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.

Published January 22, 2008 11:47AM (EST)

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.

Does it take a particular kind of person to do this type of work? There's the immense stress and crazy hours involved, but it's also necessary to really love what you do rather than just feeling obligated to do it.

I have, quite frankly, had physicians I was training to do abortions, and I knew they just didn't have the personality. And I told them that. The majority of physicians who are providing abortions now are my age and older, in our 50s and 60s. Many of them are motivated to do this because they saw women dying from illegal abortions when they were in their residency programs. They're motivated to provide safe abortions because they know that women don't stop having abortions just because it's illegal. They'll still seek them out, but there will be a lot of women who will become infertile or die.

The problem now is to try to find young physicians who understand that abortion care should be part of their entire practice. It shouldn't be that they just do deliveries or just do family practice. Physicians in those specialties need to take care of all their patient needs. What if a woman comes in, and you've delivered two of her babies, and she has early breast cancer? She needs to have radiation therapy, but she's also eight weeks pregnant, and she cannot have that treatment unless she has an abortion. If she chooses to have the abortion, that will increase the chances that she's going to live to take care of her two younger children; then you have to send her to a clinic 200 miles away because you won't do the abortion in your office.

It's the most common minor surgery in the United States, but the doctor may not be trained, even though it's a very simple procedure. Or your practice won't allow you to do it, maybe because they don't want the perceived repercussions from the community. So that's what needs to change: Instead of making it an isolated event in an outlying clinic, which may be hundreds of miles away -- which is true in most of the rural United States -- a woman should be taken care of by her physician, who has been taking care of her for everything else.

What was the turning point that made you decide to take defensive measures like wearing a bulletproof vest?

When Dr. [David] Gunn was killed [in Florida in 1993], that just changed everything. He was killed the same month that I was getting all these letters from Michael Ross [Ross, an antiabortion extremist, was eventually found guilty of intimidation after sending Wicklund more than 60 threatening letters], telling me he was going to tear me limb from limb and kill me. It was complete tunnel vision. I could not think about anything else outside that part of my life.

When I wear a vest or carry a gun, it often strikes me as I pull up to the clinic that this is absolutely absurd. I, as a physician in the United States of America performing a legal procedure, have to go to these measures to make it possible for me to go to work.

We're hearing less about clinic violence, but it's still happening. Last month, a clinic in New Mexico was burned to the ground, and two more were attacked. And we don't hear about it on the news. In Denver, protesters are going to the homes of construction workers to try to encourage them not to work on building the [new Planned Parenthood] clinic.

I wonder how easy it is to change people's minds about abortion amid so much rhetoric and so much emotion. How hopeful are you that people can come to understandings on this issue?

I'm actually much more hopeful than I've ever been. And that's because of what I've seen happening with this book. There's a certain number of people who are adamantly antiabortion and will never change their minds. But there's a huge group of people sitting on the fence who have always thought they're antiabortion, but they don't really know why they think that way. Maybe their parents [influenced them], or their church did. But they don't believe they've had a personal experience with it. They don't believe they've ever known anyone who has had an abortion.

I've had people contact me and say, "I always believed I was against abortion. And I read your book, and I really had no idea. I did not understand what it's all about, I did not understand who the women really are, and how personal this is, what the government is doing." One of them was a very good friend of mine, a woman who has heard me before. But when she read the book front to back she called me up and was just sobbing and said, "I get it now. I finally understand what you've been talking about all these years."

You write about how legal and political distractions take up a huge amount of time in your work. In an election year, is there a way you'd like to see the discussion on abortion and reproductive rights framed?

In my opinion, a candidate should get up and say, "Politics has absolutely no business in reproductive rights." A politician should say, "This is not even something I'm willing to discuss. It is a woman's right. It's not my decision." Unfortunately, that's not the way it's happening.

It has been suggested that debate moderators and the media should ask candidates about their position on birth control as a way of getting them to talk about reproductive rights more broadly. Would that be effective?

If we start engaging in that discussion, it becomes, What birth control is OK and what isn't? How far in a pregnancy can you go? Does a woman get to have an abortion if she is raped, or if she is not married? All these circumstances should be taken out of politics completely and out of the discussion.

If they're going to have any discussion in politics, then they need to go right to [saying], "If Roe v. Wade is overturned, how long will a woman spend in jail?" Then people back up and say, "Wait a minute, we're not talking about putting women in jail." Well, yes you are. If it's illegal, and a woman has an abortion, she goes to jail. When you start looking at it in those terms, people get more uncomfortable. It's ridiculous to just say it should be illegal and then not talk about what the consequences are.

How has the landscape of abortion rights changed over the 20-some years you've worked in this area?

I'm very fearful that we're going to lose Roe v. Wade. It's becoming more of a polarized issue all the time. We have the Republicans very adamantly saying we should outlaw all abortion, but the Democrats are also so far to the right on this issue, saying things like "abortion should be extremely rare." It's not rare. It's 40 percent of women in this country. And that needs to be acknowledged first.

We have fewer rights now than we did 20 years ago. It's getting harder and harder for women to get abortions. Even if Roe doesn't fall, we're still losing providers, we're still losing clinics; there are still laws being passed that are making it more difficult for women, and for the clinics themselves.

Do you think the prominence of young, pregnant celebrities and movies like "Knocked Up" and "Juno" have an effect on young women's decisions?

Is that going to affect the patient from Havre, Mont.? I don't believe it will. The patients I see are so focused on their own lives: a 17-year-old senior who got a full-ride scholarship to a college she's been dreaming of, and her parents have no money, and now she's pregnant. She either stays home and has a baby and probably stays in that town the rest of her life, or she goes off to college and plays basketball. I don't believe that patient's going to care if Britney Spears' younger sister has a baby or not. She's looking at her own life.

On the opposite end, whenever there's more talk about abortion in the media or on TV, I do hear patients mentioning that. I don't hear them mentioning the woman who keeps the pregnancy.

I guess when it's your own experience, it's really set apart from whatever cultural influences are out there.

That is so key. People say they would never have an abortion because of their religion or for whatever other reason. Then they're sitting on that table, we're ready to start doing the abortion, and they want to tell me about how, when they were 17, they made a promise to be abstinent, and here they are at 21, not married and with an unwanted pregnancy. They just want to talk about it and say, I didn't realize -- I didn't understand what it would be like when it was me.

By Eryn Loeb

Eryn Loeb is a staff writer at Nextbook.


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