“Everyone knows that abortion isn’t just a trivial thing. It really affects people. I don’t know if any of you have seen one, but abortion makes it more difficult for you to have a baby afterwards and often involves complications.”
Spoken by an anti-choice clinic harasser? A comment on an anti-abortion blog? No. These were the words of a medical student visiting my graduate level reproductive health class. And not just any reproductive health class, but a required class at a top notch public health program.
The professors, two doctors, only corrected him on one aspect (“actually, having an abortion does not impact a woman’s fertility”) and left the rest of his misinformation for students to take to task. Several others (myself included) interjected that actually, we’ve worked in abortion clinics, thank you very much, and have seen abortions, and did you know that for some women, getting an abortion is much less traumatizing than giving birth, and there are women in this room who’ve had abortions, how dare you stigmatize them, and on and on.
This medical student was shadowing one of the professors to get a taste of the public health world while in medical school. This is fantastic, but clearly not enough to balance out the lack of accurate information about abortion in medical schools. This student felt totally comfortable mansplaining abortion to us as if his misinformation were God-given medical truth. This is what his med school professors are teaching him, and it’s going unchallenged.
This is not the first time my professors have screwed up and perpetuated abortion stigma in the classroom. In a discussion about later abortion, one professor stated that many doctors “aren’t comfortable providing abortions after the first trimester. We’re talking about removing arms and legs here.”
To make this statement in front of public health students, many of whom aren’t experts in abortion care and certainly aren’t doctors, is irresponsible, inaccurate, and frankly, infuriating. Let’s go point by point.
There is undoubtedly a lack of abortion providers in the US, particularly clinicians who perform abortions after the first trimester. But my professor created a false dichotomy. In the world of abortion care, there are not two categories of abortion: first trimester and everything else. Abortions happen in the first and second trimesters on a routine basis. Abortions in the second trimester are only referred to as “later abortions” once the pregnancy is beyond 17-20 weeks or so, and even this is up for debate within the medical, public health, and reproductive rights communities.
For my professor to make the statement that abortions after the first trimester are “late abortions” is factually inaccurate and also misleading. Just like there is no broad agreement on when fetal viability begins, there is no broadly agreed upon definition of what constitutes a later abortion (for more on this, see ANSIRH’s note on why they use “later abortion” instead of “later-term abortion”).
Now on to the thornier question. Are doctors not providing abortions after the first trimester because they think this procedure is “icky”? My professor says yes, but I can’t find any research to back her up. What we know is this:
“Approximately 60 percent of abortion-providing facilities offer abortion services after 14 weeks, and only 33 percent of the facilities offer abortions at 20 weeks. Only 24 percent of the facilities offer abortions at 21 weeks and beyond. Five states lack a provider performing abortions after 12 weeks for non-maternal or fetal indications, ten states lack a provider performing abortions after 15 weeks of pregnancy and 22 do not have a provider offering abortions after 20 weeks.” (thanks, Susan Yanow!)
Yes, after 14 weeks, abortions become more difficult to obtain. Why is this? Many reasons, including: lack of training in abortion techniques, restrictive legislation banning abortion at a certain point in pregnancy, the increasing threat of anti-abortion violence towards providers of later abortions, and more. That doctors may be uncomfortable performing these procedures is just one in a constellation of factors that make abortion after the first trimester more difficult to obtain.
Instead of using stigmatizing language, my professor could’ve actually described what happens during a later abortion. She could have explained why some providers may not be able to perform these procedures instead of revealing her own judgemental views on later abortion. She could have completely corrected the medical student who provided the class with misleading, false information in the guise of scientific fact.
I expect better from professors, from medical students, from my peers and from anyone who respects science, medicine, and evidenced-based information. Don’t wait for someone else to call out these inaccuracies when you hear them. It’s up to us to make sure that people in positions of power don’t perpetuate abortion stigma.