Until I attended medical school, I had never been in a classroom with a girl or a woman. And in my medical school class there were only five women out of a hundred and ten young people.  I had no close women friends.  I did not know much about concerns they might have about sexual matters. Medical students know less about sex than one might think. I had not had occasion to wonder about abortion or about any of the moral issues that would in a few years divide the nation.

For some reason, I remember the first time I heard that some girl, a friend of a friend, had had an abortion. I must have been in college. I remember being shocked a little; and I thought the girl must have been promiscuous. Promiscuity was disreputable; and abortion was against the law. Still, I don’t remember thinking about abortion again until I was a physician. Then, after a couple of clinical experiences it was very much on my mind.

When I was an interne and on call to the emergency room, a young woman came in bleeding from her vagina with the absurd story that she had sat on a soda bottle. It turned out she had almost amputated her cervix in a misguided attempt to abort her pregnancy. She soon went into shock. Her life was saved only by the heroic efforts of a team of gynecologists and other physicians. She was still pregnant.

When I was a child fellow in psychiatry, I had to help take care of a terribly crippled child. Besides being mentally ill, he was mentally retarded and severely neurologically impaired. He could walk with difficulty, but he couldn’t talk. His mother had tried when she was pregnant to end the pregnancy with quinine, an abortifacient. This drug did not result in an abortion, but she did terrible harm to the child. Now, taking care of him was a full-time job. She had no time to have other children. This child’s birth prevented the birth of all the other children she had intended to have.

Also, when I was a resident, one of my teachers had a terrible experience which could not happen now. His wife gave birth to three Tay-Sachs children in a row! Tay-Sachs is a disease, mostly of Jews, in which a child is born healthy and grows normally for the first three or four months. Then the child begins to suffer subtle, and then gross neurological disturbances. He/she becomes hyper-reactive and may have convulsions. Over the next few years the child becomes blind and deaf and loses all mental faculties. This palpable and painful wasting away occurs slowly over a period of few years until the child dies, usually by the age of four. I saw only one such child when I walked through a pediatric ward once. The child was curled up on a bed. Its arms and legs were twisted and cramped together in contractures. The child stared sightlessly off to one side. The child’s mother was combing its hair.

These children are doomed. And, of course, the parents are doomed to watch them die. For each set of genetically vulnerable parents, the chance of such a birth each time is one in four. The chance of three such children in a row is one in sixty four! There is a test now that can diagnose this disease early in pregnancy. Then the child can, and, I think, always will be, aborted. There are people who feel very strongly that there is never a reason to abort a child; but I think in the end, if they know—if they really know-- what they and the child must confront, I don’t think anyone is so cruel as to permit such a child to be born. A few months later there is the chance to get pregnant again with a normal child.

So, I have learned something from being a doctor. I have come to believe that women should have access to a medical abortion to prevent really bad things from happening.

 As a psychiatrist, I have been asked to provide consultation to women considering an abortion. Most women who contemplate an abortion do not feel there is reason to consult a psychiatrist, so this smaller group may not be representative. Still, I have found it appropriate in these situations, each time, to recommend to the woman that she do what she thinks is right. Invariably, there is pressure being applied on her by family and others to have an abortion or not to have an abortion. When the woman accedes to these pressures, she is likely to regret it later on. I knew someone whose only pregnancy was aborted, under extreme pressure from her mother, and she regarded this decision as the central tragedy of her life. There are others who plainly feel their lives were blighted by having a child prematurely; and they resent those who insisted on them giving birth. It is in the nature of a mother-child relationship that these mothers come to want that child, whom they have loved since birth; but they recognize still that they, and sometimes it seems to them their child, would have been better off if that child had not been born. In any case, if there is going to be a mistake, it is the woman’s mistake to make.

 (c) Fredric Neuman M.D. Follow Dr. Neuman’s blog at fredricneumanmd.com/blog

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