Monday, July 19, 2010

The upside of talking to strangers

just kidding

Hanging out with foreigners is a whole other Thing for me.

I don't mean foreigners exactly. What's a good word for "people who aren't from Abortionland"? I'm in a new place with lots of new people, so this is kind of on my mind lately (can you tell?).

Sometimes it makes me nervous. Obviously. I pretty much eatsleepbreathe abortion-related business, and those split-seconds of anxiety when someone thinks they're making innocuous smalltalk and asks So What Do You Do, they're an occupational hazard we've all come to know well.

Of course we've built little silos of experiential knowledge about ways to ease into it or leave it subtle (Women's Health, Reproductive Health, Family Planning), in case the person asking is not someone you want to get into it with. Other times you want to just say it, so you just say it, and hope that's OK. And once in a while you're feeling kinda wild and might even tell someone who never asked. But no matter what you say, that anxious split-second might pass and be forgotten, or it might drag out into interminable minutes, even hours if you're unlucky, of "debating" whether what you pour your heart into is evil and exploitative. (Whee!)

The reason I still bother is that sometimes it's totally fine -- is it sad that at this point "totally fine" can be kind of a thrill? -- and what's more, someone who doesn't eatsleepbreathe this stuff might say something I haven't heard or thought of before. As you know, I am a very clever and thoughtful and well-read and humble person, so you can imagine my surprise at learning something new, but it's true.

Longwinded Example Time: yesterday I was telling a new friend (who's training in public policy) about this unexpected hitch in what sounds like a great abortion policy. Where we are, first-trimester abortion is theoretically covered -- paid for! free! -- for residents who have public health insurance and go to a public health center for the procedure. It turns out, though, that to get the required preliminary ultrasound and bloodwork, patients often have to choose between waiting THREE TO FOUR WEEKS to have those processed at the hospital providing the abortion, or paying around a hundred dollars for a private office to do it within a few days. If you're poor and you are working within a short legal time frame, this could be disastrous. (Really. I've counseled so many women through the daunting challenge of finding a hundred dollars in a couple weeks, and as a result am aware of my enormous economic privilege every day.)

So, yeah, my constant and immediate thought about this situation is: even if you have great policy, you also need support and will all the way down the healthcare structure, so that the time-sensitive nature of abortion care is given importance and so that possibly-antis within the system don't cause unnecessary delays. Otherwise safe and timely abortion access continues to be segregated by economic class. Is anyone surprised? Same old story, sucks, now what?

When I paused my rant to take a breath, my friend said, "Sounds like the market organizing to meet demand that the health system hasn't caught up to." Oh yeah: that is another conclusion you could come to. And it isn't just about how or where ultrasounds get performed. It's also about how, where, and whether abortions themselves get performed. Having only worked at non-profits, I sometimes forget that the chance to make or lose money drives service availability -- it often feels like we're giving away care, which I'm proud of, but the wider world doesn't work that way. Assuming you have a public abortion system, if its workflow or providers are causing choke-points in service delivery, would-be patients aren't going to give up. Potential consequences:
  • Feminist clinics [pdf] arise to provide women with care that isn't dependent on the patriarchal medical system (or on its judgments of what is urgent and what can be delayed). They are traditionally not-for-profit and its employees have a conflicted relationship with the need to, like, keep a roof over their heads. Seeking donations for sustenance is a whole other piece in this, Idunno, let's talk about that some other time.
  • For-profit clinics arise to fill the supply void; some are great and perfectly feminist too, and some are mostly a business like most other medical practices and seek to maximize income.
  • Private OB/GYNs and family practitioners begin providing abortions in-office after realizing that their regular patients keep seeking their advice, getting referrals to the hospital, then getting delayed.
  • People who have little or no medical training begin offering under-the-table "pregnancy remedies" that range from safe and effective to useless or lethal. A client who survives is unlikely to report them because she knows they may be someone else's only recourse, too.
  • Pharmacy workers will sell women misoprostol, an abortion-causing medication which is also prescribed as Cytotec to treat gastric ulcers, but at a significant markup because both parties know that the seller is doing an illegal favor and the buyer is desperate.
  • What else?
ETA: look at this graph I found just this afternoon!
The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society and Abortion Worldwide, New York: AGI, 1999.

Anyway, I have been turning over in my head how my own experiences and training get me in a kind of thinking-rut, where certain conclusions and interpretations are super-obvious to me, and I lose any sense of how many other useful lenses there are out there. (Notice how I ended up wandering back to economic justice anyway?) So yeah, this is something for me to keep thinking about and try to be more open to. In conclusion, um, talking to strangers can be OK.


  1. I feel the same way. Working in ob/gyn and being an abortion provider, I like to talk about what I do and what I passionately believe in. Its hard when there is no outlet, or when you don't know what the other person things or how they will react. Most of the time it really is "totally fine", though sometimes it can be strange. I'm also more comfortable talking about reproductive freedom issues with women (where are all the pro-choice men anyway?) or others in health care.
    With my hospital now closed and looking for another residency program, I still do my clinic work.

  2. Glad you all are doiung what you do. Truth is, it is mostly relgious fanatics that are opposed to abortion and they are crazy.

  3. This post really resonates with me. I'm a 20-year-old woman who isn't sure what she wants to do in life. I tried graphic design, and while I enjoy it, it can be very competitive and stressful. I'm coming to the conclusion that maybe I'd find it more enjoyable if it was a part-time hobby rather than a full-time occupation.

    I've never really been anti-choice (the most "anti-choice" I was was around age 12, when the thought of abortion made me uncomfortable, but I didn't feel as though it was something absolutely horrible), but in the past few years, I've really developed a passion for being pro-choice. I learned more about everything involved in abortion, from the smaller world of a single patient and provider to the larger views held by society. Reading about anti-choice legislature and opinions actually have the ability to make me feel genuine anger.

    So naturally, I've begun to think that maybe work in abortionland is my calling. After reading the recent article in the NYT magazine about the changing landscape of abortion providers, my mom and I started discussing it and our feelings about abortion. My mom leans towards being pro-choice, but as soon as she brought up the "I don't think abortion should be used as birth control" trope I was disappointed. I explained that I thought the "lazy woman" (and it's always the woman, isn't it? Never the man who has to take responsibility for birth control...*sigh*) who "doesn't bother with birth control and sees having multiple abortions as no big deal" was more of a myth than reality, and even if there were women like that, I still felt that their uterus was none of my business. My mom didn't necessarily agree. She asked me if working in the world of abortion was something I would be interested in (not in a judgmental or discouraging way, though). I said yes, and that I had been thinking about it recently.

    Ultimately, though she has been able to be supportive in the best way she can. She hasn't discouraged me from wanting to work in abortionland. Instead, she's encouraging me to look further into it. She asks questions like "Would you be interested in working as a nurse in a clinic? A counselor?" and more thought-provoking ones like "Would you be willing to live in the middle of nowhere to provide abortion access where otherwise there is none?"

    It was hard coming out to my mother about my desire to be involved in abortion access. I know it's something I could never mention to my grandmother (churchgoing Catholic who pretends Sex Doesn't Exist). I wonder how my sister will react. She never struck me as being anti-choice, but we've never really talked about abortion. My dad is a Republican (but more of a fiscally-conservative, socially-liberal type. Hands off people's personal lives and all that), and he also never struck me as being particularly anti-choice, but I still wonder if my interest in abortionland will make him uncomfortable. I find myself wondering what people around me think about abortion- the guy next door, my fellow servers at the restaurant where I work, the parents in the families that are my customers.

    So yeah. Talking about abortion is a complex thing. And that I understand.

    Also, if anyone could give me any guidance on different ways to be involved in abortion access, to make it a full-time occupation, I would really appreciate it. Links, a reply to this comment, anything. I want to explore all my options, and I could use a little help to push me in the right direction. Thanks!

  4. Hi Allison, thanks for your comment/questions. I strongly suggest wading into this field on a part-time, volunteer basis. This gives you a chance to see if it's your sort of thing, and if so what kinds of roles in particular you might like to take on full-time; it also gives clinics some reassurance that you didn't come out of nowhere, you have an idea of the issues involved, and they can trust your values and commitment.

    I don't know where you live, but you almost certainly have a nearby Planned Parenthood that could suggest ways to get involved locally. There may be other clinics you can contact too. In either case, understand that a clinic might be wary of someone calling out of the blue asking for access to their facilities. To mitigate this, try to find contact info labeled "outreach" or "community education" or "volunteers."

    Depending on the local context, the greatest need may be for parking-lot escorts, or interpreters during appointments, or who knows what else. That reminds me -- in addition to asking PP/clinics, you can also look for a local group of clinic escorts to get involved with. There's no single national website I can point you to, but googling yourcity+abortion+escort is a good start.

    Good luck :)


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