On Twitter, A Physician Defends People Who Need More Than One Abortion

A Twitter user and self-described feminist tweeted the following message during a conversation about the importance of ending the silence and shame around the common need people have to access more than one abortion in their lifetime:

“Multiple abortions will end stigma?? Are you crazy?? I can see one mistake, but more than one abortion is just careless and shows a stupidity beyond measure. Multiple abortions show you are a moron.”

This cruel tweet sparked the following passionate and educational thread from OB/GYN Dr. Diane Horvath:

And you call yourself a feminist. Please take a minute and ask yourself why you don’t seem to have room in your feminism for ppl who need more than one abortion (and who aren’t ashamed). There are all kinds of reasons ppl might need >1 abortion (I feel a thread coming on).

Ppl who can get #pregnant can spend >35 years of reproductive life trying not to get pregnant. If typical use failure rates for #contraceptive methods like the pill or patch are ~9%, you’re almost inevitably going to have at least one failure in a lifetime.

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Even if ppl have an average # of children, that’s still 30+ years of needing reliable #birthcontrol to avoid pregnancy.

Many of us go in and out of being insured, thanks to our profit-driven insurance & #healthcare industries, so we’re left with methods like condoms, withdrawal, periodic abstinence, & spermicides. These are unsurprisingly less effective than methods that require Rx.

If you’re relying on condoms, you’re likely to have a failure about 13% of the time (CDC stats). For fertile ppl, it stretches logic to think that you won’t have AT LEAST one unintended pregnancy in 30-35 years.

Also, not every contraceptive method is right for every person. I’ve got patients who have tried EVERYTHING and have had significant problems or contraindications for each one. Do those people have to be abstinent forever? I think that’s an unreasonable ask.

Even the most reliable methods fail. I’ve been with my current employer for 2 years and I’ve done 3 abortions where I removed the IUD at the time of the procedure. IUDs are great but not perfect, and they’re not for everybody.

We also need to talk about reproductive coercion and contraceptive sabotage. It is real and it happens more than you probably realize. Ppl’s pills get flushed down the toilet, their IUDs get removed by partners, their partner removes a condom without telling them.

If someone is in a situation like this, #abortion may be the safest and most logical way to avoid staying pregnant by an abuser. Are you willing to tell a victim of abuse that they shouldn’t have been “careless” and gotten pregnant more than once?

Shifting gears, there are also ppl who have heritable genetic conditions (often serious) that affect a certain percentage of their pregnancies. They may have more than one abortion as they are building their families.

Preimplantation genetic diagnosis can sometimes be used (along with IVF) to identify affected embryos, but this is EXPENSIVE and out of reach for many ppl. Ppl with heritable genetic conditions have as much a right to reproduce as ppl without those conditions.

Sometimes the ONLY way these families can have children who will survive is to test for the genetic or structural problem and end the pregnancies that are affected. Families deserve the ability to make this decision as many times as they need to.

To clarify - testing for genetic and structural problem once a pregnancy has already occurred. In a perfect world everyone would have access to IVF with PGD but that’s not the world we live in.

Lastly (maybe) ppl have both a right to seek sexual pleasure and satisfaction AND determine if/when/how to have a family. For some people, #abortion is the primary way they manage unintended pregnancy. No matter how you feel about it, abortion is birth control.

Okay, one more thing. Of all the mistakes you have made in your life, are there maybe some you’ve made more than once? By all means, if you’ve only ever made every mistake exactly one time, then feel free to judge.

"Those who have had abortions before will often share that experience, like elders passing on wisdom to youth."

"This is the day that changed who and what I am."