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PERSONAL PERSPECTIVE : My Clients' Lives May Be Harmed by the Supreme Court Ruling

June 23, 1991|Donna Brown | Donna Brown is the director of the Harbor Free Clinic in San Pedro

I work in a clinic that offers family-planning services. In case anyone wonders whether government decisions in Washington affect people, wonder no more: My work and the lives of my clients are directly at issue because of the recent U.S. Supreme Court decision forbidding abortion counseling at clinics receiving federal money.

Our clients are primarily undereducated, low-income women. A family-planning program provides patients with birth-control methods. However, there are many other aspects to this program, such as education regarding reproductive health, including anatomy and physiology and sexually transmitted diseases. We also do Pap tests, breast exams, blood-pressure screenings and so forth.

Many women first come to our clinic because they are already sexually active and want to find out the best birth-control method. Because there are some birth-control methods medically inappropriate for a female who might be pregnant, pregnancy testing is a mandatory component of a family-planning program. To insert a intrauterine device in a patient who is pregnant may cause serious damage to her uterus and would most likely result in a spontaneous abortion. Hormones contained in birth-control bills may cause fetal damage.

There is an incredible lack of knowledge regarding pregnancy and options. Our counselors spend a great deal of time answering questions regarding prenatal care, adoption and abortion.

Counselors throughout Los Angeles confirm an overriding concern that occurs within different cultures as well as age groups over what level of danger might be associated with therapeutic abortions. Patients ask about their chances of dying from this procedure. They are concerned about being hospitalized or someone finding out that they have had an abortion. Many also think an abortion will leave them sterile, or result in great difficulty with future pregnancies.

Patients who don't have much knowledge of their own anatomy or physiology have no concept of an abortion procedure. These patients request something to drink, a pill to take or an injection that will make them "not pregnant" any more. These same patients think their partners will be able to tell physically that they have had an abortion and will no longer be able to enjoy sex.

Some patients present religious and moral questions related to abortion. They fear some for of future punishment.

Most clinics also have patients who are unaware of their legal options, including prenatal care and delivery, adoption and abortion. They need this information regarding the availability of services--where they are available, what's involved, how they can pay for them, even how to get there on public transportation. Unfortunately, some patients delay pregnancy tests because they are unaware of available financial assistance. This delay results in limiting options and postponing vital prenatal care.

Most of the concerns and questions described are from patients otherwise medically healthy. However, we do have patients in our family-planning clinics with other medical concerns. We get questions from alcoholics, crack users, even heroin addicts regarding the effects of their habits on their pregnancy.

One clinic told me about a case that occurred recently. A patient came in for services and was excited to learn she and her husband were expecting a fourth child. They left the clinic happily making plans. A few days later, the clinic received the results of this patient's Pap test. She had cervical cancer. The clinic had to call the patient and her husband back to explain the situation. After carefully listening to all her options, the patient chose to terminate her pregnancy and begin treatment for cancer.

The recent Supreme Court decision would have prohibited this clinic from thoroughly explaining to this patient her legal medical options--in this case, the option that literally saved her life.

The legality of abortion is not at issue here. The Supreme Court interprets providing education and referrals for abortions as promoting abortion with funds it says Congress intended for birth control.

Does the court also feel that we promote cervical cancer, gonorrhea or AIDS by providing education and referrals as a component of our family-planning program? This decision denies low-income women the information they are legally entitled to. It could also make clinics guilty of negligence where withholding information of all legal options proves to be detrimental to the health of a patient. I have to ask: Is the court more interested in helping women, or punishing them?

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