[A] clear gap -- of class, income and education -- exists between those who work in this increasingly professionalized reproductive justice movement and those women who now form the majority of abortion patients. A recent study from the Guttmacher Institute, the leading research organization on reproductive health issues, paints a dramatic picture of the divide between nonpoor and poor women: "The abortion rate among women living below the federal poverty level is more than four times that of women living above 300 percent of the poverty level." Not surprisingly, there is a similar gap in access to contraception, leading the Institute to speak of "Two Americas" for American women with respect to the ability to control their reproductive lives.

The women we encountered in the waiting rooms of three abortion clinics, located in the South and Midwest, have little experience with the contemporary reproductive justice movement, or indeed of politics in general. But they are highly aware of the shame and stigma surrounding abortion. Some spoke of their fears of being recognized in the waiting room by acquaintances. Others, when asked if they would have preferred to have their abortions performed by their own doctors, in their home towns, rather than undertaking a drive of several hours to a clinic, recoiled at the thought. "I don't think that I would be comfortable going to my ob-gyn for an abortion, knowing that's the same man that delivered my children. ... I would think he would think of me differently. ... I mean, he sees me in one light, and that's the way I want him to see me."

[:::]

The stories of the women we met in the clinics are so grim -- with tales of unreliable male partners, minimum-wage jobs that don't allow them to properly care for the children they already have, broken-down cars and inadequate social support -- that it becomes clearer than ever that "reproductive justice" means far more than accessible contraception and abortion. Affordable housing, living wages, better child care, intimate partner violence programs and universal health care are things the movement must fight for in order to give these women and their children a shot at a decent life. And if that weren't enough, a challenge of a different nature is to make the lonely women in the waiting rooms feel part of that struggle.

That cannot, and will not, happen while a woman's right to choose abortion continues to be stigmatized by the very people who claim to uphold it. "Safe, legal and rare" is a meaningless mouthful of pabulum, a hollow mantra delivered by rote that has tolerated and even enabled a relentless wave of so-called "reasonable restrictions" -- all fueled by the religious right -- that might sound fairly innocuous to the uninformed. But in the aggregate, such measures even now are shutting down access to any abortion services at all, let alone to the high quality of safe and professional abortion care that any woman deserves.

A new report from the Guttmacher Institute [pdf link] details the level of repression that years of fear and intimidation by the religious right and the politicians they control -- along with years of complacency by "pro-choice" politicians heeding the advice of consultants who oppose abortion rights and tell them that they cannot risk alienating "people of faith" -- have already inflicted upon the women of our country.

We all know that abortion rights are not the be-all and end-all of reproductive justice, but we also know that there is no reproductive justice without them.  

Joffe and Cosby reflect: "Rather than expressing solidarity with others experiencing unwanted pregnancies, many abortion patients take pains to distinguish themselves as different from other women getting abortions."

How could it be otherwise for women living in states permeated by the politics of the religious right, when even the leaders of our own advocacy organizations admit to the "personal religious belief" that abortion is a sin, and feel their "knees shaking" when confronted by religious disapproval? When even dedicated advocates of a woman's right to choose abortion now fear to say the word out loud for fear of offending "nuanced" politicians and the media?

As an activist who has worked in the abortion rights movement for almost ten years, I know well the hesitation that comes when I am seated comfortably on a cross-country flight and the person next to me asks, "So what do you do?" I am proud of myself when I march for choice or counsel a woman through a difficult decision, and then wonder why I can't say the word abortion during a dinner party. I struggle to talk to the media and elected officials in ways that are on-message and yet embrace the complexity of women's lives and the nuanced positions on abortion that exist outside of sound bytes and talking points.

Dr. William F. Harrison [video link] of Fayetteville, Arkansas, has provided his patients with abortion care for many years. Considering the possible consequences of candor, no one could blame Dr. Harrison for treading softly in public -- but his friends and enemies alike know that is not his way. With the doctor's permission, I give you his own solution to that dilemma.

I have been speaking the word ABORTION on planes for a long time now when I am flying alone. I suppose I will have to stop taking my wife with me to NAF and MSFC events since she is embarrassed by my aggressive outspokenness.  As I have said, I say the word loud and clear when talking to my seat mates and as a general rule, things get very quiet for rows around.  So far, I have never found anyone who didn't say something like this at the end of my harangues, "Hummm. You have told me some things I never thought about," or "I agree with everything you said.  Why don't more doctors say these things?"  And I always have a copy of my book I give them with the request that they pass it on.  Works for me!   :-)   wfh

Dr. Harrison has his reasons.

After embarking upon his medical career in the late 1960s, he originally opted to specialize in obstetrics because of the joy he experienced at the birth of his own children. But then came what he calls a career-transforming experience.

"I was assigned a patient who was a middle-aged black woman," he explained. "She was a very sad-looking woman. When I asked what was wrong, she said she had a tumor in her belly. I examined her and quickly determined that it was a far advanced pregnancy."

"She looked at me and she began to cry. She said, 'Oh, God doctor, I was hoping that it was cancer.' I didn't tell this story for years and years, because every time I tell it, I cry."

[:::]

Then came a litany of patients who had undergone horrific, botched procedures. One woman had used such a caustic substance on herself to terminate her pregnancy that when she arrived at Harrison's clinic she had no vagina.

"If you saw the hundreds of patients who have suffered such serious trauma in trying to self-abort, you would soon realize that there has to be a more humane way of dealing with unwanted pregnancies."

Granted that for Dr. Harrison, for me, and for others who actually provide abortion care, saying abortion out loud might be easier than it is for many. After all, abortion is not a political abstraction for us -- a "special interest" to be feared as a political albatross and nuanced into oblivion -- but our everyday reality.

Depending on our specific training, we dedicate ourselves to activism, we defend against voluminous state regulations that expose doctors to criminal charges should we forget to complete yet another form, we worry about protecting our patients and ourselves from the kind of terrorism that Homeland Security ignores, we perform the ultrasound scans that legislatures want to force women to look at even against their will, we comfort worried moms and husbands, we smell blood -- and in between performing those procedures that politicians won't pronounce, when a woman tells us what she can't tell her own family, we hold her while she cries.

So we are not afraid to say the A-word.

But we aren't the only ones. Saying "abortion" out loud is no problem at all for James Dobson, for Tony Perkins, or for the GOP death pimps trying to make abortion unsafe, illegal, and rarely performed except by women themselves. Or for those among us who dismiss Roe as "badly written law" and would prefer to see the issue returned to the states -- code-speak for returning abortion to Motel 6.

God forbid, for like Dr. Harrison and so many others, Dr. Harry Jonas remembers.

When I was a first-year intern at the Barnes Hospital in St. Louis, the first patient I had was a woman who'd had 11 children and had self-aborted herself, because she couldn't get a legal abortion, with some instrument of some kind. And I was in charge of her case, as a young intern, with her intestine coming out of her vagina because she'd perforated the vagina with the instrument. And she had massive infection, multiple abscesses in all the vital organs in the body and she died.

I still remember that patient. I remember exactly what she looked like. I remember the bed she was in on Ward 1418 in Barnes Hospital. I remember seeing her in the emergency room when she came in ... and she could not raise another child. She could not feed another child. She had not been able to find any doctor that would help her. I'll never forget that.
:::
Many [women] ended up with illegal abortions, and many of them died. And for 25 years prior to Roe v. Wade in my state of Missouri, the most common cause of death in women of childbearing age was death due to infected, illegal, self-induced abortion.

This death-dealing version of a "pro-life" philosophy is what many Christians claim to want. Even without the reversal of Roe v. Wade, their vision of an America free of the "taint" of safe and legal abortion is already coming to pass -- a dark vision crowded with the ghosts of America's past. Yet another colleague knows that we are already headed back to the future.

Our local university medical hospital tells me they see 12-20 patients per year already who have either self-induced or had illegal abortions. Some make it, some don't. These are underage and/or poor women mostly and a few daughters of pro-life families who can't be seen entering a clinic or going against what their parents believe. So we're already living with this at that level and know it will increase when Roe falls. As a matter of fact I've already been approached to help them organize an 'abortion ward' -- like in the old days -- as they know their caseload will mushroom.
:::
I know other 'private' docs and hospitals are experiencing the same but just like in pre-Roe days, mum's the word. Most people don't even realize hospitals had abortion wards before Roe. Just like what's happening today, it simply wasn't talked about openly.

We deal occasionally with a patient who's attempted to self-induce (through use of caustic douching or ingestion - most common being taking an entire bottle of quinidine tabs chased with castor oil). When the quinidine dosers call, we get involved with getting them to E.R. before their cardiac rhythm is interrupted -- then if the pregnancy continues, we provide abortion care at little or no charge -- as patients are usually poor.
:::
To know now how safe and simple this care is and deal with the fallout from criminalization (knowing that those injuries and infections were totally avoidable), going back to holding women in my arms while they die a totally preventable death is not something I aspire to and not sure I can hold up to it.

Yet another provider of abortion care spoke for us all when she spoke to the nation: "I think that most women and men are asleep. I don't think they realize what's going on. And in that respect, I think that the assault on abortion rights is very clever; it's very smart. And we are losing. ..."

Steven D stands with my colleagues, with me, and with the women we dedicate ourselves to serving with the best care possible: maybe you ... your mother ... your wife ... your lover ... your sister ... your daughter ... your friend. Where do you stand? Do you have the moral courage to stand with us, and start saying "a woman's right to abortion" out loud? Because until we do, saving women's lives will remain just another politically inconvenient special interest.

Photo Dr. William Harrison: ABC Nightline