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Authors: Merle Hoffman

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BOOK: Intimate Wars
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What I saw running through those vacuum tubes when I first started my work
was
only blood and tissue, unformed and messy. It was easy to imagine the fetus as a bunch of cells that one could define as one wished. But even in the beginning I had an inkling that this mentality was the easy way out, that it didn't go far enough to do justice to the experience of abortion.
The anti-choice movement claimed that if women knew what abortion really was, if only the providers had told them the truth, they would never have killed their babies. Organizations such as Women Exploited By Abortion (WEBA) and American Victims of Abortion (AVA) were composed entirely of women who'd had abortions, but had “seen the light” and become anti-choice activists.
But women did know the truth, just as I knew it, deep down, when I allowed myself to recognize it. Mothers saw the sonogram pictures, knew that sound bites assuring them that abortion was no different from any other benign outpatient surgery were false—knew that, as the antis say, “abortion stops a beating heart.” They knew that abortion was the termination of potential life.
They knew it, but my patients who made the choice to have an abortion also knew they were making the right one, a decision so vital it was worth stopping that heart. Sometimes they felt a deep sense of the loss of possibility. In the majority of cases, they felt a deep sense of relief and the power that comes from taking responsibility for one's own life.
There is a reason that women have been having abortions, legal or not, for all of history. The act of choosing whether or not to have a child is often an act of love, and always an act of survival. “Choice” is sometimes not a choice at all. It is an outcome determined by the economic, physical, sociological, and political factors that surround women and move them toward the only action that allows them to survive at that point in their lives. Survival can sometimes be a woman's act of staying alive, but it can also be her act of refusing to put what will become an impossible burden on her shoulders.
At times this reality would move me profoundly as I sat opposite the women I counseled prior to their abortions,
acutely aware of the potential lives growing inside them that would soon cease to exist. I began to think critically, to come to terms with what was going on. Each time I did that, I came out of that process more committed than before. I had no conception, either religious or philosophical, that “life was sacred.”
My bond with my patients grew stronger as I held their hands and watched the blood flow through the tubes into the suction machine. I was aware of fetal existence, the meaning of that blood and tissue. But it never overshadowed the woman. To me, there was never a question about who should survive.
The pro-choice movement marched then, as it does now, under the banner of choice—of human and civil rights—that is always more nuanced than the pure white banner of “innocence” and “life” carried by our opponents. But attempting to simplify the issue, refusing to look at the consequences or true nature of abortion—the blood, the observable parts of the fetus, the irrevocable endings, the power of deciding whether or not to bring a new life into this world—reduces our capacity to register the depth of this issue and disrespects the profound political and social struggle women's choices engender in our society.
Asking women to deny this truth, putting them in a defensive position, also perpetuates the shame, embarrassment, and ambivalence that the antis want women to feel. “
They
have abortions for the wrong reasons.
They
want to look good in bathing suits.
They
want to get their PhDs,” the antis have always said. Pro-choicers join in this chorus with sentiments like, “I wouldn't have an abortion if I were married,” or “Why did she wait so long, until she was four or five months pregnant? If I were in the same set of circumstances, I would not have made her choice.”
But when “they” becomes “me”—when women are faced with the decision personally and choose to have an abortion—they are able to justify their own reasons as sufficient. When I started to notice this phenomenon I named it the “rape, incest, or me” position. It places undue importance on women's reasons for making their choices, leaving room for the argument that abortion is wrong because women's reasons for having abortions are wrong.
This position betrays a lack of commitment to reproductive freedom. When an individual makes a choice, it is the act of making it, the active will and power of the choosing itself, that has unconditional value. At its core, the issue is about separating the chooser from the choice. The woman is the only active agent in this decision-making process—not the state, the court, or any political body. In a world where men have historically defined criminal, ethical, moral, and religious aspects of communal and political life, a woman choosing abortion is exercising her right to decide what happens to her body, her life, and her family.
I remember an exercise given to abortion providers at a conference I attended. “If you had only one abortion left to give,” we were asked, “to whom would you give it? A woman with HIV, a twelve-year-old, a forty-eight-year-old, a woman who was raped, a woman who wants to finish her PhD? What about the woman who just doesn't want a baby?” The catch, of course, is that all of these reasons for making the choice to have an abortion are equally valid.
Why
a woman makes a decision to have an abortion is not the deciding issue. She is making the choice that is right for her, and that is what matters.
If the personal is the political, as the feminist slogan goes, then abortion is the ultimate political act. It is not politics, but necessity that drives women's choices, necessity that
forms the political and theoretical foundation for the right to choose. To withhold that right for any reason is to deny women a piece of their humanity.
In the late seventies the pro-choice movement faced the same political question it faces today. How can we create a new narrative in which choice and reproductive freedom are the theory, and abortion is the practice? How can we transcend limiting narratives and start to identify with all women struggling to make choices, defending them rather than resisting that power through guilt and denial? How do we create a world where women can have abortions without apology?
 
IN 1978, after years of operating in the cramped basement where Flushing Women's Medical Center got its start, I realized I needed more space to put Patient Power into practice. I wanted to build a facility that would serve as a model for other clinics around the country—perhaps around the world.
Flushing Women's had grown to service over one hundred patients per week. We had enough financial stability to afford a rent that was not subsidized, agree to a multiyear lease, and assume the responsibilities of the projected costs that would come with designing a new space and hiring additional employees. The hard part was getting the Department of Health's approval for a new location—and of course, convincing Marty and Dr. Orris that the project could succeed on its own terms.
In those years, finding landlords who would agree to rent space to an abortion clinic was not nearly as difficult as it is today. I found a seven-thousand-square-foot commercial space in a large building on Queens Boulevard owned by Samuel LeFrak. Marty was successful in getting HIP to countersign a twenty-year lease on the property, and soon I was ready to design, furnish, and open my own clinic.
My goal was to create the most noninstitutional environment I could imagine. I chose large, comfortable, purple and red chairs where patients could wait with their friends or significant others. The chairs would have been more fitting at a discotheque, but the patients loved them. The counseling rooms were warm and cheerfully decorated, and I chose not to furnish them with desks, to minimize the power differential between patients and providers. The ambulatory patient lounge had a kitchenette where post-surgery refreshments were prepared, and there was a dressing room where the patients could take their time before leaving the clinic. I filled the walls with artwork featuring powerful women, calm landscapes, and political posters.
Inside the examining rooms, patients received navy tailored smocks instead of gappy paper gowns so they would not feel so naked and vulnerable. I had warming trays for the speculums built into the exam tables, knowing that there is nothing quite as shocking and uncomfortable as the invasion of an ice-cold metal speculum.
My new clinic needed a name, something that embodied the spirit of the facility I was endeavoring to create. I held a competition among the staff to choose one. We collectively agreed that the best name would be simple. Choices. Wanting the letters to hold special meaning, I turned it into an acronym: Creative Health Organization for Information Counseling and Educational Services. I designed a logo to go with the name, a combination of the caduceus and the mathematical symbol for infinity, a visual expression of the myriad of medical choices my clinic would offer.
With the opening of its doors, Choices immediately garnered a great deal of favorable press. I became a person of interest and fascination. “What is abortion, really?” people would ask. “How much does it hurt?” “What is wrong with
these women?” “Do you really see the fetus?” Choices became a teaching tool, a community space, a place where every question was welcome. A few friends and family members volunteered at the clinic. My mother came in a few times, handing out tea and cookies to patients in the recovery room.
I set up a gynecological and family planning practice and offered IUD insertions, diaphragms, and oral contraceptives
.
Patients who wanted to keep their pregnancies were welcome to take part in our prenatal program, and we delivered babies at our affiliated hospitals.
Perhaps the most unique aspect of Choices—the change that fully embodied my vision of Patient Power—was the role of counselors. I began calling them facilitators instead, feeling that the word “counselor” implicitly designated that person as having power to change or manipulate the counselee. The word “facilitate” means to assist, to make easier, to guide the way. At Choices patients weren't forced into the passive role of medical victims. My facilitators were trained in family planning and abortion care and they functioned as a support system.
While degrees and credentials are factors in professional ability or expertise, the most important qualities that any individual in the health field can have are empathy, openness, and the ability to create a positive response within another individual—what I came to call “active loving.” The sessions at Choices were structured more like warm conversations than anything else. Medical information was given, consents were signed, abortion and other options were discussed, but all in an easy atmosphere where a person felt safe and autonomous till the end of her stay. There was never coercion; the existence of our prenatal program said that louder than any voice could. We facilitated each woman's experience within her own reality.
ON JANUARY 7, 1979 my name was listed in a CUNY insert in the
New York Times
as a distinguished alumnus along with Sylvia Porter, Ruby Dee, Irving Kristol, Bernard Malamud, and two Nobel prize winners: Robert Hofstadter and Rosalyn Yalow. Articles in the
New York Times, Newsday
,
Women's Week
, the
Star
, and the
New York Daily News
lauded the layout of Choices, the workshops I set up, and my ideas about Patient Power.
But my work was being noticed by others besides feminists and liberal journalists. I remember being in a plane coming back from a pro-choice meeting and learning, as we landed, that there had been demonstrators in front of Choices for the first time. I was amazed, frightened, and enraged; I suppose in some way I'd thought all that positive press would inoculate me, that no one would touch me if the
New York Times
was behind me. But like all abortion providers, I soon found I had as many enemies as I had friends.
Abortion as a Mother's Act
“Freedom is fragile and must be protected. To sacrifice it, even as a temporary measure, is to betray it.”
—GERMAINE GREER
 
 
 
 
 
N
ever one to romanticize marriage, I viewed mine as the spoils of war. On June 30, 1979, after three years of struggling for Marty's divorce to be finalized, we were formally married in New York.
We had a wonderful wedding in Garrison, but even on that night, differences permeated our union. We would always love each other, but our expression of that love began to change, to grow complicated. Ours was not to be anyone's traditional definition of happily ever after. We had our joint empires and our two homes before we were married. We had no plans to move to another location, or buy a new house, or begin having children.
I knew our time was limited and that I was not going to grow old with Marty. The Rubicon had been crossed, and with that came a nagging sense of despair. The battle to be together was replaced over the years by many others, but that was the first, and the dearest, and it was over.
WHAT NOW? I was not the only woman struggling to answer that question; it seemed to be in the air. Now that abortion was legal and women empowered, how would society change? The search for answers brought about a heightened public interest in how abortion functioned in women's lives. A
New York Post
investigation
10
reported that 20 percent of New York women had had an abortion since its legalization in the state almost ten years earlier. Soon after, the Supreme Court ruled that teenage girls need not obtain parental consent in order to have an abortion.
11
Choices and other clinics continued to be publicly lauded for pioneering a new women's health movement. Advocates for women's rights were trying to articulate the path from legalized abortion to a changed society, one in which the expression of female sexuality was truly free from the traditional bonds of reproduction.
BOOK: Intimate Wars
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