“The truth will do.”
—Dr. Willie Parker
A vacuum aspiration abortion in the first twelve weeks of pregnancy is a safe five-minute procedure. Your practitioner puts your legs in stirrups, a position that may be familiar from pap smears. She inserts a speculum into your vagina to gain access to your cervix, which is at the deepest part of the vaginal canal. She may inject a local anesthetic into your cervix—similar to local numbing in dentistry. Then she stretches the small opening in the middle of your cervix (the cervical os) with metal or plastic rods—the size of the opening needed corresponds to the age of the fetus: at eight weeks, it’s eight millimeters.1
The cervical os leads to your uterus, where the embryo has implanted itself in the uterine wall. Holding the cervix steady with a tiny clamp, the practitioner then introduces a drinking straw–like tube into your uterus. This tube is connected to a flexible line. A small pump nearby generates gentle suction to vacuum out the contents of your uterus. To make sure the entire embryo or fetus is removed, the practitioner will look at what was suctioned out to see if it is all there. If not, she may need to suction again.
At eight weeks the fetus is the size of a kidney bean. At twelve weeks it is two inches long and weighs half an ounce. (It graduates from embryo to fetus at eight weeks.) Ninety percent of abortions in the United States are performed before twelve weeks.2
During the abortion, you may feel discomfort or pain, which varies widely from individual to individual. The pain is due to muscular contractions as the uterus returns to its nonpregnant size. Patients describe this as feeling like menstrual cramps. The process of stretching open the cervix may also hurt. Usually, clinics provide an over-the-counter painkiller beforehand, and some clinics provide something to help relax the patient, like small doses of Xanax or an antihistamine. General anesthesia is more dangerous than the procedure itself, and unnecessary. In the United States, the abortion will cost you, on average, $530.
After the abortion, you may experience bleeding or spotting for a week. If the bleeding is heavy, however, it’s possible that the abortion was incomplete, and you might need to go back and have another aspiration. This is rare when the practitioner is experienced and competent. (Call your practitioner and describe any unexpected symptoms, to be sure.)
In earlier decades, the standard practice was for the clinician to use a curette, a longish metal instrument with a tiny sharpened loop or spoon on the end, to scrape out the contents of the uterus; hence the shorthand ‘‘D&C’’ for abortion: Dilation (of the cervical opening) and curettage (scraping with the curette).3
This method carries more risk of abrasions or punctures, and has largely been supplanted by aspiration. It was the organizing of the feminist women’s health movement that made vacuum aspiration the gold standard for abortion care. US doctors muddled through using D&C long after aspiration became standard in China, Japan, Europe, and the Soviet Union.4
Thirty percent of abortions in the United States are now carried out with pills, the descendants of RU-486, the French abortion pill developed in the 1980s.5
For pregnancies up to ten weeks, a clinician dispenses one pill, mifepristone, and then at least twenty-four hours later, you take a different medication, misoprostol, stimulating a miscarriage. While pill abortions are safe and could be inexpensive, US regulators have made sure that they are just as costly and difficult to obtain as the surgical kind. (There’s more on pill abortions in Chapter 4
Ten to fifteen percent of known pregnancies end in miscarriage, also known as spontaneous abortion. Thirty to forty percent of all
conceptions end in miscarriage, but mostly these occur before you know you’re pregnant.6
It’s remarkably hard to cause a miscarriage through your activities (strenuous exercise, jumping from a height, blows to the abdomen) or by what you ingest (herbs, alcohol, drugs), as many women down the ages have discovered. Instead, spontaneous abortion ordinarily occurs because genetic abnormalities mean the embryo can’t develop.
An experienced practitioner can assess how long you’ve been pregnant by feeling the size of your uterus, though some clinics also use ultrasound imaging. Information about when you last menstruated is helpful, but since many women have irregular periods, and some experience bleeding that masquerades as a light period early in pregnancy, practitioners like to check.
Abortions later than twelve weeks—that is, during the second trimester of pregnancy—may take more time, because the fetus is larger and presents a mechanical problem to remove through the cervical opening. For this reason, earlier abortions are easier on the patient—also, you’ll spend less time being pregnant. Nine percent of US abortions occur after the first trimester, while one percent occur after twenty weeks. A 2006 study finds that 58 percent of women in the United States would have liked to have had their abortions earlier than they did.7
In the hands of a competent practitioner, abortions up until twenty-four weeks—the current legal limit for elective abortions—are safe.
Roe limits how much states can restrict abortion before twenty-four weeks. But antiabortion forces have been trying to shorten the time window in which you can get an abortion. Several states restrict second-trimester abortions, and Congress even banned one second-trimester method, dilation and extraction (so-called partial birth abortion) and the Supreme Court gave its stamp of approval in 2007.
Thirty percent of women in the United States will get an abortion, if current rates hold. This figure has been remarkably stable since the 1840s, according to medical historian James Mohr. Around 25 to 30 percent of women have been getting abortions, legal or illegal, for most of the nation’s history. This means abortion has been an important element in the lives of our great grandmothers, grandmothers, mothers, aunts, sisters, teachers, coworkers, and friends, not to mention their partners, who also may not have wanted to have a child at the time. It is bizarre to treat such a common experience as an emergency measure, a last resort, or a terrible, wrenching decision.
Most women who get an abortion already have at least one child. This came as a surprise to one mother, Lauren Sandler, who writes in Vox
that she thought her determination to get an abortion made her a freak. “If I, already happily immersed in parenting, chose to terminate, wouldn’t I be unusual for doing so, maybe even stigmatized as a sort of prenatal Medea?” She was stunned to learn that seven out of ten women who get abortions are mothers. She suggests this is hidden because antiabortion forces find it difficult to demonize moms.8
Young women under eighteen are 7 percent of those getting abortions. In thirty-seven states, they face parental involvement laws. Either a parent has to sign a form consenting to the procedure or one or both parents have to attest they’ve been notified. In Florida, which requires notification, this might as well be consent, because the parent is notified forty-eight hours in advance, which allows plenty of time to stop the procedure.
Low-waged, unemployed, and uninsured women get more abortions than those with higher pay or better health insurance. This is because reliable birth control is expensive and often requires multiple clinic or doctor visits.
African-American women get abortions at higher rates than white women. Since black women experience job discrimination, they are less likely to have good medical coverage, putting reliable contraception further out of reach.
Black women are the target of extra guilt-tripping by antiabortion forces. Billboards put up by a white-led group claimed, “The most dangerous place for a Black baby is in the womb,” and a documentary claiming to be a civil rights film made by a white antiabortion filmmaker “equates abortion by black women to slavery and … eugenics experiments.”9
Dr. Willie Parker, an abortion practitioner who is African American, takes particular exception to these claims:
The people behind the black genocide [charge] … are using women of color as pawns in a much bigger game. For they understand what too few of the foot soldiers in the abortion debate do. In abortion politics, all women are sisters, linked by their ability to bear children. If the antis can change the terms … framing it as a systemic racism perpetrated by big health-care institutions against black people, then they can change the laws around abortion and no one will intervene, not even the white women who need abortions, too.10
The black genocide charge resonates because the US government has carried out very real racist sterilization and population control policies against African Americans, Puerto Ricans, Native Americans, Mexican Americans, and other people of color. (There is more on racist population control in Chapter 2
People who don’t identify as women. Trans men and others who don’t identify as women have abortions. Abortion rights are for anyone who can get pregnant.
have abortions at the same rate as the general population.11
“Female antiabortion activists who get abortions are the dirty little secret of the antiabortion movement,” writes Carol Downer, a founder of the Feminist Women’s Health Centers.12
Sylvia Stengle was director of a clinic in Allentown, Pennsylvania, that faced weekly picketers, some of whom came in for abortions. “Terminating a pregnancy throws these women into deep emotional conflict,” she observes. “They have to rationalize their actions, but can’t, because they are living in a dysfunctional value system that doesn’t allow for realistic solutions.”13
An administrator at a Cincinnati abortion clinic recalls that on two occasions, fathers whom she recognized from their regular picketing at another clinic brought their daughters in for abortions. As she explains:
These are people who can’t face having the neighbors or people at church find out that their daughters are sexually active. They also seem to believe that their daughters are different from the other women in the clinic waiting room, and the daughters seem to think so too.
The counselors make clear “that their behavior, and their predicament, is no different from that of the clinic’s other clients.”14
Behind every abortion is a man who didn’t wear a condom. In that sense, all abortions are about birth control, birth control the man didn’t use. But birth control is considered a female responsibility. When abortion is discussed, he fades out of the picture while her sexual activities and her “failure to take precautions” are picked over in detail. His sexual activities or failure to use birth control are rarely considered.
This is not to scold everyone who hasn’t used contraceptives at all times unless they want to conceive. I haven’t. Have you? But it does illustrate a double standard. The struggle for free, safe, and legal abortion is regarded as a women’s issue, something that men don’t have to think about, just like they don’t have to think about other forms of birth control. Women pay the higher price for pregnancy, both biologically and socially, so we are the ones who end up taking on the worry, discomfort, and health burdens of pills, implants, IUDs, putting in and taking out diaphragms, cervical caps, and sponges, and getting the morning-after pill. Often we bear the expense, too.
Of course, not all accidental pregnancies are his fault. What if the condom broke? Also, it’s not her fault when the birth control pill didn’t work (it’s only 91 percent effective), the diaphragm didn’t work (it’s 88 percent effective), the birth control shot didn’t work (94 percent effective), the IUD didn’t work (99 percent effective), or the vaginal ring didn’t work (91 percent effective). Condoms are 85 percent effective. All methods of birth control have failure rates, even sterilization (99 percent effective). Ninety-four percent effective means that out of one hundred couples using the method, six will get pregnant each year.
Sometimes neither partner uses birth control. “I wound up going out on a one-night stand … without using any birth control,” recalled Redstocking Colette Price at a 1989 abortion speakout:
, who used to sit and cry and worry about pregnancy [when abortion was illegal]. And I got pregnant. One time. I couldn’t believe it. I couldn’t believe that I had actually done that. So there I was pregnant. I certainly wasn’t going to have a baby from a one-night stand. [It was] one of those terrible things that you think you would never do and here I did it. So anyway, I had an abortion, and I thought to myself, God, if abortion weren’t legal, this could ruin my life
. This mistake—and I consider it a mistake, an irresponsible act on my part, a real mess up—this mistake could have ruined my life. So I consider that the Women’s Liberation Movement saved me.15
Neither partner used birth control, but you can bet that the man didn’t worry about ruining his life. When we testify about our experiences with birth control in consciousness-raising meetings, we find that women are more conscientious than men. Many of the times that we end up not using contraception, it is due to our partner’s resistance to wearing a condom.
Why should abortion be the absolute last resort? True, it can be physically uncomfortable and unpleasant—both being pregnant and the abortion itself. And in the United States, it’s expensive, and in many ...