|Fighting Against the Stigma of Abortion
Bryna Harwood, MD, is an Assistant Professor and the Director of Family Planning Research in the Department of Obstetrics and Gynecology at the University of Pittsburgh School of Medicine. Dr. Harwood is a strong advocate for comprehensive patient care, including access to abortion services.
For Dr. Harwood, the process of deciding to become an abortion provider happened gradually. “It’s been a long, continuous process of growing up, being a woman, being a feminist, going to medical school and realizing that women’s healthcare is extraordinarily important to me personally, politically and professionally,” she says. Yet the decision to become a second-trimester provider was more involved. “Where I trained in residency there were no second-trimester D&E providers,” she says. “Two patients with life-threatening conditions in pregnancy, who would have benefited from a second-trimester D&E, instead had to undergo a hysterotomy (an abortion performed through an abdominal incision), a much more risky procedure, because there was no D&E provider and they could not be transferred to a facility that could provide a D&E. I had many skilled and wonderful teachers, none of whom were willing or able to perform second-trimester procedures, even though some of them had been trained in it.
“That experience compelled me to learn how to perform D&Es so that in life-threatening situations I could do it,” Dr. Harwood continues. “Through working with patients, I realized that a second-trimester abortion is not just necessary in life-threatening situations. There are many clinical scenarios in which women need the option for this care.”
Dr. Harwood’s motivation to provide medical care to women came from a variety of sources. “I loved that it was not just about biology, but it was also about psychology, sociology and history,” she says. It’s also personally rewarding for Dr. Harwood: “It’s a safe procedure, and in a few minutes I can relieve an enormous crisis in someone’s life. There are very few times in medicine when you have the opportunity to quickly and safely do something that completely reverses a person’s pain and suffering. It’s very satisfying to care for someone in a crisis. I can’t imagine not taking care of these patients.”
Dr. Harwood has her own approach to overcoming the stigma of being an abortion provider. “I try to encourage anyone who says D&E is a safe procedure in experienced hands to drop the second line,” she says. “The truth is that D&E is a procedure that can be learned by anyone who practices gynecologic and obstetric surgery. Any procedure we do is a safe procedure in experienced hands. Nobody ever says vaginal hysterectomy is safe only in experienced hands.”
She is also very concerned with patient stigma around abortion. “When I talk to students and residents and anyone, actually, I try not to marginalize patients,” she says. “When I’m reassuring a patient, or when I’m talking to family, friends or students, I try to make clear that the women who seek abortions are the same women that they know in their lives. They have to see these patients as themselves or as their family members, because abortion care does not apply only to certain kinds of people.”
“My practice is as varied as the population of Pittsburgh. All kinds of women need abortion care, and I like to remind people that women who say they are anti-choice often seek abortion care for reasons they never imagined. And it doesn’t negate their feelings; it’s just that they may still need that medical care. This is about reproductive health and medical care, not the whims of somebody trying to make her life more convenient, which is the comment I often hear.”
As a physician, Dr. Harwood is very concerned about advocating on her patients’ behalf. “Advocacy is really important, but it’s something I have a hard time with,” she says. “As physicians, we’re incredibly overworked, we’re incredibly busy and there’s a tendency to feel like, ‘I gave at the office.’ But the truth is that if we don’t speak up for our patients and for our colleagues, then terrible things will continue to happen to women’s healthcare.”