Sex Selection

Are there ever times you feel a little – uncomfortable – with a woman’s reason for having an abortion? We’re not all Saints of Non-judgment, though some of us may strive to be. (Err…maybe some of us don’t…)

Last week, a recent immigrant from an Asian country (I won’t say which) came to our clinic for an abortion. I was the abortion counselor that day. She was in her second trimester and wanted to know if we could figure out the sex of the fetus. This isn’t a completely strange question, but I don’t get asked that often.

Because she was less than 18 weeks and because we don’t perform diagnostic ultrasounds, I explained we wouldn’t be able to identify the sex. I let her know that usually diagnostic ultrasounds to determine the sex are done between 18-22 weeks and that if she had a physician/midwife, she could schedule an ultrasound with them at that time (as it is standard practice).

She wasn’t willing to wait at least another month to have an abortion. You know the drill: she’d have to travel out of state; the cost would be much higher; she’d have to spend time away from home; someone would have to watch her small daughter while she left the area (and explain why she needed a babysitter); and her husband would have to get a lot of time off work.

We don’t ask patients why they want to have an abortion. Really, it’s none of our business. Still, lots of women offer their reasons when we ask if they’re sure of their decision, if they have support, etc.

The woman from last week calmly offered she didn’t want to have a girl.

Look, I’m about as pro-choice as they come. As long as it is a patient’s own decision to have an abortion, I’m cool with it regardless of the circumstances or gestation. I’ll admit though, it took me a slight second to register what the patient was telling me. My brain hitched.

I nodded at her and she explained herself, though she didn’t owe me any explanation at all.

In her country (like in many), girls do not have as many opportunities as boys and are considered a burden. She and her family plan to go back to their country soon and they wouldn’t be able to afford another girl (it costs a lot of money to have girls marry/dowries).

There’s been some national controversy about this (like, in May); even the pro-choicers didn’t want to really talk about sex selection abortion occurring. The reality is, though: it does. It’s not very common in our country, and I’ve never heard anyone – except someone who is from an Asian country – even mention it, at work. And I’ve been doing abortion work a long time.

The concept seems very foreign to us; but, is it really? Globally, there is underlying sexism that drives the devaluation of women. It happens here, too. Please, how many people have raised their hands saying women in this country don’t deserve to be paid equally to men? (Rolling eyes.)

It was a good reminder for me that we’re here to support women, in whatever it is they want, and trust that they know what they need for themselves, even if we may not understand it. We don’t need to understand. We just need to be there.

Abortions "To Go": Modernizing Abortion Services

We had a client yesterday who asked if she could get in and out of the clinic within an hour or so. I told her it wasn’t possible since the sedation alone would require her stay about thirty minutes after her abortion just to make sure she was feeling okay…let alone all the paperwork and labwork we’d need to do prior. She still wanted to get in and out within a maximum of two hours. She was busy and had a lot to do.

I think some clinics have entire abortion appointments that last about two hours. At our clinic, it usually takes four. I mean, of course, the abortion only takes a couple minutes, but women are usually waiting around FOREVER. I often think there’s something wrong with how either we schedule people or how we organize the appointment flow since sometimes people are at our clinic for even more than five hours. Patients complain a lot about this and I can’t blame them. It’s not like our waiting room is super comfortable or welcoming (sadly, I find this is true in a lot of clinics).

On one hand, as abortioneers, we want to spread the message that abortion is a simple and common procedure (it is!), but we make women wait ages in either over- or under- heated waiting rooms between labwork, counseling, and their abortion. They fill out millions of pieces of paper that ask for a lot of the same information repeatedly. We definitely are sending mixed messages: if abortion is simple and common, why would you be in the clinic for over three hours?

The abortion-to-go girl is right, in my opinion. If a patient is totally sure of her decision (most are by the time they come in, or else they just don’t show up for their appointment…usually), then we should be able to accommodate them and get them through their appointments quickly. That might mean clinics need to think outside the box a little and be more creative in scheduling and in how they process appointments, but they should do that then. Let women fill out their paperwork online, for example. (Or clinics should move to electronic medical records!) What if patients could make payments online before their appointment? I think clinics are so far behind technology now…imagine if a client could even book her appointment with her iPhone because the clinic has an app for that. I think it could happen.

Anyway, I really think we can all do better at actually providing abortion services in a more quick and efficient manner while holding onto warm and kind staff (who of course will be more kind and warm if patients are happy and not complaining!). What do you guys think?

All Saint's Day

All Saints Day is a Catholic holy day that celebrates Saints both known and unknown. I am no Catholic but for me this day is about celebrating ancestors and those who have come before us. I have many ancestors to celebrate today. I also celebrate many abortioneers, activists, and generally awesome people who have made it possible for the world to be the beautiful place it can be.

I would like to celebrate both of my grandmother's today. My mother's mother was a devout Catholic and a republican. She raised my mother who grew up to be a radical liberal. She swore I would be my mother's antithesis, the conservative daughter she always hoped for. I am not that conservative woman. When faced with an unintended pregnancy as a young Irish Catholic woman in the 1950's she was sent to a maternity home and essentially made to give her son up for adoption. Her spirit lives on in her children and grandchildren and I celebrate the amazing woman she was. I am because she existed.

My mother's step mother was a liberal Unitarian Universalist. She told my mother about abortion as a teenager by explaining to her that she had an abortion. When I heard this story it only verified how amazing my Grandma was. She allowed her daughter to see that abortion was not some vague thing that happened to bad or dumb people. Abortion is something good women and mothers experience. I'm thankful amazing women like my Grandmother paved the way for women to have reproductive choice.

At my first job in abortionland I had an amazing supervisor who dedicated her life to making abortion accessible to woman in spite of economic circumstances. She trained other young abortioneers like my self to be compassionate, objective, and strong. She passed away a few years ago of a long term illness. Each day I am thankful I met this woman, her passion and fervor is part of what has sustained me in this work. When I started working for her I was young, lost, and damaged myself. She offered me a since of drive and passion that has stayed with me into my adulthood.

Finally, we must always remember the women who fought for reproductive choice in pre Roe V. Wade days. We must remember provider's who have lost their lives because they were willing to risk their lives to save women's lives. We must remember the women who have lost their lives all over the world because safe abortion was not or is not available.

On this day of All Saint's, known and unknown, I raise up my ancestors and the those people who have acted as saints so women can have safe and accessible reproductive health care.

Jennie McCormack: You Rock!

I’m often in awe of the strength of women. In my experience, women who seek abortions often exhibit the most strength I’ve witnessed. In awe? Yes. Strengthened myself as a result? Yes. So women who stick their tongues out at abortion stigma and announce to others they’ve had one, and announce loudly and proudly publicly they’ve had an abortion (and to get off their backs), amaze me even more. I’m saddened it must amaze me (stigma, stigma, stigma), but still, I respect the strength.

Jennie Linn McCormack is one of these women. She’s from Idaho. Pocatello, Idaho. And if any of you know much about Idaho, you know just how conservative it is. You may not know this, but, Idaho is one of the states that made it illegal to have an abortion after 20 weeks’ gestation. Jennie was arrested in May for having an abortion (which would’ve required her to go to Salt Lake City, Utah as there aren’t any providers in Idaho that go beyond 14 weeks. She didn't have the financial means to do this, as many women don't.). Allegedly, she performed a self-induced abortion. Get this: her sister’s “friend” called her in to authorities. If you want to read more about Jennie Linn McCormick’s situation, you can read here; but obviously, since we’re abortioneers, we’re supportive of her decision to seek an abortion after 20 weeks, regardless of her reasons. Well, anyway, charges were dropped, but she has now filed a lawsuit challenging the “fetal pain abortion ban.” Jennie is pressing charges against the state saying the ban is unconstitutional as it doesn’t allow for maternal or fetal indications (as reason for abortion later in the pregnancy) as Roe v Wade promises.

I'm incredibly sad that Jennie Linn didn't know about other resources that may have been available to help her obtain a safe, legal abortion. The Justice Fund within the National Abortion Federation is a national abortion fund that can help women in Idaho pay for their abortions (they also help women from any other state where Medicaid doesn't cover abortions). I'm not sure if she ever contacted a clinic, but if she did, I can only hope they tried to connect her to the National Abortion Federation. And hopefully, then, she would've spoken to an individual who would've brainstormed with her and helped with case management in order to get her to a clinic to have an abortion either in Boise, Idaho; Spokane, Washington; Seattle, Washington; Salt Lake City, Utah; or Portland, Oregon. Traveling to such places can place a huge hardship on women, like Jennie; but there are some clinics and abortion funds that will help women pay for the cost of travel, pay for hotels, or set clients up with volunteers so they can stay in their homes.

I think Jennie Linn is a hero for pressing charges against the state and for bringing to light the lack of access to abortion services in Idaho. Whether she realizes it or not, she is facing stigma straight on and telling it to go suck itself. She’s telling the lawmakers in Idaho to do the same. All the while, she’s standing up for all Idaho women – women who are totally undeserved – in hopes of helping pave the way for better rights.

Jennie Linn McCormack. You rock.

"to go back and get it:"

The night I found out my closest sister was pregnant I was on my way home from a lecture by a Planned Parenthood representative. The lecture was about the lack of access to sexual health services in poor communities and communities of color. I was catching a ride home with someone I knew and my cousin, sister, friend called to say "I have something to tell you.....I'm pregnant" We were both 19 years old. I was in my sophomore year of college. She was living in small town, America just trying to make it.


The abstract concept that people, with out money, living in rural areas, or in urban centers, where billboards say "who's your daddy?" and promote cigarettes and liquor consumption, do not have access to accurate information about sexual health and reproduction became extremely concrete. My closest sister was pregnant. As an abortioneer my first reaction was, "ok, ok you have options" After a few hours talking with her mom and calling me she firmly decided to keep the pregnancy. As an abortioneer I was very supportive of my childhood soul mate choosing motherhood.
If my sister had a ride to the nearest planned parenthood nearly an hour away she might have been on birth control. She may have also chosen not to use birth control. The thing is her lack of access to transportation and money meant she also lacked access to birth control. She didn't have the ability or opportunity to make a choice about what birth control method to use, if any.

During the Planned Parenthood lecture I attended earlier in the evening I also learned that the father of gynecology, J. Marion Sims, developed much of the science of gynecology through experiments on enslaved African women and poor Irish immigrants. He did not use anesthesia on these patients because there was a widespread belief that they were less sensitive to pain than wealthy white women. J. Marion Sims owned slaves and it is documented that he did experimental procedures on women that he "owned". He was well known as a plantation physician and treated numerous enslaved Africans.

I was appalled to find out that gynecology was born out of a racist and classist history. In this country social inequality is built into the most basic fibers. The enslavement of Africans, annihilation of natives, and exploitation of poor people is at the very roots of the development of the good ol' U.S. of A. This country was built by people of color and poor people to serve the needs of wealthier white landowners. The science of gynecology is no exception.

The ability to determine one's life is based on one's access to resources. People who are historically disenfranchised do not have the ability to access necessary resources. Maybe that necessary resource is a ride to planned parenthood for birth control or STD testing. Maybe that resource is a safe abortion, or maybe its a condom or an education.

The history of this country cannot be erased. The West African Adinkra symbol Sankofa means "to go back and get it" and is representative of learning from the past. Racism and classism is not ancient history. Access to resources is one very concrete way the history of racism and classism in this country has translated into today. The ability to control one's body and reproduction is the most basic human right. Women need access to birth control and sexual health care in order to gain this very basic human right.

Guest post: Abortion Awakening

About a month ago, I was catching up with an old pal when my phone rang. I silenced it, and it rang again. And rang again. Three more times. Well, it turned out to be important. A young friend of mine was calling for advice. After all was said and done, my friend agreed to write about that experience for us.

~~~~~~~~~~~~~~~~~~~~~~~~~

I’ve always felt strongly about the necessity of access to abortion care, but I recently knew someone, for the first time, who was having difficulty getting an abortion. I live in a place where it wouldn’t be uncommon for an 18-year-old girl to be thrown out of the house for seeking abortion, and although I’ve been aware of that reality, it didn’t really resonate with me until I met one who was facing this and needed to pay for and obtain an abortion without her parents’ knowledge.

A girl that I’ve been good friends with for a few years came to me for help. Her friend was trying to get an abortion, she told me, and they’d had an appointment at a clinic, but when they showed up, she had been turned down because the clinic could only provide abortions up to 16 weeks, and she was at 16 weeks and 4 days. She had already had to travel for this appointment, since she lived in a small town, and now not only would she have to travel again, she had to get an overnight dilation, so she would need a place to stay in addition to the procedure costing much more than she had originally expected.

The way this could suddenly become so much more complicated amazed me. All of a sudden she had a week to find a place to stay and a large sum of money and an excuse to tell her parents that she was driving to another town. I was impressed at how committed my good friend was to helping her friend with this, but I still felt so bad that she seemed helpless. I called my friend Placenta Sandwich to see if there was anything I could do to help.

The next day, the girl and I sat down and talked. We called several abortion funds, leaving messages. We found that the clinic that would be the easiest to get funding help for was the one she had already tried. We also talked about finding a place to stay, and my sister tried to find her a host for the night. Before she left, we hadn’t resolved any of these issues, and I had a moment of indecision. I had some money on me, not that significant a percentage of the abortion cost, maybe, but it could help. Maybe it could help with a place to stay or just a small part of the procedure. And I knew $40 was a lot of money to give to someone I barely knew, but I thought about what I would do with it otherwise, and nothing I could think of spending it on seemed to be as important as helping someone with such a small support system.

I gave her the money, she gave me a hug, and she left. Through the following week we kept calling the funds each day, kept working on where she could stay, but come the day of the appointment, we had nothing. She got half of the money from her ex-boyfriend and paid for a hotel with her friend. She thanked me later, saying just knowing she had my support was a great help, and she said she felt fine after the procedure and it all went well, but I couldn’t help but feel like I had failed.

I know that it wasn’t my responsibility, nor was there anything more I could have done, but it made me realize just how difficult obtaining abortion care is. Even if you find a clinic that can help you, you might need to travel for it, which means you need a place to stay, which often requires money, you need to pay for gas, you need to pay for the procedure itself, and sometimes, this is all compounded by having to keep it completely secret. I wanted so badly to be able to help.

I don’t know if I’m going to be an abortioneer. There are some other career paths I am considering, and I’m young. But this experience definitely made me feel like I might be called to do that. For now, I want to leave the area that I live in. But I want to come back and make it a better place for women. I want people to be able to get abortions without having to go to another city. I want girls not to be struggling to figure out how they’re going to pay AND keep it a secret. I want them to feel like they have people looking out for them, whether they live in a big city or the middle of nowhere. So maybe it doesn’t matter so much that I want to live in a city or that I might want a different job; maybe it’s worth some sacrifice.

International Abortion Access

We talk a lot about abortion access here in the United States which is limited, and yet much more accessible then most countries across the world. This short documentary looks at access to reproductive health care, family planning, and abortion in Guatemala. When I see the severe lack of access in other parts of the world I feel even more sure that I need to continue to pursue a career in abortion provision. Please check it out!

Right to life Guatemala - Birthrights - Al Jazeera English

The South Dakota 3 Day Waiting Period, and Other Reasons I Am Angry

South Dakota, South Dakota, South Dakota. What are we going to do with you? Recently, the illustrious Governor of South Dakota, Dennis Daugaard, signed a law, which requires a woman seeking an abortion to wait three days after meeting with the doctor before she can obtain said abortion.

That is bad enough, right? South Dakota is a big place. To put it in perspective, it is 210 miles wide, and 380 miles long. That’s a lot of space. There were two abortion providers in 2008.

So, it’s safe to assume women in South Dakota already have to do a fair amount traveling to get to an abortion provider.

Once she has made up her mind, driven to the clinic, been counseled by the clinic staff, met with the doctor, had her blood work, etc, she must then turn around and go back home and wait THREE DAYS. You know, just to make sure. If you have a job, need childcare arrangements, have transportation issues, an unsupportive partner, or whatever – good luck getting an abortion in South Dakota! You’ll need it.

BECAUSE, on top of all this crap, a woman seeking an abortion must all consult with a crisis pregnancy center (CPC) before she can get her abortion. CPCs are anti-abortion and basically lie to women and say whatever to convince visitors not to have an abortion. They’ll tell you that you’ll get breast cancer, that you’ll become infertile, that God will not forgive you, that you’ll spend an eternity burning in Hell – if you get this abortion. They’re just so filled with Christ’s love, right?

There is no real relevant comparison in the real world, because shit that this whacked doesn’t actually happen for any other medical procedure. Suppose you were 15, homeless, pregnant, and wanted to give birth. Before giving birth, you had to go to the doctor, consult with him, be counseled by the doctor's staff, have medical work done, then go home and wait three days before you could formally decide if you wanted to give birth. During those three days, you would also have to visit an Anti-Birth Center, wherein the staff would do anything in their power to convince you to not give birth. They could tell you lies, including that God would never love you again if you carried this pregnancy to term. That tons and tons of women die during childbirth. That women who carry pregnancies to term often go crazy afterwards and their breasts fall off. Then, after three days, you could drive X hundred of miles back to the doctor. Whom your state just tried to legalize the murder of.

It seems completely f*cked up and ridiculous to try to force someone who wants to give birth not to. I'm sure most of us would be completely appalled if our pregnant friends had to go sit in an abortion clinic before they could give birth. You know -- just to let them "cool off." After having all that sex, they ought to think about what they've done and reallllllly truly ponder if motherhood is for them.

JEEZ THAT SEEMS SO AWFUL, MR. BANANA GRABBER. Well, it is JUST as f*cked up to do this to a woman seeking abortion.

For many women, obtaining an abortion is the kind, sensitive thing to do. Most women who seek abortions are already mothers, young, and low income. I feel like a broken record on this, but sometimes when women already have children and cannot make ends meet having another child is not a reality for them! Or their partner is jerk and won't provide! There are 9.3 million different reasons and they are all valid and deserve the same amount of respect as a women who choose to carry their pregnancies to term.

What Could Your Clinic Do With Just a Bit of Funding?

I've been thinking about how I wish abortion clinics got more funding. It sure would be nice if RFAs went out - publicaly - on a fairly regular basis, for clinics. Of course, this doesn't happen much and it's a shame. If my clinic could get a good influx of money, I would love to see some of the things at other surgi-centers I've seen recently.

For example, really nice, big, cushy recovery/pre-op chairs. Chairs where you can do the labwork, but also recover in. Warm blankets. Comfy socks for each woman with no-slip little soles. Perhaps a little duffel bag women can take home (a place to put their clothes when they undress from the waist down, instead of having to put them on a chair for all to see. It would be a convenient place for the meds to go, too!). Perhaps gift baskets for overnight clients who use contracted hotels that offer a discounted rate for our clinic's women. Something simple could be in that basket: some fruit, maybe some crackers or juice to have after their abortion. A thank you note. Follow-up calls for all clients the very next day to check-in on them and see how they're doing. Maybe a website for a "registered clients only" section with a question board so clients can chat - kinda of like yahoo groups or something - where staff respond to any inquires.

Oh! Electronic Medical Records for all! Including a way to electronically send prescriptions to pharmacies!

Other streamlined physicians offices do these sorts of things. Okay, not normal physician offices, but some surgi-centers do.

...seriously, my wish list would look a lot larger than this, but imagine what could be done with just a bit of funding!

Just AboutAGirl dreaming again. Bill Gates? Warren Buffet?? Anyone listening? FUND ABORTION CLINICS.

"Schooling Chris Smith" on abortion's role in the UN's Millennium Development Goals

Good evening! Just wanted to let you know that Kelly, the brilliant and gracious creator of Schooling Chris Smith, is hosting a cross-post of sorts by yours truly.

Before I get ahead of myself-- do you know who Rep. Chris Smith is? Well, number one, he's a douchebag, and number two under-informed and number three not very good at rhetoric; let's just say all that up-front before you read his op-eds and injure yourself trying to understand what the fuck he's going on about.

Number four, he's also a member of Congress (R-NJ4), and among other things he's the ranking member (second only to the chair) of the House Committee on Foreign Affairs's Subcommittee on Africa and Global Health. What does all that mean? Well, as Schooling Chris Smith puts it, it means he gets "to be seen as a strong proponent of human rights despite his complete opposition to full human rights for women." To continue quoting Kelly:

Back in September, the Washington Post published an op-ed by Chris Smith urging activists not to sidetrack the U.N. summit on global poverty by talking about abortion (which is kind of hilarious, considering this is one of the guys who sidetracks women veterans' health care into abortion politics). His op-ed obviously speaks for itself by claiming all abortions cause psychological damage for women and implying that human trafficking and child soldiering are caused by abortion (I have to admit, that's a new one for me).

Some letters were published in response to this piece, but one wasn't. [That's mine! -PS]

So, yeah, being ranking member of the House Committee on Foreign Affairs's Subcommittee on Africa and Global Health (takeanotherbreath) also means he gets to say things about global health and international development policy and have them published in newspapers. Even though he hasn't done his research, doesn't know his facts, and can't string together a logical argument. (Am I bitter that I do ALL these things but don't get published in the paper? Not at all!) The Post published a couple responses that (rightly) pointed out Smith [a] was dragging abortion into the conversation from out of nowhere and [b] had glaringly omitted mention of the life-saving importance of contraception. But those responses themselves completely omitted mention of the many errors and false claims Smith made about the role of abortion in saving lives.

Even though it's well past September now, the inauguration of Schooling Chris Smith got me thinking that I shouldn't let a good letter die unread. (If I do say so myself.) Without further chitchat, here it is:

Re: "Abortion does not further children's health," Chris Smith, op-ed 9/19

Rep. Chris Smith's op-ed was long on claims, but short on facts. Having engaged in research, education and service provision in the field of reproductive health, I am left wondering on what evidence Rep. Smith based his assertion that abortion harms children's and women's health (the focuses of the UN's Millennium Development Goals 4 and 5). His attempt to exclude abortion from MDG efforts, discarding established medical evidence in the process, is the real threat to the health of women and the children they already have.

The statement that abortion is "by definition, infant mortality" is silly, as all abortions are, "by definition," performed before birth, which precedes infancy. Terminology aside, Smith's concern for embryo survival leads him to overlook the actual women who die when safe abortion care is out of reach: some develop severe pregnancy complications; some have ectopic pregnancies; others drink bleach, insert sharp objects, or jump from tall heights in an attempt to end pregnancy themselves. Each year an estimated 50 million women worldwide obtain abortions, half under unsafe conditions; worse, the vast majority (95%) of those unsafe abortions take place in the developing world where treatment for complications is harder to obtain. As a result, around 70,000 women die each year due to unsafe abortion, and millions more suffer nonfatal injury and illness. Yet abortion performed by a trained provider in a sanitary setting is one of the safest medical procedures in existence -- much safer than carrying a pregnancy to full-term delivery, as a matter of fact! Contrary to Smith's insinuation, repeated and rigorous cohort studies demonstrate the error in claiming that properly-performed abortion causes physical or psychological complications.

Disregard for the value of human life, as Smith calls it, is made manifest in the poverty, illness, and avoidable death experienced by families who cannot afford another mouth to feed or who lose a caretaker to eclampsia, hemorrhage or sepsis. If safe abortion is struck from the agenda, then unsafe abortion will simply continue to kill women and orphan their children.


placenta sandwich, A.D.D., I.B.S.
Vice-President of Irritated Blogging and Letter-Writing
The Abortioneers
Credentials Out The Ass

(Actually, I gave them my real name and my real credentials-out-the-ass.)

There was so much more I had wanted to say, but brevity is the soul of getting published, I was told. (Am I bitter that I chopped a bunch out but didn't get published? Not at all!) Like I also wanted to say that there's empirical evidence at the family level that maternal morbidity and mortality (for example from unsafe abortion) results in greater child mortality. Not a shocker. And also that anyone who knows anything about health infrastructure can tell you that women in Chile and Ireland survive (mostly survive) their countries' abortion bans because they have access to doctors trained to treat complications of illegal/DIY abortion, not because they've stopped having abortions! Anyone who thinks an abortion ban would not increase mortality in a country with poor health infrastructure and lots of remote rural area -- like, say, Ethiopia or Zambia -- would surely not qualify to be on anyone's Subcommittee on Africa and Global Health, right?   Oh... wait. (Still not bitter!!)

I'll leave it there and ask you to head over to Schooling Chris Smith to discuss Kelly's question: What would your letter in response look like? What else has been left out?

Media Monday! "Abortion Democracy," the documentary

A few weeks ago I met a German woman named Sarah Diehl, who's in the US doing a screening tour for her documentary, "Abortion Democracy: Poland / South Africa." I saw a short preview of the film and have been looking forward to seeing it ever since.

Poland is one of the few countries in Europe that has criminalized abortion in almost all cases -- and this isn't an ancient law, either, but one passed in 1994. I remember a few years ago reading about a Polish woman who sued the government in the European Court of Human Rights after being denied an abortion that would have saved her deteriorating eyesight. Alicja Tysiac is functionally blind as a result of this denial; the court found that the Polish law did not even uphold the narrow exceptions it claimed to make for cases where a woman's health was endangered by pregnancy, the government had failed by the standards of its own law and  Tysiac's human rights had been violated. The court awarded her compensation, but of course that won't restore her sight. The story both outraged and terrified me: abortion policies aren't an abstraction limited to proving ideological points -- they are terribly, viscerally real for the women whose decision-making they vitiate.

South Africa, on the other hand, is one of the few countries in Africa that has legalized elective abortion. The law was changed in 1996 to allow abortion "on demand" in the first trimester and abortion on certain legal, medical or socioeconomic grounds in weeks 13-20. (Quick fact: "on demand" means that women are not required to stand before a judge, panel of doctors, or other jury who will approve or reject their 'case' for an abortion.) Yet legally-qualifying abortions are still quite difficult to obtain for many South African women, especially in the second trimester. In fact, "Abortion Democracy" suggests that it may be "easier to obtain an illegal abortion in Poland than it is to obtain a legal abortion in South Africa." In this sense, national policies are not the only thing that determines the nature of on-the-ground access, not by a long shot.

I'll be watching the movie tonight, so I'll be back with an update on how it was. In the meantime, I hope this trailer gets you as intrigued as I am.

Another One Bites the Dust: Feminist Clinic in Washington State Closes

We need to expand access to abortion services. We all know this. So, the question may now be, within our own Abortionland, what exactly does expanded access mean? How can abortion access expand without crushing little, struggling clinics? Is it even possible for different service delivery models (hospitals, Planned Parenthood, etc.) to expand without hurting independent clinics? And if possible (which I believe it, of course, is), is it realistic? Will providers set aside competition for altruism (increased access)? And at the risk of sounding cynical, should they set aside competition? And....are independent, feminist clinics now obsolete?

These questions are – hopefully – being asked by people besides me. You’ve probably heard all the buzz about another feminist abortion clinic closing down: Cedar River Clinics’ Yakima site (one of three in Washington State) just closed down last week after 30 years. Let me say that again: after 30 years.

I read about this closure on RH Reality Check’s site here. It’s a lovely tribute to the Yakima clinic which appears to have served women from all over the Pacific Northwest and beyond (Oregon, Washington, Idaho, and Montana). The closure also has created a big hoopla – a controversy even – because Cedar River Clinics points the finger directly at Planned Parenthood as the reason for their closure! (Ballsy, I know!) The comments on the article obviously get very feisty. (Pretty fun to read if you’re in the mood for feistiness!)

It seems like there is this clear divide, an us versus them between some independent clinics and Planned Parenthood. If you’re not up on the debate, the issue seems to be the apparent recent Planned Parenthood decision to expand all their abortion services… even in areas where there are already providers. It’s pretty obvious there are many who are uncomfortable with this pointing of fingers, saying that by pointing fingers at Planned Parenthood, abortioneers are unnecessarily feeding into all the negative media that the antis put out against them. (After all, Planned Parenthood does do a lot of good work.) Well, on this blog, we pride ourselves in talking about the things that are hard to talk about. We speak the unspeakable – the unpopular, even – at the risk of antis twisting it however they will (they’ll always twist things around).

Let’s say the independent clinics out there are right: Planned Parenthood plays a role in closing down little clinics (not intentionally, I’m sure). Should people NOT talk about it just for fear of what the antis are going to say? Of course not!! Sure, we’re all in the same boat: we want to provide abortion services to women; but like I talked about here in September, there is, of course, competition. We're only in the same boat up to a point. Abortion rates are down. Clinics still have a business to run. If another provider comes in and offers the exact same services (same gestational limits, for example) as another clinic in town, then that’s direct competition. If a small clinic is already struggling, a direct competitor will surely hurt said struggling clinic. It sounds like that’s precisely what happened in the case of the Yakima Cedar River Clinic and the Yakima Planned Parenthood.

We don't like to talk about competition: it's the big elephant in the room. The reality is, competition exists. The analogy of the big corporate store coming in, causing the little independent store to close is very similar to the small abortion clinic versus a corporate-like Planned Parenthood. I am an idealist at heart, so it's difficult for me to even acknowledge the elephant. I want to tuck myself into a little world of abortion safety where everyone is in it just for the women and the focus is so entirely on that, not politics and competition and business models and strategies and blahblahblah. The harsh - ever so harsh - reality is that when big corporate business comes in and succeeds, it offers a service that customers/clients/patients respond to. They're doing something right. That doesn't mean the small, independent clinic is doing anything wrong...

Or are they? Little businesses often fall prey to "treading water syndrome." They can be hyper-focused internally and don't always invest/have the resources to look externally. For all business - non profit or profit - it's vital to not only scan your external environment, but do an in-depth analysis. The for-profit sector and non-profit sector are not really that different. (Despite how much I'd like to bury my head in the sand and pretend they are.) They compete. And abortion providers compete, too. In the case of Yakima, it appears that Planned Parenthood came up with a strategy that worked for them. You can bet your bottom dollar that Planned Parenthood has the resources to do an in-depth SWOT analysis and probably really researched the opportunities in Yakima (and other places). Did Cedar River Clinics? Like so many small businesses, did they focus too much on putting out fires that they didn't stop to recognize Planned Parenthood as an external threat and then decide what to do about it?

Look, I am a huge fan of supporting local businesses. I support my local book store. Unless....Amazon meets my needs when browsing the internet at 1am. I would go to my independent abortion clinic if I knew it was locally owned. Unless... Planned Parenthood was more convenient (price, location, abortion days/times that fit my schedule) and made themselves more known to me (advertisement). I'm talking about the marketing mix. The Four P's:
- Product
- Promotion
- Place
- Price

Do I wish that Planned Parenthood could've expanded their gestational limits in, say, Spokane where they could've better met the needs of rural women? Or maybe opened a clinic in a region of Washington State (or Idaho, or Montana, or Oregon) where there wasn't an abortion provider at all, instead of going to Yakima and directly competing? Hell, yes. That would've been the altruistic thing to do: the thing that would've truly been in rural women's best interests (women travel upwards of 10 hours because Yakima is the only provider going further than around 15-16 weeks west of Missoula and east of Seattle). There are large areas of Washington state without abortion providers, so it seems there was/is growth potential there. Why didn't Planned Parenthood take the high road instead of directly compete? On the other hand, we could all ask Cedar River Clinics why they didn't expand to an unserved area to improve access, too.

My point is: Cedar River in Yakima must've missed some opportunities for growth that Planned Parenthood captured. So if small, independent clinics are doing anything wrong at all, it may be that they don't/can't meet the demands of the clients and what their needs are when (gulp) Planned Parenthood did/does (like Amazon sometimes meets my needs better than my local bookstore). And this does make me cringe. But we're talking about consumer behavior here.

Planned Parenthood has nothing on a legacy of a feminist clinic. It can't stand up and say it's been there for its community like a small clinic can say; but if the competition wins, it's not just because they're terribly corporate. Look, little independent clinics need to LEARN from Planned Parenthood. What do they do that's right? Branding. Clients trust them. They're everywhere. Like McDonalds. Independent clinics need to be firmly rooted in their communities. They need to promote themselves. They need to advertise. They need to be involved. They need to prove to their communities they know them better than Planned Parenthood does. They can't ostracize themselves just because they do abortions. They have to have their finger on the pulse of their clientele. Offer different days. Different hours. Have nice buildings. Decorate them well. Have them in good locations (see my dream clinic blog). Ask clients what they want. Make appointments shorter. Small, independent - even feminist - clinics will become obsolete unless they figure this out, significantly invest in strategy, and learn from Planned Parenthood. My sincere hope is that they will....

...who will pick up this gauntlet?