Suffer the Little Children: An Abortion Provider's Story

“I want her to feel pain.”

A lump formed in my throat; medical school never prepared me for this. Before I could formulate a response, he let go of his wife’s hand, crossed his arms, and spoke more forcefully through gritted teeth:

“I want to know how to make her feel as much pain as possible so this never happens again.”

“That’s not what’s going to happen today,” I started tentatively.

The mother sniffed and interrupted wetly, “I never wanted this for her. We got pregnant when I was just 15…”

Before she could continue, her husband cut her off, “Enough talk! Let’s do it. Right now. I want to watch.”

When I think about my first abortion patient, the story haunts me — not because I guided her to the best choice for her, but because I watched as her father tried to use medical care as a tool for punishment. This tactic is not as uncommon as you might think. You may even be guilty if you’ve uttered the phrase, “If you don’t behave, you’ll get a shot.” Medicine and fear are intertwined for many, but when we talk about the reality of medicine, we can start to deconstruct superstitions and stigmas. This is especially important in terms of sexual education and health.

When her parents scheduled the visit, they said they needed help addressing her interest in boys. They suspected she had a boyfriend that was sneaking into her room at night. They were a conservative Catholic family and in the state where this took place, the public school system did not offer sexual education. Children raised without access to comprehensive sexual education lack basic bodily understanding and are at risk for early pregnancy, sexually transmitted infections, and assault.

I meet first with the family together, then I separate them for individual histories. In this case, the child, 12 years old, refused to speak in front of her father. She was obviously afraid of him; she was suffering. In my office, she admitted she had a boyfriend, a 12-year-old from her class, and that his older brother had been helping the boy into her room at night.

When I asked her if she has ever had sex, she wrinkled her nose and shook her head. I asked her if she knew what I meant by that question. She admitted that she didn’t really know what sex was but they had “definitely never done it because I always keep my clothes on.”

The conversation then turned to menstruation. She had menarche (first period) only three months earlier but had not had another bleeding episode since. As soon as I started that line of questioning, I knew where it was going; I just didn’t anticipate how the father wanted to make it end.

As I gently informed her that she was pregnant, she kept asking if she could just go home. She promised she wouldn’t talk to the boy anymore. She didn’t understand why everyone was so upset. When asked if she wanted to be a mom or have a baby right now she wondered out loud, “Why would I want that?”

This case was complicated; but then again, every abortion case is complicated. My heart broke as I informed her that because she was under the age of 15, the Department of Child and Family Services needed to get involved. Frankly, even if the child wasn’t pregnant, the way her father said he wanted to watch her feel pain set off red flags. She wasn’t safe in that home. It was as if she were a dog that needed to be beaten into submission for getting knocked up by the neighborhood stray. Truly, the way he spoke about his daughter’s reproductive circumstances had about as much respect as a cattle farmer discussing breeding. His daughter was a creature in a pen and in that moment, I knew my job was to protect her as a living person, not as an incubator.

The Department of Child and Family Services took over that evening and she was referred to the closest high-risk OB/GYN. We determined she was approximately six weeks pregnant and would qualify for a medical abortion. Repeatedly and consistently, she verbalized she did not want to be pregnant, she did not want to have a child, and she chose her life. She wanted to stay a kid. The sanctity of the provider/patient relationship is why she was able to access the medical care she needed.

At our follow-up, she was depressed because her parents had taken away her phone and she could not talk to the boy anymore. After everything she experienced, she still demonstrated a lack of bodily understanding that can be directly traced to the intentional prevention of sexual education. If she had been taught that you could get pregnant without taking your clothes off, perhaps this entire case would have been avoided. While her father was advocating for “the most painful possible way” to deal with her circumstances, his reaction highlights just how dangerous it is for uninformed adults to be making decisions in medicine instead of investing in education.

Her father had no understanding of maternal/fetal medicine, but he knew he wanted her to feel pain, so he was advocating for a surgical abortion. Medical abortion is the combination of an antiprogesterone (mifepristone) and a prostaglandin (misoprostol) and can be used in pregnancies up to 11 weeks gestation. This combination of medication induces a shedding of the endometrium and any attached cells, and the effects are heavy bleeding, nausea, vomiting, and cramping. While not pleasant, it does not carry the risks of surgical abortions which are indicated in later-term pregnancies.

A surgical abortion would have been unnecessary and cruel, but that’s exactly what her father wanted and he wanted to watch. He wanted to punish her for his mistakes. Rather than break the cycle of early pregnancy that he and his wife experienced as 15-year-olds, they chose not to teach their children about sex until one was already pregnant. There was a lack of trust in that family. No one talked to each other until they talked to me.

I know that every conversation I have with my patients is dependent on that sacred trust, but patients lose that confidence if they are not assured that the provider is working on their behalf. Medical providers cannot practice medicine when men meddle without so much as a basic understanding of science.

Ten years ago, we had the autonomy to help her make the right decision for her.

Today, we don’t.

I don’t know what will happen next in clinics across the United States in a post-Roe v. Wade climate.

I do know that when we weaponize medicine, the most vulnerable in our society suffer and it will be the children that are born into this world that pay the price. Prevention starts with education and there is no place for stigma in medicine. Just like any other medical procedure, it is time we start sharing our stories about reproductive health, because if we don’t, we will continue to suffer the little children.