Nearly everywhere in the world families now have the right to limit the number of children they will conceive, according to their ability to love and cherish, feed, house, clothe, and educate them. The need for similar adult freedom of action to terminate accidental and unwanted pregnancies, for personal and social reasons as well as therapeutic ones, is being discussed covertly and sometimes openly by church, lay, and medical groups.
What are the facts about abortion in the United States today? How widely is it resorted to and by whom? What percentage is legal (therapeutic) and what illegal? Are its illegal practitioners sinister moneygrubbers without skill, knowledge, or proper instruments, or are they licensed physicians? Is the operation as potentially dangerous as generations of women have been led to believe?
Reliable statistics are, naturally enough, hard to get in the United States, though they are readily available from such countries as Sweden, Denmark, Russia, and Japan, where abortion is, in varying cases, legal. Nobody who places a bet with a bookmaker has any particular hesitation about admitting it, but few women, gossips or not, discuss their abortions at the bridge table. Lack of discussion probably has nothing to do with shame or reticence but is simply a loyal conspiracy of silence on the part of women to protect abortionists. Any woman of childbearing age who knows a reliable man in this field has a stake in keeping him in business. She may need him herself, or have a close friend who will.
I set out recently to find an abortionist in the large Eastern city where I live. My husband and I are in our mid-forties and have three children. When I discovered that I was pregnant for the fourth time, my husband and I considered the situation as honestly as we could. We both admitted that we lacked the physical resources to face 2 A.M. feedings, diapers, and the seemingly endless cycle of measles, mumps, and concussions of another child. Years of keeping a wary eye on expenditures (a new suit for my husband every two years and one for me every five) had allowed us to set up a fund which we felt would enable the children to attend reasonably good colleges away from home if some financial assistance in the form of grants or scholarships could be obtained. Since my husband's income has reached its zenith, it was plain that one of the four would have to forgo all or part of a chance at higher education. The part-time secretarial work which I had been doing for some years to augment our income would have to stop since the revenue it produces would not cover baby-sitting fees. We have no rich uncles likely to make our children their beneficiaries. We have also had sufficient experience living to acknowledge that while the Lord will sometimes provide, He may be busy looking after somebody else when you need Him most.
A brief foray for information in medical circles indicated that in the state where we live, legal grounds for abortion are limited to patients known to have cancer, ectopic (tubal or peritoneal) pregnancies, and in some rare instances, acute heart conditions or advanced psychoses.
I spent a brief moment of reflective gratitude for a clean bill of health on these counts, and then pushed my glasses up on my nose to read a book called Pregnancy, Birth and Abortion, written by four members of the Institute for Sex Research, founded by the late renowned Dr. Kinsey. It turned out to be most reassuring, though it probably wasn't intended to be. I discovered that abortion is an operation that all med students learn, even if they don't get much chance to perfect techniques; that of the institute's sample, only a minute percentage of women had suffered either physical or psychic aftereffects; and that while the authors made no attempt to estimate the number of abortions performed every year in the United States, it was plain that even without the Good Housekeeping Seal of Approval, I had lots of company.
Calmed by authoritative word and two tranquilizers, I settled down to see what could be done. First step was a visit to my obstetrician. (The boys from the institute indicated that probably every doctor in the country had been asked at least once to perform an abortion, and there was some evidence that out of compassion many had obliged.) Mine had run out of compassion by the time I saw him at 6 P.M. or else was too worried about getting his snowbound car out of the parking lot to pay much attention to me. He verified by pelvic examination the positive rabbit-test result which had previously very nearly guaranteed that I was pregnant, and refused to interfere with nature. When I asked him whether he would perform an abortion on me, he said, "No, thanks," in an absent way, as if I had offered him a cigarette he didn't want, and I left.
With the only legal avenue I knew closed, I began my search for illegal ones. I started out by going through my personal address and telephone book and selecting from it five close friends who had the following in common: all were intelligent, well educated, sympathetic, and discreet. Otherwise, they were a mixed lot. Some were married, some divorced or widowed; some were young, some mlddle-aged; two were Protestant, one was Jewish, one Catholic, and the fifth a scoffer. Of the five, one had, to my knowledge, herself had an abortion, but that was too long ago to lead me to suppose her operator was still at the same old stand.
I called each and stated bluntly that I needed an abortion and asked whether she knew anybody reasonably reliable who might do the job. Two (in addition to the one I have already mentioned) said that they themselves had obtained abortions within the last two years. Each gave me without hesitation the name, address, and telephone number of her physician. The fourth friend did a little detective work and in twenty-four hours came up with another physician, chiefly remarkable for the fact that his office was directly across the street from one of the city's police precinct stations. Fees, I was told, ranged from $300 to $750. My fifth contact got A for effort but was able to glean information only on a sort of disassembly-line procedure in a neighboring state, reputed to be supervised by a doctor. I discarded this as too shady for a middle-aged woman with obligations to a family and sat down to call the physicians.
My first call was made to the doctor whose credentials seemed to me best. When I asked for an appointment at his early convenience, he replied—somewhat nervously, I thought—that he was considering taking a trip and asked that I call back next week. Number two on my list proved able to see me the following day. My visit did a good deal to quell the panic which had been building steadily in spite of my efforts at self-control. The office seemed orderly, the tools of the trade were neatly arrayed in the glass cases dear to the hearts of the medical fraternity; the doctor's examination was brief and businesslike, and as far as I could tell identical with those performed on me over the years by obstetricians and gynecologists under different circumstances. He explained in simple and understandable terms exactly how he would perform the operation, how long it would take, that it would be painful, but not intolerably so, for a few minutes. (I gather that except for abortions done in hospitals, anesthetics are almost never used. For obvious reasons, these physicians work without assistance of any kind. They are thus not equipped to deal with the possible ill effects of anesthesia; nor can they keep patients in their offices for any great length of time without arousing suspicion about their practices.) The doctor I was consulting described precisely the minimal aftereffects I might expect. We fixed a date at mutual convenience a couple of days off for the operation.
This particular M.D. was able to strike a nice balance between willingness to help and lack of overeagerness to collect his $500, payable in advance. He stated frankly that he felt the element of physical risk was negligible but that the myths and exaggerations about abortion and the hard fact that it was an illegal procedure created prior apprehensions of sometimes damaging proportions. He urged me to call him and cancel the appointment if my husband and I felt there was any reason to reconsider our decision. Short of physical and fiscal miracles we had no right to expect, I didn't see what could alter our circumstances and told him so, but I agreed wholeheartedly about the apprehensions.
The operation was successfully concluded as scheduled. Forty-five minutes after I entered the doctor's office for the second time, I walked out, flagged a passing cab, and went home. Admirably relaxed for the first time in two weeks, I dozed over dinner, left the children to wash the dishes, and dove into bed to sleep for twelve hours. The operation and its aftereffects were exactly as described by the physician. For some five minutes I suffered "discomfort" closely approximating the contractions of advanced labor. Within ten minutes this pain subsided, and returned in the next four or five days only as the sort of mild twinge which sometimes accompanies a normal menstrual period. Bleeding was minimal.
Post hoc, my conclusions are these:
1. If five people, of my limited acquaintance, knew five different abortionists in active practice within a few square miles of each other, I find myself wondering if the abortion rate must not parallel the live birth rate in the United States.
2. Four of the five abortionists recommended to me were duly licensed physicians. Is this extraordinary, or are the dark tales about all abortions being performed in filthy surroundings by unskilled practitioners using knitting needles exaggerated?
3. My operation at least was performed with what seemed to me incredible proficiency, speed, and deftness, with sterile instruments designed for the purpose for which they were used. The Kinsey Institute is welcome to add me to its conclusions, which are that though they have been able to interview few abortionists, they are much impressed with the skill, humanity, and understanding these few showed for their patients.
I am sure that my experience is not unique. There must be hundreds like me from coast to coast who for sober and considered reasons daily undergo the same fears, search for the same kinds of operative sources, and find the money necessary to terminate unwanted pregnancy.
Some states are less rigid in enforcing antiabortion statutes than others. The low nationwide rate of convictions obtained against abortionists perhaps points not only to the difficulty of obtaining evidence against them but also to the acknowledgment by law enforcement agencies of the real necessity of such practices. As the Kinsey group says, "In our own sample we find that the great percentage of the women who had an illegal abortion stated that it had been the best solution to their immediate problem. This widespread difference between our overt culture as expressed in our laws and public pronouncements and our covert culture as expressed in what people actually do and secretly think is as true with abortion as with most types of sexual behavior."
Is the time coming when we can rid ourselves of one more hypocrisy, closing the gap between what we do and what we say we do? Therapeutic abortion practices will have to lead the way. There is some evidence that the first steps have been taken. Grounds for therapeutic abortion vary widely from state to state and from city to city. Unfavorable Rh factors, for instance, are considered reason to terminate pregnancy by some physicians in some areas, as is a case of German measles suffered in the early stages of pregnancy. Social grounds for abortion could follow, under the surveillance of abortion boards composed of M.D.'s and psychiatrists. (Such boards exist in many areas but are generally rubber-stamp groups who are notified by a physician that he will be performing a therapeutic abortion on date fixed by him in the hospital of his choice.)
I believe that dilation and curettage is the only method of abortion used, legally or illegally by most physicians in this country. Though the operation is a relatively simple one, it remains an operative procedure with some attendant risk of infection, however small, whether performed without anesthesia, in a hospital or in a doctor's office. Again citing the Kinsey group: "It is already evident that it would not be difficult to develop effective and safe abortifacients, including some to be taken orally. The fact that such a development has not been made is largely a moral matter."
The italics are mine. Is it moral anguish, fear of fine or imprisonment, and terror about illicit practices on families who have sound social reasons for terminating an unwanted pregnancy? If it is moral to prevent conception, is it immoral to interrupt an ill-advised one?