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Universal Truths

It doesn’t matter which side of the abortion debate you are on — or wherever on the spectrum of opinion on the topic you fall — there are a few universal truths that must be noted:

  1. Everyone wants fewer abortions.
  2. Abortions will always be needed.
  3. When abortion care is legal and accessible, it is safe.

Everyone wants fewer abortions.

A woman who finds out she is unexpectedly pregnant faces one of the scariest and most difficult situations of her life. Chances are, she has taken several precautions to prevent having an unplanned pregnancy, yet no birth control method is perfect and remaining abstinent goes against human nature. She must consider every possible consequence of continuing the pregnancy — with or without rearing the child — and of discontinuing the pregnancy, as well. She must consider her current health, her family situation, her financial situation, and many other aspects of her life and the lives of loved ones to decide the best course of action. This is not something she ever wanted to face. She never wanted to consider having an abortion yet, despite having taken all precautions, not everything in this world works out the way we plan. Thus, what I mean by “everyone wants fewer abortions” is that, beginning with the woman who is facing an unplanned pregnancy, everyone wants fewer abortions. We must encourage and support comprehensive sexual health education and access to highly effective contraception (see Pregnancy and Birth Control 101) in order to lower the rate of abortion. The importance and benefits of doing so have been shown in a large study out of St. Louis, MO: The CHOICE Project.

Abortions will always be needed.

Mother Nature isn’t perfect. She, too, makes mistakes. When I see a patient experiencing a devastating miscarriage from a desired pregnancy, my heart breaks for her, and I do everything within my power to comfort her. When a pregnancy is desired, that pregnancy is a child riding their bike for the first time, getting on the bus for their first day of school, and going off to college the minute the “+” sign appears on the home pregnancy test. Having a miscarriage and losing a pregnancy can be devastating. When I encounter these women, I generally tell them the following:

This is not your fault, there was nothing you did or did not do to cause this. This is Mother Nature’s way of helping you to have a healthy pregnancy next time.

I explain to her that, when cells multiply and divide such as they do during pregnancy, that it is a very complex process that goes smoothly most of the time. Sometimes, however, something zigs when it should have zagged, and the blueprints are no good. A miscarriage is simply nature’s way of sparing a woman from continuing an abnormal pregnancy for 9 months. That said, Mother Nature is not perfect. She doesn’t always get it right, and an abnormal pregnancy might not result in a miscarriage. Women sometimes receive the devastating news that their pregnancies are abnormal and will not result in a birth of a child that will live long after delivery, or that the fetus may die while she is still pregnant. This is when women need an abortion. Women can become very ill during pregnancy if the pregnancy continues into the second and third trimesters, possibly risking their own lives as well as the well-being of the pregnancy or any future pregnancies. This is also when women need an abortion. Even in a perfect world with perfect birth control that works perfectly every time, history has shown that, whether out of need or desire, women will continue to seek and acquire abortions.

When abortion care is legal and accessible, it is safe.

I will not rehash the entire Gosnell trial here, but for the record, he is not an example of how abortion is or should be performed; he is a monster who is shunned by the entire medical community and should be punished for the atrocities he committed. Anyone desiring to make an example of him to portray how abortion care is provided may as well make an example of Dr. Mengele to portray how all medical researchers conduct scientific research. I will also not recount the horrific tragedies of maternal deaths before abortion became legal in this country in 1974, but you should read about it if you have not already. There is evidence, however, that when abortion is legal and accessible, women are safer. A modern day example of what really happens to women when abortion is illegal can be seen here, courtesy of Al Jazeera: Right to Life.

How do we reduce the need for abortions?

The answer is simple: we must provide pre-teens with comprehensive sex education and provide people of reproductive age with highly effective methods of contraception. We must reduce the number of unplanned pregnancies in this country, the percentage of which has been an incredibly high 49% for more than 20 years. When pregnancies are planned, not only are they are primed for being healthy, but they are also much less likely to result in abortion. We must work to ensure that the only abortions are those that are necessary (because Mother Nature cannot be controlled) and that those abortions are legal and accessible, thus making them safe.

Science vs. Ideology

A new political low was reached in Salt Lake City Wednesday evening during a political debate arguing HB 461 which requires a 72-hour waiting period before a woman may obtain an abortion: Representative Bradley Daw made his opening remarks by reading from a “well-known philosopher and poet.” This would not have been remarkable, and perhaps it would have even been touching, had the context not been the infringement of women’s reproductive rights. Representative Daw’s opening remarks were read directly from “Horton Hears a Who” by Dr. Seuss, closing his remarks with “After all, a person is a person, no matter how small.”

Needless to say, I was outraged from the start. Representative Daw’s point was, of course, that pregnancy at any gestational age is a “person.” He failed to mention that the woman carrying the pregnancy is also a person. He was, however, quick to point out the thousands of women he represents and on their behalf advocated for HB 461. Representative Daw also seemed very knowledgeable regarding availability of health care and contraception to those in the lower socioeconomic classes, stating “contraception is available in any drug store, gas station, clinic for only a few dollars.” As someone on the front line in the daily health care battle I opine that statements like these are grossly ignorant.

Like most politicians, and like almost all who restrict women’s access to comprehensive reproductive health care, Representative Daw is not a clinician. He has no clinical training or experience and has no credentials to speak to health care provision, practice, or availability. This does not prevent him or any others from making statements such as “access to contraception is widespread,” or “pregnancy from rape is a justifiable reason to have an abortion,” as if he has a list of “justifiable” and “unjustifiable” reasons. For the record, cases like Savita’s do happen here, fortunately not often.

I have a request of journalists who have the paramount opportunity to ask questions of our legislators writing and passing laws affecting women’s lives: ask the right questions.

  • Can you speak to the risks of carrying a pregnancy to term? Of giving birth? Of rearing a child?
  • Can you speak to the risks of having an abortion? Medical versus surgical? First versus second trimester?
  • Do you feel you are medically qualified to counsel a woman on her options regarding a newly diagnosed pregnancy?

A politician no more belongs in my clinic instructing me how to care for my patients than I do in their staffing office writing legal bills. Evidence-based medicine and science, not ideology, should guide policy-making in health care.

The greater the ignorance the greater the dogmatism.
— Sir William Osler