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Desperate Measures

Desperate Measures

In my very first job as a doctor, working in a London hospital in the 1980s, I always took a ridiculously detailed past medical history for every patient I saw. I started to notice how many elderly women had had septicemia, a life-threatening infection in which enormous amounts of bacteria enter the bloodstream.

The neighborhood surrounding the hospital had once been the worst slum in London, and it didn’t take me long to guess that these infections were probably caused by illegal self-induced abortions during the hungry years of the Depression.

When I asked–slowly, carefully, subtly–I was told some intensely personal and secret stories.

One woman, Maggie, spoke to me woman to woman. She wanted to tell me what she clearly thought I needed to know.

“I always asked around about which local woman had the neighborhood ‘enema kit,’ and borrowed it,” she told me. I didn’t understand at first. Then she continued:

“You have to cut up a bar of carbolic soap. Boil it up. Squat over an enamel basin. Reach up inside yourself until you feel something like a walnut.”
Surely the cervix, I realized.
She kept on talking: “Put the nozzle into the groove you will feel there. Pump the carbolic fluid up through the groove until you feel an explosive pain in both sides of your belly. It needs to be in both sides. If it’s not the very worst pain you’ve ever felt–much worse than labor–you need to pump again. And again.
“After that,” she said, “you might, hopefully, have done it.”
No wonder there was so much septicemia, I thought. And I knew why Maggie was so insistent about the necessity of feeling pain on both sides. She was trying to squirt sort-of-sterile fluid right up through both fallopian tubes, into her abdominal cavity.

A woman named Bet didn’t want to talk about the three episodes of septicemia she’d suffered in between the births of her eight children. But she immediately knew what I was hinting at.

“My husband didn’t approve of that sort of thing,” she said, lips pursed as though she didn’t approve of it either. She paused as her gaze went far away. Then she visibly pulled herself together. “Needs must, though, eh. You do what you have to.”

She did want to tell me about something else that had happened all those years ago.

Her large family was living in two rooms. Another equally large family lived upstairs.

The sister of the upstairs neighbor had been put out on the street immediately after a “procedure,” but hadn’t made it home before she’d started torrential vaginal bleeding. She’d knocked at the upstairs neighbor’s door for help, but no one was home.
When she knocked at Bet’s door, Bet’s husband refused to let her in. He didn’t want her, he said, to abort on his premises. Bet begged and begged until he eventually allowed the woman to sit on a bucket in the back yard.
I tried not to show how appalled I felt.
Imagine being desperate enough to go for that illegal “procedure.” Now you’re standing outside a hostile stranger’s door–bleeding, in pain, humiliated. You’re lucky to be allowed to sit on a bucket in the stranger’s back yard. Then, when the bleeding lessens, you’re lucky to be able to walk home, in your soiled clothes, past your own neighbors.
“Better than nothing,” Bet said. “Needs must,” she said again, grimly.
I spent a while trying to get my head around these stories of desperate women–desperately strong women–managing by themselves.
When I told a senior ambulance man what I’d been hearing, he wasn’t the slightest bit shocked. He said that before 1967, when abortions became legal in the UK, the local ambulance crews had known that the hospital where I worked was relatively good at saving women’s lives. The nearby teaching hospital, by contrast, was more interested in calling the police. So unless a woman with septicemia or vaginal bleeding seemed likely to actually die in the ambulance, the crews would bring her to my hospital–even when it meant breaking the rules on taking patients to the nearest hospital.
Ancient history? Maybe not.

In the 1990s, I worked in another hospital, outside of London, as the UK equivalent of an ob/gyn intern. My job included scheduling the operating-room lists. If we weren’t full up with emergencies, I was told to pull notes out of the filing cabinets, which held a “waiting list” of women in need of surgery. Among these notes, I found the names of tens of women who had been left to “wait” for an abortion until they were past the legal time limit.

Since I was in charge of the scheduling, I could, and did, correct that–at least for the women who weren’t already out of time.

To me, it seemed clear that the doctors (all male) who’d previously done the scheduling had decided, in effect, that each of these women must have a baby she didn’t believe she could look after.

I don’t believe that the doctors filed those women’s names on the “waiting list” by mistake; I think they made a choice. Nearly thirty years after abortion had been legalized, the doctors had decided that these women would have no choice. The women were being forced to live for a very long time with someone else’s choice.

Fast forward to five years ago. I was back in London, working in the emergency department of the aforementioned teaching hospital. A woman named Farhana came in with profuse vaginal bleeding. She didn’t speak English, but as I recorded her vital signs and put in an intravenous line, her husband anxiously told me that they had tried many sorts of contraception.

“They’ve told me I’m too young to be sterilized,” Muhammad said, almost crying. “We’re got five children aged under six, and we’re living in two rooms. So when she missed her period, we were desperate.”

I knew straight away what he was not quite telling me. When I asked–carefully, sensitively–he slowly took some empty boxes out of his pocket.
“You can buy this in Bangladesh,” he told me. “It’s for menstrual regulation. My cousin sent three packs.”
Out of desperation and ignorance, Farhana had taken a medication overdose.
I remembered the elderly ladies saying that, when they’d used the neighborhood “enema kit,” they were always alone. At least Muhammad had tried to help, and was supporting his wife now.

“Needs must,” I said, quietly.

He didn’t understand that. But he did understand what I said next.

“We’ll help your wife now–no problem,” I told him. “And please let me tell you about the free local service. It’s at another hospital near here. There are specialists for contraception there, and if that fails, they can organize an abortion for your wife. It’s part of the National Health Service. It’s free,” I repeated.

As I handed him a leaflet, I realized that I was referring Muhammad and Farhana to the very first hospital I’d worked in–the one the ambulance crews knew would look after women.
It’s a circle, I thought.

Not quite a full circle, of course.

There are safer methods now. And some men, like Muhammad, support and help their partners. But even in the UK, where we’ve had safe, legal abortion for more than fifty years, not all women get access to it. And in the US, where abortion services have been demonized and driven from many communities, abortions are virtually inaccessible in many locales.

Because I now know what happens when abortions are not readily available, I want to share what I’ve seen and heard–what takes place when women are pregnant and desperate, when the medical care they require is out of reach…and needs must.

The author has been a physician in the UK for three decades. “I wrote this piece because I am so concerned about the increasing pressure on women in the US around abortion. I’m writing anonymously because I know that, especially in the US, clinicians also come under pressure–sometimes extreme pressure–around abortions. I want to underline the seriousness of those threats: not only to doctors but also to women’s reproductive freedom. And I don’t want to endure the highly inflammatory comments that can make up a part of that pressure. In my thirty-odd years of doctoring, I’ve never met a woman who didn’t take a potential abortion very, very seriously. Sometimes, though, it’s the least bad option. Then, in my view, it’s the woman’s choice what to do. And it’s my privilege to try to support her, to stand alongside her. It’s no different from what I do, as a doctor, in many, many other difficult situations.”


15 thoughts on “Desperate Measures”

  1. Thank you for sharing your experiences and observations. I grew up in a Southern Baptist family in eastern North Carolina in the 1950s and 60s, and yet my mother was solidly pro-choice. When people asked her why, she’d say: “If you’d seen what I’ve seen, you’d be pro choice, too.” In time, she told me about some of these things. Thank you for sharing some things you’ve seen as well. Abortion is such an emotionally charged issue; this “data” helps us make better informed judgments.

  2. Muriel Murch R.N.

    Thank you for this piece. As a nurse in England in the early 1960’s and then in California in the mid 1960’s I saw first hand some of the devastating results of illegal ab’s. And the doctors who tried – with empathy – to help their patients.
    I have forever been grateful to Planned Parenthood for taking care of my three daughter’s various needs.
    I wrote about a similar situation on
    http://www.murielmurch.com. It’s on the blog in the nursing notes section
    Thank you again.

  3. I’ve read PULSE avidly, probably form nearly your first issue.

    I sent this issue around to my husband and his siblings. After the death of my mother-in-law, we discovered that she had a previous brief marriage and pregnancy and had given up the baby. We learned the story about five years before we were contacted by the new branch of our family through 23 and Me. It has been an exciting and wondrous journey.

    This essay gave me pause to think about my mother-in-law’s experience, and my own, and the experience of so many women who have been more and less fortunate to have control over their fertility and their bodies.

    I am reminded that I was very lucky to be in my reproductive years at a time when abortion was seen as a woman’s right. Losing that right has terrible consequences for women who had no part in making the laws but must deal with the results., both as children that we don’t have the ability to bring into the world under optimal circumstances and the harm we sometimes do to ourselves when we are forced to abort in the back alley.

  4. Thank you for writing about this. As you point out in your author’s statement, abortion is becoming increasingly politicized and restricted here in the US. It is never an easy decision for a woman. Your timely piece, written with the compassion of one who’s seen the effects of more restrictive times, is a reminder of why this should remain a decision between a woman and her physician.

  5. Excellent reminder on why abortion needs to be a privacy issue and what happens when it occurs in back alleys with dirty instruments and no rhoGAM

  6. Thank you for telling this story. People who are trying to make abortions unaccessible or even to overturn Roe versus Wade don’t realize that women will revert to ways that could kill them, not all of us can add a child to our lives, most esp victims of rape or molestation. I once talked about this with a religious fanatic friend. I asked about an abortion if doctors have said the birth would kill the mother. Her reply was that she would be greeted in heaven and that there was nothing better than her giving up her life for her baby. I asked her what about the three children and husband left behind. Her only answer was that it was still right, that God would take care of them. I had an abortion when they were first legal. I was grateful I had that choice. I could not have raised a child under my personal circumstances.

  7. Indeed, this is an insightful piece, and timely. I fought for reproductive rights, including abortion, more than forty years ago. Now it seems, we are coming “full circle”. Access to safe abortion and even reliable contraception, is under attack in many states. How did it come to this once again?

  8. An extraordinarily eloquent and moving piece.

    I, too, broke down crying while reading it.

    I also was struck by the author’s
    observation that, today, things haven’t changed as much as one would like to think.

    Recently, he reports, he went back to the area where he used to work,and was struck to realize that :

    “As I handed him a leaflet . . . I was referring Muhammad and Farhana to the very first hospital I’d worked in–the one the ambulance crews knew would look after [poor] women.

    “It’s a circle, I thought.

    “Not quite a full circle, of course” but . .

    What the author is pointing out
    is that, today, just as in the past,
    hospitals in poor
    neighborhoods usually try to take care of poor patients.

    Private hospitals in wealthy
    neighborhoods still don’t.

    This is also true, today, in
    the U.S,

    I live in NYC and here, the poor know where they are not welcome: private hospitals in expensive neighborhoods.

  9. How sad women’s bodies are not theirs to control. As a nurse, I have seen the results of the “coat hanger” self abortion. Women dying because they did not want another baby and leaving children without a mother. This makes no sense.
    When is society going to support women’s health and self-determination?

  10. I broke down crying. Thank you so much for sharing these hard-to-read but vital stories. Thank you for doing what you do. Praying the United States doesn’t go farther down that hellhole.

  11. Gratitude to the author. Eloquent and heart rending stories and hope that our country (US) comes out of this dark age to truly provide care and compassion for all women and families.

  12. Thank you for this timely and necessary piece. Abortion care is health care. Beautifully written. Writing from middle America, where the battle is happening NOW.

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