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.
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:
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.
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.
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.”
“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.
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.