It’s Trust Women Week! Nearly 40 years ago, abortion was legalized in the United States. To mark the occasion, Lola McClure, a registered nurse, interviewed Dr. Nancy Stanwood, an obstetrician/gynecologist, abortion provider, mother, and board member with the Physicians for Reproductive Choice and Health. Here is an excerpt of that interview:
Hello Dr. Stanwood, it’s wonderful to meet you today! I knew I would like you instantly when I saw that you were wearing a zebra print shirt under your lab coat; I thought, “Dr. Nancy Stanwood is cool.” I guess that I’ll start there: why is the only 100% true stereotype in medicine that people who work in reproductive health are the coolest super-smart people who have excellent senses of humor and are always clinically current and up to date on evidence?
[Laughs] That’s a great question. I think there are a couple different pieces to that. I think those of us who feel prompted to help women in this way, and feel capable of doing this work and handling the controversy that comes with it, have a certain baseline balance and sense of humor. I think the second thing you asked—being up to date on evidence—I think all people are hopefully out there to be excellent doctors, no matter what we do, but I know with myself that I was raised with the five-P rule: Prior Preparation Prevents Poor Performance.
That’s why I’m in family planning! To plan. Because I think planning is good and healthy.
Being prepared, doing the right thing, and doing it well are what matter. I think a lot of us [abortion providers] sense that extra need to do it twice as well as everybody else. It’s like those women in the ’70s and ’80s: to be able to do everything the boys can do but twice as fast.
There still persists to this day almost 40 years after Roe this perception that any doctor who would do abortions on a regular basis—not the casual, four patients once a year, but those who make it a part of their integrated practice—that they must be quacks or bad doctors. There’s this stigma of the abortionist that—two generations later—still looms large. We feel like we need to prove all that much more that we’re caring, thoughtful, educated physicians who think carefully about what we do for our patients, how we counsel them, how we understand the incredible delicacy of this issue, and how we recognize the privilege it is to help women in this way.
There’s the question of how your work factors into your life, especially with pro-life friends and coworkers. How has the bigger “us versus them” manifested for you personally? How do you navigate what you do versus the fact that you have to, you know, live your life?
Day by day I think: what is the venue? What are the upsides and downsides to talking about my work? Certainly, you know, I have colleagues and acquaintances who know what I do. But in the work sphere I carry the title, I do the work, and I don’t necessarily have to keep outing myself with people. It’s who I am and what I do at work. It’s more in the social sphere … you’re out meeting with some friends and you just want to have cocktails and eat some good food. So you don’t want to—invest the energy in your advocacy work in your downtime. But there are times when it feels like the right, necessary thing to do, especially if conversation is going in the direction of “pro life, pro choice” and people are saying crazy stuff. Wrong stuff! I feel obliged to speak up—but in my downtime, I don’t necessarily seek that conflict.
I read recently something to the tune of, “Roe was so important, but rich women could always go to Puerto Rico or England and get a safe abortion.” I absolutely see this happening again, especially since the first reason people seem to have is often a financial … I’m curious about what you think about that—how even though abortion is “legal,” the distribution of access is so much along class lines.
Just to be a little historical here, it was that burden of morbidity, mortality, disease, and death that fell on the poor who couldn’t get a safe abortion illegally that led to the activism in the medical community to decriminalize abortion. I think theoretically, 39 years later, part of what’s happened is that not only can rich women get an abortion more easily, but they can get birth control more easily as well. So what I’ve seen is the proportion [of women] who are poor having abortions is increased. That disparity exists in access to reproductive healthcare in general, too. The most effective methods of contraception, like IUDS and implants, are unfortunately more expensive, and those can be out of reach.
So then I think recognizing the increasing disparity is very important, and recognizing that when those women are not able to get what they need through safe channels, some of them do unsafe things. Fortunately, it’s still relatively rare in the U.S., but there are reports of self-induced abortion and of women going to clinicians who aren’t well trained, and it’s harkening back to the pre-Roe era. The fundamental issue, again, is that making abortion less available doesn’t stop it from happening, it just means that more women suffer and die. It’s that simple. And that, unfortunately, is not a part of the public consciousness around abortion anymore, because it’s been safe and legal and accessible for the majority of women for the past 39 years. In that way, we can’t necessarily use that argument anymore, because people don’t necessarily remember, “Oh yeah, I remember when Aunt Millie died, it was all hush-hush and 10 years later I found out she had an unsafe abortion. That’s why my cousins grew up with my brother and sister.” That story happened in that era. I don’t think that discussion hits anybody at the visceral level anymore, but it’s still important to make the point.
I think that what might replace that visceral reaction in the age of legal abortion is speaking very plainly about your own experiences…because there’s still so much silence around it as an experience that actually happens to people that if you just talk about it, you’re doing so much good already.
Along those lines, it’s sometimes sadly easy to help my patients become grateful.
Women come in expecting to be judged, treated impolitely, and degraded, and if you show them even the slightest bit of normal human courtesy—not even going to the point of affirming your trust in them, and your belief that they’re doing the best they can—it’s so easy to make them grateful. Because sadly, they expect to be disrespected. They expect to be treated shamefully.
Or they’re being punished. Or like they should act like they’re going to a funeral.
Part of the way I envision it when we talk about “when does it feel safe, or good, or worthwhile to speak out and step out of the silence, or the closet”—the times when I do that, one of the things I envision is that all of my patients are standing behind me. I have this big group of patients standing behind me and they want me to share what I know, because they can’t. And it’s that much more important, for their sake, that I let people know the truth, that aside from what we talked about, we doctors who do abortions are not just “abortionists,” that we’re thoughtful, caring, compassionate people who have chosen this work because we want to, not because we want to do anything or else or that we’re in it for the quick buck. That we have made a conscious, moral, ethical decision that this is important. […] I think the flipside there is there’s this narrative of women who have abortions that goes along with the welfare-queen narrative of the ’80s. The idea that these are fallen women, women who allowed their sexuality to run rampant. This incredibly negative, demeaning perception that also has a lot of sexism, racism, classism in it—it’s all the -isms tied in together. For me to share the stories of my patients and portray them accurately, to let people know that’s not who we’re talking about here—we’re talking about your mother, sister, daughter. People you know who are thoughtful, careful, compassionate, and doing the best that they can with what they have. It’s that idea of: how can we get our society to trust women, and to realize that this is something that women know best, and that needs to remain private, in the sphere of the doctor-patient relationship?
Did you see how in 2011 they enacted 135 provisions that restricted abortion—that graph that goes like that. [draws air squiggly line with finger, then points straight up]
I’ve seen the same graph.
One of the things that seem to be moving is policing practice—the “demand” side instead of the supply side, laws like waiting periods. I’m thinking about the Texas ultrasound law, or something like reading scripts to patients with medically inaccurate lies in them. I’d like to talk about that—it’s very fascinating to me because I can’t imagine working in a clinic in Texas right now.
Restrictions that are placed on medical practice within abortion care—and only in abortion care, singled out and stigmatized within medicine—are because there’s this presumption that we’re not doing it well, that’s part of it, and there’s the harassment factor to scare physicians away or make it harder to do their job.
Specifically to the requirement that a woman would need to see ultrasound images before having an abortion—I think I can sort of understand what the anti-choice side thinks they’re doing. They think that women don’t understand, and that it’s going to change their minds. But in my experience, that’s just not the case. Women know why they feel the need to have an abortion, and seeing an ultrasound image doesn’t change the facts of their lives. They don’t feel ready for a baby, and having an ultrasound doesn’t suddenly make them ready. Again, it comes back to that respect for the responsibility of motherhood and the wish to do it well. It’s misguided to say that being shown an ultrasound will change your whole life. No! It won’t! In many cases this is a very difficult choice, let alone for people who wanted the pregnancy but now have to terminate.
And I think that it’s important to see that even if abortion were no longer safe and legal, women would still do it. Which is why thinking about the anniversary of Roe v. Wade … my entire medical career has been after Roe. I have to think back to the things that my mentors taught me in residency—the old graybeards who were almost all men, but who became ardent feminists when they saw what was happening to women, and who advocated for the decriminalization of abortion. In medicine, if something is an intern’s task, it means it’s kind of, repetitive, not particularly important, kind of menial. And what interns end up doing is sometimes telling of how things are considered to be important in medicine. I had an old graybeard attending in residency who told a story from his residency, pre-Roe, in an inner-city hospital in Detroit. The intern every morning had to mix up the IV pressors for the women who would come in septic after an abortion, and they would use these pressors to avoid dying. The ward where they put them—gallows humor, you have to deal somehow—they called the septic tank. And that’s what he saw as a trainee. He saw women incredibly sick and incredibly maimed, dying, and dead. All because of their determination and recognition of “I am not ready to be a mother. I cannot do this.” Women will take really frightening risks when they don’t have access to safe care.
Let’s say, thought experiment. Let’s say Roe v. Wade got overturned. There’d be 1.5 million women who had been seeking abortions who can’t have a safe one. Someone will have an unsafe one and will die or be damaged for life; some women will have the child and not be capable of taking care of it. And we know that women who have unplanned pregnancies who go on to deliver have a higher risk of complications in pregnancy, high rate of pre-term birth, a higher rate of the children having behavioral difficulty, poor achievement, cycles of poverty, domestic violence. And the whole idea that somehow adoption can solve it all is just not how the American public thinks. Only 1% of women with an unplanned pregnancy go forward with adoption in the U.S.—very, very small. And I hear it from my patients for all different reasons: they never could do it, the interesting thing they say is that they don’t trust anybody else to raise their child. Will the child be loved? Will the child be well cared for? Again, it gets to the idea that they understand how important motherhood is—I don’t necessarily see out there the American public ready to adopt 1 million babies. So just from a practical point of view, if you do a thought experiment of making it illegal or ridiculously more restricted than it is now, more women will die, more families will suffer, and that’s not good. That is not a moral good.
Read the rest of this interview at The Hairpin.