Teen Pregnancy: When the Choice Is Abortion : The Most Popular Option Is Still a Difficult Decision Requiring Help

“Do you have any questions?” asks the counselor.

Molly, 14, sits in a worn, overstuffed chair in the counseling room of an Orange County free clinic, staring at her lap. She shakes her head. Then she covers her face with her hands and doubles over, her shoulders shaking.

The counselor waits. Finally a single, loud sob erupts.

“What are you feeling?” asks the counselor.

“I just hurt,” says Molly (a pseudonym), responding to the news that she is eight weeks pregnant. “I’m too young to have a kid. It would just ruin my life and stuff.

“If I was older maybe I would have it. But now there’s nothing I can do. I don’t want to have it at all right now.”

Thus, at an age when some girls do not yet choose their own clothing, Molly chooses abortion.

Among teen-agers, it is the most popular solution to unwanted pregnancy.

In 1981, according to a special 1984 report from the California Senate Office of Research, 70,143 (49%) of the state’s 143,160 pregnant teen-agers, ages 15 to 19, obtained abortions. California is one of only 16 states that still provide government funding for abortions. (Every year since 1978, the American Civil Liberties Union has persuaded the courts to strike down legislation limiting Medi-Cal funding of abortions. In recent weeks, Planned Parenthood Affiliates of California also has filed suit to stop an anti-abortion provision in the state budget. The measure, which was left in the budget through a clerical error and was then supported by Gov. George Deukmejian, would take away state funding of family planning agencies that offer abortion-related services, including abortion counseling.)

Cost of an abortion ranges from $195 (at some clinics) to $1,500 (in some hospitals) for a suction abortion, a vacuum process used in the first 12 weeks (the first trimester) of pregnancy. After 12 weeks, the procedure becomes more complicated and more costly.

The risks of hemorrhage, uterine perforation and infection rise dramatically after 15 or 16 weeks, say physicians. Many stop performing abortions after 20 or 22 weeks.

Since a U. S. Supreme Court decision in 1973, American women of all ages have been able to obtain unrestricted abortions in the first trimester; however, states may impose qualifications in the second and third trimesters. California has no such restriction.

The Reagan Administration Monday asked the Supreme Court to reverse its landmark 1973 decision that established the constitutional right to an abortion. In a brief filed by the Department of Justice, the Administration argued that the court’s ruling in a case known as Roe vs. Wade was too broad and blocked even modest efforts by state and local government to regulate abortion.

Although abortion is legally and medically accepted, young women planning abortion, some doctors who perform abortions and some counselors requested anonymity for this story--fearing criticism, ostracism or retaliation from those who oppose abortion on moral grounds.

Like many pregnant teens, Molly is afraid her parents won’t understand. To the counselor, she revealed only that she became pregnant by a former boyfriend. (The counselor did not suspect sexual abuse. Otherwise, she would have reported it to the Child Abuse Registry. She also is required to report any pregnant girl age 13 or younger.)

It is not easy for a 14-year-old to arrange an abortion on her own. “Some of these girls can’t even get to school on time,” said one high school counselor. Suddenly, beyond the shock of finding themselves pregnant and making a decision, they need to hide phone calls from their parents, make up excuses to get out of school for appointments, find transportation and raise nearly $200 from friends or through Medi-Cal. (Medi-Cal cards to “pay” for an abortion are issued to income-eligible women without regard to age or parents’ income, said a spokesman from a local Medi-Cal office.)

Molly persuaded her new boyfriend, who is 16, to skip his last class of the day and drive her and a girlfriend to the free clinic for the pregnancy test. At the clinic, the matter-of-fact counselor tests Molly’s urine for pregnancy, tells her the results, informs her of her rights and options, including adoption and keeping the baby and discusses methods of birth control.

From her counselor, Molly learns that under California law she has the right to decide on her own what to do about the pregnancy and the right to confidential treatment. (Some who support SB7, proposed state legislation to require young women 17 and under to have a parent’s consent for abortion, say teens are abusing their right to abortion and using it as a form of birth control.)

After indicating that she will choose abortion, Molly learns that an abortion will involve a pelvic exam, that she can either be awake or asleep during the two- to seven-minute procedure, that, if awake, she will feel continuous cramping followed by a large cramp at the end.

Tendency to Delay

The counselor lets her know she should not delay--if abortion is her choice. Teens are more likely than older women to postpone abortion because they lack funding, transportation or access; they fear their parents may be told; they don’t understand the medical system, or they do not want to face the unpleasant truth, according to the Alan Guttmacher Institute in New York, the nonprofit research arm of Planned Parenthood. Only 34% of abortions to girls age 15 and younger are performed at the safest time: eight weeks into the pregnancy or earlier, according to the institute.

Molly’s counselor gives her a list of names, addresses and phone numbers--of clinics and hospitals that perform abortions, Medi-Cal offices from which to obtain money and agencies that provide prenatal care and adoption services.

On the list is the nonprofit Women’s Choice Clinic of the Feminist Women’s Health Center in Santa Ana. According to the Guttmacher Institute, 90% of all teen abortions take place in clinics. In addition to offering reproductive health and family planning services, the center holds abortion clinics on Monday and Wednesday afternoons and Saturday mornings.

On a recent hot Saturday, about 15 clients and their friends overflowed the waiting room into the hallway and stairwell, fanning themselves with papers.

Three of the women who had come to the clinic for abortions were 19. One came with her sister, one with a friend, the other with her live-in boyfriend.

One by one, the women are called in to pay, take one more pregnancy test, fill out a two-page medical history and sign a consent form outlining the risks of abortion. The six young men who have accompanied their girlfriends or wives wait outside, reading, working, watching.

Because this particular clinic endorses group support, the women gather in a special room for pre-abortion counseling and post-abortion recovery. They sit on chairs, couches and the floor. Men are not allowed in the group area, but may attend abortions if the women want them there. A separate group is held for Spanish-speaking women.

Some complain they were approached on the sidewalk by a lone man carrying a sign that read, “Abortion is Dead Wrong.” The man asked them, “Do you think it’s right to murder babies?”

‘Hard Enough’

“It’s hard enough for us as it is,” said one 19-year-old. “You’re constantly debating, am I doing the right thing? Once you make your decision though, I think you should stick with it.”

Several mention they were unable to sleep the previous night. Nearly all requested tranquilizers and local anesthetic.

One of the clinic’s counselor/health workers, who asked not to be identified, explains that this clinic does not offer general anesthetic, and those who want or need it are referred elsewhere. “We feel it’s highly unnecessary in an early abortion to put them to sleep for a short period. The risks of general anesthetic are greater than an early suction abortion and recovery is easier (without general anesthetic).”

Using a simplified drawing, she explains in the pre-abortion counseling session how a licensed gynecologist performing an early suction abortion will use a rubber straw (cannula) attached to a uterine aspirator to remove the contents of the uterus. “You all know your pain threshold,” she says. “A lot depends on your state of mind.”

The women return to the waiting room. One by one, they are called in.

In the recovery room the women are quiet, reclining--some with hot water bottles--and drinking juice. A nurse is dispensing tetracycline pills to fight infection and another medication to stop emergency bleeding.

After an abortion, teen-agers practice contraception more diligently than before, according to the Guttmacher Institute. A 1976 Johns Hopkins National Survey of Young Women found that teen-agers whose first pregnancy ended in abortion were only half as likely to become pregnant again the following year as those who gave birth.

Molly’s counselor gives everyone who comes into the free clinic for a pregnancy test a lecture on birth control methods. Contraceptives are available at the clinic without parental consent. Abstinence is also discussed.

After Molly’s first visit, the counselor tried to keep in touch through clandestine calls to her home. Two weeks later, she learned that Molly--discouraged by the need for excuses to leave school, transportation problems and bureaucracy at the welfare office--had obtained neither the money nor the abortion. She was then 10 weeks pregnant.

Molly, the counselor said, vacillated daily from an “I can handle everything” attitude to “I can’t handle anything.”

The counselor worried that Molly’s lack of action would lead her to a different choice by default--motherhood. “If she can’t handle appointments, she’ll be an interesting mother. What would she do when the baby gets sick?”

Another week passed and the counselor reached her. Molly was then 11 weeks pregnant. But she had told her stepmother as well as the mother of a friend. Both said they would help her.

“We try to stick by the kids who don’t get adult support until we know they have it,” said the counselor. “She’s getting enough adult support, so I can back off now. She’s supposed to have it (the abortion) this week.

“She told me everything was OK.”