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Monday, July 19, 2010

just kidding

Hanging out with foreigners is a whole other Thing for me.

I don't mean foreigners exactly. What's a good word for "people who aren't from Abortionland"? I'm in a new place with lots of new people, so this is kind of on my mind lately (can you tell?).

Sometimes it makes me nervous. Obviously. I pretty much eatsleepbreathe abortion-related business, and those split-seconds of anxiety when someone thinks they're making innocuous smalltalk and asks So What Do You Do, they're an occupational hazard we've all come to know well.

Of course we've built little silos of experiential knowledge about ways to ease into it or leave it subtle (Women's Health, Reproductive Health, Family Planning), in case the person asking is not someone you want to get into it with. Other times you want to just say it, so you just say it, and hope that's OK. And once in a while you're feeling kinda wild and might even tell someone who never asked. But no matter what you say, that anxious split-second might pass and be forgotten, or it might drag out into interminable minutes, even hours if you're unlucky, of "debating" whether what you pour your heart into is evil and exploitative. (Whee!)

The reason I still bother is that sometimes it's totally fine -- is it sad that at this point "totally fine" can be kind of a thrill? -- and what's more, someone who doesn't eatsleepbreathe this stuff might say something I haven't heard or thought of before. As you know, I am a very clever and thoughtful and well-read and humble person, so you can imagine my surprise at learning something new, but it's true.

Longwinded Example Time: yesterday I was telling a new friend (who's training in public policy) about this unexpected hitch in what sounds like a great abortion policy. Where we are, first-trimester abortion is theoretically covered -- paid for! free! -- for residents who have public health insurance and go to a public health center for the procedure. It turns out, though, that to get the required preliminary ultrasound and bloodwork, patients often have to choose between waiting THREE TO FOUR WEEKS to have those processed at the hospital providing the abortion, or paying around a hundred dollars for a private office to do it within a few days. If you're poor and you are working within a short legal time frame, this could be disastrous. (Really. I've counseled so many women through the daunting challenge of finding a hundred dollars in a couple weeks, and as a result am aware of my enormous economic privilege every day.)

So, yeah, my constant and immediate thought about this situation is: even if you have great policy, you also need support and will all the way down the healthcare structure, so that the time-sensitive nature of abortion care is given importance and so that possibly-antis within the system don't cause unnecessary delays. Otherwise safe and timely abortion access continues to be segregated by economic class. Is anyone surprised? Same old story, sucks, now what?

When I paused my rant to take a breath, my friend said, "Sounds like the market organizing to meet demand that the health system hasn't caught up to." Oh yeah: that is another conclusion you could come to. And it isn't just about how or where ultrasounds get performed. It's also about how, where, and whether abortions themselves get performed. Having only worked at non-profits, I sometimes forget that the chance to make or lose money drives service availability -- it often feels like we're giving away care, which I'm proud of, but the wider world doesn't work that way. Assuming you have a public abortion system, if its workflow or providers are causing choke-points in service delivery, would-be patients aren't going to give up. Potential consequences:
  • Feminist clinics [pdf] arise to provide women with care that isn't dependent on the patriarchal medical system (or on its judgments of what is urgent and what can be delayed). They are traditionally not-for-profit and its employees have a conflicted relationship with the need to, like, keep a roof over their heads. Seeking donations for sustenance is a whole other piece in this, Idunno, let's talk about that some other time.
  • For-profit clinics arise to fill the supply void; some are great and perfectly feminist too, and some are mostly a business like most other medical practices and seek to maximize income.
  • Private OB/GYNs and family practitioners begin providing abortions in-office after realizing that their regular patients keep seeking their advice, getting referrals to the hospital, then getting delayed.
  • People who have little or no medical training begin offering under-the-table "pregnancy remedies" that range from safe and effective to useless or lethal. A client who survives is unlikely to report them because she knows they may be someone else's only recourse, too.
  • Pharmacy workers will sell women misoprostol, an abortion-causing medication which is also prescribed as Cytotec to treat gastric ulcers, but at a significant markup because both parties know that the seller is doing an illegal favor and the buyer is desperate.
  • What else?
ETA: look at this graph I found just this afternoon!
The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society and Abortion Worldwide, New York: AGI, 1999.

Anyway, I have been turning over in my head how my own experiences and training get me in a kind of thinking-rut, where certain conclusions and interpretations are super-obvious to me, and I lose any sense of how many other useful lenses there are out there. (Notice how I ended up wandering back to economic justice anyway?) So yeah, this is something for me to keep thinking about and try to be more open to. In conclusion, um, talking to strangers can be OK.

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