Election 2002:

The Mourning After

William F. Harrison, M.D.

The election of 2002 is basically over, and as usual, there are winners and losers. The winners are the religious right, big business, rapacious capitalism, corporate raiders, the big rich, the gun lobby, stock manipulators, war munitions manufacturers, those who would rape and pillage our forests, stream, shore lines and public lands - and the politicians who serve these. The losers are our environment, the middle class, the poor, organized labor, small stockholders, wage-earners, those without medical insurance, and those who serve them, and - the biggest losers of all - girls and women of childbearing age, their children and their families. In approximately 32 states there are already laws on their books or clauses within their constitutions that will eliminate, or severely reduce access, to elective, safe, legal abortion within these states as soon as Roe v. Wade is overturned by the U. S. Supreme Court. This is now about as sure a bet as one ever finds in life.

Four Supreme Court Justices have already voted to overturn Roe v Wade: Justices Thomas, Scalia, Rehnquist and Kennedy. George W. Bush has plainly stated that his models for the federal bench are Scalia and Thomas, the two most radically ÒconservativeÓ members of the Court. These two Justices have voted to limit or to overturn Roe at every opportunity to do so during their terms on the court. And if anyone is of the mistaken impression that the ÒconservativeÓ members of the court will be reticent to overturn precedent, they need only review the Bush v. Gore decision of 2000-2001 term of the court. I sincerely hope that I am wrong in my negative assessment of the future of Roe v. Wade and therefore of safe, readily available legal abortion. And certainly in some states, notably New York and California, legal, and therefore safe and available abortion will probably continue to be the rule.

At the present time, the legislatures of these states seem not to be dominated by right wing lawmakers deeply indebted to the religious right and dedicated to criminalizing elective abortion. I was a young ob/gyn resident at the University Hospital in Little Rock, Arkansas from June 30, 1968, to July 1, 1972. During the first six months of my residency almost all abortions, except for those done ostensibly to save the life or physical health of the mother, were illegal, and safe elective abortion was only sporadically available in most of this country. During the four years of my residency, I saw, or was aware of, perhaps 5,000 or so illegal and infected or traumatic abortions seen in my hospital - either in the emergency room, in the clinics, or on the wards and in the operating rooms. A significant number of these patients required only minor surgery, intravenous fluids (sometimes blood transfusions) and large doses of antibiotics to successfully treat the short term complications that resulted from the illegal abortions these young (some no more than children) and middle aged women endured. Nearly all, with the exception of the most severely ill of these, were extremely reluctant to admit that they had undergone an illegal abortion and only rarely would tell who had done their abortions. Nor would most of them discuss the circumstances that drove them to this painful and dangerous extreme.

In January 1969, the abortion laws in Arkansas were liberalized and a few ob/gyn physicians in private practice in Little Rock began offer elective abortions in the hospitals in which they practiced, providing that the patient was referred to them by a physician not in the same practice and the patient was willing and could afford to undergo extensive medical or psychiatric evaluation by at least two psychiatrists if the abortion were to be done for reasons of mental health, or by two non-psychiatric physicians in those cases which were to be done for medical complications. We rarely saw any of these patients in our hospital with post abortion complication. However, those who could not afford, or were unaware of this option still steamed through our doors, and those of the other hospitals in town. (Ours was the smallest of the three hospitals in Little Rock, but it was the one with the largest indigent and working poor population and therefore may have had the largest number of patients with illegal abortions.) We continued to see from three to five of these girls and women in any 24-hour period even after we began to offer elective abortion in our own hospital.

The difference in the outcomes for these two populations - patients who had legal abortions done by competent surgically trained physicians in a clean environment using sterile instruments, and those done by untrained persons using marginal or even dangerous techniques, frequently utilizing unsterile instruments, or even by the patients themselves Ð was remarkable. The first group of patients had almost no significant complications, while the second group frequently had major complications requiring hospitalization, intravenous fluids, transfusions, major antibiotic therapy, and even major surgical procedures. Where as many physicians who trained or practiced before the liberalization of abortion laws in their states or before Roe v. Wade saw the awful consequences of illegal abortions just as I did, in my residency program between 1968 and 1972 we were afforded the opportunity to experience first hand the differing outcomes for both legal and illegal abortions. When I went into private practice in July 1972, there were still a large number of illegal abortion patients coming into the ER of our small community hospital even though there were three ob/gyn physicians on the staff offering abortion. (To my great shame, I didnÕt offer abortion until 1974.) It was not until the Roe v. Wade was rendered by the Supreme Court of the United States on Jan. 22, 1973 that, suddenly, physicians and emergency departments all over the country experienced a dramatic decrease in the numbers of injured and infected post-abortion patients. As a consequence the vast majority of physicians trained since Roe v. Wade have never seen a complication of an abortion and only a tiny percentage of the 40,000,000 or so girls and women who have undergone abortions in this country since Jan. 22, 1973 have had such a complication.

Because Roe was decided almost 30 years ago, there is little or no institutional memory among either physicians or women of the once terrible scourge affecting girls, women, their families, friends and loved ones when these same women and girls were faced with what they considered a catastrophic pregnancy. I sincerely hope that I am wrong about what the 2002 election of a Republican majority to the U.S. Senate portends, especially for my patients, but perhaps for my daughters and granddaughters. I am now 67 years old with a bad ticker and, perhaps, not too many more years to practice. But now I pray to God that I donÕt live and practice long enough to see a return to the days of the ubiquitous back ally abortion. For if what I have predicted comes true, thousands of younger physicians, and millions of girls and women, over the next few years are going once again to experience the terrible problems that will too often occur when a woman is diagnosed with what she considers a calamitous pregnancy, and has no one to whom she can turn.

William F. Harrison, M.D., FACOG

Fayetteville WomenÕs Clinic 1011 N. College Ave. Fayetteville, AR 72701

Tele (479) 442-8166 Fax (479) 442-0360

E-Mail Wharri3365@cox-internet.com