Terry Beresford, who died last week in Virginia, made monumental contributions to abortion care in the United States. She was one of the founders of the National Abortion Federation and was arguably the most significant innovator in the field of abortion counseling, at the very beginning of legal abortion provision in this country. Her death offers the occasion to both celebrate her work, and also to appraise the current status of the field she helped create.
Beresford was the proverbial right person, in the right place, at the right time. A trained psychologist, she was living in the Washington, D.C., area in the early 1970s, when the Preterm Clinic, one of the country’s first freestanding clinics, was established there. (The nation’s capital, like New York state, had legalized abortion several years before Roe). She was hired as director of staff development at Preterm, and with the enthusiastic support of the medical director, began to develop protocols for the non-medical aspects of abortion provision—that is, what should be discussed with the woman before her abortion, apart from an explanation of the procedure itself?
To offer some context for the situation then facing Preterm, abortion care was essentially uncharted territory: Staff of that first generation of freestanding clinics had no experience with offering out-patient abortions to huge numbers of women, many of whom came from out-of-state. The relatively few legal abortions that took place before this time were in hospital operating suites, mainly performed on very ill women. Beresford’s approach was, therefore, both cautious and very expansive. Cautious, in the sense that she wanted to ascertain that women were not at the clinic due to parental or partner coercion; and expansive, because she quickly came to understand that for many women, the abortion decision was the first major decision with which they were faced in their lives, and that this experience could be a powerful catalyst for emotional growth. As she once expressed to me in an interview:
You would help the person decide if they were clear about their decision, you’d help to weed out people who were being coerced and you would be preparing the patient to be relaxed and comfortable for an outpatient procedure … So every woman would be seen for at least up to an hour, as needed … The model was to help the patient do some self-exploration so she reaches understanding of herself, her feelings, and her options, and can then take an action, and is assisted in taking that action … Your job as a counselor is to affirm her competency and her sense of self-worth, and her ability to act on her understanding.
Shortly after the Roe decision, Beresford left Preterm and took a position as director of counseling at Planned Parenthood of Maryland. There she inaugurated a series of workshops on counseling techniques that drew people (mainly, though not exclusively, women) from all over the country who were being hired in the recently-opened clinics. Beyond the practical skills they developed, these workshops were crucial in helping to forge an occupational identity and a sense of community for those engaged in this newly created role of “abortion counselor.”
To be sure, not everyone involved in those early years of abortion care agreed that such extensive counseling was necessary, or indeed that any counseling was warranted, beyond gaining informed consent and explaining the procedure. And Beresford herself soon came to realize that the original model she pioneered—an hour for each patient—was impossible to sustain because of the rising costs of security, legal services, and other issues facing clinics that made such in-depth counseling an unaffordable luxury. But she also understood, as the years since Roe passed and there was no evidence of widespread emotional after-effects of abortion (as opponents then, as now, claimed) that not every abortion patient needed such counseling. As she and Anne Baker, another leading theorist of abortion counseling (and an attendee at one of the first Maryland workshops) wrote recently in a leading textbook on abortion: “Many patients are sure about their decision to have an abortion. And they primarily want information … Other women may wish to explore their pregnancy options more fully and obtain help in making a decision. For some women, having an abortion may be as much an emotional experience as it is physical because of personal circumstances, ambivalence, or intense and perhaps conflicting feelings the decision evokes.”
The key phrase in that passage is “some women.” For Beresford and Baker, the proper provision of abortion care demands that all women cannot be treated alike. This may sound obvious, but so much about state restrictions in the years since Roe have made it extremely difficult to put this ostensibly simple principle into action: for example, the laws that mandate that all abortion patients view and hear a description of their ultrasound—when research tells us that some women wish to view their ultrasound and others do not.
Today, facing threats like never before from their opponents and just struggling to stay open, many clinics find it difficult to devote resources for those women who do need more in-depth counseling of the kind mentioned above. Yet some clinics, particularly the independent facilities associated with the Abortion Care Network—a number of whose current directors attended Beresford’s trainings years ago—have managed to sustain and build on her more expansive approach for such patients. There could be no more fitting legacy for this deeply humane and wise pioneer.