Irish abortion referendum: If you have seen one woman die of a botched illegal abortion, you have seen one too many

Mary E Black discusses how her own views on abortion have been shaped by her medical training and life

maryeblack copyOh how sure I was when I was young. I was sure that using condoms was a sin, that sex before marriage was entirely wrong, and that abortion was murder. Then medical training, and life, intervened.

Medicine was my window into people’s lives—their stories, their secrets, and I rapidly learned that lives come in all shapes and sizes. My strongly Catholic upbringing did not leave me with enough answers for all the issues that I faced as a clinician. I found no easy, one size fits all morality and no rules that could be applied to all situations. Damage ensued when the rules applied were inflexible and when information was lacking. I saw a woman die on her seventh caesarian section, because her catholic faith would not allow her to use contraception or be sterilized; a girl who did not even know she was was pregnant until she went into labour; a student who had fallopian tubes completely gummed up with undiagnosed gonorrhea; a middle aged woman hemorrhaging from a backstreet abortion using a knitting needle. If you have seen one woman die of a botched illegal abortion you have seen one too many. I have seen more than one.

I worked in different countries, where I saw how many different lives people lead. In Bosnia and Herzegovina during the 1990’s war, I met a couple of women and girls who were determined to give birth to babies born from rape, but many more who were desperate to terminate their pregnancies. Finding a solution of any kind was hard, but much worse for a refugee, traumatized, impoverished, with a strong religious faith and having nightmares about what has happened to cause the pregnancy. Over the years I have encountered many child and adult sex workers. Some were in control of their fate but many more were abused, sold, drugged, or had clients who would not use condoms. They got pregnant. The children of such pregnancies often did not have a bright future. Some of those women opted to keep their children, many more did not. I have met married women who had got pregnant and then realized that another child would be a huge burden to bear. I have met women who were constantly careless, very naïve, who had a challenging antenatal diagnosis, or an abusive partner. Mostly women came alone, sometimes with partners. When they ended up pregnant, each woman had to work out what to do, and they all made different choices.

I found I could offer a listening ear, let them know more options than perhaps they had heard of or considered, and if they did choose to terminate their pregnancies, make sure that they found safe and legal providers. In some cases they opted to keep the baby after our discussions, and in some cases they did not. I realized that lives are complex and that stories vary. I stopped wishing to judge another person for their choice.

Despite all my efforts to lead a blameless and virtuous life, my own history has been complex. As a young sexually active medical student I did not always use contraception (it was really hard to get it in Dublin 40 years ago), and this was partly due to my own ignorance and doublethink about the consequences and partly due to the blind, impractical fog of passion that can descend on even the most educated and even medically qualified of women, especially when society proscribes that “nice” girls really should be virgins and sex is an unspoken and private matter, absent even from the medical curriculum.

On one occasion, I panicked about an unlikely, unwanted, but possible pregnancy and frantically sought solutions. At that time in Ireland there were none, so I ended up persuading a doctor to prescribe my own self designed morning after pill. He knew nothing about what to do, and I got the dose wrong, and so for three days I took massive amounts of hormones and felt very ill indeed. There followed a period of great mental distress, and I held this hurtful secret in silence for many years. That was just what women did. I am glad that now women are telling these stories and relieved that, by telling my story, I can join them. It is important that we do not put these stories into “positive” and “negative” baskets; it is possible to hold complex feelings about terminating a pregnancy, including both regret and relief, and as we age the narrative about past events may change. As for me—I feel so sorry for my younger, lonely, confused self, but content that I survived. I have since had two children and have made sure that both of them are practical, confident, and open about sex and sexuality. They will not struggle alone in the dark.

I have never lost my aversion to the termination of a pregnancy—in an ideal world none would be necessary or sought, but we do not live in an ideal world and none of us is perfect (and anyway, who can define perfect?). I do, though aspire to improving this world. As a public health doctor I have worked with UNICEF, the World Health Organisation, and health services in several countries building support for children, women and families, so that every child born can have the best start in life. I have lobbied for safe, accessible contraception, and I have tried to help women navigate the difficult decisions around a pregnancy that is not viable, or that may not be wanted. Some of those women have carried on with their pregnancies and some have terminated them. I have come to accept that in messy lives there are various messy solutions: what is best for one person may not be for another. I have wished each woman the best for her decision, and urged them to reflect well on it, but have never thought it was my decision to make.

Ireland will be voting on 25 May 2018 on whether to repeal or retain the constitutional ban on abortion. I am a non-resident Irish citizen so cannot vote. If I could I would vote “Yes.”

Mary E Black is a public health doctor. She is on Twitter @DrMaryBlack

Competing interests: I have no relevant interests to declare.