Abortion Stigma in the Classroom

14 Oct

“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.

9 Responses to “Abortion Stigma in the Classroom”

  1. Alicia October 14, 2011 at 12:46 pm #

    It’s terrible that your professor and a medical student said these things, but at the same time, it’s an opportunity to provide up-to-date facts. My college isn’t a medical school, so it’s more understandable when professors and students quote misinformation about abortion and reproductive health care. For the few people on campus who’re reproductive rights advocates, those have become welcome moments to correct misinformation and hopefully change some minds.

  2. Rachel October 14, 2011 at 1:52 pm #

    Steph, I’m so glad you’re around to correct these inaccuracies, and it’s very sad to hear that they’re made in the first place. If it’s any consolation, my medical school, located in a conservative area of the midwest, did an excellent job on our abortion lecture.

  3. Odile October 18, 2011 at 2:00 pm #

    You’re missing the difference here. While the profs are mostly correct in asserting that abortion does not impact a woman’s fertility, the med student is correct in saying that having an elective surgical abortion can cause complications with childbirth. When the cervix is artificially dilated, especially more than one time, it tends not to dilate on it’s own in the case of ‘routine’ labor and delivery, leading to an operative delivery which involves all the risks and complication of major abdominal surgery. Another complication, mostly in the case of later and late term abortions, occurs when the placenta is manually removed by curettage, especially more than one time. This could lead to potential scarring of the uterus, which might cause difficulty with the implantation of subsequent pregnancies, resulting in the risk of repeated spontaneous abortion. So the med student, while maybe not very articulate with details, was actually telling the truth.

    And stigma or not, later term abortions do involve ‘arms and legs’. This is medical fact. Your link about what happens in a later term abortion provides very one-sided information about the procedure. It says nothing about what the procedure entails for the fetus. Whether we like it or not, a human fetus is human. As early as eight weeks a fetus has a head, arms, legs, body. This is fact. If pulling out ‘arms and legs’ is what prevents providers from doing abortions, then that is a matter of their conscience, not any one else’s.

    Why are we afraid embrace the clinical facts of second trimester and later abortions? Yes, mothers know what is in there. They can feel the ‘arms and legs’ moving inside their uterus. The fetus is a living human form. When an elective surgical abortion ensues, then ‘arms and legs’ not to mention head and body, are removed. In pieces. Ok? If informing a woman of this fact causes her to cancel her abortion, then she has exercised her choice in an approriate fashion. Of course, in many cases, it will make no difference, but at the very minimum, the woman will have made her decision fully informed. This is an important consideration in terms of how a woman may or may not feel after the procedure. The time for caring for women and their mental health is before the procedure, not after, when the decision is irreversable. Abortion is legal in this country whether there is one per year, or one million – if we truly care about women then we should be supplying them with every scintilla of information when they are faced with difficult choices, ideology notwithstanding. I don’t think accurate medical facts have anything to do with stigmatization.

  4. Arielle Schecter October 18, 2011 at 6:44 pm #

    Stick it to ‘em, Steph!

  5. Katie October 20, 2011 at 3:19 am #

    And that is why I will not be going into your field. I’ve got to be honest, I love the warm and cozy feeling of being in a Gender and Women’s Studies program. Not that we don’t have similar issues, but nothing quite like that and never from a professor. But seriously, kudos. I wish I could take classes with you!

  6. NYCProchoiceMD October 20, 2011 at 8:50 am #

    Odile, what you state is simply not true. I’m not sure where you’re getting your information from, but the only possible negative effect in future pregnancies that has been seen from prior abortion is greater likelihood of preterm delivery. This is the opposite from what you’re claiming; preterm delivery is dilation that occurs too soon and too easily and has nothing to do with difficult dilation or operative delivery. The research on the association between abortion and adverse events in future pregnancies is quite mixed, most of it showing no association, and most studies that DO show an association have attributed it not to abortion itself but to the complex social circumstances surrounding abortion (ie poverty, discrimination).

    Manual curettage for removal of the placenta used to be a problem. This technique is generally not used now. So it’s not a contributor to problems with future pregnancies.

    Finally, your “arms and legs” argument doesn’t make a whole lot of sense either. The vast majority of women getting abortions get them far before any perception of fetal movement (which starts somewhere between 16-18 weeks). So 99% of women don’t feel any movement before getting their abortion.

    I don’t know where you’re getting your information, but clearly you are misinformed.

  7. Odile October 20, 2011 at 10:51 pm #

    NYCPCMD – with all due respect,

    Repeated trauma to the cervix can cause cervical stenosis.

    If you read my comment carefully, you will notice I was discussing second trimester abortions and beyond. Nine percent of abortions are done in the second trimester. That is approx. 117,000 abortions. Third trimester abortions account for 1.5% of total abortions, which is approx. 19,500 abortions. In total, accounting for 10.5% of abortions, so 89.5% of women who choose abortion do not feel fetal movement.

    I was merely asking the question, why, as abortion proponents, would we shy away from the facts? In D&E, and D&X procedures arms and legs are removed because they are part of the fetal tissue, and the placenta is removed by curettage and suction. How else would it be removed? This can lead to uterine scarring, which would potentiate the complication of future pregnancies as I have discussed, not to mention cause implantation problems if the uterus is not allowed sufficient healing time post procedure before subsequent pregnancy. These are real complications, so the medical student was not totally wrong, and not necessarily stigmatizing abortion.

    Fetal movement in a multiparous woman can be felt as early as 10 weeks, but more likely around thirteen to fourteen weeks. Since the second trimester ends at 26 weeks, that means women can feel movement for at least twelve weeks.

    Are you an abortion provider? If you are I certainly don’t need to enlighten you on what is being removed in D&E and D&X procedures, do I? Let’s not dumb women down, ok? I believe that witholding facts contributes to regret and self-recrimination. It shouldn’t be done.

  8. placenta sandwich October 31, 2011 at 9:22 pm #

    Odile: “why, as abortion proponents, would we”

    Let me just cut you off right there. Are you saying that you identify as an “abortion proponent”? I’d love to know, just out of curiosity.

  9. Odile November 1, 2011 at 10:48 am #

    Based upon the selected excerpt from my comment, why do you ask?

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