When I give a presentation about the abortion services we provide in our family medicine clinic, people often ask, “Do you have a counselor to meet with your patients to help them?” I’m a bit put off by this question. I want to say, “It’s my patients with a new diagnosis of diabetes or high blood pressure or cancer who need a counselor – they are the ones having their lives changed forever with a diagnosis and disease that won’t go away, whereas my abortion patients are addressing their issue!” But, of course, I can’t say that. I am perturbed by the implication that women having abortions are somehow being traumatized. To the extent that they are traumatized, it is the fault of our culture that demonizes women for obtaining an abortion. The abortion experience itself can be positive.
Affirmation from physicians, telling women that we understand and support their decision, goes a long way towards destigmatizing abortion. Normalizing it – telling them how common abortion really is – helps. Also, we can encourage women to bring a support person and then make every effort to give respect and praise to that support person, and to the way in which he/she being there strengthens the woman and that relationship.
Last week, for example, I had a 16-year-old couple come in who were really scared, but clearly sure of what they needed. They relaxed quite a bit after we started talking and they realized that I was very willing to help them and that I was not going to shame them or be mean to them. She wanted a medication abortion and I asked her boyfriend if he would be able to be with her the day she had chosen to have the cramping and bleeding, and he said, “of course!” I said how great it was that they had such a strong relationship to help each other through this difficult time and they started holding hands. It was truly a sweet moment. I gave them both my phone number (as we always do) and said to call with any questions/concerns. They left smiling and clearly feeling very relieved. When she came back the next week for her follow up appointment, he came with her and held her hand during her IUD insertion, and we were able to reinforce how wonderful his support was and tie it all to their goals to finish their educations and be responsible about when to be parents.
On the same day, we cared for two mother/daughter pairs. We told the moms how great it was that they were there, that their daughters could come to them, and that they supported their daughters’ goals for finishing high school and getting more education, etc. Again, it made the moms so proud to be acknowledged by the doctors as great mothers. They held their daughters hands for the procedure and it became an important bonding experience.
There are some days in our lives that we remember forever, and the day we had an abortion is often one of them. We can make a huge difference in what kind of a memory is laid down that day. I find that even activists for abortion rights sometimes imply that the most important thing is to lessen the number of abortions. I disagree. The most important thing is to expand access to abortions while decreasing the stigma associated with it. What needs to be decreased is unwanted births: that is the real tragedy! I think there is a huge unmet need out there for abortions and that women (especially teens) sometimes continue their pregnancies rather than go through the “scary and shameful” abortion experience. Although more than 82% of teen pregnancies are unplanned, only 31% end in abortion (Guttmacher). Talk about an unmet need!
We really need to reframe how we talk with patients about abortion. That means telling teens, whether they come for birth control or a URI, that we can help them if they get pregnant by mistake. We can list it like any other part of heath care that we provide: pap smears, prenatal care, IUDs, abortions, immunizations, blah blah. Make it normal! We need to let teens, their moms, and as many of our patients as we can know that abortion is incredibly common and a normal part of life.
While we are at it, we need to let our patients know that we think making decisions to finish high school or college or to find a stable partner or get a good job before having children is a totally rational and healthy approach to life (duh!). It’s amazing how many women have had abortions already and are carrying around a tiny piece of shame that we can lighten for them by just normalizing it all, once they have had us clear the way for them to talk about it. ”Well, I would say that having that abortion when you were 17 was a good thing, because look at what you would not have been able to do for the family you have now.” Or, “It’s enough of a struggle to be working and going to school, you made a good decision back then to postpone having children. You’ll be a great mom when you are ready for it.” Amazing how often tears flow when just a few sentences like this are spoken. We forget how much our patients look up to us (deserved or not), so it’s important to put that power to good use by giving respect to those hard decisions women made. And by the same token, when they do have kids and are in your office for their well child checks, telling the moms what a great job they are doing, how healthy their kids look, thanks to their huge efforts, is also super important. This world that shames women having abortions doesn’t really do much to help mothers when they do have kids, so hearing from their doctors that the tough job they are doing is acknowledged and appreciated and praised is very special and needed.
I’m not saying that there are never women who need counseling after an abortion, and I do refer women to Exhale or Backline from time to time. But I find that 99% of the time, women are relieved and ready to move on with their lives. I think we can help that process enormously by respecting their decisions, celebrating their supportive relationships, and being present with a supportive ear for whatever they need to talk through related to the whole experience.