Why I Provide


Jane Smith, MD, is a pseudonym
for the abortion provider and member of Physicians
for Reproductive Choice and Health

who wrote this post.

On May 31, 2009, Dr. George
Tiller was fatally shot in the foyer of the Reformation Lutheran Church
in Wichita, Kansas. For many Americans, this story was likely a news
brief that came and went. But not for me.

I am an abortion provider.

My colleagues and I comprise
a small, close knit community of abortion providers and advocates across
the nation. As we mourned Dr. Tiller’s loss, we also struggled to
understand what his death meant for our own lives. Reading tributes
to Dr. Tiller and his career, I was humbled. I was also embarrassed
by my own silence. Outside my chosen professional community, I’ve
kept my work a secret.

I thought about sending a card
to the Tiller family or making a donation in his name. Then I realized
the best gift I could give to honor his life is to "come out" to
friends and family, to identify myself and the work I do with pride.
So I did. I emailed or called more than a hundred friends, family members,
and acquaintances and told them that I am an abortion provider.

I was tired of the awkward
silences (awkward in my mind, at least) when people asked about my job.
"Women’s health" or "family planning" often sufficed, but
when pressed, I usually switched the subject. There were a thousand
reasons I didn’t want to identify as an abortion provider. I wondered,
will she never speak to me again? Will our kids get picked on? Will
play dates cease? Will our family members stop calling? Worse yet, could
we become the targets of harassment and violence? Yet when I revealed
this part of my job, none of these concerns became reality. Many of
my confidants expressed their support for my work. Some opened up about
their own abortions.

By remaining silent about abortion,
I contributed to the marginalization of abortion and, more important,
the women who have had abortions. These women are our neighbors and
teachers; members of our churches, synagogues, and mosques; sisters,
mothers, and daughters. All of us know women who have had abortions
(one in three women will have had an abortion by the age of 45). If
you are not aware of any, it is only because they choose not to share
their stories. It is also because we don’t ask or provide safe spaces
in which to tell.

I didn’t "come out" to
change anyone’s political views on abortion. I wanted to share a side
of my life that I find hard to discuss under ordinary circumstances.
And I would be lying if I did not admit that I hoped my letters and
calls would open up thoughtful conversations about the meaning of pregnancy,
unwanted pregnancy, parenting, and yes, abortion. Conversations that
went beyond overly simplistic stereotypes and hurtful words.

Telling the truth about what
I do was incredibly rewarding. I suspect some of my friends and family
are struggling with the news that I provide abortions, but the responses
I heard have all been positive. This is an important start for me, and
I have farther to go – I am using a pseudonym for this post because
I am not yet ready to be widely known as an abortion provider. I share
the story of my progress so far in hopes that it will encourage other
providers to reveal their secret. If each of us had the "coming out"
conversation with a hundred friends and colleagues, thousands of conversations
would begin about the need for abortion and the rewards of offering
women this service.

I never planned to be an abortion
provider. There is nothing glamorous or lucrative about this career
path. As a family doctor, I provide a breadth of care across the life
cycle; offering abortions in my own practice has been the most satisfying
part of my career. There are days when working in our current health
care "system" does not seem worthwhile, but I can honestly say that
providing women the full range of reproductive health care sustains
my passion and gets me to work every day.

Women come to me asking for
abortions for so many reasons: partners leaving them, condoms breaking,
not having insurance to pay for the most effective contraceptives, ambivalence
about pregnancy and parenting-I could go on. Most recently, the economy
has been a major driving force. Many of the women and men I care for
are losing their jobs and struggling to care for the children they already
have.

Some stories I find more compelling
than others. All stories are rich and highly personal; they challenge
and push me every day to continually uphold one of the core ethical
principals in medicine: "respect [patient] autonomy." This is the
nature of my work, which reflects the nature of being human in an increasingly
complex world. I cannot claim to understand women’s choices all the
time – whether they decide to become parents, end the pregnancy, or
make an adoption plan – but I trust that they are doing what is best
for them and their families at that certain place and that certain time
in their lives.

In Dr. Tiller’s own words:
"Abortion is not a cerebral or a reproductive issue. Abortion is a
matter of the heart. For until one understands the heart of a woman,
nothing else about abortion makes any sense at all."

By telling the truth about
my professional life, I hope I’ve helped my friends and family understand
my own heart, and my patients’ hearts, a little better.

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To schedule an interview with contact director of communications Rachel Perrone at rachel@rhrealitycheck.org.

  • invalid-0

    Your work is valuable. Thank you.

  • heather-corinna

    This is so awesome.  YOU are awesome. 

    As someone who also works "out" in the field, thank you, but as someone who also has had an abortion, a big double-thanks. Choosing to be out, and risk more than usual in doing so, in service of all of what you’ve talked about here at heart, is an amazing act and gesture.

  • invalid-0

    I have said this here before, but I think it bears repeating. If Dr. Smith’s story warms your heart (it certainly does mine), you owe it to yourself to read Dr. Susan Wicklund’s memoir, This Common Secret. In the first chapter, she comes out to her grandmother about her work as an abortion provider. That little story alone is worth the price of the book. No exaggeration, it will blow you away.

  • heather-corinna

    Agreed.  Wicklund’s book is really amazing.

  • invalid-0

    Thank you for sharing :) I all agree, Susan Wicklund’s book is a must read, truly amazing.

  • invalid-0

    Absolutely agreed on the recommendation of “This Common Secret”… and yeah, you’re going to be a sobbing mess by Page 8. So worth it, though.

    Dr. Smith, thanks for your work AND for your voice. It means so much.

  • invalid-0

    How stupid is “do your job for free or else clearly you have no principles?” Do you do your job for free? Do you think Dr. Smith’s medical degree was free? Do you think her facility is free? Her mortgage, her groceries? Do you live in a fairy land? And can I come visit if so?

    I swear, people should have to pass an IQ test before being given internet access…

  • therealistmom

    It is incredibly sad that it is necessary to remain anonymous for the purposes of posting, but you have the right to safety and well-being in a society that has a marginal fringe harming so many who provide services. Thank you for your bravery in ensuring women have access to all of their health care needs when it can be so difficult and dangerous to do so. Years ago it was a family doctor who helped me in my time of need and his kindness and compassion surely helped a great many women just like me. In my mind physicians like yourself who are truly concerned about their patients health and well-being truly encompass the Oath.

  • invalid-0

    I have had the privilege of knowing and working with abortion providers all over the country since 1985. What I know from this experience is that they are the heroes of the prochoice movement — everyone who works in a clinic to provide abortions to those who need them. It is way past time for our movement to find ways to honor providers — not just once but every year. Our local and state organizations must put in place an annual event in our communities where we show our appreciation for all of those who take such great risks to make abortion rights a reality. We must use the term heroes when referring to the physicians, nurses, technicians, administrators, receptionists, accountants, and cleaning people who make it possible for the women in our communities to carry out a decision to end a pregnancy. These brave providers are picketed at home, their children are harassed at school, they are followed to the supermarket, and obviously, their religious affiliations are known. None of us has a target on our backs for being prochoice, nor for our choice of work. If we honor those who take this level of risk, we can contribute to ending the stigma of abortion. Thank you, Dr. Smith, and everyone who works with you, and everyone else in the US who bravely provides a medical service that is obviously needed by more than 1 million women a year.
    Without providers, there is no choice.

  • invalid-0

    Thank you Dr. Smith!

  • invalid-0

    Thank you for your service to women. Providing safe abortion procedures definitely saves women’s lives.

  • invalid-0

    I used to be anti-choice, when I was young and ignorant. And I was lucky to never need an abortion. But I matured and came to really appreciate what it means to deny a woman agency over her own body, and how messed up the “pro-life” movement is, and how little interest they have in women who aren’t pregnant or whose children are already born. And I began to see clearly what the truly ethical side was in this debate.

    You are doing good work, and brave work, and helping women in an essential way. Thank you for what you do, and may there be many more like you in future.

  • invalid-0

    how little interest they have in women who aren’t pregnant or whose children are already born.

    Well put, emjaybee. May I quote at need?

    Dr Smith, count me in with those folks who are truly grateful for your courage and commitment. By remaining silent about abortion, I contributed to the marginalization of abortion and, more important, the women who have had abortions. These women are our neighbors and teachers; members of our churches, synagogues, and mosques; sisters, mothers, and daughters. All of us know women who have had abortions (one in three women will have had an abortion by the age of 45). If you are not aware of any, it is only because they choose not to share their stories. It is also because we don’t ask or provide safe spaces in which to tell. Physicians like you are the true advocates for women and their families.

  • invalid-0

    I’ve read Susan Wicklund’s book which is excellent. You and she and other providers are why I stand at a clinic once a month to make sure that patients can access the property without being targeted and harassed.

  • invalid-0

    Dr. “jane Smith”
    Although I admire your thoughts about Dr, Tiller, I am confused about your continued anonymity about being an abortion provider. Dr. Warren Hern’s clinic in Boulder, CO is called The Boulder Abortion Clinic. He tells it like it is.At first I used the title “Family Planning Consultant” on my business card. Many of us marginalized our existense and only came out of the closet at NAF meetings. We made it easy for the antis to assault us. Several were murdered. Others had their licenses revoked for “botched abortions”
    a pejorative term for some complications.Dr. Kenneth Edelin was charged with homicide for performing a legal 3rd. trimester abortion in Boston.His book,Broken Justice, describes the torment and injustice he had to endure. I too was charged with homicide for the tragic death of a patient following an abortion. I wrote a memoir about my trial and incarceration , Jailhouse Journal of an OB/GYN. I agree that it is time for abortion providers to come out of the closet. Bruce Steir, M.D.,MPH,(retired abortion provider)

    • invalid-0

      The doctor states, “I too was charged with homicide for the tragic death of a patient following an abortion. I wrote a memoir about my trial and incarceration , Jailhouse Journal of an OB/GYN. I agree that it is time for abortion providers to come out of the closet. Bruce Steir, M.D.,MPH,(retired abortion provider.)”

      Come on Doc.–a jury of your peers convicted you of homicide, not pro-life protestors. In fact, anyone with prolife sentiments could be rejected as “too biased” for jury participation by your attorney. Which makes the fact that you were convicted all the more convining of your malpractice. (And I can’t believe you just did a “book plug” about the murder.)

      When I read about women being seen in abortion clinics in “sisterly groups” of up to 7 women at a time, it’s hard to believe it doesn’t happen more often.

  • invalid-0

    Thank you for providing a much needed service!!

  • invalid-0

    After years of working in the family planning and obstetrics field, my husband and I saw so many weary,poor, physically and emotionally overwhelmed grand and great-grandmothers take on multiple results of their teen’s (as in age 12, 13, 14 years )unplanned pregnancies: women in their 60’s, 70’s and even 80’s who could not bear to see their “children raising children” which guaranteed disasterous results (specifically the unbroken cycle of poverty.) My husband reluctantly became a provider himself in response to this visable need in our community. He helped out on weekends at the local PP for several years until someone “outed” him and consequently his life and his job, at a Women’s Hospital, were threatened. We had to make the difficult decision to stop provding terminations, and I have never gotten over it. Stories like these of Dr. Smiths reassure me that there are those out there that are stronger than we could be. Thank you for what you do, Dr. and hang in there.

  • invalid-0

    There is nothing gained by providing any fodder to the crazies out there. All of our providers have responsibilities to their families as well as to our patients Keeping under cover in this world does more good for our cause than identifying us in a public forum like this.We must always remember: As we go throughout life pursuing our goal keep your eye on the donut not on the hole. Safe abortion is our GOAL Our name is the hole. See u in LA

  • invalid-0

    I am Pro-life of the woman and the baby.

  • invalid-0

    I have been a practicing physician for over 28 years and I simply cannot understand how anyone who is an abortion provider can justify what they do. I would like to recommend a little informative reading to my colleagues. It’s called the Hippocratic Oath. The foundation of our care is that we first do no harm. No one has been able to argue successfully that an unborn child is not a human being.[I refer you to the site:”I am not answering these Questions” for one such very public debate between Senator Boxer and Santorum]. This fact is ignored, disregarded, or otherwise obscured by the pro-abortionist but never refuted. Our government has chosen not to protect the right to life these unborn people which is a horrendous crime of which we must all share part of the blame but that does not change the absolute fact that unborn children are truely our fellow human beings. The arguments for the murder of these innocents are so lame. They claim the so-called ‘right to choose’ extends to taking the life of one’s child. Anyone who has gotten as far a 7th grade biology can tell you that the child you carry is not part of your body. This child is a seperate and distinct human being with totally different DNA, half the time a different sex, with different capabilities, different potential different aspirations. You are blessed with the priviledge of hosting and nourishing this new life in it’s beganning until it can live outside of you [but not without your help and protection]. The health of the mother, the possibility of an imperfect child, the wrong sex, too many people etc.,–all the lamest of lame arguments to justify the murder of a person. Think about it. What is there about the passage of a child through the birth canal [or through the abdominal wall in the case of a C-section]that somehow makes an infant a human being. If he or she is human and you can be prosecuted for murdering her or him one minute after birth why then is it not equally wrong to murder this person when everything but her head has cleared the introitus. A physician [or any person for that matter] cannot be vicariously exempted from wrong action by deferring the the decision of another person to have something intrinsically evil done to their child. You’re not off the hook if it was the mother’s decision. It is still completely, unequivocally, fundamentally wrong for you to murder a innocent human being.

    • independentminded

      A fetus is merely a blueprint for a human life, and it’s not a person until it’s born.  

  • invalid-0

    I have been a practicing physician for over 28 years and I simply cannot understand how anyone who is an abortion provider can justify what they do.

    Maybe you should avail yourself of a little “informative reading” and look up some stories of why women have chosen abortion.

    No one has been able to argue successfully that an unborn child is not a human being.

    No one has argued successfully that a fetus is a human being, let alone a blastocyst. Whether or not you believe it to have the same moral worth as a born human is a matter of faith, and as with many matters of faith, people disagree on it.

    Our government has chosen not to protect the right to life these unborn people which is a horrendous crime of which we must all share part of the blame but that does not change the absolute fact that unborn children are truely our fellow human beings.

    It is not an absolute fact, no more than the existence of God is an absolute fact. It is your view. We do not share it.

    They claim the so-called ‘right to choose’ extends to taking the life of one’s child.

    Oh? So the authorities will be dropping charges against Otty Sanchez soon, I take it.

    You are blessed with the priviledge of hosting and nourishing this new life in it’s beganning until it can live outside of you [but not without your help and protection].

    Unless you don’t want this “priviledge,” [sic] in which case, your sentence would start with “You are cursed with the misfortune…”

    The health of the mother, the possibility of an imperfect child, the wrong sex, too many people etc.,–all the lamest of lame arguments to justify the murder of a person.

    You must not be a very good doctor if you consider “the health of the mother” to be a “lamest of lame argument.” Oh, and abortion is not murder.

    Think about it. What is there about the passage of a child through the birth canal [or through the abdominal wall in the case of a C-section]that somehow makes an infant a human being. If he or she is human and you can be prosecuted for murdering her or him one minute after birth why then is it not equally wrong to murder this person when everything but her head has cleared the introitus.

    The fact that the child is now physically separate and no longer imposing on the bodily integrity of the woman. Before birth, the fetus has a tremendous effect on the woman’s health and life (complications can result in death), and as long as she is subject to that, she is the one who calls the shots. After birth, she still calls the shots, but the child is no longer within that realm of her authority.

    Your confusion is due to the fact that, like most pro-lifers, you focus so narrowly on the fetus/child that you lose sight of the very critical fact its presence in the woman’s body is not an incidental matter, is not just a “different location.” It is the fundamental core of why you are wrong—and why, if the world did things your way, terrible injustice would be inflicted on pregnant women every single day.

    A physician [or any person for that matter] cannot be vicariously exempted from wrong action by deferring the the decision of another person to have something intrinsically evil done to their child. You’re not off the hook if it was the mother’s decision. It is still completely, unequivocally, fundamentally wrong for you to murder a innocent human being.

    You believe that abortion is wrong. Your recourse is not to perform any. You have no claim against your colleagues who believe that abortion is a woman’s right, and the sooner you learn that the world doesn’t have to work as you see fit, the sooner you’ll be able to let go of a lot of stress and angst in your life.

  • invalid-0

    Thank you for your services. You’re very brave, to stand up and to fight for our reproductive rights like this. Thank you.

  • independentminded

    I second this:

    Thank you for your services. You’re very brave, to stand up and to fight for our reproductive rights like this. Thank you.

    Brava!

  • invalid-0

    I see Annonymous, July 29, has some opposing thoughts. Let me be a little clearer. I said the health of the mother was a lame excuse because it is extremely rare that this is truely a reason a termination of pregnancy would be considered. This is typical rethoric for Pro-Abs to claim every abortion is a case of dire poverty, incest, rape, or some terrible threat to the mother when, in fact, the overwhelming majority of abortions are preformed because the mother found it inconvienent to have a child. The reasons I have heard are: “We just wern’t ready for another child yet.” “I’m just not the mothering type [this is from a woman who had 3 abortions].” “It’s too soon after we got married to start having children” There are very few actual situations in medicine when the life of the mother is actually threathened by pregnancy. My comments were directed toward the annomoyous Dr. Smith. Dr. Smith if you are still reading this column please consider what you are doing. You are taking the lives of innocent children. The very lives that you became a doctor to protect. George Tiller used to brag about how he aborted a woman on the day she was due to have a baby. He had ‘going away parties’ in his office for the infants he had murdered. I have seen the pictures of a woman codling her mangled dead baby in his clinic alongside of the note she later wrote expressing her horror and regret at what she had done. You are not helping women by assisting them to kill their children. Gorge Tiller was a sadistic serial murderer of innocent defensless infants. You don’t have to be. Please stop now you don’t have to do this anymore.

  • invalid-0

    No, it’s not just “inconvenience”. If you must describe it that way, then at the very least it’s an inconvenience that lasts THE REST OF THE WOMAN’S LIFE. Even if she gives a child up for adoption, that doesn’t put an end to the permanent side effects that giving birth to a child has on a woman’s body and her life. It doesn’t change the fact that she is still a birth mother. No person should ever be forced to give away a good chunk of their life for another person- even if it means saving their life. People aren’t forced to donate blood ever 8 weeks, and people aren’t forced to donate kidneys if there are no other people to donate. It’s just common sense. By using the “regret” argument you are implying that women are too stupid to choose for themselves. Sure, some women may regret an abortion.. But you can regret any choice, it doesn’t mean that you have to take every choice away. I may regret not studying for that test, I may regret dating that one guy.. Hell, some people regret having kids (Andrea Yates anyone?). Women are smarter than you think. Believe it or not, we do put thought into our actions. And by the way, I’d like to see PROOF of the rumors that you’re spreading about Dr. Tiller. I won’t bother checking back to this thread because I know you’re just making crap up. You have no proof. -Yours truly, a future abortion provider.

    • invalid-0

      …I will provide. Because of “doctors” like you who refuse to provide lifesaving care for women. Who are the reason so many women continue to feel threatened or defeated by people they ought to be able to trust, literally, with their lives. You make me sick.

      Though I really have to say, “M.D. in Illinois,” I’m calling your bluff. I don’t actually believe you’re a doctor. Nobody could get through medical school with your incredibly subpar spelling/punctuation abilities. Further, I’m the first to admit I am not yet a physician, but I could easily rattle off a dozen rather common complications of pregnancy and childbirth that may threaten a woman’s life, and only in the physical sense. And last, hardly anybody punctuates “M.D.” like that. So no, you and both of your posts are total bunk.

  • crowepps

    The problem with the anonymity of the web that is that ALL the posters are incredibly handsome/beatiful, incredibly well educated top-ranked physician/jet pilot/philosophers. But who, nevertheless, can’t seem to come up with any original arguments and recycle the same bumpersticker slogans.