By Alana Cartens
For most of my life I have danced around the sidelines of the reproductive justice movement, always supporting, but more actively involved in work around racial justice and international human rights. Attending the Medical Students for Choice Conference on Family Planning last December shifted my focus to see how, in many ways, the fight around reproductive health sits at the epicenter of most justice movements. The lecturers and students I met inspired me to rethink how access to abortion care serves as an indicator for a society’s social, political, and economic well-being.
Since then, I have reaffirmed my commitment to be an advocate for reproductive justice, and as a medical student with dreams of becoming an Ob/Gyn and abortion provider, I am inspired by the limitless opportunities to learn and involve myself in reproductive health advocacy locally and globally. When I heard about MSFC’s RHE Funding Program, I knew this was an opportunity to learn about what life is like for physicians on the frontline of this struggle.
The first day of my externship I arrived to a sweet little 3 story clinic tucked between mom and pop shops in a residential neighborhood in Mexico City’s Avante neighborhood. I showed up ready and eager. I had done my research: spoken to previous students who had attended the clinic, read up on procedural standards, researched the history of reproductive rights in Latin America, and familiarized myself with the current policies that highlight Mexico City as a sanctuary within the country at large*. This new information added an extra pep to my steps alongside the pro-choice activism I’ve been engaged with through medical, political, and social spheres. These two weeks were to be an officiation, a baptism of sorts; a way to fully immerse myself in the work I’ve been so passionate about.
The experience was structured for me to follow patients throughout their visits. First, was the medical consultation where clinical histories were taken, ultrasounds performed to confirm gestational ages, and discussion were had about birth control options moving forward. Second, was the counseling session with the psychologist. Recognizing that most patients arrived resolute, the purpose was not to help women make a decision. Rather, it served as a space to reflect on a woman’s ability to decide, to have control over her life and body, to help strengthen her ability to confront fears and conflicts, both internal and external. At the end of the session patients received their medications. As preventative measures, a dose of antibiotics and ibuprofen; as preparatory, a dose of misoprostol**. Lastly, they moved to the operating room for a 15 minute procedure that started with paracervical anesthesia***, then cervical dilation, and lastly manual vacuum aspiration.
Like a mute shadow, I followed along, observing. Each stop through the process showed a new depth of compassion offered by members of the clinical team to the women that passed through their care. I was touched, inspired really.
Until I saw my first abortion. Halfway through the procedure I had to dismiss myself and sit in the hallway outside. I heard the nurse speak softly to the patient, “Breathe in, hold for 3, breathe out,” and I followed along.
When it was over, the doctor came out and met me with just as much kindness as he did his patients. Just breathe, sit down whenever you need to. Let us know if it ever becomes too much, he told me. This happens everyone’s first time, he said with a smile. But that was just the problem. See, I wasn’t supposed to be this grossed out. This is the work I had come here to do, this is what I had prepared myself for. I wanted so badly to be a model student, to not be everyone else.
Like most falls from hubris, the fact was I was just disappointed in myself. Disappointed that I couldn’t handle it, and even more disappointed that I had assumed otherwise. The truth is that there are some experiences no amount of work can prepare you for. Some journeys have no shortcuts and the only one road to take is the one that passes through. So it was and I continued down the path.
I wish I could say that each day it became easier. But that is not what happened. I did not learn to disconnect myself, nor to stop imagining the sensations of what I saw. I did not learn how to still my focus on the procedure or concentrate on the anatomy involved.
And as the days turned to weeks, I learned this was okay. These are skills that can come with time and practice. Instead, the experience taught me more important lessons.
I learned that abortions are not pretty, they are not fun, and they are not a desired procedure. But they have always been necessary, and as long as human continue to mate, they will remain necessarily. That women will always need access to abortion services is not up for debate. Rather, the question is always how, where, and in what conditions they occur. Quality care goes beyond safety. It requires honesty, trust, and difficult conversations, as much as it does tender handholding and empathy.
I learned not to minimize abortions; that the experiences they bring are as varied as the women who have them. As a physical procedure, they can bring the pain of invasion as much as they can an ecstasy of liberation, a reclaiming of one’s body. As a process, abortions span an ocean of emotions where despair and relief, fear and gratitude, loneliness and solidarity are tangled up like seaweed.
As future abortion providers, our job involves more than a procedure. It requires meeting women where they are at, walking with them and providing a safe space to support them through their process, whatever form theirs might take.
* In Mexico, similar to the U.S., states are able to regulate the national abortion law, which only mandates approval for abortions in cases of rape or incest. Although other exceptions exists such as when the life or health of the mother is at risk, for socioeconomic security, or for the health of the fetus, these vary on a state by state basis. Then 2007 rolled around and Mexico City brought with it the decriminalization of all first trimester abortions. As of now it sits in the middle of a country as a quasi sanctuary city for women seeking safe abortions. Women come from other states of Mexico and other countries, as far away as Brazil and as close as El Paso, Texas.
** Depending on the gestational age, misoprostol was taken either sublingually (when less than 12 weeks) and buccally (when over 12 weeks), to contract uterine muscles, helping preventing perforation, and to dilate the cervix.
*** For pregnancies over 15 weeks general anesthesia is used.