Tag Archives: abortion

Becoming an Abortion Doctor

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Laurie and Debbie say:

The closing of abortion clinics around the United States is reasonably common knowledge, but neither of us knew how few doctors perform abortions in the U.S., or how a grass-roots organization of women is working to change that. In “The Future Abortionists of America,” published at Medium, Malcolm Harris takes us on a long detailed walk through the current landscape by attending a conference of Medical Students for Choice (MSFC), an organization almost entirely of young progressive women who are circumventing the current medical school norms of barely mentioning, let alone teaching, abortion procedures.

For two decades after Roe, the number of residency programs for obstetricians and gynecologists—the medical specialty where most abortionists train—that included abortion instruction declined steadily, until 1996 when the American Council on Graduate Medical Education (ACGME) began requiring access to abortion-training as part of residency accreditation.

Though the requirement halted the decline, there’s little evidence it has been meaningfully implemented. An ACGME clarification issued in June 2017 stated that, due to moral/religious opt-out provisions, no students necessarily had to receive abortion education in order for programs to be in compliance. In the most recent national survey of medical schools on the topic (2005), only 19 percent reported a single preclinical lecture on abortion, and two-thirds reported no knowledge of any formal abortion education at all in the first two years of instruction. Only 10 percent of third-year OB/GYN clinical rotation programs reported any clinical abortion experience (think, a field trip to Planned Parenthood), in which most students participated.

MSFC is working to change that, from the ground up, knitting the modern knowledge and techniques of abortion into the centuries-old world of women helping women, women transmitting women’s knowledge. Their work is desperately needed: according to Harris, right now about 1700 providers around the U.S. perform somewhere between 650,000 and 750,000 abortions each year, or one per provider per day, every day. Ninety-five percent of these procedures are performed in clinics, such as those run by Planned Parenthood. That shockingly low number is due to a combination of right-wing pressure on the laws, right-wing pressure on the clinics and doctors, and right-wing pressure on the medical schools — a small minority acting like a 1000-pound gorilla, successfully.

So MSFC members have their work cut out for them.

Nationwide, students at over 150 med schools are organized in campus chapters of MSFC, where they support and train each other in an extracurricular fashion, as well as lobby their schools for resources and for abortion to be incorporated into standard syllabi. At the annual conference, organized by the small Philadelphia-based national office, students from around the country meet to steel their collective resolve and to learn.

Harris salts the nuts and bolts information about where they learn and what they learn with who the students are. The article is low on quotations from the students themselves and (tellingly) uses initials for all of them, with a disclaimer at the end saying they didn’t necessarily request anonymity–it was an editorial choice.

Although they were nearly all progressive young women, the attendees had the kind of racial and regional diversity that’s hard to achieve without intention. Unusually for this kind of event, students from elite schools were proportionally represented, which is to say they were nearly absent. Universities are concentrated in East Coast cities, but those students don’t have the most to gain.

The article simultaneously downplays and highlights the dangers of the path these young women are taking.

Emily Young, a doctor from Charlottesville, Virginia, reassured students that as providers, they would not have to live in daily fear; they could be both the doctor on the block and an abortionist. Simply by virtue of being themselves and doing the work, they would be advocates. “Everyone knows I’m the abortion provider in Charlottesville,” she said, “and I like that.”

[Dr. Sarah] Horvath agreed, saying that by doing abortions in addition to a full-range of medical practice she hopes to normalize it. Medical students want to be doctors, and the roomful seemed happy to hear that performing abortions would not automatically forfeit all the benefits and prestige of being a doctor. There was a relieved sigh when the audience heard that psychiatrists are more likely to be murdered in the course of their work than abortionists are.

And yet … the article starts by describing how secretive the conference chooses to be about its meeting. It refers to the high-profile 2009 murder of Dr. George Tiller for performing abortions. It does not say what Lizz Winstead of (soon to be renamed) Lady Parts Justice League says elsewhere, which is that abortion providers almost invariably hear that their neighbors are getting letters saying “A murderer lives on your block.” Eighty percent of Americans may support some sort of legal abortion, but the other 20% are mighty comfortable with threats and intimidation.

Perhaps the most surprising statistic in the article is the extraordinary safety of abortion procedures.

While American maternal mortality has increased alarmingly in recent years (an increase of almost 60% from 1990 to 2015), the number of abortion mortalities is so low that the Centers for Disease Control and Prevention (CDC) calculates using five-year averages. Over the last three years for which there are data (2011–2013), the CDC reported 10 total abortion deaths, and the agency has not recorded a fatality due to an illegal abortion since 2004.

Harris doesn’t say this, but that increase in maternal mortality is very strongly skewed to women of color; somehow, even though women of color are nine times as likely as white non-Hispanic women to have abortions, this seems to be one area where the outcomes are not disproportionately affected by race (or if they are, the risks are still vanishingly small for everyone).

Women helping women, women learning the skills they need to take care of women’s needs, and women organizing to teach each other — this works. And since what we have now is not working at all for women in need of abortions, MSFC is helping move the country in the right direction.

 

 

 

Pat Maginnis: A Hero of Her Time … and Ours

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Laurie and Debbie say:

In 1928, when Pat Maginnis was born, abortion was illegal in all 50 states (and many other countries) but according to Wikipedia, the laws were “unevenly enforced, at best.” According to the marvelous Lili Loofbourow’s profile of Maginnis in Slate, at some unspecified point, Maginnis

got her first abortion in Mexico and swore to herself that she would never again leave her own country to get medical care. She spent the next decade producing a list of legitimate abortion providers outside the country while also working quietly with those within it. Despite her best efforts, she would get pregnant twice more. But she would continue to have a sex life. And the horror of having to wrestle down her own fertility forged her into the formidable antagonist to the law that she became.

In the course of profiling Maginnis, Loofbourow delves into the history of abortion, something both of us know at first hand.

She came of age long before the sexual revolution, which meant she had a particular experience of—and a particular fury about—what women had been routinely expected to tolerate. It’s hard for statistics to express just how urgent the abortion conversation was in the 1960s, or how difficult it was to even have the conversation, given the laws. 

Laurie, who was born in 1942, remembers always having money on hand in the late 1950s for an abortion if needed, even when money was hard to come by, and also always having names of “good” abortionists for people who needed them–in effect, being part of an informal abortion underground. Debbie, who was born in 1951, remembers taking a friend to an illegal abortion in a nearby city in 1969 or 1970 — with meetings on street corners, surreptitious passing of cash, and bloody follow-ups because no abortionist at the time provided anything like aftercare. So we know just how urgent and difficult the conversation was.

In the same climate where we were doing those things, Pat Maginnis was making public statements on the streets of San Francisco,

The entire concept had become untouchable, a boogeyman. “The word abortion was taboo,” she says. “And I thought: That’s crazy. People won’t talk about abortion! They’re afraid to. I’m going to talk about abortion! ABORTION!” she yelled. “Women weren’t talking about it. They were afraid to talk about it.”

Maginnis wasn’t. She relied on logistical help from two women, Lana Phelan and Rowena Gurner, who joined her to form the Society for Humane Abortion’s central trio, which came to be known as the “Army of Three.” Maginnis was the fire, Gurner the strategist and organizational genius, and Phelan the organization’s eloquent mouthpiece. Gurner, like Maginnis, also worked full time, professionalizing the organization in her spare hours. She spent many nights sleeping on SHA’s floor.

Maginnis decided, without the support of her organization, to intentionally flout the law.

“I plan to leaflet for abortion until they get sick of me and arrest me or repeal the law,” Maginnis had announced to the Berkeley Barb when she launched her campaign on June 16, 1966. Her initial plan had been to distribute a thousand leaflets. A week later, when she hadn’t been arrested, she escalated. “My minimum goal is to distribute 50,000 leaflets by July 25, telling women where they can get abortions,” she announced through the press. When she finally was arrested…, she caused the city ordinance under which she was arrested to be ruled unconstitutional. She had no intention of stopping there. “I was arrested under a local ordinance,” she told the [Berkeley] Barb in 1966. “Now it’s the state laws that need changing.” …

As Gurner put it to the Barb: “We just want to get this law on trial. … We obviously and willingly broke the law. And we did it so that no DA could weasel out because of ‘insufficient evidence.’ ” It worked. They were arrested on Feb. 20, 1967, and faced (according to the Barb) a sentence of five to seven years in state prison if found guilty. While their hearing was in progress—in a courthouse in Redwood City—an unrepentant Gurner and Maginnis advertised that they were still looking for a place in Berkeley they could rent on Thursday nights to hold more abortion classes. 

Radical acts take many forms. Maginnis and her companions chose one of the most effective and most memorable is to simply stand up (or sit down, whichever is forbidden) and speak your truth, over and over, until the state is forced to take notice of you. A great majority of important legal changes begin with illegal activism, and a refusal to listen to anyone who tells you to stop.  This is perhaps made most clear when we look at Maginnis’s relationship to Margaret Sanger:

Her admiration of Sanger, though, is genuine. “Sanger took rotten eggs and tomatoes and rotten fruit thrown at her when she went out, and I don’t think people know that today,” she says. She understood that an organization with Planned Parenthood’s institutional heft needed to keep some distance from the SHA; Maginnis’ strategy of flagrantly flouting the law had made her something of a too-hot-to-handle legend.

Loofbourow goes on to describe what the Army of Three and the SHA taught in their classes, how they organized out-of-the-country trips for women needing abortions, the SHA’s response to the vicious (by the standards of that time, mild by the standards of our time) anti-abortion bill signed by Ronald Reagan in 1967, and exactly how Maginnis (and Phelan) induced their own abortions, her reaction to Roe v. Wade, and her sense of current abortion politics.

The first time we met, I asked Maginnis what she thought women should be doing now, as the country seems poised once again to try to control our bodies. “I’ve thought about that,” she said then. “If I was going to reinvolve myself at this point, what would be the entry point? Kind of like setting out a map, looking for an entry.” She doesn’t quite have an answer. Yet. … “Keep talking about the issue,” she says. “Sure, not everyone is a brilliant speaker, but I think people have to keep talking about it.” She looks at me, her eyes bright. “Don’t you?” 

We do.