Lederer, 30, can’t relate to the images that drew an older generation of physicians into abortion work. She can barely picture it when they talk about life before legal abortion: the blood-spattered apartments, the women racked with infection from stabbing sticks into their wombs.
But she and other young doctors-in-training have found their own motivation to enter a field that they know will put them at risk of isolation, harassment and hatred. For them, doing abortions is an act of defiance — a way of pushing back against mounting restrictions on a right they’ve taken for granted all their lives.
It’s also out of sheer necessity. Abortion may still be legal, but it’s inacessible for many women all across the country. Almost 90 percent of U.S. counties lack an abortion provider. Several states only have one clinic. Women have to travel hundreds of miles to obtain abortions. Doctors are required to read blatantly untrue statements to women seeking abortions. The cost of abortion is not covered by federal health care funding, and few states cover it.
I’ve written before about my work for Haven, a pro-choice group in New York City that provides housing for low-income women travelling to New York for abortions. These women come from all over the East coast. They come to New York because this state offers abortion through the second trimester — something that is highly limited in many other states. The women who come to New York and use Haven’s services are terminating for a variety of reasons, but without exception they are poor. They are usually women of color. They usually could not get an abortion in their home state because of all the regulations. They often have children. Listening to them has been incredibly influential in shaping my views of later-term abortion. I don’t usually ask them questions about their medical decisions because it’s not any of my damn business, but ocassionally they offer pieces of their stories. Often, it seems like they’re trying to justify their actions to me — like women all over the world, they’ve been told that they have to apologize or defend their basic exercise of bodily autonomy, even to a person who they know is pro-choice. They’ve been told that they are lazy, stupid, selfish, and they want to explain why that isn’t true.
It’s never true. There are always circumstances, individual stories. Often, they’re getting later abortions because it took that long to get everything together. To save enough money to pay for the procedure — which gets more expensive as the pregnancy progresses. To sell whatever you can and to beg your family and friends for money. To apply for federal aid to help pay for it. To be turned down for that aid. To ask for money again. To watch the days tick by and the price go up. To request more hours at work. To get the time off of work. To find a baby-sitter for her children. To figure out transportation. To ask someone to drive her, since she knows the clinic will likely not let her drive home alone after surgery. To find a bus or a train. To drive to the clinic in her state, which may be hours away. To be turned away and told that state law requires she come back in two days. To not be able to take work off again. To not be able to get a baby-sitter again. To watch more days tick by. To be told it’s too late. To go through the whole process all over again — but this time to plan on going to New York.
The “right to choose” is already a right that too many women are lacking.
I can’t really blame doctors for choosing to become anything other than abortion providers. The pay isn’t good, especially compared to almost any other field of medicine. You’re an ideological lightening rod. And your life is in danger, as anti-choice terrorists regularly bomb or set fire to abortion clinics, send anthrax (or what they say is anthrax) to doctors, physically assault clinic workers, and list the home addresses of abortion providers so that their followers can harass and even try to kill them.
Not surprisingly, there’s been a steep decline of abortion providers since the period immediately following Roe. Young doctors and med students didn’t live through the bad old days when women came into ERs with perforated uteruses, hemorraging, or dying of septic infection from illegal abortions. But young doctors and med students did grow up witnessing the harassment, assaults and murders of abortion providers.
So I have a lot of respect for the women who are taking steps to become providers:
Listening to news of the Supreme Court’s ruling, third-year medical student Lysie Cirona, 24, found herself shouting at her radio in frustration. Then she took a hard look at her career plans. She had always been interested in psychiatry, but now she envisioned herself flying to North Dakota or Nebraska a few times a month to perform abortions.
“It wasn’t on my radar screen” a year ago, Cirona said, but her priorities have changed as she’s learned more about the history and current state of abortion rights. Cirona has taken to badgering her professors to include information about abortion in their lectures. She attended workshops on how to respond effectively to antiabortion protesters.
Some days, she still wants to be a psychiatrist. Other days, she thinks of the women who drive 10 hours to reach the nearest abortion clinic. “This is what I’m going to do,” she tells herself.
Her roommate at the University of Colorado, Michelle Cleeves, is also drawn to abortion work; simply voting for liberal politicians, she said, no longer seems like an adequate response to the abortion wars.
“It doesn’t matter what you believe if you don’t back it up with action,” said Cleeves, 24. “The right to abortion doesn’t mean anything if women don’t have access.”
But the dangers and intimidations are so deepl that even veteran abortion providers are reluctant to encourage younger doctors to enter their field:
That upbeat message was a marked contrast from the lecture Lederer and her friends heard last fall at the University of Colorado’s medical school in downtown Denver. Medical Students for Choice had invited Dr. Warren Hern, a legend in the abortion rights movement, to give them encouragement. He offered none.
None of you will be an abortion provider, he told the students. You don’t have it in you.
“Do something else. Fix broken legs,” he often advises. “No reasonable person would do this.”
Hern, 68, practices in Boulder, Colo., a liberal college town. Still, he’s afraid to open his blinds at night for fear of a sniper hidden in the bushes. His clinic is protected by a fence and four layers of bulletproof glass.
Abortion is so stigmatized, Hern said, that his fellow physicians shun him. Even his patients often regard him with disgust: “They’ve absorbed so much antiabortion rhetoric, they feel a sense of revulsion that they have to come into my office and seek treatment.”
There is a lot of danger, a lot of stigma, and not a whole lot of thanks. But there are still women willing to rise to the challenge:
She also knows that the few doctors who perform late second- and third-trimester abortions are mostly in their 60s or 70s. “Who’s going to do this when they leave? Someone has to,” Lederer said. “I feel in my heart of hearts that it’s the right thing to do.”
It is. And I’m incredibly grateful for people like her.
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