The front door to the Providence Planned Parenthood, where I’m a volunteer, is not locked. Outside, there’s a security agent and protestors with signs and rosaries. Next door, people pick at pastries at Olga’s. Construction hums on Point Street. The second door, however, is locked, controlled by a nurse who works behind the front desk. According to Planned Parenthood, one in five women, and nearly three million people each year, have walked through doors like these in cities across the country. They come to receive cancer screenings, checkups, contraceptives, and STI testing. They come for body image, relationship, and gender and sexuality counseling. Only three percent of these women receive abortions.
It’s Friday, so the abortion clinic is open. By the window in the main waiting room, women fill out paperwork. They list their health insurance provider, method of payment, and medical history. Jessica (patients’ names have been changed for privacy), a 21-year-old patient, nervously arrives at the window at 8 AM; because she’s choosing to be sedated during her abortion, she has not drunk or eaten since midnight. After the paperwork, the nurse leads Jessica through a third door.
Beyond the third door, there are two inlets with chairs, pamphlets, and posters, where women wait for their blood work and ultrasound results. One woman pulls down an IUD pamphlet. It’s quiet, except for the sound of doors opening and closing.
Around the corner is the pre-operation room, the final waiting room before surgery. On a table rests spiral notebooks where women can write their stories.
I flip through them:
I’m 25. Me and my boyfriend were trying to be responsible and we had an IUD put in. It failed. I am getting ready to move into my boyfriend’s house (it has lead in it, not child safe). I had a previous abortion in high school, just cause I didn’t want to end up like one of those “16 and pregnant girls.” I really want to have kids one day though. [All of these stories are anonymous and published with permission of the clinic director. Some of the stories have been used in Planned Parenthood’s Story Bank.]
The nurse begins the ultrasound to see how far along Jessica is in her pregnancy. Although an ultrasound is required for surgical reasons, Jessica is not legally forced to look at it, at least not in Rhode Island. While certain states require patients to see their sonogram, women in Rhode Island are not required to see the image or hear the fetus’s heartbeat. So Jessica does not look at the screen and the nurse tucks the ultrasound image into the back of the file.
Women in Louisiana, Texas, and Wisconsin do not have this same choice. Senator Mary Lazich (R.) from Wisconsin argued in June 2013 that requiring women to see and hear the fetus would provide women with more information for their “life-altering decision.” Fox News, in an article from January 2014, states that “advocates for ultrasound laws base the requirement on the idea that showing a woman the image of her fetus might cause her to have a change of heart about terminating the pregnancy.”
Medically, it is unnecessary for the patient to see her ultrasound.
I am 38 years old. I have a 16-year-old daughter who I thought of terminating too but I saw the ultrasound and could not go through with it ...
Another woman, who waits with Jessica, shuffles her feet as she sees the image of her uterus move on the screen.
She and her boyfriend were beginning to get serious; she said they were excited when they found out she was pregnant, but they couldn’t afford to have a baby. She proceeds with the abortion, but asks if she can keep her ultrasound. The nurse photocopies it for her.
The ultrasound is important for the doctor: if it has been less than nine weeks since a woman’s last period, she can take a pill called mifepristone to terminate her pregnancy. This pill—also referred to as a medical abortion—can cost from $300 to $800. Mifepristone is a single pill taken in the clinic that blocks the hormone progesterone, which ends the pregnancy. In two days, a woman will take another pill at home, called misoprostol, causing bleeding and cramping. Despite the discomfort, the woman still avoids invasive surgical procedure. The medical abortion is 97 percent effective, and the patient must have a follow-up appointment to confirm that the abortion is complete. However, Jessica’s ultrasound shows that she is in her second trimester, and will need to have an in-clinic, or surgical, abortion.
Planned Parenthood offers a sliding fee on all procedures based on income, household size, and other factors. They also accept many forms of health insurance, and other state and federal plans. Rhode Island only accepts Medicaid for abortions involving rape or incest. Jessica does not have health insurance, and will pay for her abortion in cash. Planned Parenthood’s website reports that a first-trimester abortion, including the ultrasound and bloodwork, costs between $300 and $1,700, and sedation is not included. Hospitals usually charge more.
After the ultrasound, Jessica walks down the hallway and opens the door to Harriet Singer’s office. Harriet is 87, and has counseled for Planned Parenthood since 1978; she has seen every president of the organization but Margaret Sanger. On her desk is an image of the first Providence clinic: the 1970s 12th-floor office, on the corner of Dorrance and Westminster streets, easily accessible by public transportation. Near her bookshelf are the two sequential Wayland Square locations: both in cramped doctors’ offices. There have been different sequences of rooms, changing political climates, and developments in medicine, but there has always been Harriet.
In 1978, Harriet’s job was to counsel women who took in-clinic pregnancy tests in the morning, and to wait as their results were released that afternoon. Often men came in for counseling on AIDS. She remembers eating dinner at patients’ homes to celebrate negative tests. Planned Parenthood still extends its services to men for STD testing and sexual education.
Jessica and Harriet discuss her marijuana use, her husband’s support of her abortion, her confidence terminating the pregnancy, and her two children at home.
When asked about abortion counseling in an interview, Harriet offers, “Today we can’t say it’s totally accepted, only that it’s accepted as a fact. Then it wasn’t even accepted as a fact. Counseling depends so much on the families, and the partners of the patients.” Medical charts list the patient’s ride and their relationship. Support systems are medical topics for Harriet. She always asks about home life.
I am a widowed mom of three children my husband just died a year ago. I have been with/ dating my boyfriend for just under six months. I start a nursing program in September that is competitive and difficult to get into. It ends next June but I’d be due in March. Because their father died I have to do what is right for my three girls now... I send this little one up to my husband in heaven, and for him to take care of ours down here.
I planned on keeping this child, this unexpected, unplanned gift...my mother, father, boyfriend all want me to get this abortion. I’m disgusted in myself, I need to leave here. God forgive me.
If no one is listed to pick up the patient, then the patient cannot have sedation or anxiety medicine because she will need to drive herself home. If the patient is a minor, the guardian must be included in counseling. In Rhode Island, if the patient is under 18 the legal guardian must give permission for the abortion. If no parental consent is given, a judge can grant judicial bypass. Often, when a patient cannot get parental permission or judicial bypass, Harriet suggests they travel to a clinic in Connecticut where there is not a Parental Consent and Notification law in place.
I am 15 years old in a few days. I know, young! I finally said yes to my boyfriend and this happens. 2 months ago I was drawing in my room now I am in a waiting room. I am scared and I feel so alone right now and god do I wish my boyfriend was here so I could cry on him. I don’t know what I am going to do but I bet i’ll be okay, or I hope at least. And you will be too. I promise.
After thirty-five years, Harriet still does not know exactly what to say, but will do anything to make it easier for her patients. Some women leave through these locked doors if they begin to doubt their decision. Harriet always walks them out.
The goal of counseling is to communicate to her patients that “choosing to end a pregnancy is in the normal lifecycle of a woman, in her normal gynecology lifecycle.” She believes her age gives her credibility and makes the women more comfortable with their decision to have an abortion: “If an old woman, like me, tells the patient what she is doing is OK, then it must be OK.” She ends counseling with a hug.
Leaving Harriet’s arms and office, Jessica turns the corner and proceeds to the pre-operation room. Through the swinging doors, she sees women wrapped in fuzzy blankets that have been lent to them by Planned Parenthood. Some are asleep. They will wait until their names are called. On the table are tissue boxes, books with titles like, 1 in 3 Women Will Have an Abortion in Her Lifetime, and the spiral notebooks. Most women open the patterned spiral notebooks with “Tell Me Your Story” written on the cover in black sharpie. Jessica reads:
I hope these stories entertain you because these movies are like 30 years old.
I am 25 years old. I am a student, a friend, a daughter, a sister...I was promised it would be okay. It will, and it will for you, too. May god bless you and keep you safe.
I do not agree with my self morally over this decision so I am asking you God to please forgive me as this is the best decision for myself and my father.
Don’t let no one judge you. You’re free to make your own decisions in life that will better your self.
I am 24 years old and this is my 4th pregnancy. I’m up vomiting can’t hold anything down. First pregnancy was a miscarriage. My second I had my baby boy. These last two pregnancies I was on birth control and I still got pregnant.
Harriet has noticed that when a woman begins a conversation in the pre-op room, women are more willing to talk about what to expect during the surgery, who is or isn’t waiting for them in the waiting room, and what they want to eat after the procedure. Even if the room is silent, in the book there are voices:
Hello whoever is reading this today? I don’t need to tell you why I’m here today, all you need to know is I’m here with you. As a fellow girl I want to give you words of love and support. If this is the right decision for you then everything will be ok.
There’s a half-written entry a couple pages after the last entry, “Reading other stories doesn’t help me. Probably because I cant yet tell mine. I guess there isn’t much of a story any ways...” I feel voyeuristic thumbing through these stories.
In the half-scrawled notebook pages or the kept ultrasound stored in a bedroom drawer, there is a sense of grasping at what was erased. At Planned Parenthood, women typically return to their same homes, their same families, but with an entirely new experience. The journal entries allow women to reach out from the often-hidden circumstances of abortion and find a network of women, all sharing this singular experience.
When they call Jessica’s name she walks out of the double doors to the left and into the operating room. She takes off the rest of her clothes under her hospital gown, and sits down on the surgical chair. The doctor introduces himself, confirms Jessica’s name and date of birth, and asks if she is ready to fall asleep. When she’s asleep, the doctor numbs her cervix and dilates it, inserts a tube into her uterus, and gently uses a suction machine to empty it. Then the surgery is over. The doctors turn on the sink and let the water wash over the surgical devices.
The nurse wheels Jessica out, around the corner, and into the recovery room, next to three or four other women.
I volunteer in the recovery room. I take Jessica’s blood pressure and squeeze her hand. The nurse reminds her, as she begins to wake up, that she is at the Planned Parenthood on Point Street, in the last of a long sequence of rooms, that she will leave soon. Jessica says she forgot she had the surgery. She asks how long she was in the operating room. Ten minutes. Jessica begins to cry silently and tells us that she is not sure why—the nurse tells her that it can be a side effect of the sedation. A volunteer pages the waiting room to confirm her ride. They call a cab for another patient. Jessica’s husband waits outside the locked doors, but knows nothing of the rooms she has been in.
Often women ask for notes for their jobs. The head nurse has written notes excusing women from high school gym class, graduate seminars, and butcher shifts. Not everyone’s commitments are excusable, however. A woman before Jessica goes through the procedure without sedation in order to drive herself to Wal-Mart for her shift that afternoon.
A woman told Harriet she got pregnant because she could not afford to pay for her birth control. She said that the price of her contraceptives was most of her salary as a florist. Planned Parenthood offers free contraceptive methods if the patient’s income is 250 percent below the federal poverty level; they offer to all patients a year of birth control pills, the insertion of an IUD, three shots of Depo, and a year of the patch.
Jessica is ready to walk out. The head nurse reminds her not to put anything in her vagina for two weeks, drink alcohol, or lift her children. Jessica takes two lollipops for them. It’s 3:15 PM. After fasting for the sedation, she’s excited for dinner. She thinks Chinese food. On her left is the door she just exited and on her right is the door she entered at 8 AM that morning.