Some Thoughts on Abortion

I know, this has nothing to do with service dogs.  It is somewhat related to my disability, though.  And I see so much discussion on this topic on Facebook and in the news and everywhere these days.  I just wanted to take the opportunity to put some of my own thoughts into words.

I guess I should start by saying I am pro-choice.  That doesn’t mean that I think abortion is something that should be chosen lightly, and I don’t think many women do make the choice lightly.  I can think of three women I’ve personally known that had abortions (there are probably more but it’s something most people don’t share with everyone they know) and I know all three of them put a lot of thought into making that decision.  I know two of them considered themselves pro-life or at least never thought they would choose to have an abortion, until they found themselves in circumstances in which they could not see another solution.  I know one of them got pregnant while using condoms and one of them got pregnant while taking birth control pills; the third was not using any form of birth control because she was not sexually active when she was raped and became pregnant.  I know one of them would have loved to have another child but it just did not seem feasible at that time, in those circumstances.  None of them was relying on abortion as a form of birth control.

I’ll also say that while I am pro-choice, abortion is not necessarily the choice I would make if I found myself facing an unexpected pregnancy.  I actually got pregnant when I was 16, and both my parents and the father’s parents encouraged us to either place the child for adoption or have an abortion.  I chose not to have an abortion.  I gave birth at age 17; my daughter was mostly raised by her father.  I see abortion as a last resort type of thing.  It’s what I would choose if I felt I was unable to carry a pregnancy to term for some reason.  If I felt I could carry a pregnancy to term but not raise a child myself, then I would place the child for adoption.

So what does all this have to do with being disabled?  Well, to begin with, being disabled affects my access to contraception.  I’m on Medicare, and I would like to have a tubal ligation because I definitely do not want to become pregnant, ever again.  However, Medicare will  not pay for a tubal ligation.  My primary care provider recommends I avoid birth control pills because I have a family history of breast cancer and the pills increase one’s risk of breast cancer.  She and I agree that it is best that I avoid all hormonal forms of birth control, since side effects can include depression and I already have a history of very severe depression.  That doesn’t leave me with many options, but Medicare will not cover a tubal ligation.  Unfortunately, I don’t have the $5,000 the surgeon told me it would cost to pay for it myself.

So because I am disabled, I don’t have access to real effective birth control.  I can use condoms, and I do, but they are not nearly as effective as a tubal ligation.  Am I just supposed to be celibate to make sure I don’t become pregnant if I don’t want to be?  I’ve been on Medicare since I was in my mid-30’s.  Do our legislators just assume disabled people aren’t interested in having sex?  And none of the pro-life folks have offered to pay for my tubal ligation in order to prevent an unwanted pregnancy, either.

At this point in my life, if I did become pregnant, I believe I would have to abort.  I don’t want to have to do that, so I am super careful about birth control (which at this point means condoms and vaginal contraceptive film).  But what if my birth control failed?  Even a tubal ligation can fail, although it’s very rare.  I asked the surgeon I spoke to how that could possibly happen, and it said that in some cases the tubes simply grow back together, or grow around an obstruction.  How bizarre is that?  It’s kind of cool, too, if you think about it, the body’s remarkable ability to heal and repair itself.  But it wouldn’t be so cool for a woman that had a tubal ligation and then found herself pregnant.

And let’s not forget that fact that some women that are abstinent become pregnant after being raped.  And women with disabilities of any kind are more likely to be raped than women without disabilities, although of course it can happen to anyone.

Anyway, if I became pregnant at this point in my life, I think I would have no choice but to abort.  I don’t see how I could possibly get through a pregnancy.  And that’s because of my disability.

For a moment, let’s just forget about my fear of doctors and hospitals.  I’d have to have a home birth, with a midwife, but that’s what I would have wanted before developing this fear, anyway.

I have severe depression, which is sort of stable at the moment, but the physical and emotional stress associated with pregnancy could wreak havoc on my psyche.  The hormonal upheaval scares the crap out of me.  Looking back on my life, I think I was depressed from a very young age, but it was not diagnosed until I was pregnant the first time.  And in the postpartum period, my depression was very severe; that’s when I attempted suicide for the first time.  Perhaps a second pregnancy would be easier than my first, but I don’t believe it would.  I believe there is a very good chance my depression would get significantly worse.  I believe I would be at risk for killing myself.

How does a severely depressed, suicidal person get through nine months of pregnancy?  Even if I  wanted to spend nine months on a locked psych ward (and I don’t), that wouldn’t happen.  Who would pay for it?  You’d be looking at about $1,000 a day, maybe more; that’s about $30,000 a month.  Medicare isn’t going to cover that; I think my co-pay for inpatient hospitalization is something like $450 per day right now, because I’ve already used up a lot of my inpatient days on my Medicare Part A plan.  As far as I’m aware, none of the prolife organizations offer to pay for inpatient psychiatric care for suicidal pregnant women, either.

Then there is the issue of quality of life.  Who would want to spend nine months on a locked psych ward, even if that was an option?  Who would want to spend nine months suffering from severe depression, from self-hatred, from feelings of guilt and hopelessness and despair?  

Medication wouldn’t be an option, since most psychotropic drugs have not been proven safe during pregnancy and many are now known to cause serious birth defects.  There are currently some class action lawsuits in the works for women that were given antidepressant drugs while pregnant and told the drugs were safe.

The bottom line is that I do not believe I would live through a pregnancy.  Now, many prolife folks, though not all, believe abortion is OK if a woman’s life is at risk.  Not all do, though.  And even if it is legal to have an abortion if my life is at risk, who gets to decide whether my life is at risk or if the risk is great enough?  Do I have to convince a doctor that my depression is that severe?  We all know how well doctors listen, right?  Who is in a better position to decide whether or not I really need to have an abortion than me?