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Abortion Services: A Family Doctor's Perspective

Prine Headshot

Approaching the 40th anniversary of the decision that legalized abortion, Dr. Linda Prine describes its provision as part of a continuum of care.

On January 22, we will celebrate the 40th anniversary of Roe v. Wade, the landmark Supreme Court abortion decision.  Only one year before the decision, in 1972, the Court had legalized contraception for unmarried couples.  Those of us who came of age during those years can still taste the fear of becoming pregnant for lack of adequate contraception and of needing an illegal abortion.  And we can also taste the sweetness of those early years of reproductive freedom. 

Doctors like Linda Prine, a family medicine practitioner, also remember that time after Roe when abortion services were abundant, at least in the New York metropolitan area.  “When I was an operating room nurse in the seventies, there was a circulating nurse, and a scrub nurse, and an anesthesiologist for every procedure, including early abortions … and I was even working in a Catholic hospital!”  By the 1980s when Prine had embarked on a medical career and was a resident, her training in abortion was relegated to a “deserted wing of a medical building” where there was virtually no other staff in attendance.

Prine acknowledges the good intentions of the women’s health activists who opened freestanding clinics around the country to ensure that women needing abortions would get specialized attention in a supportive setting.  But the resulting marginalization of abortion as an integral part of medical care made it possible for medical schools and hospitals to not teach these skills.  As the clinics came under attack, cresting in a wave of murders of clinic personnel in the 1990s, it became harder to find and train doctors and staff to provide this service.

Prine considers herself lucky to have trained in the 1980s under courageous doctors like William Rashbaum, a legendary ob/gyn and abortion provider in New York City.  She was determined to help her own students gain abortion training, and improve access for patients, by making it part of mainstream medicine.  Last year she was honored by Physicians for Reproductive Choice and Health for providing outstanding abortion services and serving as an inspirational leader for colleagues, residents, and medical students.

Nearly one in three women in this country will have an abortion by age 45, according to the Guttmacher Institute. Abortion is thus part of many women’s reproductive lives.  The continuum may include any or all of the following:  pregnancy, miscarriage, childbirth, infertility, abortion, and menopause.  Linda Prine’s practice incorporates almost all of these, as well as sore throats, strained muscles, and annual check-ups: care that she calls “patient-centered.”  She treats multiple generations of the same family from birth to death.  In addition, she oversees women’s care in a network of community health centers in the greater New York City area, offering her a window into the many reasons women need abortions. 

“If we are really all about creating healthy families,” she says, “we need to help women make those families only when they are ready to.”  Prine is a skilled and experienced practitioner.  But she also has a singular gift for recording the stories of her interactions with her patients. As a way to encourage support for increased access to abortion, she shares them at professional meetings, in testimony before policymakers, and especially on a listserv she started to help build community among her family medicine peers and medical students. “It keeps us strong," she said, "especially those doctors who really risk their safety when they go to work in parts of our country where there is not much of a community of support.”

There’s the pregnant 43-year-old mother of two, suffering from diabetes and hypertension, whose last pregnancy had been very complicated.  Her sister, a patient of Prine, brought her in for a medication abortion without the knowledge of her husband.  “If she told her husband she wanted an abortion, it would end the marriage,” Prine recalls.  “But if she went ahead with the pregnancy, she would risk her health and possibly life.”  Prine helped her resolve the feelings of stupidity and selfishness that she confessed, and she went ahead with the abortion.

Or the 33-year-old woman, pregnant for the first time and working two jobs, who imagined marrying her fiancé in another year or two but couldn’t handle it now.  Her gynecologist had delayed her early efforts to obtain an abortion by giving her inaccurate information such as warning that an abortion could make her infertile.  She came to Prine’s office after realizing she could no longer trust him.  She had the abortion and then decided on an IUD and to return to the office for continued care.  Says Prine,  “It’s one thing to be against abortions and not offer them in one’s practice, but to actively sabotage a patient’s efforts to terminate pregnancy by misleading her and pushing her to get married, that is so unprofessional.”

Or the teenager who wanted to be able to finish high school and go to nursing school.  She had brought her mother with her for a follow-up visit and insertion of an IUD after a medication abortion.  Mom held her hand, stroked her hair, and told her how proud she was of her daughter.  Says Prine, “I find most mothers welcome the chance to be supportive of their daughters, even if they are unhappy about their daughters having sex, and it builds that bond when we, as doctors, pay respect to it.”

Or the distraught mother who had come in with her hard-to-control toddler for his 15-month well-child check-up and, while in the office, asked for a pregnancy test.  When she found out it was positive, she started to cry. When Prine explained that she could give her a pill to induce cramping and bleeding and end the pregnancy, she cried again, this time out of gratitude.

“It is a huge thing we do for women, in the bigger picture of their lives,” Prine says.  “But medically, it shouldn’t be a very big deal.  It should just be a routine part of our scope of practice.”

Prine is lucky to be practicing in a state that has not passed restrictive abortion laws to place near-impossible burdens on doctors and clinics offering women essential reproductive health services.  A record 92 such restrictive provisions were passed in states in 2011, and 2012 ended with the second highest record. The Guttmacher Institute’s Elizabeth Nash, who tracks state reproductive health policy trends, warns that “all signs are pointing to another year where state legislators will work to undercut abortion rights and access.”

Constant vigilance is required on both the state and federal level to hold back the tidal wave of attacks on abortion.  The courts, legislatures, and government agencies are all arenas for advocacy, as are medical institutions.  Pro-choice activists continue to protect the rights that Roe encoded.  A younger generation of doctors has demanded training in abortion techniques.  This is good, because more providers are desperately needed in large swaths of our country.

Doctors who give abortion care face what Prine acknowledges is “an incredible uphill battle.”  They should be honored not just on the 40th anniversary of Roe v. Wade but every day of the year.  Family medicine practices, embedded in small towns and inner cities, could be the most effective place to incorporate contraception and abortion into a full spectrum of health services.  Perhaps better than any other approach, family medicine doctors like Linda Prine demonstrate that abortion is part of the continuum of women’s reproductive lives and the lives of healthy families.

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