The abortion doctor

Susan Wicklund has received death threats and worn a bulletproof vest to work. But what really scares her, she writes in "This Common Secret," is the war on reproductive rights.

By Eryn Loeb

Read more: Abortion, Books, Salon Books, Medicine, Doctors, Pregnancy, Reproductive rights, Life

Jan. 22, 2008 | Thirty-five years after Roe v. Wade made abortion legal, it is the most common minor surgery in the United States, yet 87 percent of U.S. counties are without a provider. Because of the shortage of doctors trained in providing abortions, dedicated physicians often split their time among several locations, in some cases regularly traveling hundreds of miles to perform abortions in clinics that are open only one day every other week.

Dr. Susan Wicklund is one of them. She has been providing abortion services for 20 years, first quietly skirting regulations as a general practitioner, then putting in 100-hour weeks as the abortion provider for multiple clinics in the Midwest, and later in her very own clinic in rural Montana. Wicklund's new book, "This Common Secret: My Journey as an Abortion Doctor," weaves her personal story with those of many women she has treated over the years. She deftly turns individual stories into indictments of abortion policies she sees as misleading, condescending and unsafe.

Wicklund describes her work as a privilege and an honor. But it's also a job, often a dangerous one. She has donned disguises to get past the protesters who scream and wave signs outside both her home and her medical office. She's worn a bulletproof vest and carried a gun. In some states, Wicklund is required to read abortion patients misleading, politician-penned scripts that refer to an embryo as an "unborn baby" and warn that the procedure can be fatal (with no mention of the fact that wisdom tooth removal is far riskier).

While young celebrities like Nicole Richie and Jamie Lynn Spears beam and pose through their unplanned pregnancies and movies like "Juno," "Waitress" and "Knocked Up" portray childbirth as clearly the best path, plenty of people are making other choices, ones we don't hear about. Salon spoke with Wicklund recently about the complicated landscape of abortion rights.

How did you come to do this work?

I had been involved in home births, and midwives were being arrested for practicing medicine without a license. It was important to me to learn how to do abortions for my own patients, because as a young woman I'd had an abortion that was not done under very good circumstances. I really felt that care should be much better than the care I'd received. By my own choice, I was trained to do abortions as part of my medical training.

Shortly after that, I got into private practice, and I was told by the practice that I was not allowed to do abortions. I was angry and very frustrated. At the March for Women's Lives in Washington, D.C., in 1989, I really felt a personal call to action. I went back to the Midwest where I was practicing, made some phone calls, and ended up meeting with directors from a number of different clinics and going to work in the clinics as an abortion provider. Some of them were rather remote and underserved, and they were having a very difficult time finding doctors.

Abortion is a "common secret" in that 40 percent of American women have an abortion during their childbearing years, but it's rarely spoken about. Why do you think there's such profound discomfort in talking about this?

In other cultures and other countries -- in Europe, for instance -- it isn't such a taboo subject. There's also a much freer atmosphere around recognizing or talking about people's individual sexuality. In this country we have sex all around us, on billboards and in advertising. It's so pervasive, and yet for somebody to have a child out of wedlock, in most communities, is still something that people talk about [negatively]. It's an outward sign that they've had sex. If you've had an abortion, obviously it means you've also had sex. The religious right has told us over and over again that it is wrong, and we continue to buckle under that. I don't understand why.

Your book is full of stories about the women you've treated and the different circumstances under which they come to have abortions. Are there some that particularly stand out for you?

It seems like not a single day goes by without a patient who has an absolutely horrendous situation at home. We had a woman come into the clinic who was abused by her boyfriend, and she was terrified. She felt that if he found out she was pregnant, he would never let her out of his grips. This is a woman who said to me, "If I can't have this abortion, I'll kill myself. But I'm afraid if I do have this abortion, he'll kill me." We don't see situations every day that are so dramatic. But it just drives home how desperate women are. They'll tell me over and over again that if abortion isn't legal, they're still going to end the pregnancy somehow, and if they can't end the pregnancy, they'll end their own life.

We also had a woman recently who was 52 years old and hadn't had a menstrual cycle for over six months. She'd been having peri-menopausal symptoms for two years. Her doctor told her she was in menopause and there was no way she could conceive, and she and her husband hadn't been using birth control because of that. But she did conceive. And she was devastated. This is a woman who had never thought abortion was a good option for women, but she found herself pregnant and was not in a position to carry a pregnancy full term. She was one of the patients we spent a lot of time with, just talking.

There is no typical patient situation. It isn't all students who want to stay in school, it isn't all career women who want to continue with their careers and not have children right now. It isn't all single women who aren't married and not ready to have a child on their own. And it isn't all married women who had kids but now feel financially strapped. It's all of those women. When people start stereotyping who it is that has an abortion, it drives me crazy.

When you work in the area of women's reproductive heath, how important is activism?

To me, it's very important that all the people who are working in the clinics are doing it because of their strong belief that women must have freedom of choice. Anyone who comes to those organizations or clinics simply because it's a job treats it very differently and treats women very differently. The clinics that were first opened in the mid-'70s, right after Roe v. Wade, were run by people who had very strong feminist backgrounds, and who really knew from experience -- possibly their own experience -- that women should be treated with care, with dignity, with respect. This was not just [about] coming in for a Pap smear or for contraceptives.

At one of the clinics where I worked, there was a very young woman who was short the amount of money needed for the abortion. She'd come a long distance. It was her second trip to the clinic. The first time she wasn't really sure of her decision. The second time she came back she was very sure of her decision, but she didn't have quite enough money to pay for it. So the clinic sent her away. I went out into the parking lot and talked to her and offered to lend her the money -- only because I'd been in that kind of situation myself, and I knew how frustrating it was. I ended up lending her some money so that she could have the procedure done. But I was reprimanded by the administration of that clinic for helping the patient with the funds. I didn't think that was right. It was our job as a clinic to take care of that patient. (There are many facilities -- the bulk of clinics -- that don't turn patients away, so I don't want people to get the idea that this is a common thing.)

I'm challenged frequently to separate myself, and I'm not good at it. I get very involved in the needs of the patients beyond just their needs at that moment. For instance, making sure that somebody who I worry is a battered woman, or is in need of mental health care, has resources in her hands before she leaves the clinic. Sometimes I'll take their phone numbers home with me and call them a week later to see how they're doing, or if they've gotten the help they need.

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