Sunday’s New York Times Magazine features an optimistic cover story: “The New Abortion Providers” by Emily Bazelon. It recounts the decades-long struggle of abortion advocates to become more accepted by the medical profession, because at the moment, the vast majority of abortions are done in isolated, high-volume, abortion-specialized clinics. The new goal for abortion supporters is “to recast doctors, changing them from a weak link to abortion to a strong one . . . with the hope that, eventually, more and more doctors will use their training to bring abortion into their practices . . . to integrate abortion so that it’s a seamless part of health care for women—embraced rather than shunned.”
“This is the future,” writes Bazelon. “Or rather, one possible future. There’s a long way to go,” she exhorts.
But it’s not the future. And it won’t be—for the same reasons abortion hasn’t really become accepted in all these decades it’s been legal in America—indeed, for the very same reasons Bazelon cites in her article. Young OB-GYNs aren’t keeping up with their predecessors in performing abortions (“in a 1992 survey of OB-GYNs, 59 percent of those age 65 and older said they performed abortions, compared with 28 percent of those age 50 and younger”); fewer OB-GYN residencies are offering abortion training (“in 1995, the number . . . fell to a low 12 percent”); donors who fund abortion-training residency fellowships are scarce (two of the only main fellowship grants come “from one foundation and from one family [of which] the donor has chosen to remain anonymous”); the number of doctors providing abortions out of their offices has dropped significantly (“doctors’ offices now account for only 2 percent of the total number of procedures; hospitals account for barely 5 percent”); and the American public is more anti-abortion now than ever (“some poll numbers [show] that for the first time, more Americans call themselves pro-life than pro-choice—a shift that includes young people.”). Basically abortion supporters are growing old and aren’t being replaced as quickly by the younger generation. The dream to make abortion mainstream is dying.
With the facts as they are, the article’s optimism for increased abortion acceptance in mainstream America is at best wishful thinking, at worst willful delusion. The publication of the piece can’t help but seem a part of a pro-abortion agenda: trying to prop it up to be a successful, growing industry, supported by most of the public—despite the fact that it isn’t.
America and abortion have always been an uneasy match. Unlike in Europe, where abortion was legislated slowly over time democratically and with regulations built in from the start, abortion on demand in America was legalized overnight by a Supreme Court decision, which in part explains why it’s still such a volatile, unresolved issue in America today. Legalized abortion was rushed and forced from the start, and it’s been a hard, rocky road since. After a while the abortion supporters in this article start to sound like the infatuated person who’s in denial that her partner really isn’t right for her. She keeps thinking he’ll change, or somehow the road will smooth out and things will work, even though things have never gone smoothly with him. When it comes to widely accepted abortion, the shoe never quite fit for mainstream America, and, more than thirty years later, it doesn’t look like it ever will. Still, as this article reports, abortion providers are determined to keep trying desperately to make this relationship work.
But this is unfair, right? How can I say this? Well, really, because the abortion supporters say it themselves. They embody the single biggest indicator of delusion, which is this: In order to see things working out their way, they have to imagine the world different than it is. Bazelon describes one Planned Parenthood director who “looked out the window, at all the people who she wished could feel the urgency she does, and pointed out that change in medicine comes slowly.”
And abortion supporters need this to keep going—they need to keep looking forward to the vision they have in mind. But what they lose along the way is a deeper understanding of why abortion isn’t accepted in public and medical life. Rather than trying to understand why support for abortion dwindles, they turn away, they cover up, they try to hide the discomforting part of abortion from patients, from nurses, from themselves. As Bazelon reports, one woman who’s working to increase the reach of abortion training, asks residents when they’re done with her program,
how they feel about doing the procedure at seven or ten or thirteen weeks. “Some will say, ‘I’m perfectly okay going up to ten weeks, but after that I can see more of the fetus moving on an ultrasound, and I’m just not comfortable with that.’” She has set her own threshold at fourteen weeks. “I’m not an OB-GYN, and I’m not a surgeon, and that’s as far as I can safely go,” she said. “But to be honest with you, I haven’t seen a lot of terminations past nineteen weeks. There’s a part of me that’s almost grateful that it’s not even an option for me.”
This abortion provider acknowledges that some “nurses don’t want to assist her, and she tries to meet them halfway by doing abortions only up to nine weeks of pregnancy.” “The early threshold means that no one on staff has to contend with recognizable fetal parts,” explains Bazelon.
And there’s the story of University of Michigan professor, Lisa Harris, who wrote an academic article two years ago about performing an eighteen-week abortion while she was eighteen weeks pregnant. As Bazelon recounts it:
Harris described grasping the fetus’ leg with her forceps, feeling a kick in her own uterus and starting to cry. “It was an overwhelming feeling—a brutally visceral response—heartfelt and unmediated by my training or my feminist pro-choice politics,” she wrote. “It was one of the more raw moments in my life.”
Somewhere in these women’s stories lies the reason why abortion still causes hesitation for much of the American public; the reason why many women who support the availability of abortion in the abstract say they wouldn’t do it themselves; the reason why many doctors who support abortion in polls don’t perform them in their offices. But abortion supporters, like those quoted in Bazelon’s article, find it hard to look closer to understand these reasons and grapple with them. One abortion provider says, “We want to bring this discussion more to the forefront, but it’s a bit dangerous.” It could distract from the agenda; taking a closer look into what makes the American public hesitate about abortion could make them hesitate, and they don’t want to risk that.
When they do hesitate, when they do find a moment when they feel uncomfortable or conflicted, as the women Bazelon interviews seem to show, they stop, reboot, and remind themselves why they’re doing this: It’s all for the protection of women. Despite all the pain, mainstream abortion access is important, supporters insist, because without it women may risk their lives attempting illegal abortions, like the woman in Kenya one practitioner witnessed, who came for medical attention “with a stick hanging out of her.” Without access to legal abortions, we’re back to back-alley abortions.
At least in America, women can legally have an abortion and survive. But in many ways, it’s still in the back alley. The story Bazelon’s article really tells us is just how impossible it is to take the back alley out of abortion. Abortion still isn’t accepted in the American medical profession; it still isn’t widely accepted in the American community; there will always be nurses or office staff who are uncomfortable assisting in abortions; there will always be doctors who don’t feel comfortable having abortion providers in their medical group; there will always be the health risks that come with abortion that causes medical-malpractice insurance coverage to be so high that family practice doctors don’t want to afford it; there will always be protests by people who see fetuses as deserving the same protections by law as babies after birth. These are the things we still see, and in growing number, decades after abortion was made legal in this country. This issue is not about to be settled anytime soon, and abortion will never be mainstream.
The procedure may be legally available and it may be performed quickly, cleanly, and skillfully, but the hard fact that some abortion supporters have trouble seeing is this: In many ways, abortion will always be in the back alley of public life. For many post-abortive women, it remains in the back alley of their minds: It’s not a place they’re proud of, not a place they’d like to linger, not a memory they’d like to revisit. And who can blame them?
Mary Rose Somarriba is managing editor of First Things.