YOU SAY YOU WANT TO END ABORTION. . .?
“Tell Jake to sleep on the roof.”— In 1912, Sadie Sachs was living in terrible poverty with 3 hungry children in a tiny one room apartment in New York City. Barely surviving the complications of a desperate self-induced abortion, she begged the doctor to tell her anything she could do to keep from getting pregnant again. This was all the Doctor would say – “Tell Jake to sleep on the roof.” Six months later, after another attempted self-induced abortion, Ms. Sachs was dead.
“There’s a high school girl with a bourgeois dream/Just like the pictures in the magazine/She found on the floor of the laundry mat/Well a woman with kids can forget all that/If she turns up pregnant, what’ll she do?/Forget the career, forget about school?/Can she live on faith, live on hope?/High on Jesus or hooked on dope?/When it’s way too late to just say no/You can’t make it here anymore.”—from We Can’t Make It Here Anymore, on the album Childish Things, by James McMurtry, 2005.
This subject will be difficult for many of you. Few issues are more immersed in raw emotion than this one, nor have such potential to divide us into warring factions.
So if you can stay with me, I hope we can approach this from a standpoint of reason and logic, rather than hatred and demonization.
Fair warning—I’m not writing about philosophy or theology here. That’s what makes this different from 99% of what’s usually written about abortion.
Most people want to argue about the nature of an embryo or a fetus. Is it really alive? Is it life? Is it human life? Is it a human life? Does it have a heartbeat? When does it get a heartbeat? Does that make any difference?
Does it have a “soul?” When does it get a “soul?” What is a “soul” anyway, and what does it mean to have a “soul?” Is it connected to an afterlife? What kind? Does it feel? Does it think? Is it just a mass of dividing tissue? If it’s not life, then what is it? When does it become “life?” When does it become a “life?”
Feel free to argue about that stuff with your friends and neighbors all you want. But you’ll probably just make yourself nuts in the process.
I’m not going to do that. Because today, people are getting shot, clinics burned, and nurses and doctors harassed and threatened by some of the bitterest people I’ve ever met, all who seem to think they have the moral high ground.
What they don’t seem to realize is that their hatred is accomplishing nothing. That’s why any honest discussion of abortion needs to be based on thought and reason.
So if you’re really someone who wants to end abortions, here’s what you need to know.
First, let’s start with some basic facts. Humans have been having sex for centuries, and it hasn’t changed much.
Every bit of research shows that the age at which people begin having sex is similar across most groups, usually beginning in the mid to late teens. Kids in conservative homes, kids in Christian schools, kids who attend multiple religious services, all seem to have sex no differently from their peers. And just as often, they get pregnant. No, religion doesn’t somehow magically protect you from pregnancy. And it certainly doesn’t keep religious young men from getting young women pregnant, either.
In fact, teens exposed to “abstinence only” sex-education have higher pregnancy rates than those who learn about other methods of birth control.
Let’s get down to brass tacks. Abortion becomes an issue only if someone gets pregnant. Someone only gets pregnant if they have sex. And people have—and will continue to have—sex, regardless of how much preaching is done.
You can’t legislate away sex. And the hard truth is that you can’t legislate away abortions, either.
This is what the people who demand that we overturn Roe vs. Wade refuse to acknowledge.
As a physician, I can’t begin to tell you how many times I’ve sat in an examination room with a woman who was crying, shaking, and desperately trying to come to terms with an unplanned pregnancy. Each was different. Some were married, some weren’t. Their ages varied, their lives varied, their families varied. The impact of the pregnancy on the future of each one of them was profoundly different.
Each one struggled with the physical, psychological, emotional, and spiritual aspect of what they might have to do. And in most instances, there wasn’t a male in sight.
And no, not a single one of them approached it lightly. I’ve never had a patient who came in and said, “Gee Doc, I got up this morning and thought ‘what can I do today? Go to the zoo? Clean out the garage? Hey, you know what, I think I’ll just go get an abortion!’” Rather, for each woman, it was the most gut-wrenching decision they ever made, regardless of whether they ultimately had the abortion or not.
But the last thing any of them was concerned about was whether or not it was “legal.”
I went to a rural Missouri high school. We had 39 students in my graduating class. And in my school alone, I knew of 2 young women who had abortions. There were undoubtedly more.
This was in the 1960’s—before Roe vs. Wade. Abortions were technically illegal, just like they were in 1912. That didn’t keep them from happening—whether in 1912 New York or 1968 Missouri. According to her biographers, Frank Sinatra’s mother was the “go-to” person in Hoboken, New Jersey if you were an Italian-American woman who needed an abortion.
Long before Roe vs. Wade.
If you had money, you could get a relatively safe abortion. But it would cost you. And if you didn’t have money? Then you had to engage in the Russian Roulette of unsafe, risky abortions.
You might bleed to death. You might become septic, dying of dehydration, fever, and an overwhelming infection.
The conditions of the procedure were sometimes medieval. One woman from California had to drive to Mexico for an abortion. She screamed in pain as the doctor performed the procedure without any form of anesthesia or pain killer. “You must burn for your sins,” he snorted.
Burn for your sins? No mention of the son-of-a-bitch who got her pregnant in the first place, burning for his sins.
Most often, a pregnant woman, especially an unmarried young woman, confronts her condition without the support of the man who impregnated her, often with rejection from her family, and all too often, with her future shattered.
And it doesn’t end there. Records show that domestic violence against women actually increases during pregnancy. And if you already have a child you’re trying to protect, getting out of a dangerous relationship while pregnant becomes even harder. Without community or family support, it may be impossible.
What if the abuser resents your pregnancy, blames you for the imposition it might place on his life, and if he’s cruel, controlling, and paranoid enough, starts thinking that he might not even be the child’s father?
We see the outcomes all of the time. The woman winds up dead. Pregnancy is a documented risk factor for both physical abuse and homicide.
All too often, it’s the women who most need help that can’t get it. Poorer states and communities often have nothing to offer women other than thoughts and prayers.
In addition, assistance with oral contraception (birth control pills), condoms, and other birth control methods is often most lacking in poorer areas where women can least afford to pay for them out of pocket.
Why? First, because state budgets often prioritize just about everything ahead of women’s health, and secondly, because many self-righteous politicians seem to think that making birth control more readily available will turn women into sex-crazed creatures who’ll go out and have sex faster than a bunch of rabbits in spring.
The second point is obviously ridiculous. Let’s go over it again. People already have sex, and without contraception women will become pregnant. Contraception doesn’t force anyone to have sex, but it will allow people to plan families, and eliminate the need for abortion.
But only if contraception is actually available. More on that in a minute. But for the moment, let’s just say that anyone who claims to be “pro-life” and “anti-contraception” is as loony as someone who is “pro-health” but “anti-health care.” Study after study has shown that woman who use contraception have sex no more often than women who don’t. They just don’t get pregnant.
And thus don’t confront the issue of abortion.
Don’t just take my word for it. Look at the rest of the world. The United States has higher rates of abortion than any country in western Europe. Yet in each of those countries, abortions are easier to obtain than in the U.S.
Let me say that again. European countries that make abortion more available have fewer abortions. The key is that they also make contraception far easier to obtain, and it works. Fewer unplanned pregnancies, and fewer abortions. And sex occurs just as often as in the U.S.
But these facts haven’t stopped many hypocrites in American politics and media from acting in outrageous ways. These are people like former Georgia Congressman Bob Barr, an outspoken proponent of “pro-life family values” who repeatedly voted to block any funding for abortions. According to one of his several ex-wives, Barr not only encouraged her to get abortions, but actually drove her to the clinic for the procedures and later picked her up. He apparently didn’t want to be seen in the waiting room.
And then there’s Republican Congressman Dr. Scott Desjarlais of Tennessee, who might best be described as the Gynecologist from Hell. He’s admitted to having sex with his patients (he got a $500 fine and a slap on the wrist). He also supported his ex-wife’s decision to get two abortions, and has been caught on tape advising a patient (who was pregnant by way of the good doctor) to go out of state for an abortion. He claims he wants to now outlaw all abortions (apparently only for other people). And he keeps getting reelected.
And don’t forget Rush Limbaugh. The multiply-wedded pride of Cape Girardeau, Missouri and self-proclaimed Family Values Guy famously told a Georgetown co-ed who spoke out about the need for affordable contraception that she was a “slut” and he “wanted to see movies” of her sex life.
Who knows? He might be watching movies right now by a very warm fire.
Finally, let’s not forget that abortions for the rich and famous have always been around. When a man who’s rich and powerful gets a woman pregnant, he can easily hush the whole thing up with a pay-off and an abortion. And the more women he has sex with? The greater the possibility for a pregnancy—and an abortion.
To anyone who thinks that a certain ex-president, who’s openly bragged about his multiple sex partners, hasn’t gotten some of those women pregnant and paid for their abortions, let me say this: I’ve got a big bridge in New York City I’ll sell you.
The four examples I’ve just given you are, of course, all men. And if any of them had somehow gotten pregnant themselves, do you think they would have hesitated for a minute before getting an abortion? You know the answer as well as I do.
I’ve known several people who worked for Planned Parenthood. They were subjected to daily abuse and scorn from protestors. Yet on several occasions, they’d see some of those same protesters in a different light—when they’d show up afterhours, tearfully describing a pregnant daughter, and asking for help in getting an abortion.
Hypocritical? Of course it was. But in each case, the parent rationalized that their situation was somehow different, that they were the exception.
A few weeks would go by, and the parent would be back outside protesting as if nothing had happened. This, my friends said, was what convinced them that their work was indeed essential.
But let’s talk about legislation for a moment. In state after state, legislators are passing laws making access to abortion more and more difficult (except for the rich, of course). Texas has tried to lead the way by placing a $10,000 “bounty” on anyone who performs an abortion. I’ll have a few things to say about that in a minute. But for the time being, keep in mind that the law hasn’t significantly reduced the number of Texas women getting abortions, bounty or no bounty.
Currently, with a far-right Supreme Court, Roe vs. Wade may soon be declared unconstitutional and abortions will be banned across wide swaths of America (presumably, there will be exceptions made for the kinds of politicians I mentioned above).
And if this happens, there’ll likely be a huge party. Anti-abortion advocates will high five and fist bump. But they will have accomplished nothing.
Abortions will continue, just like they continue in every state where attempts have been made to restrict them. Rich women (or women pregnant by rich men) will continue to get them under the table. Poor women will get them in unsafe situations, and many will die. But abortions will still occur, just like they did before Roe vs. Wade.
So you say you want to do whatever’s necessary to end abortion? Twenty years ago, I was on a panel of speakers discussing health care in front of a large group of medical students. The subject of abortion came up. This was at a Catholic medical school, and some of the panel talked about overturning Roe vs. Wade. Finally, it was my turn. These students need to hear the truth, I thought. So I told them.
Abortions won’t go away if Roe is overturned, I said bluntly. Overturning a law is easy. But ending abortion? That’s much harder. Here’s what it will take.
Only when contraception is universally available, and barriers to access are removed. Only when contraception is affordable to everyone, and not hidden off in a corner somewhere. Only when it’s over-the-counter (like Aleve or Tylenol), as it is in many countries. Only when parents accept the reality of sex, and don’t block their children’s’ access to contraception—for both men and women
Only when women are finally treated with respect as equals. Only when the male who caused the pregnancy has the same accountability as the woman. Only when their future, their life, their opportunities are impacted to the same degree as the woman.
Only when women aren’t shamed for a pregnancy while the male gets off with a wink and a nod. Only when women aren’t rejected by their families and friends. Only when social supports truly provide the assistance that a woman and her family need to have a decent life, a fair opportunity, and a healthy environment.
Only when a pregnancy doesn’t mean the end of a career or an education. Only when it doesn’t place a woman at risk for abuse and harm.
So if you want to end abortion, work to make these things happen. When they do—and only when they do—abortions will end. But not a moment before. In the meantime, all the protests you do, all of the signs you carry, all the letters you write about overturning Roe vs. Wade, will accomplish nothing.
Nothing.
I pushed the microphone away, and glanced at the other faculty members at the table. They were staring at me with their mouths open. Up to that point, whenever anyone on the panel had spoken, the students responded as students usually do—with polite applause.
But my remarks were met with stunned silence at first. Then they gave me a standing ovation.
Today, I would say the same things I told those students 20 years ago, but with one addition. That Texas Law—the one that allows a $10,000 bounty on anyone performing an abortion? I’d actually be willing to support that.
But only if in order to collect the bounty you’d also have to find the bastard that got the woman pregnant, and drop off his testicles in a mayonnaise jar at the county courthouse. I think that would be more effective in ending abortions than anything the Texas Governor and his Legislature could do.
In the meantime, people can rant and scream, picket and protest, pass restrictive laws and overturn judicial decisions, and even resort to violence. They can debate the issues of “what is life?” and “is abortion murder?” until the cows come home. But until they have the resolve to deal with the underlying issues, abortions—anywhere—will not end.
And one more small detail. The sad story that opened this piece, about the death of Sadie Sachs? Each time the Doctor who treated Ms. Sachs made a home visit, he was accompanied by his Nurse. The day Ms. Sachs died, the Nurse was so overwhelmed by the death that she spent hours walking through the streets of New York, trying to come to terms with what had happened, and wondering what she might have done to have prevented the tragedy from happening.
The Nurse’s name was Margaret Sanger. She did do something. She founded an organization called Planned Parenthood.
I just thought you might want to know.
References for those interested:
https://worldpopulationreview.com/country-rankings/abortion-rates-by-country
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2017/201706_NSFG.htm
https://www.theguardian.com/world/2022/jan/22/us-abortion-roe-v-wade-supreme-court-49-years
https://pubmed.ncbi.nlm.nih.gov/15255879/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653097/
https://lasvegassun.com/news/2017/oct/06/in-congress-pro-life-concerns-often-evaporate-when/
Most Women Denied Abortions by Texas Law Got Them Another Way – The New York Times (nytimes.com)
Terrific post, Don! (although I expect people have been having sex for more than centuries — for as long as there are people). I don’t know if anyone will be convinced, because the issue is so polarized. You suggest that you can’t be both “anti-abortion” and “anti-contraception”; logically that should be true, but people whose basic motivation is that they hate women (or, more rarely, and not the folks you cited, hate sex) don’t seem to have that problem.
Thank you, Josh. You’re right, it’s been a lot longer than centuries. Hopefully enough people of good will can commit themselves to work for social justice. I wish we’d have more of those. And thank you for all you’ve done and continue to do to bring justice to the world, both in health care and beyond.
thank you Dr. Frey. Should be required reading at the start of each Unicameral session.
Thanks, Mark. All of us need to stop and think about what it would be like in someone else’s shoes.
Don I’ve always felt that politics should not be involved in reproductive rights and or religion.if this is a fair and equal country everyone should be making their own decisions as long as it is legal.not only our government is out of their league but church goers do the same. And both are railing on government being to big. Each and everyone of us need to make decisions based on our needs and let our neighbor make theirs.
Completely agree, Greg. From what I’ve seen, when you start mixing politics and religion, sooner or later all you’ve got left are politics.
One of the best pieces I’ve read on the topic. Mayonnaise jars of “nuts” in various public places and free condoms in every public restroom would be great ways to drastically reduced abortion numbers.
Thank you, Don.
Yes Dave, it would sure make people stop and think, wouldn’t it? Actually, it wouldn’t have to be mayonnaise jar, I guess. Any run of the mill Mason jar would probably do just as well.
Don, thank you for such a honest article regarding a sensitive issue. An unplanned pregnancy leaves a woman to weigh a decision which, either way, will be with her the rest of her life.
Yes, it is a decision that no male can understand, or even comprehend.
Thank you Don for your candid and honest review of a horrible situation. Women should not be the target of any politician. And men should be held accountable to the utmost degree!
Thank you for the kind words, Karen. I hope you, Steve, and the whole family are doing well.