The Great Macy's Fourth of July Abortion Sale: Get 'em while you can! (offer valid only in Mississippi until 7/11/2012)

This is actually a breadline, not a bank run or a premodern Black Friday. But when I thought about it, the breadline matched the vibe of the clinic waiting room better than those. People are there -- with their spouse, mom, kid, infant -- because they really need to be. 

So...

Remember my last post, where I was kinda sick and tired of legislators playing doctor (and not in the sexy way) (but also, is playing doctor actually sexy to anyone?), and I was writing about the last abortion clinic in Mississippi being legislated out of existence, and about Rep. Bubba Carpenter, and how he was talking in what I imagine is a too-bad-so-sad wah-wah voice about how the other side talks way too much about "some poor pitiful women" who might risk their health and lives trying to end their pregnancies by any means available, and I think I might have blacked out shortly after that as an internal defense mechanism?

Yeah, I know: oof. But let's talk about Mississippi some more!

So the bill passed and was signed by the governor and its stipulations include that abortion providers must have hospital admitting privileges -- something Bubba Carpenter noted was notoriously difficult for anyone to obtain, not just abortion providers -- and that means that this last clinic in Mississippi, which has not been able to secure admitting privileges, will have to close. But then, since as Bubba Carpenter noted this law is not trying that hard to be constitutional, a judge stayed the new law until a court hearing planned for July 11 -- giving the clinic a reprieve of, uh, about a week.

And here's something that interests me as an abortioneer.

But it has also created a rush of women from across Mississippi wanting to have abortions. The clinic's three doctors normally perform about 40 abortions a week, but received more than 100 calls in one day last week from women trying to schedule appointments. Two of the doctors live out of state and will fly in to perform abortions this week, said Diane Derzis, the clinic owner.

"What women are hearing is, You may not be able to have an abortion soon," she said. "If you're pregnant and you don’t want to be, you’re thinking, 'By God, I've got to get in there fast.'"

Seems kind of weird, doesn't it? Like a run on the banks, as my arm candy quipped. You'd think that the need for abortion care is pretty much static over the course of a year, since pregnancy can occur in any season and any abortion clinic is the potential provider for at least several million people of reproductive capacity. But demand for services really does seem to have a certain flux to it. While I can't remember hearing of a run on the clinics (though I guess it's not hard to understand), I have noticed other ups and downs and maybe patterns.

I've mentioned before that I had many clients who were able to finally secure their abortion care when their tax refund came back -- and even some who specifically filed early in order to make sure they raised enough money before they reached 12 weeks when the fee would start progressively increasing. Those patients were very resourceful and very on top of it. And I sympathized with their certainty that they made little enough to be owed a refund -- my full-time job qualified me for both a tax refund and assistance from an emergency abortion fund should I ever need it.

But demand also seems to drop on holidays, especially big ones. It's hard to seek an appointment while hosting extended family, driving to grandma's, juggling your parents' or grown children's multiple Thanksgivings after a divorce, entertaining your school-aged kids at home, or arguing with your teenager about sharing the family car over winter break. You don't have as much privacy, time, or energy for taking care of yourself. Shit's hectic.

Then, weeks after a holiday, demand bounces back to levels even higher than before. Phones ring off the hook at the emergency abortion fund, they ring all day although you have multiple phone lines and someone answering every line. Same thing happening at the clinic, which is also jam-packed with people -- you have to bring more chairs into the waiting room -- and clients want to know what is the point of making an appointment if you still have to wait all damn day. (The answer is you struggle with turning people away from care, and wish there was such a thing as walk-in care, but in your state there's a law requiring advance appointments so pregnant people can take time to "cool off" and think hard about their impulsive and flighty decisions. As Sarah Silverman says, maybe they're not as hungry as they think they are.)

I say "weeks" after a holiday but we'd often remark that it seemed to be about four to six weeks after a holiday. Kind of joking, because that's how long it takes from fertilization (four) or last normal menstrual period (six) to the earliest point in pregnancy that most clinics are able to offer abortion care. Kind of not joking, because it really happened. At least three years I noticed that after a December-January lull, we'd have the most insane February and March. That's the time of year that I first became an abortioneer, actually. At first I thought that was just how it was -- that we'd have 100 appointments per day forever. (On the plus side, a lot of those were double-bookings or ambivalent patients who ended up going to another clinic for prenatal or abortion care. We didn't actually check that many patients in per day.)

I could surmise that stereotypically hectic and overburdened times (Thanksgiving/Christmas) or stereotypically romantic times (New Year's/Valentine's) or stereotypically hedonistic times (spring break, New Year's again) lead to unintended pregnancy. And surely the delaying of one's own needs during family-heavy holidays would explain part of the resurgence of appointment requests afterward. But I don't really know and I don't think there's any way to find out on a large scale. It'd be interesting, though, to ask individual women to recount the story of what prompted them to seek abortion care when they did, and why. If only such questions weren't so politically loaded, so likely to suggest there's a right and a wrong answer, maybe we'd hear a lot of honest and interesting stories.

The story of the time I was a dick

Why does she keep shouting ABORTION at me? 

Yesterday our guest blogger Amy mentioned that phone calls about abortion care often sound like this:

"Um...I wanted to know how much it costs?" and "Hi...I'm looking for some information about...abortion?" (spoken as a question, with the word "abortion" issued in a whisper)

And that her responses sometimes sounded like this:

"I would be happy to answer any questions you have about ABORTION! What type of ABORTION do you think you might be interested in having?"

I can totally relate. Who hasn't had this kind of call? It was one of the first patterns I noticed about callers when I started working on the phone lines.

Maybe Amy was more mature or less self-centered than me when she started her clinic work. But for my part, there was a real evolution in how I understood such callers. Initially, I felt frustrated to pick up the phone at my work and hear that the person on the other end of the line couldn't bring themselves to speak about my work. I experienced it as stigmatizing of ME, like they were attempting to distance themselves from my work even as they were asking me to tell them about it.

Sometimes they would ask with words like "terminations" or "D&C" instead of "abortion" -- maybe those words sounded more genteel or more like medicalese.

I'm ashamed to say that, early on, if someone called and said, "Hi, I need to know how much it costs," I would reply, "For what kind of services?" Even though it soon became clear that, if someone was calling about, say, a Pap smear, they simply said "Hi, I need to know how much a Pap smear costs." For a brief period of time, I believed that it was more important for the caller to say the word abortion than to feel comfortable asking about it.

At least that phase ended rather quickly. When a woman called and I heard echoes as she asked me questions, I mentioned her voice was sounding funny, as though she was in a bathroom or something -- and she said yes, she was at work and this was the only private place she could duck into. Duh, me.

Whether because they're not sure they've called the right place, they can't believe they're in this situation, or they can't risk being overheard by a coworker or family member, callers can't always discuss abortion openly and explicitly over the phone.

There will be time for that at their appointment, if they make one, when they meet with the counselor or health educator to express any questions or concerns about their health, the procedure itself, their experiences leading up to the appointment and how they will fare afterward. Usually patients can bring a loved one or support person into the counseling/education session, but a portion is also dedicated to one-on-one time with the staff person, in case the patient has something that might not be easy or safe to express in front of their companion. These sessions can be conducted as part of an abortion appointment, or prior to deciding whether or not to have an abortion. It's dramatically different from a phone call that might by necessity be taking place in public.

So now I know better. I learned to respond to "I need to know how much you charge" with something like, "Sure, I can talk to you about our different fees, but we provide many kinds of care here. Were you asking about a Pap smear, or...an abortion, or...?" If they are asking about an abortion, they normally stop me there and say "Yes, that's it." Easy peasy. It's okay for me to do the talking, if that's what the caller is looking for.

Not that every caller is in this situation! It runs the gamut: on one end is this (or even, as Amy writes, the ones who never call), and on the other end is someone calling to set up their appointment while also ordering dinner for five from the drive-through. But that's a story for another post.

Guest post: Caring for the Ones Who Never Call

I'm incredibly pleased to introduce a guest writer today. Amy Littlefield is a former abortion counselor and founder of The Provider Project: Stories From the Abortion-Providing Community, an excellent and groundbreaking endeavor that really strikes a chord with our own blog's founding mission.

Stay tuned to the Provider Project, where Amy's piece is cross-posted, and you might see an Abortioneers post there soon!

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

Amy Littlefield

Caring for the Ones Who Never Call

It can be a scary prospect to call up an abortion clinic and make an appointment for what has become one of our society's most stigmatized -- and yet one of its most common -- medical procedures.

Which is probably why some patients don't immediately admit that's why they're calling.

As a former phone counselor at a clinic, I used to hear a lot of: "Um...I wanted to know how much it costs?" and "Hi...I'm looking for some information about...abortion?"

(This last one was spoken as a question, with the word "abortion" issued in a whisper, like a big, bad, ugly secret.)

I sometimes tried to use the word as much as possible when I answered those tentative calls.

"I would be happy to answer any questions you have about ABORTION! What type of ABORTION do you think you might be interested in having?"

Often, these patients weren’t simply calling for information; they knew they wanted an abortion, but they were scared and confused about what the process might entail.

I sometimes felt like women called just to test us out. Maybe they had always believed abortion was murder and they wanted to know whether we would tell them what they were doing was wrong or try to make them feel guilty. Maybe they were wondering whether the women who worked in the Big, Bad Baby-Killing Center were human beings like them. Many were scared they wouldn't be able to have children in the future, or that we would do something violent and terrible to remove their unwanted pregnancies.

They were certain we would judge them, just as others in their life had judged them. They were wondering whether they could trust us with their stories.

They ached to justify themselves.

"Look, I have to do this, I have a nine-month-old at home."

"I'm homeless and I already have two kids."

"I've never believed in abortion, but I just can't have a baby right now."

I was sometimes amazed at how relieved women were to tell their stories. To a stranger. Over the phone. And to have that stranger accept their stories Without judgment. Without telling them what was right and what was wrong. So listening became part of the process of making an appointment. When I finished booking the appointment and asked if they had any other questions, I could sometimes hear the relief in their voices.

Given how terrifying that first step can be for many patients, I often wondered how many women wanted to call, but never did.

The abortion rate has been declining among almost all groups of women across the country (although a recent study [pdf] showed that the global abortion rate has stalled after a period of decline). Many in the abortion-providing community believe this decline is a result of rising stigma, not of improved access to birth control or sex education (since, by and large, those things are not improving). Nor is it happening because women's economic situations have magically improved, since the abortion rate is still rising among poor women (which proves, by the way, that you can't advocate for reproductive justice without combating capitalist exploitation of the poor).

Brigit Ordway, a veteran counselor whom I interviewed as part of an audio project compiling voices from the abortion-providing community told me she thinks women face more stigma now than they did back in the decade or so after it was legalized.

She said:

"That's the biggest difference now -- women aren't telling each other about this. We all did and we got support, for the most part. Now, probably most women would get support from their friends and family, but they’re assuming that they won't. They're assuming that everybody is not pro-choice and that they're going to be judged and maybe even worse, you know, maybe somebody's going to come throw something at them. So women are silent about it now. They don't get the support of each other or society, because they don't talk about it, I think. It's a huge difference. It's all now secret and shameful for people."

So abortion counseling, for me, whether it was done on the phone or in person, became largely about trying to lift the burden of guilt that women thought they were obligated to feel for having an abortion. It was about helping them realize that they were still good, still loving, still worthy of respect. They drove past protesters and graphic posters of chopped-up babies to get into the clinic, but once they were inside, they were treated with respect.

Every so often we would get a call from a woman who wanted to come to the clinic, but couldn't bring herself to enter the doors after she saw the protesters' signs. Those women reminded me how limited my understanding of abortion is. I saw women who were beating themselves up emotionally for having an abortion they felt was necessary. But I never saw the women who were too scared to come in, too scared to even call.

One abortion provider whom I interviewed has found a way to help those women.

Dr. Deborah Oyer, who owns a clinic in Seattle, Washington, created a series of videos describing the process of an abortion at her clinic. In a soothing and straightforward voice, she describes the steps a patient goes through, from the moment she enters the door until she leaves. This is the kind of education I tried to do with patients over the phone -- but she has found a way to do it without requiring women to take that scary first step. Instead, wrapped in the Internet's comfy blanket of anonymity, they can learn that abortion is not as scary as they might have imagined.

The videos provide basic education about abortion and birth control that counteract common and harmful myths. They also show women that -- contrary to popular mythology -- the doctor who will be performing their abortion is a friendly and approachable woman, not a crazy, rabid devil-monster with horns (Oyer told me she often sees women relax visibly after she enters the room, since she is so un-monsterlike). She has one video that consists entirely of her introducing herself. That video, uploaded two years ago, has 550 views on YouTube.

The video about surgical abortion has 58,816.

The one on medication abortion has 27,668.

Clearly, people need this information.

I'm grateful to Deborah Oyer for putting her voice and face out there, despite the risks that it could mean for her in a world where abortion providers are targeted with hate speech and harassment, and even sometimes with bullets. I'm grateful that there is accurate information out there about abortion for everyone -- of every gender -- who wonders how it is done. But I’m especially grateful that there is education for the patients whom I never got to talk to -- for the ones who never call.

Listen to Deborah Oyer discussing the videos at The Provider Project, www.theproviderproject.org.

Phone Etiquette

Lately, I've been thinking about how people who call doctors' offices can act strange on the phone. I've had/or my friends have had any of the following situations occur before:

1) Patient who wants an abortion ordering McDonalds while trying to schedule an appointment.
2) Patient screaming at her kid while trying to schedule an abortion (I always cringe whenever this happens).
3) Client's mother screaming at daughter (who needs/wants an abortion) because the daughter was so "stupid to get knocked up!" (Ugh. Also cringe-worthy.)
4) Patient's boyfriend who calls to "make sure she really had her abortion."
5) Patient's driver calling to pick up the patient after her abortion, but refusing to walk inside the clinic to get her.

If I could make a request of people: please don't call us and scream. Please don't scream at us, in our ear, at your child, at your mother, or at your partner when talking to us on the phone. Thanks!

I'm sure you've had crazy phone situations, too. Though sometimes I want to hang up - especially when yelling ensues - I am grateful that people are so different that they keep us on our toes.