Our patient was a 15-year-old girl who came to the emergency room of our hospital saying she wanted to commit suicide after being raped several weeks ago at a classmate’s party. In the emergency room, a urine pregnancy test was positive. On admission to the hospital, she was very clear that her thoughts of killing herself came from her rape and current pregnancy. She was clear that she wished to end the pregnancy.
Her mother, who was by her side throughout the hospitalization, supported her daughter’s right to seek an abortion. Our supervising doctor (who is also an abortion provider at an outside clinic) informed me that our hospital, despite its lack of religious affiliation, had a policy of performing no abortions under any circumstance. Angry and distressed at the patient’s story, she informed me that the hospital had made this policy decision years ago to “avoid conflict.”
The patient was eventually discharged to the only available inpatient pediatric psychiatry bed in the state which was at a Catholic hospital. She stayed there for several weeks and was unable to have her desired abortion. She now has a young child, has dropped out of school, and has had repeated admissions since then for multiple suicide attempts that she attributes to her undesired pregnancy and home situation.
Nearly half of all pregnancies in this country are unintended, and people from lower socioeconomic backgrounds are more likely to be affected. Although abortion has been legal since 1973, 87 percent of all counties in the U.S. lacked an abortion provider in 2008. In the few counties where patients can access a legal abortion, there are often significant barriers to access. These may include gestational age limits, restriction of public funding, mandatory waiting periods, and state-mandated counseling (which is often medically inaccurate). In addition to these barriers, women from underserved backgrounds already face many barriers to accessing health care (linguistic, financial, legal) that are further exacerbated by abortion laws. With the recent civil terrorist attacks on Planned Parenthood of the Rocky Mountains in Colorado, women now more than ever risk physical violence to seek out a desired legal abortion.
Our other patient was 19 years old. She had had one sexual partner in her lifetime, her current boyfriend. They never used condoms. Before coming in, she took a home pregnancy test, and it was positive.
These are the details we had before walking into the exam room: The story of why she came to our clinic. However, we soon found out that her story had so much more to it. She was a child of immigrants, a first-generation college student, and hoped to become the first in her family to attend graduate school. She had never received any kind of education or information regarding her reproductive health. She had never used condoms because her boyfriend disliked them and told her that it was safe to not use them. She had come to our clinic because she desired an abortion.
We were able to see her again a few weeks later, after she’d had her abortion in a safe and respectful environment. After counseling and discussion, she asked for a hormone implant for birth control. Through education, she became empowered and in control of her body. Her story would not end with her as a teen mother who had dropped out of college.
While abortion is a controversial political topic, it is a common medical intervention. About one in three women in the United States will have an abortion in her lifetime. Anecdotal evidence often claims that abortion is physically and psychologically damaging. In truth, undergoing an abortion carries far fewer physical health risks than those posed by continuing a pregnancy to term. Studies also show that having an abortion does not lead to an increased risk of developing a mental health disorder. The women most likely to feel emotional effects are those who had mental health concerns preceding their abortion, and it should be noted that they would be at increased risk for post-partum depression had they carried their pregnancy to term. Abortion is a common, safe, medical procedure and restricting abortion access leads to unsafe procedures and emotional distress.
In our experience as primary care providers, we have seen a wide range of patient experiences related to abortion. As these two examples illustrate, patient access to abortion varies widely and tends to disproportionately affect those with poorer access to health care and other social services. Furthermore, unintended and undesired pregnancy continues to serve as a major driver for the perpetuation of socioeconomic inequality. Although abortion access has been protected by the Supreme Court decision in the case of Whole Woman’s Health v. Hellerstedt, it is constantly threatened by restrictive legislation. We believe that primary care physicians should strongly advocate for preservation of an even less restrictive take on women’s choices.
Joshua St. Louis and Dana Desmond are family medicine residents.