A few years ago, a colleague and I were asked to write a fantasy essay on what abortion services could look like in the future. Since we could be as creative as we wanted, we decided to write a piece that would reflect our belief that not all women would want the same kind of experience. That is, some women need the counseling and support services that good abortion providers offer, while others might instead value a faster, less intensive appointment. Going beyond the most obvious, we allowed our minds to wander, coming up with a kind of spa abortion and then, from there, a more spiritual experience. Since the time that this essay first appeared in Viable Utopian Ideas, edited by Arthur Shostak, PhD, we have instead come to see the erosion of abortion rights. The Supreme Court has just handed down a decision that removes women's health and safety from physcians and puts it in the hands of the Court. Further erosion of reproductive rights is likely.
We are abortion providers, each with over 20 years in the field. We are constantly looking for ways to change the experience of abortion in a field that has remained nearly unchanged since its legalization in 1973. From our perspective, the abortion issue has been stigmatized, polarized, and essentially frozen in time, with disastrous effects on real people.
In real time, women--and men--make thoughtful choices that are sometimes painful and sometimes empowering, but they have nowhere to go with their feelings, thoughts, and experiences. Will the future hold promise for breaking the deadlock around the abortion issue? If so, what do we really want?
As long time abortion providers who talk to women every day, we recognize that many women do not know how to even begin, what questions to ask, or what to ask for. Because of the silence surrounding the abortion experience, this is uncharted territory for the women and men who come to us. So we peopled our model world with guides and a menu of options. A trustworthy guide is always a good thing, whether you face a death in the family, or you're learning about Australian wines. In the abortion world, you hope to be lucky enough to find a guide who will listen to your story, who will pass on the wisdom of others who have traveled this same path, someone who will tell you what to expect and how to get through the bumps and twists along the way. And most of all, someone who can notice the good things--the gifts--that this unexpected-- and unwanted-- journey can surprise you with.
We hope --and expect-- that in the future the popular culture will include complete information and perspectives on a multitude of abortion experiences. Women will be able to freely talk over their decision with trusted friends or family, get accurate information in health books as well as TV and movies, easily find a counselor, get abortion services readily, and enjoy seamless ongoing care. They will be able to buy self help books and DVDs or attend workshops on post abortion feelings. Taken together, women may find that they can piece together, on their own, the parts they need to create their own ideal experience including the appropriate emotional and physical recovery afterwards.
Interestingly, all of the options and the complete menu of packages we present below could happen today, not in the distant future. The future may yet bring us further options, new technology, and hopefully better birth control. The recent advent of abortion with a medication (now known as RU486 or Mifeprex) has already introduced the idea of different methods to have an abortion. Breakthroughs in genetic research, cloning needed body parts, and gene therapy will alter how we see life on a cellular level, and perhaps by extension, the issue of abortion. But what the future promises most is the open consideration of all aspects of pregnancy, without judgment and with compassion. Choice will finally mean choices. Some day, perhaps not too long from now, someone may be saying to you, "How do you want your abortion today?" And hopefully you will meet Jane:
Hi, my name is Jane and I'm going to help you decide what kind of abortion is right for you. First of all, let me say that I'm sorry you are in this situation, but it may help to learn what's available and then decide what's right for you. We have a number of packages available or you can customize an experience that fits with your situation and needs. Let me describe our most frequently requested packages to you.
1. Economy-- This is our most popular package which has been offered since 1973 and enjoyed by several millions of women in the United States. You can expect to be in an abortion facility about 4 hours. Several other clients will be joining you as you learn about the basics of pregnancy termination, birth control, and aftercare. Outpatient surgery is simple, quick, and safe. Personal review of medical history and emotional check-in are available; beverages and snacks will be served and a choice of pain relievers is yours, all for a reasonable fee of $350.
2. The Lunch Hour Special-- Designed for the busy woman for whom time is more valuable than money. Make your appointment on line and submit your personal medical information for review in advance of your appointment. Lab work can be performed at your convenience ahead of time. The physician is kind, quick, and gentle. Some sedatives may not be available in this time frame, but we guarantee service in one hour. $600.
3. The Family Package-- This is an important decision in your life and of course you want your loved ones around you!! You can be accompanied through every phase of this process by the person you choose. Counseling is available for all family members and includes training and suggestions for them to participate in your care. Flowers, breakfast in bed, baby-sitting, just tell us what you want and we'll pass it along. We stress support and coping skills before, during, and after your abortion. Choice of abortion pill (additional $100) or surgical abortion. $650.
4. DIY (Do-It-Yourself)-- Are you the kind of person who does a lot of research? Someone who is knows what you want? Do you want to avoid the hustle bustle--and waiting time-- of a busy clinic? Would you like your abortion in the comfort of your own home? Take a pill today and choose when you bleed anytime in the next three days, safely, completely, in your own home. Full instructions and educational video included and our 24 hour advice line is open to you. Available only in early pregnancy. Some restrictions apply. Like everything else you do, have this experience on your own terms! $550.
5. Deluxe Spa Treatment-- Get the luxury and personal attention you deserve!! Check into our special suite at the Jetson Hotel where you will meet with our experienced guide, who will be available to you for your abortion experience. After extensive orientation for you and your partner or family, enjoy a relaxing massage and jacuzzi. Full emotional support is available to you and those close to you, tailored to your needs. A full range of sedatives and pain relievers to choose from make for a pain free procedure by our experienced and friendly physician. Recover back in your suite and choose from 3 relaxing options--a foot massage, a mud pack facial, or a rebalancing of your shakras by our expert Reiki master. Then, enjoy room service from a 4 star restaurant. Our guide will be available to you to review aftercare and discuss any emotional issues. Full cable and choice of video entertainment available, and enjoy our feather pillow beds for a good night's sleep. $3000
6. Spiritual Journey-- Ending a pregnancy is not just a physical act but also a spiritual process. Meet with our spirit healer and guide a week in advance to plan the ritual journey that will meet your spiritual needs. Native American (Taino clan tradition), Eastern philosophy, nature-inspired (pagan), or custom designed ceremonies are available to you and to the support people who will accompany you on your spirit quest. Or, design your own rituals with the help of our experienced guides. Check in to our mountain retreat Friday night for a ritual cleansing and spiritual preparation. Have the surgical procedure when you are ready for a separation of paths with the spirit child within you. Miscarriage with medicines and herbs is also available early in pregnancy. A follow-up ritual a year and a day later is included in this package. $5000
7. Full Emotional Support-- Deciding to end a pregnancy may well be the most difficult emotional crisis a woman or couple may face. Our experienced counselor will spend 2 hours with you and support person of your choice, and your appointment will be scheduled 2-7 days after that. The counselor will explore relationship and identity issues, personal goals, religious and spiritual concerns and offer interactive skill building to you and your significant other. A choice of 3 self help books are included with additional suggestions for grief work and emotional aftercare. The procedure will be performed by an experienced and kind physician in privacy with your choice of pain relievers and sedatives. Or, choose to miscarry with medicine taken at home. ($100 extra.) Two follow up visits with our licensed and experienced counselors are available one week and one month after the procedure. Consultation by phone with the clergy or spiritual leader from your belief system included, if desired. $1000.
8. Discount Package-- A basic "no frills" package is available for those women who don't need ambiance or additional support. No additional sedation is available without additional cost. Licensed physicians perform the safe surgery in less than 5 minutes. Expect delays and waiting time. No support people allowed in counseling or medical areas. If you want to spend the money on something else, this package may work for you, but we encourage you to consult our website for a complete overview of the abortion experience. $250, cash only.
9. Abortions Anonymous-- For the woman who wants to tell no one, keep it secret, and have no record of having been there, we offer an anonymous service with private hours. Counseling offered to explore any feelings and potential emotional side effects. No names taken. $950, cash only.
Note: All materials for emotional healing, aftercare, and information on women's wellness is available on our website, www.pregnancyoptions.info.
Disclaimer: Matters of pregnancy, including abortion are profound and complex and should beattended to in accordance with your personal needs and preferences. The medical process, though not usually complicated, still needs your complete cooperation and disclosure of information. Our first concern is your safety and health and medical concerns supersede all other plans, agreements, and considerations. Thank you for your understanding.
In most utopian scenarios, price tags are not offered because we assume money will be replaced by a better system of valuation. We have included these imaginary prices, in 2002 dollars, as a way to think about what an experience is worth to us. It may seem strange to think about market forces at work in abortion services but, actually, the stigma long associated with abortion has kept the principles of market economics from working for the consumer of abortion care. Abortion fees have been historically low in relation to medical inflation, and consumers have few choices. Abortion services, by and large, have not changedmuch in the last 30 years. If people were given real choices of how they wanted their abortion experience to be, the market would reflect a range of price tags as well as desires. When the stigma of abortion dissipates, women will actually have more choices and more recognition of the range of feelings, circumstances and their needs in facing an unintended pregnancy.
As providers, what impresses us the most about our work is the women's stories, each different, complex, nuanced depending on her history, her stage of life, the support she has, how she reacts to this turn of events, and many many other factors. It is difficult to represent this variety of stories in the rich detail each one deserves. Indeed, we are painfully aware that we are sometimes the only ones who hear these stories since society is largely deaf to the real experience of abortion. An abortion provider we know said, "A woman can have a profound experience while she is in the clinic, but when she leaves, what is on the other side of the door? Frequently, silence."
Envisioning the future of abortion must recognize these separate and different realities of the millions of women who have had and will have an abortion. We live in a multicultural society which sometimes feels like a culture-less society. American culture does not offer much helpful advice about pregnancy loss. Sometimes we say to our patients who choose abortion but also feel a sense of loss, "There is no Hallmark card for what you are feeling. No one will drop by with a casserole. You have to figure out your own grieving." In a future and ideal world, the culture will find many ways of offering solace to women in dealing with the social and emotional aspects of unintended pregnancy.
Of course, in our ideal world, birth control works, sex goes beyond trading fluids to a trading of souls, and society is understanding of the emotional and spiritual issues in the rare situations where pregnancies happen and are not desirable. Of course, we also realize that even in the future, enlightened or not, people will take risks around sex, and love will still be blind. And, abortion will still be needed. However, in our vision of the future, abortion is a non-issue; pregnancy is seen as a profound and life-altering event and everything about it is treated as sacred--even, or perhaps, especially its ending. Children are miraculous and welcomed, miscarriages are mourned, and abortions are considered carefully, and carried out lovingly, with the support and comfort of the woman's community. Men may be involved in all aspects and grandparents, aunts, uncles, siblings and friends rally around to support the woman in her chosen path. At the same time, a couple's decision not to have children is equally honored. She recognizes that she is the gatekeeper of life and so creates a special place for herself to consider this question: "Is this the right time for new life to come into the world through my body?"
In this question at least, there is no difference between the future and the present. Every day thousands of women, and men, answer some variation of this question. It may be surprising to anyone outside the abortion field that the query "do I want an abortion?" is not the question at all, but one answer (and usually the last resort) to the real question about what we want from life and what we can offer to life. Most people we talk to say, "I never thought I would be here..." or "I always thought I was against abortion." The denial around the possibility of being faced with an unintended pregnancy is nearly universal, yet 43% of all women will have an abortion before they are 45.
Nonetheless, when the question becomes real for you, it's like a bright light shines on your life. Frequently, the light seems harsh and all the flaws show up, but sometimes you can see the perfect parts too. One of our patients said, "Since I have been making this decision, I have been appreciating my three daughters. They are such a blessing to me."
"Where am I going?"
"How will a child affect my other children? My career? My education?"
"Who is with me on this journey? What do they think about me and my life?"
"What are my beliefs about life, death, and doing the right thing?"
"How is my health? Who is depending on me to care for them?"
"How strong is my relationship with my partner, my family, my friends?"
"What can I handle financially, emotionally, physically?"
In this internal quest for the right decision, a woman soon notices that she is part of a web of relationships where what happens to each person affects others. Obviously, the woman is the nexus for many threads, and her own desires, needs, and strengths get the most consideration. The threads connecting her to partner, children, and family must be fully considered. It is important to realize that the decisions each woman makes affect the entire web from the earth we stand on to the spirituality and culture of a society.
When we thought about the future of abortion, we knew it had to include many different perspectives and experiences. We also knew that the interesting questions were not about legal rights or access, but about the quality of the abortion experience. We realized that the question about abortion for the 21st century had to be: "How do you want your abortion?"
The answer to the future of abortion is to be found in many people standing in the future and answering the above question. This "Stand in the Future" technique has enabled us to think about a world we would like to live in. The technique is also valuable in understanding how to map a course from the present to that vision of the future. It is tempting for those of us in the abortion field to say, "if we could just get rid of restrictive laws" or "let's get rid of the stigma around abortion." What is more useful in shifting our perspective is imagining a utopian world where each of us constructs how we would like abortion--indeed, all pregnancy experiences-- to be. We are not looking for reform as much as transformation. When we focus on how we want an experience to be, often we discover that meaningful change is within our own power right now, in the present time.
©Margaret R. Johnston and Claire Keyes.
Margaret R. Johnston has been providing abortion services to women in upstate New York for over 20 years. She has written extensively on the abortion issue and has created two self help guides, "Pregnant? Need Help? Pregnancy Options Workbook" and "Abortion: Which Method is Right for Me?" (www.pregnancyoptions.info ). She has been a trainer in abortion counseling for both the National Abortion Federation and the National Coalition of Abortion Providers (NCAP) and is currently the President of NCAP. E-mail: info@pregnancyoptions.info .
Claire Keyes reports, "Most of my life's work has been in abortion. Although I have been the Executive Director of Allegheny Reproductive Health Center in Pittsburgh for nearly 30 years, my heart," she says, "has always been in counseling." For the past decade she has been training counselors; she has presented at both the National Abortion Federation and the National Coalition of Abortion Providers, focusing on new paradigms for healing spiritually and emotionally after abortion as well as men's issues. Most recently she created the only pro-choice site for men www.MenAndAbortion.com. She would like to hear from anyone who wants to comment; E-mail: claire_keyes@yahoo.com
Used with permission from Viable Utopian Ideas: Shaping a Better World, edited by Arthur B. Shostak (At press: M.E.Sharpe; due out in January, 2003.
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