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.