I gave a man an abortion. At a recent session at the health clinic where I provide abortions once a month, I was reminded by the staff to use the pronoun "he." I was preparing to terminate an early pregnancy for a transgender man who had experienced a contraceptive failure.
I couldn't help but place myself in this man's shoes, or more appropriately, "foot rests," and imagine what he might be going through. I reflected on his struggle as a transgender person, the thoughtful decision to obtain contraception designed to prevent pregnancy and lighten periods to a negligible trickle, and ultimately the painful reality of ending up pregnant.
I am an abortion provider. I have cared for patients with unintended pregnancies as teenagers, women approaching menopause who thought they could no longer get pregnant, and families already at their desired size. Tears have welled up in my eyes watching a teenage girl and her mother hold hands and chat about what they'd have for dinner later that night as a distraction to what's going on below the waist.
Other patients have put on a brave facade, describing their educational or career goals that seem impossible as single parents. Some women have cried throughout the process, despite feeling that they are making the right choice for their families. I have come to appreciate the complexities surrounding this hot button issue of abortion.
Nearly half of pregnancies in the United States are unintended. A recent analysis published in The New England Journal of Medicine found that the unintended pregnancy rate is at its lowest in 30 years, thought largely due to changes in contraceptive use. However, contraception is not always effective. Despite having an intrauterine device (IUD) designed to provide long-acting reversible contraception, my transgender patient still got pregnant. IUDs are more than 99 percent effective in preventing pregnancy, but no method is 100 percent perfect.
Sometimes pregnancies are unintended despite use of contraception, often they are unintended or unwanted for more complex reasons, and other times they are a simple mistake. One of my patients in her mid-30s became pregnant with a boyfriend of just a few months. She was getting older and wasn't sure if the opportunity for motherhood would happen again, so decided to continue the pregnancy. She and her boyfriend are now raising their daughter together and adjusting to a lifestyle change that neither had envisioned on their first date just over a year ago.
There are a lot of abortion-related issues making headlines these days. The Zika epidemic highlights women's access to safe abortion as a basic human right. The U.S. Supreme Court is expected to make a decision in June 2016 concerning a Texas law designed to shut down more than 75 percent of all women's health clinics that provide abortion services in the state.
March 10 was National Day of Appreciation for Abortion Providers. The decision to terminate a pregnancy can be complex, it can be simple, or it can just be what is best for the person in that moment. Each individual deserves the right to choose abortion and to access abortion timely, compassionately, safely and legally.
As a doctor and abortion provider, it is my duty to convey why the right to access safe and legal abortion matters and to appreciate why patient care is individualized. I urge the reader to consider these subtleties before making sweeping anti-choice statements. The complexities around abortion should not be underestimated.