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February 18, 2014 by The Jailhouse Doc

“Yeah, probably.”

More than five. Abortions.

So many thoughts right now. So here they are. She sat awkwardly, trying to cooperate but the reality is that I don’t know if she was even truthful, maybe she really knows how many pregnancies and abortions she’s had but she’s too ashamed to tell, so saying yes to “more than five?” was less painful than confessing the actual amount. Or maybe she truly doesn’t know. Either way, it was a lot. And it was hard for her to say.  And she told me it was hard to talk about.  Hard to think about.  And it was hard for me to wrap my mind around.

The irony of this moment was only overshadowed by my grief for her in having to discuss this with me, a total stranger, who, for all she knew, was going to judge her for her choices.
Ironic because that very week was the anniversary of Roe v. Wade, a week of snarky memes and graphic photos of aborted babies marauding my facebook wall. A week of people ranting about “baby killers,” and “irresponsible baby mamas,” and photos of people protesting, holding signs, and taking to social media to lament the legality of abortions that has led, in all reality, to the fact that there thousands of humans that aren’t on this world because their lives were ended during pregnancy. A week of stories on NPR like the one discussing the fact that there are places in the south where you have to leave the state to find a clinic that will perform an abortion. A week of people demanding that women have the right to choose what they do with their bodies, a week of ranting about “ignorant extremists” who want to take away your right to reproductive health decisions. A week about,… well,.. an angry week. An angry week in which,.. I don’t really think there was much understanding or compassion for people like my patient.

What kind of reality must you be living in to have her story?

I don’t know all the specific details, I don’t know why she was even in jail. But let’s consider some scenarios, and some tough questions.
If she had the opportunity of multiple choice, does anyone think that she would go back and choose to abort over five babies? I challenge even the most cynical of pro-lifers to a duel over that one. Even the most liberal of women who have been through abortion still feel its sting to some degree for the rest of their lives. If not only for the end of a pregnancy, a potential child that never came into this world, but also for all the surrounding circumstances that led them to that choice. It’s truly grotesque to me to accuse women who have had abortions of being wantonly cavalier with life.
So how did it come to be that my patient had not one, but numerous abortions? Let’s consider the “cavalier” argument again in terms of birth control. Use condoms! I cheerfully chant this to all my patients, hand condoms out like candy from the HIV testing van to embarrassed pedestrians , and exercise the “facepalm” when discussing teenage unprotected sexual activities. Just use a condom, People! Prevent STDs, prevent pregnancies. But it’s not that easy, and I don’t mean that it’s not that easy to grab a condom in a moment of passion. I’m talking it’s not that easy for vulnerable women. Who are vulnerable women? I’m pretty sure I was sitting uncomfortably next to one that day in my exam room. And this is where I think that lack of understanding forces compassion to give way to disdain for many people. When you have conservative talking heads jeering that women can’t control their sexual appetites, it’s easy to think that women are just irresponsible, and again, cavalier. “Why didn’t you use a condom!” Is the wrong question. “Why didn’t you use a condom?” is getting closer to the right question.
This is what we should be asking:

Are you in sexual relationships in which you have the power to insist that your partner wears a condom? (do you hear silence? Or BOOM goes the dynamite? I hear both.)
Are you trading sex for money, drugs, housing or clothing? (feel the squirm. In yourself.)
What happens when your partner(s) don’t want to use a condom? (are you starting to see that maybe she can’t just walk away?)
Do you feel threatened by your partners?
Do you feel like you could leave your sexual partners if you wanted to?
Are your partners having sex with other people?
Do you have enough income to buy condoms? (oh yeah,… they do cost.)
Would you use contraception if you had access to it?                                                     Do you want to have the power over when you become pregnant?(is there any doubt?!)    

Women in poverty do not have the choices and resources that we, the affluent have.

Vulnerable women do not have the luxury of steady incomes, appropriate housing, and access to healthcare. Vulnerable women are more likely to be trafficked, abused, and have mental health disorders. Vulnerable women do what it takes to survive, and care for their children. If that means they stay with an abusive boyfriend who won’t wear a condom but provides housing, they may do it. Vulnerable women sell sex for basic needs including food and shelter, and drugs. Now there! There is something to point the finger at: irresponsible sex to pay for irresponsible lifestyle- DRUGS. Because (sarcasms very intended) women WANT to become addicted to drugs, women WANT their physical and mental health to waste away, women WANT to degrade themselves to prostitution in order to get the next fix, women WANT to remain in that circle of hell. (end sarcasm.)

Yes, we all make choices. But I think we can have a lot more compassion for people who fall into drugs as a way to cope with the destitution of the poverty, hopelessness and dysfunction in their lives.

The women I talk to want out of their addictions. They want out of prostitution. They want control over their lives. They want control over their bodies. They want control over their sexuality. They want to take care of their kids. They want hope, they want a future.

My patient had abortions because she saw no better options in those moments of darkness. Maybe her pimp made her get abortions. Maybe her dealer. Maybe her abuser. Maybe her abusive boyfriend. Maybe her abusive relative. Maybe she was groomed into prostitution as a 12 year old. Maybe she wanted to afford contraception but chose to put food on the table, or pay her electricity bill instead. Maybe she had boyfriends who threatened to kick her out. There are innumerable maybes that are very good possible explanations for the choices she made.  Or the literal lack of choice.

The idea that maybe she just couldn’t control her sexual lusts, slept around for fun, shrugged her shoulders at the risks of unprotected sex, just didn’t feel like using condoms, and ignored the advice of her healthcare providers to use the pill, or patch, or depo injection is excruciating.  It doesn’t just make me want to cry, I actually do.  And cry out to God, on behalf of these women, and in anger towards the accusers.  The myth grows.  She just waltzed into abortion clinics and underwent risky surgical procedures to rip the growing lives from within her uterus (more than FIVE. TIMES.) after which she headed out to the clubs with her boyfriends to do it all over again, without so much as a care for the life lost, the loss of motherhood, the despair. The maddening absurdity of these common conclusions is beyond comprehension.

Vulnerable women do not have the luxury of doing things because they do or don’t “feel like it.”

Five abortions is the sad conclusion of poverty+vulnerability+lack of resources+lack of access to birth control.

As long as vulnerable women do not have access to free contraceptives, their need for abortions will continue. As long as we do not have robust drug and alcohol, and mental health treatment programs, the need for abortions will continue. As long as women who are in prostitution and have been trafficked are prosecuted while the johns walk free, the sex industry will continue, and need for abortions will continue.

As long as we condemn vulnerable women for the poverty induced choices they make, nothing will change.

So I spoke tenderly to her,. tried to communicate that I love her, don’t judge her, and she is no less human than I. I may never see her again. I asked one of my next patients if she had the power to insist on condoms, and she told me “sometimes.” See? Exactly. That realization is a game changer, because we have to grapple with the fact that they do not have the power in their lives. And I don’t believe that forcing them to bring babies into those situations just to eradicate abortions is the right answer either. The situation is much, much more complicated. If we could harness the energy of the anti-abortion movement and siphon it into getting contraceptives and resources out to populations most at risk, we could truly almost eradicate the need for abortions.
Then, perhaps I’d hear more stories like:
“I haven’t had any abortions, I get my depo shots every three months to prevent pregnancy, and I use condoms to prevent STDs every time I have sex. I also get tested annually for HIV. I will not get pregnant until I’m in a stable relationship and am ready, because I have control over my reproductive decisions.”

Or something like that. Someday! Someday.

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