A few months ago, I sat down with the doctor who performed my abortion, Stacy De-Lin, to talk about her experience working as an abortion provider at Planned Parenthood in New York City. Given the variation in abortion laws across the country, which has effectively culminated in making one's access to reproductive healthcare dependent on her ZIP code, I suspected De-Lin's experience would be rather different from, say, a provider at a Planned Parenthood in a Southern city, such as Houston, or from a family practice provider in rural Kansas.
That's because it's not just laws that influence providers' ability to do their jobs, but also the local culture that shapes those laws in the first place; and it's not just the laws that are influenced by culture, but abortion providers' freedom to live their lives safely, openly and fearlessly, as well.
Over the past several months, I've set out to speak with abortion providers from around the country about their day-to-day lives. I've asked each about the way their places of work and residence limit or enhance their ability to do their jobs as well as all the rest -- to be spouses, parents, children and friends, to be engaged members of their communities who also provide a highly necessary, highly stigmatized service for women. It's been a slow-going process, but one that I hope will continue -- especially as more physicians come forward.
While there are many abortion providers willing and eager to talk to me, a number of them have cited legitimate concerns about their own safety, the safety of their families and the safety of their colleagues in declining or holding off. They need time to mull over serious concerns before they can agree to go public, and I can't fault them for that. I can only see it as another example of how far we have to come in destigmatizing a procedure that one in three women will have by age 45.
This week, in honor of the National Day of Appreciation for Abortion Providers, I spoke with Dr. Jaclyn Grentzer, an OB-GYN in St. Louis. Grentzer performs abortions at Planned Parenthood, as well as a local hospital that provides care for women who are not candidates for outpatient abortion, often because of threats to maternal life. She told Salon about the differences working in two such distinct clinical environments, how Missouri's notoriously restrictive abortion laws impact her patients, and what motivates her to keep caring for women. Our conversation has been condensed and lightly edited for clarity.
How long have you been an abortion provider, and how did you decide to pursue this line of work?
I think it goes back to when I was younger, probably when I was in high school, my mom -- who has always been really open and honest with my sister and me about sex and relationships -- took me immediately to an OB-GYN [in Southern California] when I started dating my first boyfriend. I remember that OB-GYN told me, “Well, you should be on birth control pills.” I didn’t know anything, so I just got a prescription, and like a lot of teenagers I could never remember to take my pill. So I went back to the doctor’s office, and that OB-GYN said, essentially, “Well, you’re just going to have to get better at taking it.” There was no other discussion of other methods of birth control. I had no clue; I thought taking the pill was what you did.
Fast-forward eight years of this inconsistent pill use, I’m sitting in this medical school lecture about birth control, and -- surprise! -- there’s all these other birth control methods. I was angry. I trusted that OB-GYN to help me find the best option, and she didn’t. I think that’s probably when I made up my mind to be an OB-GYN, so that I could give women the best care possible -- and, more importantly, give them all the information that they needed to make the right healthcare decisions for them. From there, making the decision to become an abortion provider was really easy. If you’re an OB-GYN, I think you should be able to provide 100 percent of reproductive healthcare services women need, whether that’s abortion, adoption or raising a child. And if you’re not willing to do all three, then I feel like you’re not really committed to your patients 100 percent.
Did you have to seek out abortion care training, or was it available to you?
I was lucky enough to have done my medical school at an institution that had a family planning division at that time. Already it was very standard that you learned about abortion in medical school and that you had the opportunity, if you wanted, to do a “special topics in reproductive health.” I chose to do a special topics in reproductive health at Planned Parenthood, and it allowed me to feel more comfortable with this concept of providing abortion care because I got to see it in action, and see the compassionate care that’s delivered at the Planned Parenthood here in St. Louis. After I was done with residency, an adviser suggested that I do an elective in San Francisco, so I spent a month working at an abortion clinic there. I came back and my mind was made up: If I was an OB-GYN, I was going to be an abortion provider.
At Salon, we’ve written a lot about the abortion restrictions in Missouri -- specifically the 72-hour waiting period, which is one of the strictest in the country -- and I’m wondering how those laws affect you, and affect your ability to do your job.
I have been in St. Louis since before the 24-hour wait limit was instituted, and I remember when that went into effect. I found that challenging in itself. Women have to travel really far to get here, and making the waiting period 72 hours is even more of a burden for patients and their families. On average, at the Planned Parenthood in St. Louis, a woman travels nearly 100 miles. Ten percent of our patients travel more than 300 miles. For most women, they come to the clinic, they get counseled face-to-face, and then they drive home -- and then the day of the procedure they have to come back. If they’re having a two-day procedure, then the second time they come back, they have to stay overnight. For those women, that’s lost wages, the costs for childcare -- more than 50 percent of women who are seeking abortion care already have children at home -- and paying for gas. Not to mention the cost of the abortion. It’s a huge economic burden.
I’m curious how much time you get to spend with these patients. I spoke with a provider a few weeks ago who travels to Texas, and she said that because there are so many women traveling such far distances, she simply doesn’t have the time to do the sort of in-depth face-to-face consultations she’d like to do. I wonder if you face a similar problem.
Sometimes it feels that way. At Planned Parenthood, women receive their counseling by one of our licensed workers who is usually either a social worker or a nurse, and then their procedures are done by the physicians who staff the center. Sometimes I feel like I don’t have that same freedom to spend time with women. The first time I meet them, it’s when they’re in the procedure room. So I always find time to stop before we even do anything and I just sit next to them, and we talk. I ask questions. I let them ask questions. However long it takes them, is how long it’s going to take them. Whatever they need to talk about, we talk about. Probably that’s not sustainable when there are so many women traveling from so far away to get care. But I think it’s really important to those individual patients.
I want to get back to your personal relationships as a provider. While you said your mother is very supportive, I’m curious how that initial conversation about your work went.
So, I don’t even know where to start. It’s a conversation that happens almost every time we’re on the phone with each other. Even though my mom is incredibly supportive, I think she still worries all the time -- that something’s going to happen to me, especially when I tell her about the protesters at our clinic. I think she is still a little bit hesitant about my decision to be an abortion provider in public. I think she wishes that I was too scared to identify as an abortion provider in public so that she wouldn’t have to worry about my safety. But I think she’s come to peace. She always tells me, “Well, I’m worried about you. But I’m so proud that you’re the same woman that I knew you were going to be when you were 10, resolved to do what you think is right.”
Why do you tell people you’re an abortion provider?
I think it’s important to destigmatize something that one in three women go through by the time they’re 45 years old. Women don’t talk about it with each other, even though it’s a normal reproductive option. One in three women have it. It’s normal. I think the more that abortion providers hide in the shadows, the more it leads to continued stigma.
How public and open are you? How often do you disclose your job and to whom?
Anybody who asks me what I do for a living. And I say the same thing every time. They say, “What do you do?” And I say, “I’m an OB-GYN.” “Oh, well, where do you practice?” “I’m in St. Louis, and I’m a fellow in family planning.” And they always say, “What’s family planning?” And I say, “That’s specialized training in complex contraception and abortion.” And then I wait. I drop the bomb and then I wait. And most people are so supportive; even strangers will get really quiet and then say, “Thank you for doing the job that you do.” And some people will say, “Oh that’s interesting, do you like being an OB-GYN?” And then it’s over. I thought it would be such a big deal and it’s not a big deal.
What sorts of protester issues have you had? Is it mostly at Planned Parenthood or is it at the hospital as well?
It’s only at Planned Parenthood. Probably they’re not aggressive or violent, but it was a big surprise to me when I started working there, that they were always taking pictures of me, my car and my license plate. Taking pictures of my license plate felt very personal and very threatening. At first I was concerned about my safety, but I quickly got over that because their presence and their protesting really only strengthened my desire to provide compassionate care to these women. Mostly I was concerned that somehow, their having pictures of me and my license plate was going to affect the safety of my family.
I know that’s a huge issue in a lot of places. But you haven’t had any sort of personal encounters with protesters off the premises of Planned Parenthood?
I have not. Luckily our Planned Parenthood is gated, the parking lot is gated. I drive through the protesters in order to get into the parking lot. And then crossing the parking lot, they generally are yelling their counseling at me as I’m walking in. I’m not sure they know if I’m a provider. Luckily most of the time when I am leaving Planned Parenthood I go right to my hospital that I work at. So I don’t ever feel like there’s an opportunity for them to follow me to a place that’s more isolated.
You said it strengthens your resolve when you see protesters. But how do you deal with that emotionally?
When I first started working at Planned Parenthood, it used to make me feel really vulnerable, and really sad -- sad and angry. And not so much sad and angry for myself; I can handle it. I have no problem coming in every day. But I used to get really sad and angry for the women who had to walk through them and had to listen to what they were saying, because having an unplanned pregnancy is a crisis in itself. These women are already dealing with a very important decision in their life, and they are super-thoughtful before they’re even coming to our Planned Parenthood. They’ve already made their decision. They’ve thought about it. They’ve talked to their families if it’s safe for them to talk to their families. And for them to have gone through all of that emotional stress, and then have to deal with somebody who doesn’t know anything about their situation pass judgment on them without having that information -- that’s what makes me so angry.
And in Missouri they have to do that twice over the course of 72 hours.
Right, and drive 300 miles. When I first started my fellowship, I used to be so upset and angry when a woman would tell me that she drove two hours to come to her appointment. I would think to myself, “Oh my gosh, two hours, that’s crazy to have to drive that far.” And then I started to get a little bit numb to the two hours, and my mark would be four hours. If she told me she drove four hours to come to her appointment, I would just feel devastated and horrible and totally impotent to help her social situation. And then I got immune to that. And now, when she tells me she’s driven eight hours, that’s when I have that knot in my stomach -- like how did we get here? How have we eliminated women’s healthcare so much?
Given all of the downsides, what about your work have you been most hopeful?
When I first started the fellowship, I remember, I used to go home every night and just be so emotionally overwhelmed with everything that had happened that day. All of these situations women were in -- where they were just trying to get help and they were trying to get plugged into the system, or sad situations where they had a desired pregnancy that then was going to have to end for either fetal anomalies or threat to maternal life. I would come home and I would tell myself: I don’t know if I have enough room in my heart to feel all these emotions all the time. Eventually, you just realize that your heart gets bigger and bigger, and there’s room because you don’t have a choice. Your heart can expand exponentially to take care of every woman who needs you.
I think the reactions from the patients really give me a lot of hope because they’re always so grateful that somebody is there to take care of them. And it’s not uncommon that I hear a woman say to me, “Wow, you’re so nice, everybody here is so nice, thank you for being so nice.” And that is really heartbreaking, but also makes me feel good at the same time. Like, you drove eight hours to get here and I’m so glad you felt like we care about you, because we do, and we wish you didn’t have to drive eight hours to get here. But we care about these women so much, we just want them to be safe, and we want them to be happy and to be so secure in their decisions. I think knowing that I’m not going anywhere and that patients are always going to get really high-quality care, that gives me a lot of hope.