CHAPTER THIRTEEN
CLIENTS

POPULATION TRENDS

The number of abortion providers is not the only thing which is making the massive industry slowly fizzle out. Population trends among the women getting abortions also show that a downturn is on its way.

The number of abortions went up each year from 1973, the year of nation-wide legalization, until about 1981. Then it stayed roughly steady for many years. In the 1990s, it started a significant, steady decline. In the 1994 figures, the Centers for Disease Control found a drop of 4.7% in the numbers compared to 1993, the lowest number reported since 1978.[1] New figures take time to come in -- the 1994 figures are reported in 1997 -- but more recent figures show a continuing steady decline.

This drop in numbers is not merely due to lower numbers of women of child-bearing age. The rate and the ratio of abortions has also gone down. The rate is the number of abortions per 1,000 women of child-bearing age. According to the Centers for Disease Control (CDC), in 1980, it was 25 abortions per 1,000 women, and in 1994, it was down to 21. This a 16 percent decline, and gets it back to the level of 1976. The ratio is the number of abortions compared to live births. The CDC said it was 359 abortions for every 1,000 live births in 1980, and went down to 334 per 1,000 in 1993 and again down to 321 per thousand in 1994. Between 1980 and 1994, then there's a 10.6% percent decline, and again down to 1976 levels.

Over this time, the first-timers of yesteryear became repeaters. The Alan Guttmacher Institute, the research arm of Planned Parenthood, has reported that by 1988, 42.9 percent of women having abortions admitted to having had at least one previously. About 1 in 10 are getting their fourth one, or even higher. That's the figure of women admitting to having done it before. It's higher than the figures of previous years, and it's gotten higher in the years since then.

When there are fewer abortions, but more and more of those are repeats, that means that the number of first-timers has gone down very dramatically indeed. It is those that are repeating that are keeping the numbers up as high as they are.

Without those first-timers, from where are the repeaters of tomorrow going to come? All repeaters will reach menopause eventually. Some will become sterile by one means or another before that, and quite a few will become prolifers.

The most worrisome population trend for the abortion business is that of their own clientele turning into their opposition. A study in Family Planning Perspectives, associated with Planned Parenthood, showed this as far back as 1981. Sociologist David Greenberg did a study comparing the membership characteristics of the nation's two largest organizations supporting and opposing abortion. The National Abortion Rights Action League (NARAL) and the National Right to Life Committee (NRL) each had about 450 of their members surveyed. Most of what he found wasn't surprising, but he did ask the female members whether they had ever had an abortion, and those results showed that 32 percent of NARAL's women members had, while only three percent of NRL's did.[2] Greenberg then concluded that women who had abortions were more likely to favor having it available. What he didn't look at, though, were the absolute numbers, rather than the percentages.

According to the Encyclopedia of Associations, NARAL had a total membership of 156,000, while NRL had 12 million. Granberg found 78 percent of NARAL's membership was female, while 63 percent of NRL's was. So 32 percent of 78 percent of 156,000 gives 39,000 such members, while three percent of 63 percent of 12 million yields 245,000 women who have had abortions. In other words, of those women who have had abortions who then proceed to become active on the abortion issue, six times as many joined the opposition.

This is strengthened by the possibility that women who belong to NARAL are more inclined to get abortions at the time they are members, while the abortions would be in the past for the NRL members. Apparently, the low percentage for NRL is not because it doesn't attract an ample supply of women who've had abortions, but because it has a greater ability to attract people who haven't as well. Any pro-life activist who has attended conventions and meetings knows that women who have had abortions are a major constituency group of the movement.

PAIN

Even among those women who have had abortions who remain firmly among abortion defenders, writing books with such titles as In Necessity and Sorrow and The Ambivalence of Abortion can't be heartening to those looking for support and gratitude.

Dr. Sloan reflects on his knowing about post-abortion pain: "The importance of what has happened remains, even for women who have been through the procedure and say they would do it again, and again, and again. The sting is there. I could see it in her eyes."[3] After detailing an incident in which he encountered a woman in a coffeeshop five years after he had given her an abortion, he was overwhelmed with ill feelings after she had poured out her post-abortion pain. He said, "I must have performed abortions on who knows how many like her, and never known. Couldn't have. Maybe I didn't' want to know."

Judith Fetrow said, "I often saw women who had been injured emotionally by abortion. However, my supervisor told me, 'If she's having a problem after her abortion, it's because she was having a problem before her abortion.' This was a philosophy that I could not support. Additionally, I could not reconcile that statement with the post-abortion counseling brochure that we had in each counseling room. It struck me that blaming the woman, making the emotional aftermath her fault, was perilously close to what batterers do to their victims."

She was saddened that the charge for post-abortion counseling sessions was greater than the charge for the abortion itself. It was an amount not readily accessible to most of the clients.

"The saddest emotional complications of abortion are the young women who come back for repeat abortions. These are young women that are still hurting from their first abortion, and their pain has never been addressed by Planned Parenthood. Even clinic workers judge these women harshly. However, repeat abortion is what Alice Miller calls the 'repetition compulsion.' It is continually repeating the same trauma, hoping for a different outcome. But the outcome is always the same."

Joan Appleton had a lengthy questioning process, and said this on a panel discussion of former abortion providers: "I counseled these women so well. They were so sure of their decision. Why are they coming back after me now, months and years later, psychological wrecks? . . . And there numbers were increasing. And I kept asking, why?"

GRATITUDE?

If other doctors and the pro-choice movement are inadequate as sources of support, then surely at least the clients can be expected to be grateful. Some of them are, but many seriously do not want to be there. This isn't unusual in medicine, but most medicine has on-going care so that the doctor is able to monitor the patient and see that she's improving, allowing for both a sense of accomplishment and gratitude.

The assembly-line set-up of the average abortion clinic is not asking for respect from the clients. In fact, this technique may be employed partly because of knowledge that the gratitude is never really going to come. It's deliberately not asked for.

In a telephone conversation, the Dallas clinic administrator comments on this. "There's two ways to look at how change happens. One is, we have to get people out there to respect them. But, from my experience, that never works.

"For most people they're looking for something bigger than themselves. In abortion, I think this all fits together with how women experience abortion. For many women nowadays, they're angry that they had a choice. It's too bizarre, but it's like, if you weren't here, I wouldn't have had to make this choice. . .

"We're working real hard at this clinic to assist women in moving from a place of experiencing themselves as victim of their decision, or of their boyfriend, to moving to a place where they see this differently. I think that the same thing needs to happen with the physician. If the physician is a victim of the anti-abortion movement, or a victim of the other anti-abortion doctors or a victim of Operation Rescue -- no change is going to come from that. Plus, victims are too annoying, you know. They don't invite your participation."

This clinic administrator knows that the lack of appreciation is not only an intense problem, but she's giving up on the idea of fixing it by getting more appreciation. The doctors need inner strength instead.

An abortion doctor who had a problem with inner strength commented on this in the Boston Globe. "I could have put up with some more, but I felt no community support at all. I could have taken a lot more abuse, but there was not even a patient saying, 'I know you're not a murderer.' That demoralized me."[4]

THE FEELING IS MUTUAL

Feeling highly stressed can be expected to lead to a lashing out. The lambaste can be aimed at several targets, and for the abortion doctor, there are plenty available. Pro-life picketers are among the best to aim for, but they're outside the building. Throwing barbs at them on the way in and on the way out only does so much. Politicians, media, other doctors, and the pro-choice movement can be complained about, but they're off somewhere else and so can be targeted only verbally. Staff people are close by and can make excellent targets, but they're hired and not likely to stay if they are the butt of too much resentment. Besides, they're in the same fix.

There is one target left that falls into place nicely -- the person that the doctor has never seen before and likely will never see again; the person who is going to allow the doctor to come close to her with sharp instruments; the person who makes this whole job necessary, then isn't even grateful.

He can blame the person who, if she had only kept her pants on, wouldn't be needing this. Never mind that there is, in each and every case, another person who could also have prevented it by keeping his pants on. He's not there to lash out at, and she is. Besides, blaming the woman for getting pregnant is traditional.

Current abortion opponents are not the only ones to have noticed this phenomenon. Marjorie Brerer's position is unambiguously in favor of ready access to abortion. She refers to anti-abortion people as anti-choice. Yet on a panel discussion at a conference on RU-486 she listed one of the reasons for someone being an abortion provider as, "a relatively sadistic way of punishing women." She later says that, with RU-486, she, "would like to ask whether providers will still be able to have a punitive role, if that's the role they want to have."

Those that have looked at this in scholarly fashion have found indications of this. "Many faculty and resident physicians doing abortion work reported clinical symptomology. Among these symptoms, the researchers discovered obsession over abortion per se and over the morality of abortion, depression, a need to find 'reasons' for performing the abortions, and anger directed primarily at the aborting women."[5]

Dr. Hern notes this in his paper to Planned Parenthood. "One respondent expressed increasing resentment of the casual attitudes of some patients considering the emotional cost to those providing the service."[6]

The American Medical News article, "Abortion Providers Share Inner Conflicts," indicates that anger at the woman is regarded as a commonplace, especially for women who wait for late terms. "A New Mexico physician said he was sometimes surprised by the anger a late-term abortion can arouse in him. On the one hand, the physician said, he is angry at the woman. 'But paradoxically,' he added, 'I have angry feelings at myself.'"[7] Why is this paradoxical, when he is just as much a participant as she is? Because it's unusual to admit that responsibility lies on everyone involved, and blaming the woman alone is more common.

Another example is recounted in Don Sloan's book, Abortion: A Doctor's Perspective, a Woman's Dilemma. Dr. Sloan is an abortionist (his own self-description) who was still in the field and still advocated for it strongly. He does tell this story as told to him by one of his patients: "I was working upstate, and I got involved with this guy -- it was dumb, but I got pregnant. I mean, we both knew it was just a summer thing, that we weren't going to see each other again. Well, I asked around and got the name of a doctor there who did abortions in his office. It wasn't that expensive, a few hundred bucks, and we could get that together between us. I mean, the guy was all right, he just wasn't the love of my life. So I made an appointment.

"The people in the office seemed real nice, so I was kind of surprised by this guy. He kind of leered at me, you know? But at the same time he really had an attitude -- like I was dirt or something. I thought, was it 'cause I'm black? But I think it was just him.

"He said, 'Get your things off and lie down.' And I'm thinking isn't there a gown or something? I was standing right there. So I asked for some place to change and he said, 'Do it here. We have to get this over with.' But he gave a sheet to wrap up in, which was clean, at least.

"When I went to put my feet in the stirrups, my legs were too long. And while he's adjusting them, he's making these cute little remarks about my legs and my nail polish. I'd already paid, and I wanted to get it over with too, or I'd have been out of there, I swear. I was that angry.

"It hurt -- a lot. And I could hear the suction thing -- it was real loud, and it was like it was sucking out my whole insides. I kept asking questions, and the whole time, he didn't say one thing. Just ignored me."

It seemed like an eternity, Keisha said, but it was probably only a few minutes until the doctor told her he was done.

"When I got up, I felt sort of faint, and there was blood running down my leg. I showed him, and he said it was nothing. But when I went to get my clothes, the blood was getting on the floor. And he said to me, 'You're dirtying things up. Get back up here.' He did some more stuff, and I heard the machine again. It didn't hurt as much, though, or maybe I was just so out of it I didn't care."

He gestured to her to get up again, and this time he gave her a sanitary napkin. 'You know how to use these things, I suppose?' he sneered."

Dr. Sloan blames this unknown doctor's attitude on sexism, a reasonable assessment. He then goes on to relate it to other kinds of sexism in the health care system, as with obstetrics, and he's right that those are areas in need of improvement. Of course, in any individual case, the doctor may have had a major argument with somebody that day and been in a sour mood. Nor would it be fair to draw any conclusions from one incident.

Still, it does fit the pattern. It could be that the doctor was frustrated for the reasons we're talking about now, or it could be that the patient was seeing the symptom of estrangement from others that is a symptom of post-traumatic stress.

Sexism is something that can be gotten rid of, to a large extent, if it's worked on. It certainly can be removed from areas like obstetrics, diagnostic D & C's, hysterectomies, and c-sections. Much progress has been made already, and hopefully more will be made. If that's the problem with abortion, progress will be made there as well. But if the problem is the lashing out or the alienation, then progress toward sensitivity to the clients could be harder to come by.

LEGAL DANGERS

Without sensitivity to clients, however, there comes some basic problems in keeping up the business. In general, treating clients in that manner is no way to keep a business going, and it increases the stigma on abortion. But there are also specific legal dangers. One is malpractice suits, and another is enough reports to licensing boards to put the license in danger. This has already led to the departure of many abortion doctors from the field.

This would be a very small irritant if the legalization of abortion had led to the sanitary and safe conditions its proponents were sure it would have. It will only be a problem if there really are large amounts of malpractice.

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