The Vital Need for Family Planning and Abortion Services

Richard Grossman, a member of Durango (Colo.) Meeting, has practiced obstetrics and gynecology in Durango since 1976. He is clerk of Quaker Earthcare Witness.

I am proud to belong to a religion that honors diversity. This seems to be a constant in Quakerism. Our testimonies are not set in stone, but seem to vary with time and location. Since many of us have different backgrounds (and many did not grow up in Quakerism), it is only natural that we should have varying opinions. And one of the important aspects of our religion is that we honor each other’s beliefs.

When I read Rachel MacNair’s “My Personal Journey on the Abortion Issue” in the February 2010 issue of FRIENDS JOURNAL, I did not agree with some of what she wrote, but I honor her convictions and the pathway she describes that led her to them. Of course, other people have reached different conclusions about abortion, and it is important to have other sides of this multifaceted story represented in FRIENDS JOURNAL.

I would like to explain why I believe that it is important for both individuals and society that women have access to safe and legal abortion services, and further, why I have chosen to be an abortion provider for over a third of a century.

When I was a student in a Quaker high school, I resolved to work for peace. I recognized that my strengths were in science, not politics, and I headed toward a career in medicine. Albert Schweitzer was one of my heroes. Also, even before publication of the book The Population Bomb, written by another of my heroes, Paul Ehrlich, I recognized that increasing human population is associated with an increased risk of war.

As a senior at Swarthmore College, I met a young lawyer who predicted that the climate in the United States would change and that abortion would become legal. I was incredulous, since I had been brought up to assume that abortion would always remain illegal. It was not until years later that we learned the autopsy results of an attractive Swarthmore student who had committed suicide. The autopsy showed that she was pregnant. Apparently, she felt that the best way to deal with an unplanned pregnancy was to lie on the railroad tracks one morning as the train came around a curve.

I graduated from medical school in 1969, an era when abortion was illegal in most parts of this country. Although I personally never took care of a woman who suffered from a back-alley butcher job, I remember hearing about the sad consequences. In addition to humiliation, these women suffered from hemorrhages, infections, sterility, and even death.

I started my specialty training in obstetrics and gynecology shortly after the 1973 Supreme Court decision, Roe v. Wade, which made abortion legal. It did not take me long to realize that women requesting abortions are often the victims of difficult circumstances. They are commonly of lower socioeconomic status. Some have medical problems that would make a pregnancy dangerous to their health. Many women don’t know where to access family planning services or can’t afford birth control pills. Some women experience a failure of their contraceptive methods. Others fail to use their family planning methods correctly. A fewSome women are victims of rape. I see many women who, unfortunately, have suffered lifelong abuse and don’t feel empowered enough to say “no.”

Requests for abortion are almost always due to a failure: failure of a contraceptive method, failure to use contraception, failure to respect a woman, or failure of a relationship. Sometimes the pregnancy is desired, but the fetus has a serious genetic condition. Rarely, the mother’s physical health makes it dangerous for her to carry the pregnancy. Preexisting mental health problems are common also among women requesting abortions.

I perform abortions at a Planned Parenthood clinic that has a wonderful staff. They are caring, women-centered, and well trained to recognize and deal with women’s feelings about a problem pregnancy. They offer support if the woman wishes to continue thea pregnancy, and help if she decides to relinquish the infant.

I cannot say much for the people who picket outside the clinic. They yell at women who are already emotionally vulnerable. I am sure that these picketers believe what they are doing is laudable, but I perceive that they are more motivated by an attempt to exert power over women than by Jesus’ teachings of love.

Certainly hate was part of the motivation of the man who killed abortion provider Dr. George Tiller in Wichita, Kansas, on May 31, 2009. I met this dedicated abortion provider just once. He seemed to have a gentle, caring soul, which many others have also ascribed to him. I have worn a bulletproof vest at times. However, my chief protection against people who might want to kill me because I perform abortions is different. I feel fairly safe in my community because of my Quaker beliefs.

It is interesting that a number of women who come to me for abortions admit that they had been against abortion until they themselves faced an unwanted pregnancy. Apparently, they lacked the empathy to realize how distressing and life-changing this situation could be.

I also provide obstetrical care if a woman decides to continue an unplanned pregnancy. To me, this is the true meaning of “choice.”

What is the alternative to safe, legal, and empathetic abortion care? Unfortunately, we know the answer to this question all too well. Anthropologists tell us that abortion has been around much longer than modern healthcare. Women still seek to terminate pregnancies in countries where abortion is illegal, and where the risk is greater that abortions are done without respect for the woman. As with other black-market services, money may well be the main motivation in such places.

Before 1973, in the United States, illegal abortions often ended with injury to the woman or her death. Tens of thousands of women still die each year in other countries because of laws prohibiting abortion. Examples of techniques that are used include beating or kicking the woman’s abdomen or inserting sharp objects into her uterus. Laws prohibiting abortion do not prevent it, but instead, drive women to desperate, degrading measures.

What about psychological damage to the mother from having an abortion? Former Surgeon General Everett Koop—strongly against abortion¬¬—called the psychological harm caused by abortion “minuscule from a public health perspective.” He came to this conclusion after President Reagan, also against choice, asked Koop to review the literature on legal abortion. My experience from many years of providing care suggests that women who have had an abortion sometimes express regret, but usually not. Most often they express happiness that they were able to have the abortion.

People who are against abortion usually base their belief on religious convictions. Sometimes they don’t let facts stand in their way; I call this “lying for Jesus.” An example is the notion that, if a woman aborts a pregnancy, she will develop breast cancer. Although an old study suggested that the incidence of breast cancer was higher among women who had had an abortion, more recent studies have found no association between abortion and breast cancer. In 2003, the American College of Obstetricians and Gynecologists echoed the findings of other professional groups when it found that: “There is no evidence supporting a causal link between induced abortion and subsequent development of breast cancer.” Yet anti-abortion literature still tries to scare women with this lie.

What happens to the children who are “saved” from abortion? Careful studies done in the Czech Republic, where access to abortion is tightly controlled, answer this question. The results showed that unwanted children, whose mothers had been denied abortions, were less likely to graduate from high school and have satisfying relationships, and more likely to be jailed and experience addiction than desired children. American psychologist Henry David published these findings in 1988 in Born Unwanted: developmental effects of denied abortion.

It is essential that abortion be legal and available to all women—both here in the United States and in the rest of the world. There is another, public health-related reason to increase access to abortion that is no less important than aiding individual women and couples. Unfortunately, this second reason is seldom considered in the abortion debate. This reason is that our planet is already overpopulated. It would take one-and-two-fifths planet Earths to support the present human population sustainably at our current level of consumption. Since few people seem interested in voluntary simplicity, the best way to keep humans from wrecking the planet’s ecosystem entirely is by helping women and couples voluntarily control their fertility. This means providing access to modern family planning and abortion.

Using the Ecological Footprint method at to compare what humanity uses of the world’s resources, we can estimate that we are using 40 percent more than is sustainable. This calculation assumes that all resources support humans and does not allow any resources for non-human species! The discrepancy between demand and supply contributes to many of the problems that we all know—global climate change, decreasing soil fertility, increasing pollution, peak oil, plummeting ocean fisheries, accelerated extinction of species, and more.

According to the Guttmacher Institute, an estimated 215 million couples worldwide want to limit their fertility but do not have access to effective, modern contraceptive methods. What a difference it would make if all these people could use safe family planning! Making voluntary family planning services available to all would decrease the rate of global climate change more than any other means, and would cost less.

A report published in 2009, “Fewer Emitters, Lower Emissions, Less Cost,” available at , supports the point that the best, least expensive way to slow climate change is with family planning services. Making voluntary family planning available to all may also be the most effective way to slow many of the pestilences that are confronting us. I also think that it may be the best way to decrease the risk of armed conflict in the future.

What?—“Condoms for Peace”? Yes, there is strong evidence that our present course will increase the incidence of war. Many of the problems cited above will make life more difficult, especially for the billion or so of the world’s poorest people who live on less than two dollars a day. Wars are fought over scarce resources. The projected impact of climate change leads one scholar to estimate that hundreds of millions of people will starve to death later this century.

One of the greatest disgraces in the United States is that almost half of pregnancies conceived here are unplanned, according to the Guttmacher Institute. Unfortunately, every society will have some unplanned pregnancies due to the failure rate of even the best contraceptive methods—and all the other aforementioned failures.

What can a woman do to protect herself after an encounter that may have led to an unwanted pregnancy? Amazingly safe and effective emergency contraception (EC) pills are available without prescription in the United States and many other countries. In the U.S., the brand name is “Plan B” or “Plan B One Step.” Although there is a concern among those who are against abortion that emergency contraception can cause an abortion, medical science does not support this concern. Another viable option for women is a copper-containing IUD (Paragard in the U.S.), which is even more effective than the hormonal EC and can be used for up to five days after unprotected sex.

If the goal is zero population growth (ZPG—a total fertility rate of approximately 2.1), then almost no society has reached that goal without access to legal abortion. Yes, there are exceptions to this rule; in Ireland, where abortion is illegal, they have nevertheless achieved ZPG. Ireland is an interesting case where abortion is available to those who can afford the service by taking a quick trip to England.

I honor those who are against abortion, especially if that belief is part of a broader belief in the sacredness of life. These people may also be pacifists who don’t eat meat and are against capital punishment. I have less respect for people whose beliefs are against abortion because their religion tells them to be against abortion. My perception is that the real reason behind this prohibition is fear—fear that women will have too much power if they are allowed to control their own reproduction.

The reality, as I see it, is that all life is sacred—not just human life. We must not lose sight of the fact that we are just one very important species in the web of life. Unfortunately, humans can overwhelm that web and cause its deterioration. The web of life, just like a farmer’s field, has a limited carrying capacity. If there are too many animals in the farmer’s field, then it is quickly overgrazed, and the field’s ability to support life diminishes.

It now appears that the world that we will leave to our progeny will be less rich than the world we ourselves have enjoyed. This saddens me as I think of my granddaughters’ future.

I would be happy if all pregnancies were planned and desired so that I would never again be called upon to perform another abortion. Until that time, however, I will work so that safe, legal, and compassionate abortion services remain available in this country.

A high school senior voiced the best statement supporting the availability of safe, legal abortion. She was quiet before the procedure, but sat up when it was finished and said, “Thank you, Doctor. You have given me back my future.”

This article appeared in FRIENDS JOURNAL September, 2010.