Abortioneer gone AWOL

I’m graduating from graduate school in three weeks. When I applied to my public health program almost three years ago I wrote my personal statement about my abortion clinic. I will be starting a part-time public health doctoral program in the Fall and I also wrote my personal statement for this application about abortion. Yet, the full time job I have accepted is working with persons living with HIV/AIDS. There were a lot of factors that went into my decision to accept an ostensibly non-reproductive health job. I did not make the decision quickly or lightly, but I still feel some sadness that I won’t be working day-to-day in reproductive health and specifically abortion. I know a job is not necessarily a lifetime commitment, but I do envision staying somewhere for awhile. I can also pursue whatever I want in my doctoral program and dissertation, but it doesn’t feel like enough. Part of me thinks I was a fraud on my personal statements for going on and on about how I wanted to learn skills and gain knowledge to improve this field. But, how could I have known when I applied where I would end up three years later?

Then I think back to the times when I was a full-time paid abortioneer. I worked at a non-profit clinic usually 50 hours a week and even during my time off I was immersed in abortion (rallies, volunteer positions, fielding phone calls from staff, baking fetus cookies, etc). Frankly, I got burned out. It was too much. When I moved up here for school I started abortion patient hosting as a way to stay connected, but not too connected. I get to compartmentalize my abortioneering and host when it works with my schedule. These last few months I have held an internship on a teen pregnancy prevention program which has brought me back to the field I love, but I sit in an office and plan evaluations and interventions. There is little talk of laminaria, or medical abortions, or LMPs, or even fetus jokes.

Every time I get a call from our patient hosting coordinator I smile, knowing I get to head to an abortion clinic and pick up a woman and essentially “do my thing”. I love entering the clinic…I love feeling a part of it all. I love how connected the staff are, and that knowledge that every day you leave work you significantly helped someone change their life. I remember one weekend I spent 2 days at a clinic waiting for a woman who traveled alone from Canada. The clinic had undergone some renovations and their heat was not working properly and it was January. I huddled on the floor with my laptop and books and photocopies of readings for class and I couldn’t have been happier to be studying there. I was in a room surrounded by strangers yet I felt so at home.

I honestly don’t know if I’ll ever get back into the abortion clinic as an employee. There aren’t many jobs for people with advanced degrees outside of healthcare workers. My new employer does have a clinic for our HIV/AIDS clients and I’m hoping I can grow to love it as much as I love my abortion clinics.

Burn-out

Thank you to deliverance for joining us again as guest blogger today!

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I was talking with a co-worker yesterday about our work in abortion care. "We should all work part-time here, and then part-time somewhere else, like…an ice cream shop!"

What a great idea, I thought.

Burnout has gotten me down and it is harder than ever to self-motivate. A sanctuary-type environment where I used to continually stumble upon joyful moments, has become a normal office building with boring tasks.

It's not the absence of all joy or gratification, but those moments have become few *and* far between.

Part of it is repetition--the same stories ("I feel like I am killing."), the same obstacles (poverty), and less patient interaction in my current position.

It's also about money. Recently I called a few clinics to get an idea of how much others charge for abortions. There was a clinic a few states away charging over $600.00 for first trimester abortions. Considering how challenging it is for patients at our clinic to pay for procedures, I can't imagine how difficult it is to come up with twice as much money. Then again, women in that state probably don't have any other option.

According to the National Abortion Federation, women cannot access abortion in 88% of counties in the U.S., and that percentage rises to 97% for women in rural areas (http://www.prochoice.org/about_abortion/facts/access_abortion.html). It doesn't take a genius to figure out why we need people who have a ton of passion and motivation to work in abortion care--this right is, and has been, on the brink of extinction.

I have met and waved goodbye to numerous abortioneers who have flung their entire selves into abortion care, but when it comes down to it (and I really do hate to say it), what we make isn't sustainable. If you want to have a family, go back to school, travel to get away from such stressful work, while also meeting rent, buying groceries, and paying off student loans (a Bachelor's degree is required for many positions at clinics)--good luck.

There is an effort on many of our parts to not only be happy, but to thrive with less--we don't need most of the shit we buy anyway--but fair pay is surely a feminist issue, one which many clinics want to avoid discussing. "Everyone needs a raise," is a reply I've gotten quite often, but I don't think that's so true when looking at wages for administrators and doctors.

Despite all of this, there are still some abortioneers who stick around. They have worked at clinics in the same position for 7 or 8 years, and although many clinics don't have much room for advancement, they hang on because our work can be that important and fulfilling. Some go to medical school to become providers. Others study midwifery, so they can deliver babies as well as provide abortions, in the few states where midwives are able to do such comprehensive care. A few play the game of working their way up to an administrative position.

When I realized I wouldn't be one of those people, I started to make plans to "move on," as people call it (even though I will take this work everywhere with me). I feel guilty for knowing I will one day leave, and resentful for what could've been.

For those of you who stay for the duration of your working life, thank you for being the backbones of our movement. Your amount of commitment and dedication is astounding to me.

Close your eyes and imagine something for me

welcome to your new home

What if you moved to another country and had no family there, and your first language was one that very few people in your new home had even heard of, and you spoke very little of theirs? You might be relieved and happy to find someone who shared your mother tongue and your host country's language, someone who could help you navigate this new place as well as be a friend who understood where you came from.

You might start dating this person, move in with him, end up relying on him in most aspects of your life. He might be a lot older than you, take advantage of your dependence, control your access to food or transportation or a phone, and refuse to use birth control. 

What if you got pregnant? What if you got pregnant and had always looked forward to having children and this person who had final say in your life was not a fan of the idea? And what if you couldn't get your own job or lease or even typical social services -- shelter, healthcare, food for an infant -- because your immigration status wasn't clear? What would you do? 

You might decide that, as much as you'd rather have a child, the only feasible course of action is to seek an abortion, just like he is telling you. You might have to rely on him to translate during the counseling session, and there's really no point trying to say how you really feel, because he already knows it, and he won't translate it to the counselor, and anyway what you'd rather do doesn't change what you must do. 

After the abortion you might try to spill your guts, in spurts, and using a combination of elementary vocabulary and charades, to the various staff in the recovery room. Unfortunately, if you talked to me, I might have a really hard time understanding the full extent of your situation, and try to comfort you with tissues and talk about the hope of having a child when you're in better circumstances -- not realizing that the road to better circumstances isn't visible from here. (It's a lot harder for me to write about this failure to listen well than to read J's story of a failure in his early days as an aid worker: why?) But I'd notice that you kept saying you didn't feel strong enough to get dressed and be discharged yet, even though your vital signs were normal three times in a row. 

If you talked to my more perceptive colleague, she might try to ask you if you had "somewhere else to go" -- but you don't know anyone or anyplace other than this man. She might call in a counselor and make a bunch of phone calls to informal assistance resources, trying in vain to find someone who spoke the right language. The three of you might make a plan to have you come back in a few days for "a check-up" and hope that this guy at least respects medical orders and will give you another ride to the clinic. 

All of this, to our regret, would happen after the abortion that you wished you didn't have to have, because while antis are lately fixated on stopping "coerced" abortions, they are apparently completely clueless about the forces and circumstances that actually make women have abortions they wish they didn't have to have. When language barriers don't prevent women and girls from telling us what's in their heart, when immigration laws don't leave the most vulnerable with nowhere to turn, when men don't take the opportunity to take advantage, when families don't make their daughters believe that can't possibly come home pregnant, (you fill in the blank): that's when women will only have the abortions they want. 

All I Need to Know About Life I Learned from Working at an Abortion Clinic

Item #9:
1. It pays to be nice
When I'm taking payments, some clients are a few dollars short. If they've been a pleasure to work with at every step of the process, I comp the difference and send them on their way. But if they've been a pill, a pain, and a pest (as my grandma used to say) to everyone they encountered, I'm going to insist that they go borrow some cash from their driver or else reschedule. You better believe I'm nice to cashiers and sales associates, and I tip super-well.

2. Sometimes, the most important person to forgive and the most difficult person to forgive is yourself
Clients can forgive their ex-boyfriends for poking holes in the condom, they can forgive their sisters for not replacing their last pack of Plan B that was on reserve, and they can be at peace that God will forgive them. But when it comes to forgiving themselves, all bets are off. And when they can finally do it, good things happen.

3. Plato was right: We must "[b]e kind, for everyone you meet is fighting a hard battle."
Even the obnoxious clients mentioned above in item #1 have their stories to tell. And I don't relish the thought of counseling the woman who declares, "I don't believe in abortion, but I have to do this," but when she tells me why she "has to," it's difficult for my heart not to melt a little bit. And it makes me appreciate all the compassion I've been shown in my life.

4. Listening is a valuable skill to have
Oh, so when you made your appointment, no one told you that you couldn't drive after anesthesia, that you couldn't eat or drink anything the day of your appointment, and that we don't take payment in the form of IOUs? My co-workers and I could give those instructions in our sleep. Just admit you weren't listening. That's why I always carry around a notebook and pen.

5. Maybe we don't know what we REALLY want until we've wanted both things
A friend of mine once told me about her unplanned pregnancy. She knew right off the bat that she was going to have an abortion. Until she saw a glowing pregnant woman. It was only when she really considered both realities, she said, that she could make the most informed and honest decision. She had the abortion.

6. When you miss a period, take a pregnancy test immediately
Don't assume it's a fluke, don't assume your body's being wonky. Especially, don't take a test, see a positive result, and then believe that if you ignore it, it'll go away. That's how you end up to be 25 weeks pregnant. And that's fine, but the procedure could have been quicker and cheaper if you had just taken that first test all those months ago. My co-workers and I sure make use of the free tests at the clinic.

7. You will make a decision when you are meant to make a decision
I learned from a wise, veteran counselor that some women know what their ultimate decision will be, but they don't know how they will arrive at that decision. It can be a long process, and a painful process, but it's a process that needs to happen. I've never had to deal with an unintended pregnancy, but I sure have dealt with tough decisions, and I took my sweet time.

8. A medical history is no place for forgetfulness
nor creative writing
Oops! When you wrote, "No known allergies, no history of major health problems," it turns out that you really meant, "Allergic to every item you will use at this clinic and a history of weekly seizures since birth." Details, details! And my friends, those details are what cause those major complications. I could say, "I'm 5'9" and I've never had any mental health issues," and it sure would be fun to say those things for a change. But that doesn't make them true.

9. Wear what you love
When we schedule your appointment, we suggest wearing comfy clothing since you'll be groggy and crampy. The first time I saw a client step out of the recovery room in 4" platform heels and a mini dress, I doubted the comfort level and practicality, but she rocked it and she was proud of it, and groggy, crampiness be damned. I, on the other hand, will wear hoodies and sweatpants whenever possible, but it's just my personal jam, and no one else's.

10. Some of the best people work in abortion clinics
When clients express nervousness or when they ask if the next person they see will be nice, I sometimes tell them that I honestly work with some of my best friends. And every person in the field that I've met has been amazingly compassionate, passionate, kind, giving, determined, and an absolute champion of women.

Plug for a fellow blogger: more on fathers

Sparky's had an unexpected travel-related contretemps these past couple of days, but that doesn't mean the pro-choice summer reading stops! I urge you to visit Every Saturday Morning, the blog of a team of clinic escorts in Kentucky, where today Dan has written on the intersection of fatherhood and escorting, and about a confrontation with

disapproving men willing to abandon their daughters during their moment of deepest emotional distress, embarrassment, and fear, and leave them to walk through this gauntlet of hatred with a complete stranger, a man who will be in her life for only a few minutes, but is willing and able to be her surrogate father.

The post is both heartfelt and heart-rending. Dan, thank you for writing about your struggle that day, and thank you for being a pro-choice dad and a compassionate escort. And happy Fathers' Day to you!

Voting with my wallet?

I hate getting my hair cut. I loathe going to the dentist. I dread calling my apartment's maintenance people. I have such disdain for these events partially because they involve coming out as an abortioneer when the stylist breezily asks me what I do, when I hand my insurance card with the clinic name to the dentist's receptionist, and when the maintenance man sees an apartment that's basically a shrine to abortion (a plush smiling uterus hangs from my freezer door and every bookcase is full of abortiony titles). But I've mostly learned to handle those circumstances. What's tricker is gauging how comfortable I am giving my business to people who might end up not to be so abortion-friendly.

One of my dear friends and co-workers once told me that she makes a habit of questioning contractors or proprietors about their attitudes toward choice. If she's giving them money, she reasons, she should know exactly what she's supporting, directly or indirectly. I can get behind that. As funny as it is go to out to brunch with a fellow Abortioneer and say, as we each plunk down a Visa card, "This meal paid for by abortion!", how do we really know that our hard-earned abortion money isn't going to fund a trip to Hobby Lobby (I'm not choosing that store arbitrarily. Hoo boy, are they ever Christian. But I'm also not giving it a link.) to get supplies for fetus porn that will appear outside of my clinic?

I've never been able to bring myself to ask about a business owner's views, though. The closest I got was when I was a friend's wing woman at a party and to ascertain whether she would be going home with the right guy, I blurted out, "Are you pro-choice?" (He was, he was lovely, but she ended up not going home with him.) I manage to surround myself with abortion-loving people and I know (thanks to Facebook) who's in the local choice community. But I think I fall short of the comfort level that would let me question it, point blank. What about you, readers? Have you ever vetted establishments for their worth as allies?

What to/not to Say During Your Abortioneer's Security Threat

Dear Friend/Lover/Co-worker/Relative/Booty-Call/Partner/Spouse/Whatever of an Abortioneer:

In efforts to help you be better supportive of your Abortioneer when they’re undergoing security threats at work, here are the top 20 worst things to say:
1. Don’t freak out.
2. When are you going to get a new job?
3. Don’t worry about it. It will be fine.
4. There’s not really proof it’s as bad as you think it is, right?
5. Well, isn’t that to be expected?
6. Oh. (Then look away)
7. Don’t you have a security guard or something there?
8. They’re just trying to scare you.
9. They’re just trying to intimidate you.
10. Do you have a gun? No? Oh. You might want to get one.
11. Get a new job. It isn’t worth it.
12. Don’t you guys use the buddy system or something?
13. Why do you put yourself in that situation?
14. I guess you better get used to this. I mean. It’s part of the territory, right?
15. You need to think about your family. You’re putting everyone at risk.
16. Please look for a new job.
17. Are you sure that’s what you saw?
18. You better start changing all your routes and routines. What if someone’s following you?
19. Why do you work there?
20. Don’t freak out. Don’t worry about it. XYZ won’t happen. It’s not that big of a deal. But you should get a new job.
*Abortioneers: you may have more to add!



Are you confused? I’m sure you’ve said some of the above to us before. Don’t get me wrong; I think you’re well-intentioned. You want us to be safe. It’s uncomfortable - maybe worrying - for you that we do this work. You probably have concerns for our safety. What you should probably know: we know you worry. We usually try not to talk to you about the protesters that bug us every clinic day. So as not to worry you more. You see, we want your support. And we worry that if you hear about the regular-everyday nuisances that occur to us - which are part and parcel of our work - you might not be quite as supportive.

A lot of us wait to tell you anything unless something big happens. Like if we get a bomb threats and have to evacuate, or big vandalism occurs, or we get stalked, or we get a very threatening letter in the mail. I may or may not tell my loved ones when law enforcement gets more involved. (Don’t assume we always tell you even when the big stuff happens.)

What’s the big deal about telling us any of the top 20 bad things? It makes us feel worse. It does not help to tell us to get a new job. We’re already scared. Trust me. And when you tell us to get a new job, you belittle our work (which isn’t just “work”) and at the same time, you show us you don’t really know us/who we are. You don’t respect our choices. I mean, most of the time, people don’t question (at least not tons) if someone feels the need to serve our country in some capacity (running for office, getting into law enforcement, joining the military). It might help you to view it that way. We’re not much different. We feel the call to serve our community, too. Our women. Just in a different way. Senators get threats. Police officers are in constant danger, as are our military. Do you tell them to quit their jobs?

Co-abortioneers aren’t always perfect, either. In attempts to make yourself feel less scared/less threatened, be mindful not to diminish the actual incident around co-workers. As Abortioneers, we have to be able to support each other. We’re the only ones that really can understand one another; so if you’re turning around and questioning how serious the security threat was or downplaying it in any way, you could actually cause more harm to your fellow abortioneers who just experienced the same thing. Let’s say you get repeated bomb threats and one of you at work, in efforts to not freak her own self out, acts like she’s brushing it off, like it wasn’t that big of a deal. Your other co-workers may begin to second-guess their own feelings and their own experience of the threat, which could lend itself to additional trauma and stress. I know of abortioneers who were, very sadly, tempted to quit their jobs after a security threat not because of the security threat itself, but because of how their clinic administration or co-workers responded to it.

We need to show our love to our Abortioneers. On to the next list.

Top 20 things TO say to your Abortioneer during security threats:
1. Are you okay?
2. Do what you need to do to stay safe.
3. I’m so sorry.
4. How are you feeling?
5. How can I help? Do you need anything?
6. I wish you didn’t have to go through this.
7. I wish those bastards would just let you do your job in peace. I’m sorry.
8. Are you getting rest? Sleeping?
9. If you need me - really - I mean it - call me.
10. I know you probably can’t talk too much about it, but I’m here for you.
11. I wish I could do more.
12. Thank you for doing the work you do.
13. I’m sorry you have to live in fear for doing a job no one should think twice about doing.
14. I feel for you. If you need a vacation and want to come stay with me, you’re welcome!
15. I’m so sorry this happened to you.
16. You’re safety is most important! Do what you have to do!
17. I’m thinking of you.
18. Is there something extra you can have at this time to give you more peace of mind?
19. Ugh. I’m so sorry.
20. I’m here for you. I’m sorry. Can I help? I’m here. Thank you for doing this important work. Take care of yourself.

I'm grateful to have co-bloggers who would know just exactly what to say.

Sad Times

Recently, federal agents raided Dr. Kermit Gosnell's clinic in Pennslyvania and discovered one of my worst nightmares realized: an unsafe clinic, with unsanitary conditions, sketchy staff, and to top it all off, fetus parts in jars. The doctor has killed at least a couple women, injured more, and who knows how many women who went there and just had a bad experience. So why did women go there? It had a terrible reputation. The answer: Gosnell charged very low prices. Women who were going there couldn't afford the extra it cost to go to a safe clinic. So, essentially they had two choices - carry an unwanted pregnancy to term, or go to this super sketchy clinic that was affordable, and hope for the best. Not really very good choices, huh?

Since most of his patients were poor and uneducated, that meant most of his patients would not be filing lawsuits, sending in reports to authorities, going to the press, etc. Other pro-choice organizations had tried to intervene on behalf of patients to no avail as well:

More than a decade ago, CHOICE, a Philadelphia abortion referral service, contacted the state medical board about Gosnell because some of his patients had called CHOICE with appalling stories, said Brenda Green, the organization's executive director.

"We were told that we could not file a complaint. It had to be a patient. It could not be a third party," Green said.

Reproductive health activists and Gilbert Abramson, a lawyer who filed the 2008 case that was later dropped, said they urged Gosnell's patients to file complaints with the state. But when the women learned that they would have to provide medical records and other forms, plus attend a hearing in Harrisburg, they changed their minds.

So, you just had a terrible experience in a medical facility and want to file a complaint -- but in order to do so you must be willing to submit all your medical information including the abortion you just had, and be able to travel two hours to another city to go to a hearing. And people wonder why more reports weren't filed.

I am so glad that this clinic is closed and this doctor is not allowed to perform abortions anymore. But this brings up a sticky topic -- bad clinics. We have all heard stories about this place or that place. I have plenty of experience working with a clinic that drives me insane. (I should pause for a moment and clarify that when I say "bad" I mean that the quality of care isn't amazing -- clinics that have rude staffers, won't be flexible with low-income women, etc. Dr. Gosnell's clinic is definitely AWFUL and the vast vast vast majority of clinics are not even vaguely like that.) What can we do to make clinics that don't provide the best care possible better? And what can we do to make sure a clinic like Dr. Gosnell's never exists ever again?? Can we create some sort of regulatory commission? Since clearly, the health department dropped the ball on this one big time. How we can get this information to low income women?

Unfortunately, many anti-choicers hear stories like Dr. Gosnell's and think that is what abortion care is like and all clinics are like that and they just want to make money and blah blah blah. None of that is true. I think I can say I speak for all the Abortioneers when I say that we all want clinics with qualified, caring doctors, spotless floors, compassionate staff, etc.

I think the saddest part of all of this is best summed up by Susan Schewel, executive director of the Women's Medical Fund, which provides financial help to poor women seeking abortions:

"What happened inside that building is not the real story. The real story is why women sought care there at all," Schewel said. "This prohibition on Medicaid payment leaves desperate women vulnerable to substandard providers."

Stand-alone or lump-together?

Recently I was talking with someone whom I admire very much as a professional in the field -- someone who was a provider in the past but has done many years of research, education, and advocacy since then. Nearly all of this work has been around abortion, and for reasons similar to my own: abortion is a neglected/marginalized need and until it is not, those who are willing should work for it.

Anyway, this recent conversation involved the time that my friend headed the reproductive health department of a large institution, and the birth defects department "offered" a merger between the two. My friend ended up telling them, essentially, "No, because we'd be addressing birth defects and you still wouldn't be addressing abortion." And that until that attitude changed, "combining resources" was only going to marginalize abortion further. Given the context, it was a risky but wise response.

So, here's what I am turning over and over in my mind -- something I've turned over and over in my mind for a couple of years now, and still haven't satisfactorily decided about: if holistic health care is probably better health care, but everyone else does everything but abortion care, what's the best way to structure your health services, as a provider or organization?

Focus everything on abortion care until a day comes when the need no longer so greatly outstrips availability? Or offer as many health services as possible under one roof, from primary care on down, so as to help normalize abortion care rather than section it off from health needs that are perceived as more "legitimate"? I think there are moral/ethical arguments for each.

There's also the "strategic" question of having limited resources that you might want to focus carefully, or on the other hand of trying to reach out to other providers and other patient populations in order to increase resources -- not just money and space but also, crucially, a support network.

In terms of clinical benefits to the patient, I'm again torn: it seems like specialization would promote a culture of expertise around abortion, but on the other hand integration would promote continuity of care and possibly better whole-person treatment (not sure how to quantify that!).

I know just among the authors of this blog, there are going to be differences of opinion. What do you think, fellow bloggers? And what do you think, readers? Have you worked in an abortion-and-contraception clinic, a women's health center, a sexual health clinic, a private doctor's office, a general hospital, a fertility center, a family health center? What worked, what didn't? If you went into medicine and intended to provide abortion care, are you / would you be a gynecologist or a general practitioner or...? What would your ideal abortion-providing setting be? (Assume it has to be within the medical paradigm, I guess -- but I'd love to hear counterfactual fantasies, too!)

Media Friday!

As you may or may not be aware, there is going to be a huge protest at Dr. Carhart's clinic this weekend. This is the first full scale gathering of this nature since Dr. Tiller's assassination, so obviously, we are all a bit nervous how this is going to go down. Anti-choicers are claiming they'll be "peaceful," but you know, I guess that depends on what peaceful means to you. Personally, I think screaming, shouting, harrassing, and threatening is the antithesis of peaceful, but hey, maybe that's just me. *Insert bitter glare toward the religious right*

Rachel Maddow recently interviewed Dr. Carhart on this matter.

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To Dr. Carhart and his staff - you are all in our thoughts and prayers. To the wonderful counter-protestors showing up to support Dr. Carhart, please be careful!