The Abortion Provider Gets a Makeover

It’s Great For the Cause But How Will It Affect Our Patients?

This weekend, The New York Times Sunday Magazine will feature a story on “The New Abortion Providers,” suggesting a major step forward in abortion rights – new training opportunities that are increasing the number of abortion providers, and moving the practice of abortion out of stand-alone clinics and into traditional medical settings like doctors’ offices and hospitals. While clinics provide low cost services and doctors with experience, they are also targets for demonstrations and violence, and the parallel world of clinics has helped push abortion out of the medical mainstream, increasing stigma, and decreasing access for women in rural and conservative areas.

So this is a win for pro-choice advocates. A very good story – but a good story that encapsulates a cautionary tale. One thing that leaped out at me reading the article was the emphasis on early abortion not just as a public health benefit (which it is, of course) but as a counterbalance to the success of the ongoing way on abortion rights. The author puts it this way:

“It has long been an abortion-rights selling point that almost 90 percent of the abortions in the U.S. are performed before 12 weeks; in addition, four years ago, the proportion of procedures performed before 9 weeks reached 62 percent. The statistic points to a paradox: Anti-abortion advocates succeeded in focusing the country’s attention on graphic descriptions and bans of late-term abortion even as more and more women were ending their pregnancies earlier and earlier.”

In the article, one of the two doctors profiled at length will not perform abortions after nine weeks gestation in consideration of the feelings of her staff. She mentions elsewhere that her own comfort level is 14 weeks – beyond that she would not feel medically or personally prepared to proceed. Training programs are described as taking similar measures to restrict the gestational age in order to make abortions more acceptable to their students.

Abortions aren’t a happy topic. Early is better than late – and not just for PR reasons. Medically, psychologically and (I am going to go ahead and say the word) morally, every day of gestation that passes makes abortion more of a challenge. Pro-choice activists who deny the essential logic of this argument by relying on the Roe framework of viability or the simple logic of it-isn’t-a-person-before-birth risk making themselves irrelevant to the discussion, because anyone looking with their eyes and their heart open can see the difference between an eight-week fetus and an eighteen-week fetus – those on both sides who deny this are willfully ignoring what a child would know.

However, early abortion won’t cover women who terminate for cause as we all know. The catch-22 of late abortion is that while it is the least defensible, it affects disproportionately more of those we would like to defend – not just our patients, but other vulnerable individuals such as the newly diagnosed cancer patient, the very young, the developmentally delayed and the mentally ill. If it weren’t for them would it be so hard to draw a line in the sand earlier on?

So as a genetic counselor, I was slightly concerned to find that these complexities were nowhere reflected in this generally well-written and positive article. I almost felt like the author was offering this as the new face of abortion: younger, less ideological, mainstream literally and figuratively, sanitized. It’s a very attractive proposition, but I wonder if it will then fall to people like us to champion the difficult cases, and the grizzled or fervent individuals willing to take them on.