Everyone has some mild contradictions in their thoughts that they must deal with. Abortion defenders surely find such items among their opponents.

For abortion personnel, we need to look not merely at whether they might have some conflicting thoughts, but whether those are way above average. Does the actual practice of abortion differ from its defenders' ideas of how it's supposed to be? Does the knowledge of those differences cause tension in the minds of those involved?

This chapter won't discuss the arguments over whether abortion is right or wrong, whether it should be practiced or not, whether it should be legal or not. It will discuss the psychological impact of performing abortions on those who do them. Some abortion facilities aren't going to have some of the problems highlighted here. But wherever these contradictions are widespread, then the sense of cognitive dissonance is likely to be also. That means that the stress and the strategies to reduce it should be present also.


Volumes could be, and have been, written about the poor safety record of legal abortion. Newspapers have run major stories on scandals from Chicago to Los Angeles to Miami, and smaller newspaper articles from all over the country abound. Even 60 Minutes has done a story on this problem, and the Wall Street Journal ran a summary called "Legal But Not Safe" on July 31, 1996. The most comprehensive compilation of such scandals can be found in the 1996 book, Lime 5: Exploited by Choice, published by Life Dynamics.

Increasing safety was one of the major justifications for legalizing abortion. Getting the back alley butchers out of the business is now and always has been one of the most effective arguments of abortion defenders. That being the case, the relative safety of legal abortion is a cognitive element that is absolutely essential to anyone working in the abortion field.

The record immediately after Roe v. Wade did not show the back alley butchers being yanked out of business. An example from the beginning is given by Dr. Bernard Nathanson, who had been active with the National Association to Repeal Abortion Laws (NARAL) and was given the assignment of improving a New York clinic. A staffwoman is giving him a list of all the tasks he must do:

"One more thing. You got to get those doctors shaped up. I mean half of them don't even wash their hands anymore before doing an abortion, let alone scrubbing. They refuse to use masks or caps, and their moustaches are dragging into the suction machines. I swear, one of these days we're going to lose one of those guys right into the suction trap and the lab is going to tell us the tissue is pregnancy tissue and the abortion is complete."[1]

More recently, Abu Hayat made national headlines. The most memorable is the case of Ana Rodriguez, who was born without an arm because he had chopped it off in a failed abortion attempt. He had so many other problems that even Ms. magazine did an article on him, showing that the "back alley butchers" were not totally out of business.[2]

In that article, Barbara Radford, head of the National Abortion Federation, which is essentially the industry trade group, was quoted as saying that there are doctors like Abu Hayat in every city.

That certainly establishes that safety problems are, in fact, widespread. You needn't take the prolifers' word for it. Abortion defenders have admitted it outright.

They will, of course, immediately point out that there are clinics that have better safety records than others, and insist that some of them are quite good.

But the question is, what kind of psychological effect does it have on those people who do work at those places with safety records less than admirable? How do people who advocate legalization for safety reasons deal with the dissonant information that safety problems are, in fact, widespread under legal abortion? Why does NAF, which is the obvious choice for watchdog over the clinics, feel little or no obligation to get these places cleaned up? Why would they leave all efforts at cleaning up the safety records of abortion clinics to the opposition? If they have confidence in their own stated views, this is puzzling.

We have two cognitive elements:

(1) legalization of abortion is necessary to make it safe for women; and
(2) there are a lot of places where abortions are performed where it's not safe for women.

It may seem logical that the best way to resolve this one is by changing number two. If watchdog efforts can be applied, that second point could be either eliminated, or at least brought down to the level that it can be accounted for by noting that nobody's perfect. Other product providers use that technique all the time.

Ignoring the second point, and deliberately sweeping it under the rug, is certainly a way of dealing with the dissonance it creates. But since abortion defenders have a strong urge for the public to believe the first point, it would seem that ignoring the second point would be an odd way of dealing with it. But the theory of cognitive dissonance would predict such a reaction as a possible way of dealing with it.

Judith Fetrow, a former Planned Parenthood worker, summed up the tension at a pro-life conference. "It is extremely difficult to watch doctors lie, clinic workers cover up, and hear horrifying stories of women dragged out of clinics to die in cars on the way to the hospital without beginning to question the party line. I began to wonder if we were really caring of these women, or if we were just working for another corporation whose only interest was the bottom line. But these are questions that one does not voice at Planned Parenthood."[3]


The boldest incongruity with the idea of choice is when women are pushed unwillingly into the clinic, or when they change their minds once there and their pregnancies are aborted anyway. Accusations of this have been made in malpractice suits all over the country. Having a lack of choice this blatant is a very small portion of cases, but having it happen is troubling.

When Joy Davis, former employee of Dr. Tucker, said women were sometimes held down after trying to back out. "We would medicate the patient before the doctor ever came in the room. I have seen cases where, when the doctor came in the room, the patient would scream, 'I can't do this. I can't murder my baby. Don't do this. I can't.' And I have actually seen Dr. Tucker slap that patient and tell her to lie down and shut up, and order the nurse to give her more medication and knock her out. I've certainly seen it more than twenty times."

Perhaps the reasoning in that kind of case would be that the woman had actually made a decision, but was getting cold feet, and therefore needed a firm hand to go through with the commitment to the plan. In the case where the abortion was clearly someone else's idea, and she was being literally pushed to the clinic, possible reasoning could be that she was deciding to go along with her current relationships, and that was her choice. As long as she didn't charge out of the place the second she had a chance, but gave any indication whatever of putting up with this, then it can be accounted as her choice.

The nature of what brings women to the clinic in the first place doesn't make abortion merely one of a number of options. Nurse Sallie Tisdale reflected on her work at the abortion clinic. "We talk glibly about choice. But the choice for what? . . . Women who have the fewest choices of all exercise their right to abortion the most."[4]

Planned Parenthood put out The Complete Guide to Pregnancy Testing and Counseling in 1985. One section (pp 24-25) presents the hypothetical situation of a married woman who has agreed to have an abortion, but is having difficulty accepting the decision. The suggested responses included:

Tell her that no one makes the decision to have an abortion easily or ever feels really "good" about it. Acknowledge that feelings of discomfort and sadness are normal. Ask about the reasons for which she and her husband decided on an abortion. Help her to reaffirm that this is the best decision for them right now. Remind her that feelings of guilt, sadness or loss do not mean that a wrong decision was made.

Note the striking absence of responding with the possibility that they may wish to change their minds. It is the counselor's job to "help her reaffirm," not work it through any further. What is the difference between this kind of "options counseling" and pushing for one option only?

The Department of Health and Human Services, in its Counseling Adolescents in Reproductive Health Care Settings, 1980, notes that when a client experiences anxiety and guilt over her decision to abort, "the counselor may be able to reduce the intensity of the feelings or the possibility of their interfering with commitment to the plans." Again, the purpose of "options counseling" is to make it look like a choice is being made, when in fact one course only is being pushed.

People of the abortion clinics have been quite insistent on keeping all the money-making potential of counseling to themselves. While anyone could understand people resenting the government telling them how to do their jobs, very few people would make a big fuss about it if the government were only mandating what they were already doing. If one is a professional, one would be disgusted by people who didn't meet certain standards. In the abortion field, however, the laws providing for "informed consent" by the patients were regarded as so intolerable that court cases against them were brought. For a time, they actually succeeded. In spite of the fact that, under the informed consent statute under question, the woman was only to be told of the availability of information on fetal development, and was not required to actually look at it, the Supreme Court struck down the provision with Justice Blackmun using these words: this was "not medical information that is always relevant to the woman's decision, and it may serve only to confuse and punish her and to heighten her anxiety, contrary to accepted medical practice."[5]

Even information regarding the "detrimental physical and psychological effects" and "particular medical risks" of the abortion was also struck as likely to "compound the problem of medical attendance, increase the patient's anxiety, and intrude upon the physician's exercise of proper professional judgment."

How many people, when going in for any kind of surgery, find that having more information about it increases anxiety? The very admission that accurate information might increase anxiety would seem to make this kind of surgery different from others.

More importantly, the Supreme Court in this case found for women a constitutional right to ignorance. The abortion clinics demanded this, and got it for a time. This was explicitly overturned in the Casey decision of 1992.

Consider the bringing together of these two cognitive elements: choice, and ignorance about what is chosen. Or another set: women's ability to control their own destiny, and a patronizing attitude about what information they should be given, and who should decide if they get it.

That kind of incongruity deserves a little more exploration. Consciousness-raising is a hallmark of the feminist philosophy that many abortion defenders claim to be using.


Deliberately keeping information from someone is in direct contradiction with the doctrine of helping women to take control of their lives. Raising consciousness is a technique that, among other things, helps to locate, and thereby helps to eradicate, any self-destructive behavior. That would make it particularly startling to find the following points, all made in clearly "pro-choice" literature.

Sallie Tisdale worked as a nurse in an abortion clinic and wrote about her experiences in Harper's magazine.

I describe the procedure to come, using care with my language. I don't say "pain" any more than I would say "baby." . . . It is when I am holding a plastic uterus in one hand, a suction tube in the other, moving them together in imitation of the scrubbing to come, that women ask the most secret question. I am speaking in a matter-of-fact voice about "the tissue" and "the contents" when the woman suddenly catches my eye and asks, "How big is the baby now?" These words suggest a quiet need for a definition of the boundaries being drawn. It isn't so odd, after all, that she feels relief when I describe the growing bud's bulbous shape, its miniature nature. Again I gauge, and sometimes lie a little, weaseling around its infantile features until its clinging power slackens.[6]

In an article in the American Medical News, "Abortion Providers Share Inner Conflicts," someone is speaking at a National Abortion Federation workshop. "'I don't think her problem is pregnancy or her problem is repeat abortions. But she has a problem. This is self-destructive behavior,' another counselor said. . . For one counselor, the issue was not one of morality but risk. 'Abortion is a procedure not without consequences,' she said. 'And so to subject yourself to risk 20 times is like mountain climbing on a peak without a rope. Twenty times is more risky than once.'"

It could cause an "inner conflict" to realize that you are actually an enabler in self-destructive behavior. The idea of no longer being such an enabler doesn't fit with continuing to provide abortions.

"One thing that doesn't change over time, however, is the kinds of questions patients ask. Questions that sometimes stump the staff. Like whether the fetus feels pain during the procedure. 'This is a big concern' for both staff and patients, said a clinic employee from Massachusetts. After all, she said, 'it is a dismembered body.' Patients also sometimes ask to view the fetal remains. A Toronto physician said she didn't know 'how and whether we [should] protect the patient from the reality of the procedure.' She said she regularly hid the ultrasound screen."[7]

The theme of deliberate ignorance is depressingly common in the literature. An article in ObGyn News discussed the topic. "Besides its use in ascertaining fetal age, sonography can be very helpful during actual abortion procedures, both as a teaching tool and as a means of enhancing safety. But sonography in connection with induced abortion may have psychological hazards. Seeing a blown-up, moving image of the embryo she is carrying can be distressing to a woman who is about to undergo an abortion, Dr. Dorfman noted. She stressed that the screen should be turned away from the patient."[8]

Another example of this comes from the textbook Abortion Practice:

"Vital signs should be observed regularly, and a Doppler inaudible to the patient should be used at intervals to determine the presence or absence of fetal heart tones. This is a controversial area, but most professionals in the field feel that it is not advisable for patients to view the products of conception, to be told the sex of the fetus, or to be informed of a multiple pregnancy."[9]

This deliberate ignorance is to be encouraged. It is noted and fostered. As Sallie Tisdale says, "Whether the blame lies in a failed IUD, a slipped condom, or a false impression of safety, that fetus is a thing whose creation has been actively worked against. Its existence is an error. I think this is why so few women, even late in a pregnancy, will consider giving a baby up for adoption. To do so means making the fetus real -- imagining it as something whole and outside oneself. The decision to terminate a pregnancy is sometimes so difficult and confounding that it creates an enormous demand for immediate action. The decision is a rejection; the pregnancy has become something to be rid of, a condition to be ended. It is a burden, a weight, a thing separate."

Thus, the element of deliberately withholding information finds its logical justification. It's what the woman wants. That this contradicts the ideals of consciousness-raising is screened out.

There is another cognitive element. This is the possibility that if the woman knows, she may make another choice, and the industry may make less money. Acknowledging that in public doesn't work as well as the explanation that it's best for the woman, so that kind of explanation is more likely to come from former employees. As Luhra Tivis said on her experience with Dr. Tiller:

"I was required to falsify the medical records. But not just that, related to that, I was required to lie to the women over the phone. And the way he'd explain it to me was, without coming right out and saying it, these are really third trimester abortions, but we're going to tell them they're only in the second trimester. They would say, well, I've already had a sonogram, and my bpd was 7.8 or 8.3 or whatever. He said, when they tell you that, don't turn them away as being too far along. Tell them to come in, and we'll do our own sonogram, and it will show they're not that far along. Tell them that sonogram reading is an art, not a science. He explained to me that the bpd is a measurement of the angle of the baby's head, where at that angle, the baby's head is roughly egg-shaped. The usual way that you measure the bpd is from the top of the egg to the bottom of the egg, which is at the widest point. But we measure it from side to side, at the narrowest point."

Ms. Tivis lasted seven months at that location and is currently a strong advocate against abortion. Dr. Tiller certainly has staff that has stayed much longer. In a short time, people are not able to foresee all the consequences that might come, but those that have been around a long time certainly can. That strengthens the effects of cognitive dissonance and gives more urgency to the strategies to alleviate it.


People who are still doing abortion counseling will insist that they use non-directive techniques and have the client's best interest in mind. At a conference called "Meet the Abortion Providers," a far different picture was painted by those who had done counseling in the past. Each of the following comes from a woman who had served as an abortion counselor.

The counseling at this particular abortion clinic was so effective that 99 out of every 100 women would go ahead and abort. So that's very effective counseling, a very important part of that abortion clinic.

--Kathy Sparks

I was trained by a professional marketing director how to sell abortions over the telephone. This man came into our clinic and he took every one of our receptionists, all of the nurses, anyone that would be on the phone, and he took us through an extensive training period where we learned how to sell abortions over the telephone. So that when the girl called, we hooked the sale. So she wouldn't go down the street and get an abortion somewhere else, and so that she wouldn't adopt out her baby, or so that she wouldn't change her mind. We were doing it to get her money. It was for the money.

--Nita Whitten

We would find their weaknesses, and work on it. After the basic questions, they were told briefly about what was to happen to them after the procedure. All they were told about the procedure itself is that they would experience slight cramping, similar to menstrual cramps, and that was it.

--Debby Henry

They decided they would train me to answer the phone. So I thought they were going to tell me how they wanted the information sheet filled out, and how to keep the phone record, and this and that. But what I was handed instead was a packet of information, materials to study, on how to be a high-pressure salesperson over the phone -- you know, like telemarketing. How to convince somebody to buy your product. There was nothing in the material that had anything to do with the medical profession or helping women. I was very puzzled as to why they would be doing this. I hadn't found out how lucrative it was yet. So I studied, and I tried to answer the phone the way they wanted me to, even up to the very end. I had to, because I had a very strong urge to tell women, "You don't want to come here!" But I knew that if I'd done that, he probably would have shot me or something.

--Luhra Tivis

Carol Everett made a similar point in a brochure. "When a woman calls the abortion clinic exploring her alternatives, the abortion counselor is paid to sell one product, abortion . . . The abortion counselors are paid more than they can make anywhere else and they believe in their product. In the clinics I was involved in, we didn't do any real counseling. We answered only the questions the woman asked and tried not to 'rock the boat'. We did not discuss any alternatives to abortion unless the woman forced us to. The counselor does try to determine the reason this woman wants the abortion. Not so much to help as to use the fear to reinforce the abortion decision."[10]

Such techniques would not be necessary if women really were battering down the doors in eagerness to get abortions in huge numbers. This is not the same thing as the women who, were it illegal, would desperately seek out someone in the back alley.

If a clinic at which this form of telemarketing takes place goes out of business, and the counselors are no longer there to draw women in, then there are many abortions that not only won't happen but won't be missed.


Any claim for women's rights must include a respect for women. Any evidence of a lack of respect for women should introduce a feeling of dissonance to anyone who asserts a position as being in favor of women's rights.

Joy Davis commented on one of the doctors she believed showed this kind of disrespect, "I was very uncomfortable around Dr. P, so I decided not to work for him any longer. He invited me to go out to dinner with him to discuss it. I went to dinner with him to discuss how I felt about the way he treated his patients, and how he acted. He stated to me that he loved inflicting pain on women, which was the reason he did not use any medications for pain." She mentioned another doctor from Tennessee that had told her "that he did not have any respect for women, that he never respected a woman, and that he certainly didn't respect women that let him come in there and let him do an abortion on them."

Luhra Tivis reports that the person in charge of the escort service organized by the local NOW at Dr. Tiller's clinic "stopped the escort service because she went with him while he did some abortions, accompanied him, and didn't like the way he treated the women. Real rough, and arrogant, and not respecting their privacy." That NOW chapter still refused to run an article against him in their local newsletter, however. There was no warning to women of what they were facing to come from them.

As another startling example of unusual medical practice, Joy Davis reports on Dr. Tucker. "Generally at his office, we would have the patient asleep before he ever came into the room. When they were awake, he would say, 'Hi, my name is Dr. Tucker.' But then, if they said anything after that, he'd slap them. If they talked during the procedure, or moved or flinched in any way, he would hit them. I've seen him hit so many patients."

This has not escaped the attention of people active in the abortion movement. For example, Marge Brerer, in a presentation on "Feminist Perspectives and Reactions," comparing RU486 and surgical abortions, contemplated the reasons a doctor might be in the business. She wondered "whether it's out of a political commitment, or whether it's for money, or whether it's a relatively sadistic way of punishing women." [11]


Some readers will have objected to our use of the words "industry" and "business" for abortion provision, on the grounds that it's a primarily a medical service. Money tends to be ample in all medical services, but the primary point is that people need the health care.

A perusal of any reasonably-sized Yellow Pages would show that the term "business" is completely appropriate. The large display ads, used to get business away from competitors, make an interesting contrast with other doctors. Discount coupons are not uncommon, and toll-free 800 numbers are prevalent.

Davis told a story of one of the few times the abortion clinics within Birmingham got together. "They sat down and agreed, we're going to take a half page ad [in the Yellow Pages]. That way, nobody went with a full-page ad . . . We took out the half page ad, and all the rest of them came out with full page ads."

This burst of integrity on Dr. Tucker's part didn't mean that his outfit wasn't interested in the supply and demand aspects of figuring out how to make the most money. "We always did that in Birmingham, with Summit and New Women's Health Care. We would call and act like patients to find out what they were charging for that day, and then that's what our price would be."

Abortion is one of the few medical procedures where cash is demanded before it's done.

There are also reports of performing "terminations" on people whose urine pregnancy tests came back negative. This has been reported in many of the newspaper series on scandals. Major examples include the Miami Herald, Chicago Sun-Times, and Los Angeles Times. People who do that can't even pretend to be providing a medical service.

Everett worked hard at the appearance of providing a medical service. "It was always difficult to find and train telemarketers who could call themselves 'counselors' while selling abortions. 'We're helping women,' I had to remind them constantly. Those who didn't buy my pitch quickly left.

"I started to believe my own rhetoric. I had to be convincing in order to persuade my telephone counselors. But each time I met with Chuck, I was quickly snapped back to reality. We were in business to make money, a lot of it."[12]

Ms. Everett was intent on the purpose of looking good on TV while actually making good money. "I put on my PR hat and got creative. In one of our weekly meetings, I said, 'Many of the women come in alleging they were raped, but they have neither reported it to the police nor gone to the hospital. I think we can get a lot of publicity if we have a press conference announcing that we will do abortions free for rape victims if they report it to the authorities. The percentage of conceptions in actual rapes is very low, and with the conditions attached, I don't think we'll do many free abortions. But we'll get a ton of free publicity!

"Just as I had promised, we got prime-time news coverage at 6:00 P.M. and 10:00 P.M. Also, several newspapers and radio stations picked it up. I personally called on all of the 'do-gooder' organizations in town and let them know. We received lots of good, free publicity!

"We never did a single free abortion for a rape victim."[13]


Although it's not a terribly common thing in this country, aborting a pregnancy after prenatal tests show the fetus to be of undesired gender do happen.

It's common enough to be listed as one of the inner conflicts bothering providers in the American Medical News article. "One of the most vexing problems providers face is their feelings about procedures done for reasons that make them -- or others -- uncomfortable. Sometimes it's 'sex selection' -- the patient wants a boy and is carrying a girl."

Such drastic gender discrimination before birth can't have a healthy impact on gender discrimination after birth. This point should bring extreme discomfort to anyone laying claim to being an advocate for women's rights.

Nurse Sallie Tisdale commented on this also. "Always couples would abort a girl and keep a boy. . . An eighteen-year-old woman with three daughters brought her husband to the interview. He glared first at me, than at this wife, as he sank lower and lower in the chair, picking his teeth with a toothpick. He interrupted a conversation with his wife to ask if I could tell whether the baby would be a boy or a girl. I told him I could not. 'Good,' he replied in a slow and strangely malevolent voice, 'cause if it was a boy I'd wring her neck.'"

How is it supposed to make the woman feel to decide to abort a girl but carry a boy? What does that say to her about her own gender? Is this the woman who is boldly making decisions to guard her own autonomy? Is this helping her self-esteem? This is a form of sex discrimination, and practicing one form of sex discrimination interferes with getting rid of any others.


Much of the advocacy for abortion is done by left-wing people who find racism appalling, and steadfastly neglect the racists that applaud the consequences of their abortion advocacy.

Dr. Sloan recalls this when he was active in trying to get the New York state legislature to liberalize their abortion laws. "We had needed only a single precious vote to go our way, and one conservative upstate lawmaker had switched his vote at the last minute." A colleague said the vote had gone their way because the legislator was counting on abortion to limit the number of poor babies and keep the welfare rolls down. "'It was part people who want to put abortion into the medical code where it belongs and part racism.' . . . I hated to think that abortion reform had come out of such a philosophy, but I knew plenty of people saw abortion as a way to control the poor. . . Ending poverty would never be so simple as getting rid of poor babies. But if indeed that had been the reason behind the vote, it wouldn't have been new in history."[14]

He details Margaret Sanger's eugenics views as another example. She was the founder of Planned Parenthood. That organization routinely leaves out those racist views whenever they're praising her.

Edward Allred specializes in abortion and does it in many clinics. He was featured in a 1980 newspaper article, stating:

Population control is too important to be stopped by some right-wing pro-life types. Take the new influx of Hispanic immigrants. Their lack of respect of democracy and social order is frightening. I hope I can do something to stem that tide; I'd set up a clinic in Mexico for free if I could. Maybe one in Calexico would help. The survival of our society could be at stake . . . The Aid to Families With Dependent Children program is the worst boondoggle ever created. When a sullen black woman can decide to have a baby and get welfare and food stamps and become a burden to all of us it's time to stop. In parts of South Los Angeles having babies for welfare is the only industry the people have."[15]

Dr. Allred's aversion to government subsidies did not prevent him from collecting approximately three million dollars in public subsidies for performing abortions in 1980.

It's certainly true that all groups might have racists in them. You can't hold a bad apple like this against the entire business, certainly not against African-American abortion doctors. No one would say that all judges, or politicians, or celebrities, must be racist just because one of them made a similar remark. The remark would be held against the individual, not against the group to which they belong. Disciplining the individual would not be seen as weakening the group. To the contrary, it would strengthen the group by helping to purge it of the sickening reverberations of racism.

The abortion field seems to be different. Saying anything against that individual would mean admitting that the problem actually exists, and needs to be paid attention to. That's painful to admit, and doesn't fit into previously held beliefs about the noble goals of abortion provision.

Racist attitudes are not merely outrageous remarks. The consequences can be much more ominous. The following letter shows this:

I am the mother of Belinda A. Byrd, victim of abortionists at 426 East 99th Street in Inglewood. I am also the grandmother of her three young children who are left behind and motherless. I cry every day when I think how horrible her death was. She was slashed by them and then she bled to death, taken from this world on January 27,1987. She has been stone dead for two years now, and nobody cares. I know that other young black women are now dead after abortion at that address -- Cora Mae Lewis and Yvonne Tanner. Where is [the abortionist] now? Has he been stopped? Has anything happened to him because of what he did to my Belinda? Has he served jail time for any of these cruel deaths? People tell me nothing has happened, that nothing ever happens to white abortionists who leave young black women dead. I'm hurting real bad and want some justice for Belinda and all other women who go like sheep to slaughter."[16]

Though these cases were reported in the Los Angeles Times as abortion deaths, official records for the State of California never listed them that way.

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