping offer to write a referral to the Planned Parenthood clinic in a neighboring state for you.

So this wasn't a big problem for me - I'm privileged with a car and money for gas and the $400 cash upfront. But what happens to all the women who don't have access to transportation, or can't take the time off work to drive to a clinic in another state twice in a two-week period, and can't find child care for the kids they may already have (no kids allowed at the clinic), etc. etc.? If they could just go to their local women's health clinic and access abortion services from the same provider who is more than happy to take their money and give them pregnancy or preventative care, so many steps and so much stress and trouble would be cut out of the process.

And this is another case where I really feel that if this was a health issue that impacted men, these services would be locally and easily available, in a much less visible and stigmatized way. But once again women's health in general, and abortion services in particular, are ghettoized and undervalued. And this enables the hatred and violence that surrounds abortion in our country. By separating out and clearly marking abortion from other women's health services, we create an environment that enables the hatred and violence to continue. But why isn't anyone talking about this factor? And why aren't we exploring this option for reducing the hatred and violence?


  1. Anonymous6/16/2009

    I think you're right that integrating abortion services would help to destigmatize them. I wonder if there are any legal guidelines or restrictions that prevent this.

  2. This may be the best post title I've read all week.

  3. Anonymous6/16/2009

    I always assumed there must be legal restrictions to prevent abortions from being performed in regular clinics. Maybe it's a liability issue or an insurance coverage issue?