Abortion: An Expensive Affair

"The whole thing was a nightmare, just an incredible hassle. In a sense, it was really surrealistic. I can't believe it really happened. But all of a sudden something reminds me and it blows my mind. Three days in London and it was all over. But it's not all over. I can't get it out of my head."

Marty got pregnant this summer. She was looking much better when I saw her last week, and I told her so. "That's because I've lost weight," she said, patting her stomach. She talked about her trip to London. "Tim and I flew in Thursday night. Friday I saw my doctor and the two psychiatrists. It was strange-they asked me questions like did I have any previous history of mental illness and did I get along with my parents and all. I said that I'd been through the usual number of hassles but that I was basically pretty stable. They gave me the OK anyway, and I checked into the nursing home Saturday morning."

"It was really nice there, clean, and I had a semi-private room. I got talking to the girl next to me, who was there for the same reason. Around 11 a nurse came in and gave me a pill she said would make me groggy. I remember crawling into a wheel chair, really enjoying the fogginess. But then they gave me a shot and I was gone. I woke up about seven hours later, there was a nurse sort of wandering around the room, and I said, "When am I going in?" "You've already been in," she said. I thought she was joking-I didn't remember anything. They let me stay that night and we flew home the next morning, Sunday."

"It was such an amazing trip. I remembered all the shit we had gone through trying to get one over here. We called Houston, New York, Florida, San Juan, everywhere, and it was the same answer. Most places said that I needed an appointment a month or two in advance and Christ, I couldn't wait that long. Tim and I went to Philadelphia, but we took one look at the doctor's office and walked out. The doctor would have done the operation using local anaesthesia, and I couldn't face that."

"All the people we talked to over here, all the doctors anyway, made us feel lousy. They were hustlers, and I was scared to death of letting them touch me. If I had gone to San Juan, I would have had to go alone to some greasy hotel and meet someone there who would lead me blind-folded to the doctor's office. I couldn't have stood that either. The whole experience was a mind blower anyway, and this back office stuff made it worse."

I told her that she had had me fooled for most of the summer. "I know," she said. "That's one of the reasons I decided not to have it done in Boston. I was talking to a friend and he told me if I walked into a psychiatrist's office here looking even relatively self-assured, I would get turned down. I wasn't going to lie and say I was about to commit suicide. And I didn't have any record of mental illness. Besides, I heard that there was a chance that they might contact my parents, and I couldn't risk that. They didn't ask for parental consent in London, Just a letter from my doctor here."

We talked for a while about the summer and about school. Then Marty got back on the subject. "You know, Tim and I have been talking about getting married. But he's said to me that if I marry someone else, I should be really careful about telling him that I've been through this. My friends have said that anyone who would hold it against me would be an incredible hypocrite. But I can't help thinking, who will have me?"

II

A 1957 Planned Parenthood conference report estimated that there are between 200,000 and 1,200,000 abortions performed yearly in the United States. Most specialists accept the latter figure as accurate. According to an article by O. J. Sikes, M. P. H., in "Sexology," one million of the twelve hundred thousand are performed illegally.

In about one out of four illegal abortions, practically all of which are done without the proper hospital precautions, the woman requires hospitalization due to hemorrhaging or infection. The Association for the Study of Abortion reports that two women die every day as the result of an illegal abortion.

"An abortion performed in a good hospital by a qualified physician under sanitary conditions is statistically as safe as having one's tonsil's removed," writes Sikes. The operation, done correctly, usually takes about 15 to 20 minutes. The most common procedure (called a D and C-dilatation and curettage) removes the fetus by a simple scraping of the womb. In England, doctors use the newly developed vacuum aspirator, which pulls the fetus out like a vacuum cleaner. Both methods are effective until the woman is in her twelfth week of pregnancy.

After the twelfth week a more complicated operation is required, and many Boston hospitals and abortionists refuse to perform the necessary surgery. In England, abortions are performed up to the twenty-second week, but the operation after the sixteenth week resembles a small Caesarian. Abortions in Puerto Rico (which are illegal) are generally not done after the tenth week.

Prices for hospital abortions vary greatly in the Boston area, usually from $300 to $600. In England the cost runs from $350 for an abortion done in the first twelve weeks of pregnancy to about $450 for one done in the sixteenth week. Including air fare (about $400) and travel expense, the total cost comes close to $1000.

III

Boston's Planned Parenthood office is located on the corner of Berkeley and Boylston Streets, right across from Bonwit Teller. I parked where the sign said "Customer Parking Only" and walked across the street. The elevator operator stopped at the fourth floor without my asking him to. He was used to the traffic.

The office was sparsely furnished, and all the table and desk surfaces were covered with papers on family planning, instruction folders explaining the proper use of the pill, and magazine articles on legal and illegal sexual positions. A new secretary was trying to master the art of hold buttons and transferred calls. A black girl sat smoking a cigarette. I concentrated on not looking pregnant.

When I finally spoke to Betsy Sable, a recently married Smith graduate whose official title was Family Planning Counselor, she seemed relieved to talk about abortion objectively. We talked about the history of the Planned Parenthood League of Massachusetts. The organization started in 1930 as the Massachusetts Birth Control Clinic, operating clinics for married women whose health required contraception. Complaints were lodged in 1937, and in 1939 the Supreme Judicial Court of Massachusetts ruled that the clinics would have to close, as birth control had been declared illegal in an 1879 statute.

In 1942 and 1948 bills legalizing birth control for married women were defeated in the Massachusetts legislature. The organization subsequently abandoned attempts to change the law but decided to use the right of free speech to educate people about the importance of family planning. In 1945 it changed its name to the Planned Parenthood League of Massachusetts.

One of the major services of the organization now is counseling, discussing with clients proper birth control methods, including sterilization, and the possibility of therapeutic abortion for those "unhappily pregnant." Because of the 1966 bill legalizing contraceptive care and prescriptions for married persons, the organization can now refer clients to doctors who will give them prescriptions for the pill.

IV

Betsy described a typical interview with a woman coming for advice about an unwanted pregnancy. "At least 50 per cent of them say that they weren't using a contraceptive at the time of conception. My response is, 'Why not? Didn't you know you could get pregnant?' Many say that it was the first time they had had intercourse without using one, or that it was the first time they had slept with anyone. They can't believe that one time can do it."

"What's even more appalling is that over 25 per cent of them believe that they can use the rhythm method as an effective means of contraception. I've had professional men in their 30's and 40's come in here saying that they've used the rhythm method for ten years and suddenly their wives have become pregnant. They don't know that it's almost assured that sooner or later, usually sooner, the rhythm method will fail."

V

At this point a tall man with disheveled hair and a wrinkled shirt came into the room. Betsy explained what I was doing, and the word "abortion" seemed to trigger an explosion in his mind. It was 5:30 in the afternoon, Betsy's contact lenses were bothering her, and frustration poured out of him in a massive harangue.

"Our society is responsible for the high abortion rate in this country. It's not just blind stupidity, the country is sick. We're afraid to touch each other, afraid to get close to each other, because of all the phony moralistic ideas about sex. Current books and movies flaunt sex in young people's faces, but at the same time the society is saying, it's wrong, don't do it. It's got people so hung up that they can't talk to each other. We have to face the fact that we're all sexual beings, and we've got to learn to take the responsibility for our sexuality."

VI

He stormed out of the room. Betsy told me that he was William Stromm, executive director of PP. "He gets very worked up, but in a sense he's right. The attitude of the young in this country is different now from what it was even ten years ago. It's trite, but I think we tend to live dangerously, take more chances. Of course that behavior is going to include sex. It's just incredibly unfortunate that the laws are made for twenty years ago, and even then they were unfair."

VII

Massachusetts' current law on abortion is potentially one of the most liberal in the United States. Sections 19 and 21 of Chapter 272 of the General Laws impose a criminal penalty on anyone who "unlawfully" uses instruments, etc., with intention to procure an abortion or who "sells, lends, gives away, etc. . . . any instrument for the prevention of conception or for causing unlawful abortion."

The word "unlawful" implies that there is such a thing as a lawful abortion, and recent court cases have established the criteria determining the legality of such operations. In the case of Commonwealt v. Brunelle, 1961, the Massachusetts Supreme Judicial Court ruled, "We have held that a physician is justified in effecting an abortion where he has exercised his skill and judgment in the honest belief that his acts were necessary to save the woman from great peril to her life or health. . . ."

"It was said in Commonwealth v. Wheeler, . . . 'a physician may lawfully procure the abortion of a patient if in good faith he believes it to be necessary to save her life or to prevent serious impairment of her health, mental or physical, and if his judgment corresponds with the general opinion of competent practitioners in the community in which he practices.' "

Although the clause allowing abortion on the grounds of mental health appears liberal, the problem in Massachusetts rests in the final clause. Boston hospitals vary in their practices, but most require the consent of two psychiatrists, the woman's gynecologist and the chief of the gynecology department before they will allow an abortion to be performed. A veto by one of these men usually means the rejection of the case.

Many factors influence Boston doctors in making the decision to accept or refuse an abortion case. Department heads fear that if they allow too many abortions, their hospital will become known as an abortion clinic. So if they accept an unusually large number of cases one month, they are likely to cut the number drastically in the next, even though the cases are similar. Some hospitals have considered setting up a quota, so abortions would be done on a first-come, first-served basis.

Most Boston hospitals demand that the consenting doctors be members of the hospital staff. Also, most require a previous history of mental illness. Some ask for parental permission, although most have adopted the emancipated minor' policy. If a girl has been living away from home, is self-supporting, and asks that her parents not be notified, she is considered an emancipated minor, and parental permission is waived.

VIII

English laws, although they resemble Massachusetts policy on paper, are much more liberal and are liberally interpreted. There are four general conditions for abortion, any one of which is sufficient:

The continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated;

The continuance of the pregnancy would involve risk of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated;

The continuance of the pregnancy would involve risk of injury to the physical or mental health of the existing child (ren) of the family of the pregnant woman greater than if the pregnancy were terminated;

There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

Most American women qualify under the second condition. Unmarried, divorced or widowed women and victims of rape or incest, who are not specifically protected under any American abortion laws, have no trouble obtaining abortions in Britain. Doctors do not require a previous history of mental illness, nor do they require parental permission for women under 21.

IX

Mrs. Marianne Parker, an attractive young women with a Swedish accent, had just finished the first day of her graduate school comprehensives at Tufts. We talked about her experiences at Planned Parenthood with the unfortunate unpredictability of female physiology.

"Most people don't realize that a woman's fertility rate changes from month to month. A lot of women I spoke to said that because they didn't get pregnant last month, they didn't think they would this month. They don't know that emotional excitement, fatigue, or any number of psychological strains can reduce or increase fertility."

I asked her about the infamous rhythm method. "I consider using the rhythm method the same as using no contraceptive. The method is based on the assumption that all women ovulate on the 15th day of their cycles. It just isn't true. Some women ovulate the day before their period comes, or the day after it ends. And even if a woman ovulates on the 15th day, you have to consider that both the egg and the sperm can live for two days in the woman's body. That means even if you're absolutely sure which day you ovulate, there are five fertile days every month you have to avoid."

I asked her if she thought better birth control practices would mean less abortions. "Of course birth control is the logical way to avoid abortion. However, recent articles on the pill, reporting that it causes blood clotting and breast cancer, have scared many girls away. They're afraid of the pill, but they aren't informed about the other methods. So they use the rhythm method and get into trouble."

X

I remembered some of the "sex education" films I'd seen in high school. It struck me that none of them had contained any information on birth control. One movie on unwanted pregnancy, a melodrama called "Phoebe," carried with it the moral that the way to avoid pregnancy was to avoid sex until marriage. In the plight of poor pregnant Phoebe, afraid to tell her boyfriend or her parents, missing out on all the fun the gang was having, there was no mention of foams, diaphragms or the pill.

XI

Marianne pointed out, as did everyone I talked to the inequities of abortion practices. "One of the real problems with the law is that it punishes the young, unmarried, and relatively stable girls. If a girl doesn't have any obvious mental problems, isn't a heavy drug user and is not considering suicide, she has a harder time getting an abortion than if she had been seeing a psychiatrist for three years."

More important, though, was Betsy Sable's point on this subject. "The hardship cases are the real problems here at Planned Parenthood. These women don't have the money to go to England, and they don't have the pull to get into a local hospital without the staff psychiatrists consent. Most have never seen a psychiatrist in their lives, so that they can't possibly have a mental record. And they usually come to us after it's too late to have the operation performed locally. They're the ones who wind up in the back offices, in the hands of the burchers."

XII

"Even at Planned Parenthood, a lot of cases don't reach us. Planned Parenthood is a middle-class organization; the idea that someone will do an abortion for you legally is a middle-class idea." A visit to the PP office confirms this comment. The PP building stands isolated in a middle to upper class world. Across the street is Bonwit-Teller, adjacent is Brooks Brothers, in the neighborhood are Lord and Taylor, Peck and Peck and other unlikely hang-outs for those women who would be trapped by the abortion laws.

Getting an abortion is, in most cases, a question of getting the money. Women with influence (money) can get into local hospitals without a psychiatric record. Money means a private physician, and a private physician means pull within the hospital system.

Anyone who can raise the money can go to England. Anyone who can't, and can't get a legal abortion, is left with non-existent choices. She can try for an illegal (and only slighlty less expensive) operation in Puerto Rico. She can tap the spring of underground abortionists, risking sterilization or death in the hands of a quack. Or she can do it herself, with soap solutions, knitting needles, wire coat hangers, and other home-made instruments of torture.

XIII

Antiquated abortion laws and practices in the United States must share the responsibility for the high abortion death rate with the illegal abortionists. Abortion is the third biggest racket in the United States (behind gambling and prostitution). Although some competent doctors perform illegal abortions because they are convinced the laws are unfair, the majority of abortionists are incompetent money scroungers. However, under the present legal system, a woman is forced to turn to these people if she is to retain the right to make decisions about her life. The power in the present system lies in the hands of the legislators and doctors. A woman must accept the legislators' distinction between legal abortion and murder. She can do no more than present her case to a number of doctors and hope that they are merciful. She doesn't have the power to decide and do what she feels is right.

Restrictions on birth control distribution complicate the abortion dilemma. In Massachusetts, it is illegal for doctors to prescribe contraceptives for unmarried women, and illegal for druggists to fill these prescriptions. Many physicians circumvent this problem by inventing a medical excuse for prescribing the pill or by assuming that all of their patients are married. But only warped logic could fail to see that law restricting contraceptive distribution (especially in a state where abortion is viewed conservatively) forces women into the hands of underground abortionists.

Birth control and family planning are obviously the best abortion preventatives. However, more important is education; people must learn how to use contraceptives and what happens when they don't. Abortion is a forbidden topic, a dirty word, because it carries with it moral implications. Sadly enough, these implications do not just include the taking of a potential life.

XIV

Implicit behind abortion and birth control laws is society's fear and moral condemnation of "sexual promiscuity." The moral code implied by the laws is clear. Unmarried women are not supposed to engage in sexual inter-course. Women who cannot afford or are uninformed about birth control should not sleep with their husbands if they want to avoid having children. Any violator of the code is on her own. outside the protection of the law. If she dies in the hands of a quack, it's too bad but it's her fault. She has to suffer for her wrongdoing.