Systemic Breakdown

I often deal with other institutions on behalf of women seeking abortion care. I interact with many different abortion funds or social assistance agencies, when I worked for a fund I helped women deal with medical clinics, I also deal with a myriad of other kinds of institutions in order to help women access safe medical care in both my personal and professional life.

The thing is, usually I am able to figure out how to help a woman get care when someone seeks my help. Sometimes there are legal issues like when a woman is a minor and has to get parental consent or judicial bypass. I have extensive experience in different types of case management, but sometimes I just can't figure it out. The many laws, regulations, dollars, and other barriers between a woman and her abortion are impenetrable. I have spent 3 work days trying to figure how to help a young woman get seen before she is too late to be seen at the clinic where I work. I have been able to raise some money for her from a myriad of places, but the money isn't the issue. There are so many institutions that can work together to stop a woman from accessing safe and simple health care.

It's really frustrating. Today I had to accept that a woman who does not want to be pregnant and should not have to will stay pregnant. This woman has medical issues that warrant abortion, and yet it isn't any easier. The answer doesn't change: she will most likely have to stay pregnant. I don't understand it. Access to health care should not be this disjointed in the United States.

I remember the first time I had to tell someone who was 26+ weeks pregnant with a severely deformed fetus that was incompatible with life that I could not pull all the strings to get her abortion. I felt like my heart might fall to pieces. This happened at least two years ago, and yet I still remember minute details about our interaction.

Accepting that helping everyone is not possible is a really important part of self-care for me. I cannot absorb the world's problems. I try to help people access something that should be available, but when a system of legal, medical, and social service agencies fails someone, I cannot feel personally responsible. I have to find a way to accept it and move on because I can't help everyone.

Thankfully, the work I do usually results in women getting the care they need. Learning how to take time for my spirit to recuperate is really important. I'm constantly trying to balance dedication to my work with self-care. In this emotionally intense line of work, abortioneer burn-out seems only inevitable. What are some of the ways other folks in the abortioneer community deal with this disappointment, when a patient isn't able to get seen or something else emotionally draining happens?

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. 

Choice

Choice really is a beautiful thing.

I have met women that are struggling to conceive. And although the odds are against them, they have made the choice to continue with the long, challenging, expensive, and sometimes heartbreaking process. Their doctors support them and foster this decision.

I have met women that are very sick during their pregnancy. They have diabetes, high blood pressure, seizures, and/or blood loss. It may have been in their best interest health-wise to terminate the pregnancy, but they made the choice to continue. They fight for this pregnancy, a wanted pregnancy, even when it dramatically hurts their physical well being. Again, the providers stand by these patients with their decision, care for them, and do the best they can to help bring a healthy child into this world.

I have met women who are struggling financially, have no support, are in an abusive relationship, in danger physically because of the pregnancy, are not ready to be a mother and have made the choice to have an abortion. Their provider supports their decision* and provides them with unbiased information to help each woman make the best decision for her.

Choice is everywhere in healthcare and in women’s reproductive health. We need to support women, we need to listen to women, and most of all we need to trust women.

*I realize this isn’t always the case, but it should be.