I grew up in a small town, the son of small town teachers. We were Methodists but we went to whichever of the two churches (they alternated services) was open on a particular day for worship, Sunday School, MYF, BTU, prayer meeting or revival; the Baptist or the Methodist, it didn't matter...we were there! My father was the Sunday School superintendent (at the Methodist church) and my mother played the piano at both churches. Obviously we were well churched. We were also poor as church mice since my parents had five children on a very limited income.

I had no concept that I would ever be able to go to medical school when I was young, and when we started in 1964, I had no idea how we were going to be able to finish. But my mother always said to me, "the Lord has a special purpose for your life." (I suspect that she told all her children that.) The longer I live, even though I am not a particularly superstitious man, the more I have come to believe that to be true for each of us - if we make it happen.

By 1967 I was a third year medical student, still with no visible means of support, and we were pregnant with our third child. It was the spring of that year and I was ending my rotation in the Ob-Gyn Service clinic. I was assigned a 40 plus year old, poverty stricken mother of several children. I think she was unmarried but I am not sure of that now. This care worn mother-of-several had a large abdominal mass that I rapidly determined to be a well advanced pregnancy. I asked my resident to come and break the news to this woman; it was very obvious to me that she was not going to be happy about the news of another pregnancy. When told that she - already unable to adequately feed and clothe her family - was again pregnant, she looked up at me and the resident. There we stood, two white males, well clothed, well feed young men with superior educations. We were, in her eyes, stunningly blessed and obviously going places in the world. She began to weep silently. She must have assumed, for good reason, that there was no way that we would understand her problems; she knew also that there was nothing that we could or would do to relieve her lacerating misery.

"Oh God, doctor," she said quietly, "I was hoping it was cancer."

That mother's anguished whisper eventually became a shriek of despair and hopelessness that has reverberated in my heart and mind and soul for over thirty years. Before that moment, forever seared like a brand on my memory, I would have described myself as "Pro-Life" had I then known this political term .

Over the next few years, I was exposed to real life as it is lived by millions of people who don't have the sanctification granted in America to those who are white, male, well educated, well gene-ed, well nurtured, well advantaged. I learned that what this woman knew was a personal tragedy for herself and her family, was only one face in a multifaceted problem confronting thousands of girls and women every day.

How did I learn this?

I learned it - really made it a part of my essential being - by seeing the repercussions of desperation walk, and crawl, and be carried through our emergency room door three, four, five times, every night for four years. Each night we would admit to the wards of University Hospital in Little Rock (a fairly small hospital, as metropolitan hospitals go) girls and women with raging fevers, extraordinary uterine and pelvic infections, enormous blood loss, and a multitude of serious injuries of the pelvic and intra-abdominal organs as a result of illegal and self-induced abortions. During the years 1970 through the end of my residency in June, 1972 we did in the same hospital perhaps twenty to thirty safe, legal abortions a month on girls and women of various ages for mostly elective reasons. The contrast between the outcomes for these two sets of women was dramatic, not only for what happened to them immediately - that is, the almost total lack of complications in those undergoing legal abortions and the terrible consequences of some of the illegal abortions that we saw - but also for what happened over the next few years to those who had illegal abortions as they discovered that they were sterile, or faced total hysterectomy for the effects of injuries suffered during their illegal procedures.

I could and sometimes do go on for hours about what I saw during those years of training and in early private practice, before abortion became universally legal and affordable in the first few months of pregnancy for any woman who determined, for a myriad of reasons, that carrying a pregnancy to term and delivering a baby was not in her best interest. Or perhaps not in the best interests of her family. (The very poor in those early days of legal abortion were covered by Medicaid.)

But what of the concern for, as a ninth grader expressed it, "someone who is often forgotten, the little life who doesn't even have a chance to live."

No one, neither the patient receiving an abortion, nor the person doing the abortion, is ever, at anytime, unaware that they are ending a life. We just don't believe that a developing embryo or fetus, whose mother cannot or will not accept it, has the same moral claims on us, claims to autonomy and justice, that an adolescent or adult woman has. I have never seen an abortion decision entered into lightly by anyone involved. The decision to have an abortion is most often made in the time of the first great personal moral crisis that ever faces a girl, a woman, her family and the people who love them. It is only those who stand outside and condemn the women and families who are faced with these dilemmas who take lightly the decisions made in these straits and trivialize the circumstances in which they are made.

Moral dilemmas are always about difficult problems. Decisions between right and wrong are not moral dilemmas; decisions between right and wrong should be no-brainers and should never be difficult.

It is in deciding between what we consider morally near-equal alternatives that we are forced to make agonizing appraisals. The decision between competing evils or competing goods - these are the judgments that may burn in your mind and live forever in your memory, that fry your soul. And it matters not whether one believes elective abortion a good or an evil, for every abortion decision is made between self-perceived competing goods or competing evils, not between obvious good and self-evident evil.

Is legal abortion dangerous? I personally have not seen an abortion injury to a woman since 1974, with three exceptions: One was a young women who became sterile after a post legal-abortion infection in 1974 in my practice; another was a woman from my practice who had a ruptured uterus in about 1975 as the result of an abortion done in Little Rock at about twenty-four weeks by a resident using a no-longer-used method of abortion. (Since I wrote this several years ago, I have had another patient with an abortion related injury in July, 2003. Apparently, as I was dilating the cervix so that I might remove the fetus and placenta in an 18 year old, I perforated her uterus. It turned out that no significant harm was done, but I felt obligated to evaluate her pelvic and intra-abdominal organs with the laproscope under general anesthesia before sending her home.)

The other exception was a mother of five whom I admitted to my hospital in about 1991 with a septic abortion at about twenty-six weeks pregnant. She or someone else had obviously tried to abort her. The fetus was alive, but the fetal membranes were ruptured and blood from the uterus was mixed with a stinking pus, fouling her body, her clothes, and her bedclothes. (She was the sickest obstetric patient I had seen in a number of years, and the sickest abortion patient I had seen since June 1, 1971.) She had a fever of about 104 on admission and exhibited signs of impending septic shock. We got her stabilized and loaded her with massive doses of antibiotics. She was lucky. We were able to induce labor, deliver the extremely premature and septic fetus that died almost immediately, and she went home in about three days. Arkansas Medicaid did not cover her abortion, but it did pay part of the bill for her recovery from one, which was well over ten times the cost of a safe first trimester abortion.

I know of only two deaths from legal abortions in the state of Arkansas since 1970. One was in about 1980 or 1981, a young woman from Springdale with severe heart disease who died as a result of complications of her heart disease, who had the abortion done by another physician at my hospital where she died in the recovery room, before she was to go to Houston for open heart surgery; the other was probably a patient of Dr Bernard Nathanson, an early abortion provider in New York state and maker of The Silent Scream. This was a doctor's daughter from Northeast Arkansas who died after she came home, in about 1970 or 1971, as a result of self-neglected complications of an abortion that Dr. Nathanson may have performed in New York. The girl came home, started having serious problems and died rather than tell her parents of the abortion. It was only discovered at autopsy, and her story was then told by a friend. There may have been others; if so, I am not aware of them.

There are risks to any medical procedure; however, legal abortion, done by competent medical personnel is among the safest operative procedures performed today in the United States. From 1972 through 1990, there were 563 deaths from abortions of all types - legal, illegal and spontaneous - in the U.S.; fewer than half that number were from legal abortions. In 1990, there were in the United States a total of 5 women who died from legal abortions and another 5 from spontaneous abortions.*

*{Taken from the Mortality and Morbidity Weekly Report (MMWR) published by the Center for Disease Control. New editions of the MMWR covering abortion usually come out in May of each year. It takes several years to collect reasonably accurate statistics about abortion deaths, since each death report must be thoroughly reviewed before the CDC publishes their data in order to make sure that the most reliable numbers are available for making public health policies. The numbers through 1991 will be published in May, 1997.}

I mentioned earlier that my mother always said to me, "the Lord has a special purpose for your life," and that the older I get, the more I think she may have been right; not just for my life, but for all of us. (But we have to find that purpose ourselves.) We each have unique skills, talents and abilities to be used in the service of our fellow human beings. What I mean by this is, that I was led into OB-Gyn by my love for delivering babies. Gynecology was really to be only an appendage to my obstetrical practice and I am sure that providing abortions, even thinking about abortions, would never have been a major part of my life had other physicians in my area continued to provide them as was being done prior to 1984.

However, I soon found my practice inundated with abortion patients because other physicians who had also been providing abortions stopped doing so. In late 1983 it suddenly became uncomfortable, and very soon dangerous, to provide abortions. I literally had no option but to make a "Sophie's choice" between delivering babies, which I loved, or making what for me would be an immoral and unethical decision, that is, to choose to abandon those girls, women and families who started coming to my office by the dozens. How could I look my children, my wife, my mother and my friends - myself - in the face and say, "I believe that abortion should be legal, safe, and available. But now some people disapprove and it's become very uncomfortable, perhaps even dangerous, to provide them. And so I am going to stop doing what I know to be absolutely right. When it gets uncomfortable or dangerous, it's OK to say, `not me, coach.'"

Was that the morality that I wanted to demonstrate to my children? To parade in front of my wife, my family and friends?

Not me, coach!

Why do I provide abortions?

Here is the short answer.

Like multitudes before me and, I trust, multitudes to come, I eventually heard (Try as I might to avoid hearing it!) in that mother's grief-filled declaration, "Oh God, Doctor, I was hoping it was cancer", a still, small voice asking, "Whom shall I send, and who will go for us?" to which I was at last compelled to reply, "here am I, send me."

William F Harrison, MD, FACOG