For several years, I was a woman's health counselor for both Planned Parenthood and for a private GYN who performed abortions in addition to providing primary women's health care. I also co-lead a post-abortion grief board on the Internet. Many of the board members there felt coerced into their abortions. I think what we're dealing with here is two separate issues that tend to get lumped together: The first is the woman who feels forced by circumstance as perceived by the people around her or herself; the second is the woman who aborts because of an actual or implied physical or emotional threat. The solution to the first problem, as I see it, is education, more education, and further education. Most of the educating that needs to be done has to do with false presumptions about various options. Adoption as a choice is hobbled by a number of weird ideas that have become "common knowledge". Among these assumptions is that every adoption is closed, that closed adoption doesn't allow the birth mother to have any say in who raises her child, and that birth mothers have ongoing emotional and mental wounds after placing a child with an adoptive family. There are a variety of agencies, both secular and religious, that offer adoptions ranging from totally open with visitation to almost completely closed--the birth mother has some input into what sort of family she'd like to see adopt her baby, but after that, there's no contact. Further, I've yet to work with an adoption agency of any stripe that doesn't offer counseling prior to and after the birth of the baby. Many (like Lutheran Social Services, Hope Cottage in Texas, and Edna Gladney Home), even offer educational and housing aid. A problem that women who wish to parent run into is the stereotype of the poor, neglected, welfare-dependent single mother. It's true that single people--especially teenagers--face obstacles in raising kids that a two-parent or extended-relative family wouldn't face, but many of those can be overcome or at least mitigated with proper help. At PP, we had a list as long as my arm of social service organizations from private church-based mentoring programs to Federal programs that could lessen the load for women trying to raise kids on their own. I found that a lot of women I ran into who were conflicted about their choices and leaning toward abortion as the "simplest" option simply had no idea, many times, of the resources available to them. In addition to educating women about options in pregnancy, I think that we as counselors need to remember that folks sometimes (okay, often) make rotten decisions out of panic. They tend to get blinders on, make an appointment, keep the blinders on through it, and then realize some months or weeks later that they've done something totally at odds with their moral or religious or ethical bent. I was *not* shy about sending women home from the clinic--even for a day or two--and I also wasn't shy about handing out pamphlets, contact numbers, and booklets to women who had that "I've *got* to do this; I don't have *any* other choice", round-eyed, panicky look. Sometimes, yes, abortion is going to be the decision that makes the most sense to the woman at the time, but you have to really stress taking a step back and looking at the long view/big picture. Now then...as to the second issue--that of physical or emotional threat or coercion....that's a hard one. Sometimes it's easy to tell if a woman's being coerced. Her affect, her physical posture and stance, and the behavior of her partner can all set off warning bells. Sometimes it's almost impossible to tell. With young women, it can be even harder--a teenager in crisis tends to master emotional control to an extent I never imagined before I saw it. What can we do in cases of obvious physical coercion? We call the proper authorities. If a woman tells us her partner has beaten her and has threatened her if she doesn't go through with an abortion, we call the cops. If a child (under 17) tells us a similar story, we call the protective service people. Most of the time, an emergency pickup and safe haven can be had for these women/girls. What do you do when a woman won't tell you, exhibits no physical signs or symptoms of abuse, or denies that she's being coerced? That's harder...if you have "good faith" that abuse is taking place, you are required to call the appropriate authorities, but sometimes it's hard to get the woman or girl in question to follow up with them. After all, they don't have to get into the car with the social worker if they don't want to. Many of them fear reprisals if they do. All in all, the physical and emotional force takes place in a much broader context than that of a woman who's having an abortion. Many times, the woman in question is dealing with a long-term abusive relationship (be it spouse, SO, or parent) and all the issues that go along with that. The only way to stop this sort of coercion is to treat the entire problem of domestic violence and child abuse. I think the primary thing to remember (if you're still with me at this length!) is that abortion and unplanned/unwanted pregnancy don't happen in a vacuum. Women don't toddle into an abortion clinic when everything's going swimmingly--there's usually at least one other area of their lives that's in crisis *in addition to* the pregnancy. If we can, as folks, policymakers, and grassroots workers, get rid of this crisis-pregnancy myopia and instead tease out all the threads of the particular difficult situation, I think we'd see a significant decline in the number of women who feel hopeless, pressured, and backed up to a wall. Goodness. I don't think I've written this much in forever.
Followup:
That said...my state has no state-mandated education, which meant that we were on our own as far as educational materials went. One of the pamphlets I used most often for women who were undecided was "Am I Parent Material?", published by PPFA (Planned Parenthood Federation of America). It's a good one that guides the reader through self-administered quizzes to determine which option(s) deserve more study. As far as abortion counseling went, we used a triple-pronged approach at both clinics. We provided a packet of information on alternatives (both local and state/national), informational pamphlets on the abortion process itself, and a pamphlet that described (with line drawings) fetal development up to 24 weeks. At the doc's office, we also used--in addition to all the pamphlets--a book written for medical professionals that showed actual POC (products of conception; a horrid term) post-abortion and pictures of the embryo and placental sac to scale. Full color, captioned, with centimeter and inch scales at the side of each picture. If a patient asked me, "Is this a baby?" or "Is this alive?" I would have to--and did--answer honestly: "I don't know." For me, an eight-week embryo is not equal to a baby, but what *I* thought at the time didn't matter, and I tried to make that clear. What the *woman* in the situation thinks is the only thing that is of any consequence, and if she was unclear on whether she could accomodate, morally, the action of and consequences of aborting, I sent her on to her minister/priest/rabbi/imam and to one of a number of private licensed professional counselors who'd agreed to do pre- and post-abortion counseling for free. Occasionally I'd see a woman post-abortion or get a call from a woman post-abortion who was having problems dealing with her abortion. In those cases, I'd hand over a booklet called "How to Cope Successfully After an Abortion" by Anne Baker. It's published by and copyrighted by the Hope Clinic for Women in Granite City, IL. It's a good resource. In addition, I had sheets that listed groups like Project Rachel and the Shrine of the Holy Innocents as well as the names and numbers of the aforementioned LPCs. We also had lists of resources at both places for child care, transportation vouchers, Medicaid and WIC, domestic violence and rape crisis centers, elder care, genetic testing and counseling (did some of that, too), housing assistance, community schooling, scholarships, and job training. There are gonna be rotten apples in every barrel in *any* profession. Abortion counselors, doctors, and nurses are no exception. The majority of us, though, do try very hard in the face of really weird work situations and huge workloads to provide the best possible care for our clients. Meg
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