The People Doing the Work

The Quickening Newsletter #5

I was a pre-med student who ended up with a bachelor’s degree in Latin American Studies and a master’s in English. I had wanted to go into women’s health, but my studies took a turn, in part guided by mediocre grades in chemistry and genetics. Still, women’s health was a desire that tugged at me even after I was an English teacher for two-plus decades, and a couple years ago, I decided to make a go at nursing school. I chose to take my pre-requisites—microbiology, physiology, and anatomy—at Cal Poly. There was, in fact, a fourth prerequisite: English Composition, a class I’d been teaching at Cal Poly for 15 years.

I turned 49 in January 2020 and enrolled in Bio 231: Human Anatomy and Physiology, taught by Mike Jones, who was younger than me. My lab partner, a very cool young woman, turned out to a be enrolled in my evening English class. It was all awkward. When my spouse, Derek, told our emergency room doctor friend what I was doing, he asked, “Wow. Is Melanie smart?” I had a lot going on—I was finishing up a historical novel for an agent in New York, teaching my own classes, raising boys, and running a household. But that’s all excuses. Despite studying ‘til midnight every night after my children went to bed, I earned a D on the midterm. The writing was on the wall, and it read: “Melanie, you are not smart.”

Thankfully, there are a lot of very smart and amazing people out there who have dedicated their lives to providing vital healthcare to women.

I had a dream the other night that I was in a classroom where a handful of us were learning how to perform abortions. There were plastic anatomical models of females and an array of medical tools. We were in another country, a developing country, and I was the only English speaker. There were men and women in the classroom. Of course, abortion happens all over the world, in places where it is legal and illegal. Everywhere, it’s a needed skill, providing safe abortions. A great many brave people are doing the work and training others—and so many brave others are learning.

In July 2010, I read an article called “The New Abortion Providers” by Emily Bazelon, which was published in The New York Times Sunday Magazine. I can still picture where I was when I read the article—we were in Michigan with our then-young sons at a hotel; we would fly back to California that morning. It was dawn, and I couldn’t sleep. I read the article while my family slept. I found it riveting.

Bazelon explains how after Roe v. Wade made abortion legal in all 50 states, the backlash came, and doctors and hospitals retreated, leaving feminist activists to fill a void: “They set up stand-alone clinics to care for women in their moments of crisis. In many ways, the clinics were a rebel-sister success story. Instead of a sterile and expensive hospital operating room, patients could go to a low-cost clinic with pastel walls and sympathetic staff members.” But the stand-alone nature of those clinics made them very vulnerable. In 1973, “hospitals made up 80 percent of the country’s abortion facilities. But by 1981, however, clinics outnumbered hospitals, and 15 years later, 90 percent of the abortions in the U.S. were performed at clinics.”

Those clinics became the focus of protesters, and the staff were regularly threatened. Dr. George Tiller, an abortion provider, was gunned down in his church. Julie Burkhart—Tiller was her mentor—responded by founding Trust Women, whose mission is “to open clinics that provide abortion care in underserved communities so that all women can make their own decisions about their health care”; its vision is that “all women will have access to health care, including abortions, regardless of where they live or their ability to pay.”

That abortion would be provided almost exclusively in vulnerable clinics was, according to Bazelon, “never the feminist plan.” And there was another problem: fewer and fewer medical schools were offering training for abortion: “In 1995, the number of OB-GYN residencies offering abortion training fell to a low of 12 percent.” The doctors who performed abortions were aging and new ones were not replacing them. A 1992 survey of OB-GYNs, found that “59 percent of those age 65 and older said that they performed abortions, compared with 28 percent of those age 50 and younger.”

But then a movement took off to bring abortion back into mainstream medical training and to increase fellowships and residencies at university hospitals, the goal being to “to integrate abortion so that it’s a seamless part of health care for women — embraced rather than shunned.” In Bazelon’s article, she introduces us to Jody Steinauer. At the time, Steinauer was an OB-GYN professor at the University of California at San Francisco; now she is director of The UCSF Bixby Center for Global Reproductive Health, which “integrates research, training, clinical care, and advocacy to advance reproductive autonomy, equitable and compassionate care, and reproductive and sexual health worldwide.” When Steinauer began medical school in 1992, she received a mailer with this “joke”:

Q: What would you do if you found yourself in a room with Hitler, Mussolini and an abortionist, and you had a gun with only two bullets?

A: Shoot the abortionist twice.

At the time, abortion was not a topic in even one of her classes. She took a year off to start Medical Students for Choice, which now has chapters at medical school campuses and residency programs in more than 28 countries. Because of their work with the National Abortion Federation, “about half of the more than 200 OB-GYN residency programs integrate abortion into their residents’ regular rotations,” and “another 40 percent of them offer only elective training.”

More progress came—the Family Planning Fellowship, “a two-year stint following residency that pays doctors to sharpen their skills in abortion and contraception, to venture into research and to do international work.” This fellowship has expanded to include even more schools in conservative states, like Utah and Georgia. Bazelon writes, “When Salt Lake City and Atlanta are home to programs that train doctors to be expert in abortion and contraception, the profession sends a signal that family- planning practices are an accepted, not just tolerated, part of what doctors do. That helps draw young physicians.” This comes back to the idea that is being reiterated now – the idea I’ve seen displayed on protest signs and t-shirts and posters:

“Abortion is Healthcare.”

Most of that work was done by male doctors in the years after Roe v. Wade. But Bazelon notes: “Since then, women have streamed into the ranks of OB-GYN and family medicine. They are now the main force behind providing abortion.” When I stumbled on the fellowship page at Northwestern, I saw that all the fellows were women.

Most do not see themselves as “abortion doctors,” but rather as physicians making the procedure part of “their broader medical practice.” Most spend their time for primary care or general gynecology visits and by delivering babies. Bazelon writes: “If the young doctors succeed at making abortion mainstream and respected within medicine, abortion could move from clinics to doctor’s offices and hospitals. And if that happened, would the politics surrounding it finally change? Would protesters stand outside a hospital or a primary-care clinic or a group practice that treats all kinds of patients?”

Bazelon tells us about Uta Landy, a former director of the National Abortion Federation, and Philip Darney, her husband and an OB-GYN professor at U.C.S.F. Together, they created the Kenneth J. Ryan Residency Training Program, which gives medical schools two or three years of seed money for abortion training for OB-GYN residents. Through it, 58 campuses in the U.S. and Canada have received financing. Landy also directs that Family Planning Fellowship I mentioned. Jody Steinauer is the associate director. I am so awed by all these people.

Writing is an act of discovery. One of the reasons I started this newsletter is because I care about abortion rights; I wanted to think about abortion in all its facets. And the “discovery” I continue to make is connecting the dots—here, thanks to Emily Bazelon’s journalism—of the people who are doing really meaningful work to make sure women and girls have access to safe abortion. Yet in addition to these leaders, organizations, training programs, and fellowships, are all the individuals working behind the scenes: the receptionists, the security guards, the medical assistants, the janitors, the volunteer chaperones.

It’s not just women helping women—and it’s not just the liberally-minded.

I was moved by a New York Times story that mentioned Louis Padilla, a security guard at an Oklahoma Trust Women clinic (started by the aforementioned Julie Burkhart). He’s a self-proclaimed “Catholic and Republican,” who was “won over to the cause after working there a while.” He told the Times reporter that “each woman has her own story,” so who are men like him to judge them? According to the article, “He mows the clinic’s lawn, puts up its flag and sometimes fixes appliances because repairmen refuse to come to an abortion clinic. He even bought a drone with his own money to watch the protesters outside.”

When I read about the myriad brave individuals in the trenches doing the vitally important yet sadly controversial work of promoting, implementing, and furthering women’s health, it gives me hope and inspires me to be a part of this important movement. As for my role, failing basic human anatomy has jettisoned my plans to go into nursing, but I think my newsletter writing skills are solid.

Also, my spouse just reminded me that my toilet-cleaning skills are legendary, and that abortion clinics have toilets—if I really want to make myself useful.