Saturday, March 12, 2011

Anybody worried?

One of my first year students was a former surgical nurse, in her 30s, who had had to defer her dream of going to medical school because she had gotten pregnant as a teenager and was raising her child. Though she graduated, did a challenging residency and now has more children, I wonder how many other young women with the dreams we all started with are stopped at the gate by unplanned pregnancy. The recent political discussions about removing all federal support for Planned Parenthood has left me and my pediatrician sister both feeling like our hair is on fire. My student was exceptional in many ways. She did not have the luxury that we have had to worry about when it might be best for us to have our families, or the tools to make our choices feasible.

Choice about childbearing comes in many forms. In my own case, it was because I came through training at a time when professional women had trouble finding men who valued us--or maybe it was my evil temper. In any case, I married quite late and had my last child at age 39. This is not necessarily the path I recommend, but I do think that if we support women's professional aspirations, we should be committed to the proposition that all women should have access to reproductive health services. If Congress prevails, many women who might otherwise make up the next generations of mothers in medicine are going to be instead mothers who lack education, income and the privilege of being able to care for others as well as their own children, in the ways we all do.

I have been writing letters opposing the Congressional initiative to defund Planned Parenthood to my congressional representatives. I hope those who read this will be moved to do the same.

32 comments:

  1. One of my close friends had an abortion after her birth control failed during school. After the abortion she changed her method of birth control, graduated, and went on to become a fine doctor.

    Both of us support funding for Planned Parenthood. Education about birth control options prevents unplanned pregnancies, which are a major barrier to womens' ability to support themselves and their children.

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  2. Thank you so much for writing about this.

    I am a member of Medical Students for Choice and wear a "Trust Women" pin on my coat. I am horrified by the federal and state by state assaults on reproductive choice.

    I have dealt with unplanned pregnancy in different ways at different points in my life. All of my pregnancies have been unplanned. I feel embarrassed when I admit that. I am not an idiot, or a party girl. None of them were due to one night stands or inebriation. Three of the four times I was using birth control. The first time was a case of date rape in high school, and I had an abortion. I am just abnormally fertile, I guess.

    I put off medical school twice due to unplanned pregnancies, in order to have my kids and be there for them as infants. I had a miscarriage from an unplanned pregnancy in between. I am now going to start residency the year I turn 39. I don't necessarily recommend this for anyone else, either.

    There is a vast difference between personally deciding to have an abortion and supporting the ability of all women to get STD testing, access to contraception and abortion services through Planned Parenthood and other avenues. I think some people have a hard time delineating between what they would choose themselves and what is ethical, right and in the interest of public health for all women.

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  3. I am a pro-life pre-med student, and while I don't support public funds for abortions, I do think it makes little sense to remove funding for access to birth control, as not possessing adequate means of birth control would seem to increase the demand for unnecessary abortions, rather than decrease it. So, even as a pro-lifer, I can't get behind this legislation.

    I am a 26 year old mother of two, who is finally finishing her undergraduate education after postponing my education to have my children. Child #1 was an unplanned pregnancy. However, I don't really see it as "unplanned," as I knew that engaging in sex could result in a pregnancy, even if I was on birth control. My professional aspirations did not die with the birth of my child, they were simply postponed, and for very worthwhile reasons. As someone who will likely begin medical school at age 30 (I want to wait until my daughter is in school full time), I hardly think that delaying medical training for a several years is a worthwhile reason to end the life of a child. Even still, I don't believe that eliminating the access to birth control altogether is an appropriate response, either. It seems to serve no purpose whatsoever, and will likely not help anyone.

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  4. I would be cautious on both sides of this debate. I am totally against PP, but I think there should be affordable access to birth control. Luckily there are other avenues, and I hope if this legislation passes, there will be more money for the other organizations that do provide birth control at a low to no cost.

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  5. When I was younger I would have considered an abortion, but now I know I wouldn't. I'm heading into my 30s and fertility starts to decline soon after that. So I don't want to lose my chance to have a child and I recognize a child for the blessing it is, especially because there are so many women who can't have children.

    That said, I support pro-choice efforts because what is right for me isn't right for everyone. Also, keeping funding available for STD-testing, pregnancy counseling and access to birth control is very important for women on all walks of life. Plus, I would be afraid if funding were taken away, illegal abortions would become a problem.

    More important to this discussion is the the support (or lack thereof) that women receive in reaching their career aspirations. I'm considering medical school but at my age (you'd think I was 70 or something) people gape in horror or insinuate that I'm getting too old to consider this route ... all because I'm at child-bearing age and I don't have any children yet. (People say these things without even asking if I and my husband plan to have children in the first place.)

    Why should women have to choose between having a family (planned or otherwise) and being the people they want to be? That question seems much more important to me. Society shouldn't point to children and say they are an obstacle to our careers and goals. We should be supported in whatever decision we make -- to have children or not (including ending a pregnancy) -- so we can equally reach our goals in life.

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  6. "while I don't support public funds for abortions"

    Kelley:

    My tax dollars pay for many things I don't support, even some things I see as morally reprehensible. That doesn't mean I don't pay my taxes, or that I don't recognize that others may benefit from programs with which I disagree.

    AJU5's Mom: Planned Parenthood is reviled for providing abortion services, but that's because they're a recognized brand name. The fact is, most of their programs are aimed at providing birth control and preventing unplanned pregnancies in the first place. They also provide prenatal care, STD testing and treatment and routine GYN care.

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  7. I was a med student in the ED when a 16yo came in with a botched abortion by a neighborhood quack. It was horrible. While I choose life, I cannot support the loss of funding for an organization that provides safe access to care for many young women regardless of SES. How can you judge someone else's choices. If our govt can provide corporate welfare, I think it is a responsibility to provide access to safe care.

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  8. A few weeks ago, the administration asked me to become faculty advisor for Medical Students 4 Choice, a student group on our campus. While I wish abortion were never used, I feel that anything that restricts a woman's right to have an abortion is a slippery slope. What's next? No more tubal ligation? I agreed to take on this advisory role for this reason.

    As a mother, I'm more worried about my son than my daughter. I can put my daugher on the pill or on Depo, but what can I do to protect my son from early parenthood? Education is one thing, but what are the odds he'll remember his parents' sage advice in the heat of the moment?

    This student's story is alarming, and I'm glad it worked out OK for her.

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  9. I object to calling terminating a pregnancy ending the life of a child. Neither my first trimester abortion nor my miscarriage was killing a living child, and I am not a murderer. 1/3 of women in this country have an abortion at some point in their reproductive years, and we really should watch the tone of our rhetoric. Calling 30% of women murderers is pretty harsh, and out of step with most of America's attitudes toward abortion and miscarriage.

    One of the leading causes of maternal death in the world is complications following illegal abortion. Most of these women were already mothers, and leave behind real living, breathing orphans who are four times more likely to die once their moms are dead. In these countries, where making abortion goes hand in hand with reducing access to contraception, just like it does here, abortion rates actually increase.

    I am not sure what these other options are other than Planned Parenthood, especially with the same politicians trying to cut Title X funding for contraception in general, and wanting to cut social programs to pay for these children once they're really alive. If we are talking about Crisis Pregnancy Centers, most do not provide any health care and are not run with any licensed health care workers. Only 2% of Planned Parenthood's services involve termination of pregnancy, and they serve poor communities where unplanned pregnancies and STDs are more prevalent.

    It's all fine and dandy to sit in a privileged seat and call yourself pro-life, but there's rhetoric and then there's reality. Cutting funding to Planned Parenthood will increase unplanned pregnancy and abortion, and possibly maternal and child death in the long run.

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  10. While I respect your right to disagree with my beliefs, I personally, believe that a child is a life at the moment of conception. Thus, ending that life for no other reason than it's "inconvenient," is akin to murder. You'll notice I chose not to use that word, because it's inflammatory and doesn't help anyone, but it's certainly not all that far off from what I believe.

    That being said, I agree that cutting funding to planned parenthood is a poor choice, given that decreasing the availability of safe and effective birth control options will only serve to increase the number of abortions in the community currently served by that agency. It seems to do nothing to really solve the problem and likely makes it worse.

    I also wanted to respond to the post questioning whether having children forces a woman to somehow abandon her identity, and her career goals. I don't believe that a woman has to give up her identity and/or career goals simply by virtue of giving birth to a child. However, I do think that there need to be priorities in one's life, and children should rank at the absolute top.

    If you can pursue your career goals while still being the kind of mother you are proud of, then go right ahead, I will cheer you on, every step of the way. For me, personally there was no way I could be both the kind of mother and the kind of physician I wanted to be, at the ages my children were at the time. So I chose to finish my bachelor's degree in nursing, and tend to my children until they are old enough that my necessary absence won't be as acutely felt. This way, I still get to practice some form of medicine, and I don't come home each day feeling like I sacrificed my children for my dreams.

    I believe that I will one day still be a fabulous physician, and a fabulous mother. My dreams are not dead, they are simply on hold, or in slow-motion, while I foster the dreams of my children. These are just my own personal wishes and desires about motherhood. I wanted to be a stay-at-home Mom, and I wanted to pursue my dreams of a career in medicine. For me, the two were obviously not possible to accomplish at the same time. I don't have any regrets about the path my life has taken me, and while it may be difficult to watch others in my classes progress, and be accepted to medical school, begin residency, etc, I know that the choices I made are right for me. I also know that my time will come. In a few years, when my children are in school full-time, and need less from me than they do currently (at 4 and 1), it will be my time to pursue my dreams.

    I don't support the notion that a woman must give up her identity or her dreams in order to be a good mother, but I also don't support the notion that a woman can have everything without sacrificing something. Something has to give, somewhere, and it's up to each individual mother to determine what can be comfortably sacrificed in her life.

    I have seen and met some truly phenomenal mother-physicians in my time, raising beautiful, healthy and well-adjusted children, and sustaining successful practices that leave them feeling fulfilled and satisfied. I applaud them for their efforts and their abilities. I'm proud of their accomplishments, and look forward to being added to those ranks. For the time being though, it's just not the right stage for me. When it is, I hope to have women at my side, cheering me along, as well.

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  11. >>I do think that there need to be priorities in one's life, and children should rank at the absolute top.>>

    Then I guess my life must be worth virtually nothing to you, because I'm childless by choice. That's so nice to know.

    >>Something has to give, somewhere, and it's up to each individual mother to determine what can be comfortably sacrificed in her life.>>

    Sometimes delaying childbearing, via birth control and, yes, abortion, when birth control fails, is the best decision for individual women. Not for you, but for my friend the doctor who had an abortion during school, it definitely was the best decision.

    She doesn't regret the abortion, just as I don't regret never having children. No, I've never had an abortion - just lucky, because all of us can agree birth control isn't foolproof.

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  12. Anonymous, when I said children should rank at the top of a list of priorities, I was referring to women who already have them. I should have been more specific. Obviously if you don't have children your priorities are more fluid. My point was simply that when you have children, your dreams don't have to die, but they do have to take a back burner to the needs of your children. I wasn't trying to invalidate the lives of women who don't yet have children, or who might not want them at all.

    As far as the abortion discussion, I guess we'll just have to agree to disagree, as for me, there are VERY few situations in which an abortion is justified, and the "best choice" for anyone. That's just my own opinion, and I doubt either of us could change the opinion of the other.

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  13. Kelley, I'm just curious. If you believe that life begins at conception, why are you ok with publicly funding access to contraception but not abortion? Many methods of contraception prevent implantation which by your definition would still be "killing a child".

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  14. As the author of the original post, I need to weigh in. I think our discussion so far shows that we struggle to avoid the polarizing terms of the current political debate, but they continue to plague us. Abortion has become a proxy for all women's health services, which then becomes the focus of these political attacks. Even those of us who would not chose abortion under most circumstances recognize that as physicians we have to promote access to needed health care.

    I am in full agreement that women must make sacrifices and that career advancement is not an ultimate value. In fact, one of my children was unplanned (conceived through contraception-- no, my dears, the sponge is not an adequate substitute for a medically fitted diaphragm--even for a nursing mother).Though my husband and were both somewhat derailed in mid-career by this event, I happily carried that pregnancy to term (the resulting child finally, in the minds of my family achieved full personhood when admitted to graduate school). So I am sympathetic to the notion that how we deal with fertility and childbearing is a complicated individual (and family) matter, and that ethical lines will be drawn by different people at different places under different circumstances. That, in fact, is what choice means--the choice to live by our own principles and values. That is why I, too, am a faculty advisor of MS4C. As a psychiatrist, I have no direct role in providing abortion services. I do have a role in supporting women's autonomy.

    Like anonymous,I pay taxes that kill literally thousands of the born through the warlike activities of our government and the failure to adequate address health care needs generally. The arguments about funding are bogus (though in fact, women who need/want abortion are not much deterred by funding isseus. Society must choose between legal, regulated abortion and illegal abortion with its horrifying consequences--not between abortion and the love of children).

    Nothing in this debate is easy, but it will not be improved by trumpeting slogans and taking a meat ax to an important part of health care funding.

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  15. >>Abortion has become a proxy for all women's health services>>

    Quite true. It's also been separated from the rest of women's healthcare in some, but not all, circumstances. Some private OB/GYNs and PCPs offer abortion services (sometimes on the QT at Catholic hospitals), others don't. It's hit-or-miss. Many women wouldn't go to their regular, otherwise trusted MD in any case simply because they have no way of knowing if their physician is like MomsTFH, or like Kelley. As a woman, I find it disturbing that we've become so accustomed to playing the game.

    That's why I support Planned Parenthood, which has the guts to continue to offer abortion services. It would be much easier for them to concentrate on the 98% of its services that are less controversial.

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  16. I'm not going to get into this heated debate, but I do want to say that I am 100% behind Kelley's views. A child is a blessing and a privilege from the moment of conception. If you had a problem keeping your legs closed or your birth control method actually failed, it is not the child's fault or problem - it is yours. Each time you have sex you KNOW that there is a chance you can become pregnant. If you choose to still have sex and then terminate the pregnancy you are a murderer. Period. I have no pity for people like that, and as doctors we are here "to do no harm", to save lives and not to end them.

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  17. Saying a child is a blessing and a privilege from the moment of conception ignores the reality of the 50% of pregnancies in this country that are unplanned, the 30% of women who choose termination at some point, and the 50% or more of pregnancies (some say up to 80%) that spontaneously abort in the first trimester.

    Villfying women who choose abortion as not being able to keep their legs together and only choosing abortion as a convenience is speaking from a very privileged viewpoint. The man who date raped me in high school did not give me the option of using birth control as I cried and said no to him. I have been in an abusive relationship, and it was hard enough to leave with the one child we had together that I decided to keep when I got pregnant, unplanned, while using contraception. If I got pregnant again, I might be still living with him with a new "blessing", if I was forced to keep the baby. And before any lovely judgmental people say I shouldn't have had sex with an abuser in the first place, most abusers don't start abusing until their partner gets pregnant, and that is what happened with me. He seemed like a fine, upstanding member of society before that point.

    Thank goodness I found a midwife who was willing to put in an IUD after the baby, after I was denied one by a physician because I was divorced when I first started the relationship with the abuser. (No I'm not kidding. This is why we need Planned Parenthood, and we need to step back from judging women for not having effective birth contol). Being judgmental has NO PLACE in medicine, especially not in reproductive issues.

    Anyone who mistakenly thinks an embryo is a living child can personally choose to keep any unplanned pregnancy. But your rights end where mine begin. The only alternative is forced pregnancy. I believe children are far too sacred, important blessings to be forced on a woman because her rights were taken away by someone who will never, ever have to raise them and will probably vote for politicians who will defund health care and social services for them.

    As others have said, I think bombing civilians is murder. I think capital punishment is murder. No one can argue that the victims of these acts are not living, breathing human beings instead of one inch long bundles of cells completely dependent on another human being who has to risk her life for them for the better part of a year. Save the philosophical conversations for church and around the dinner table. Otherwise, you be the physician in Nicaragua who has to stand there while a woman dies with a ruptured ectopic pregnancy, and tell her surviving orphaned children that well, technically, that embryo's "life" was worth more than the convenience of them having a mother, and she should have just kept her legs together if she didn't want to take that risk.

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  18. I haven't had time to read through all the comments yet, but I just wanted to challenge the assumption that more access to birth control leads to fewer unplanned pregnancies. I was reading about this funding battle a few weeks ago and an article presented data that regions with more access to birth control actually see no difference in unplanned pregnancies or abortions. The assertion of birth control --> less pregnancy certainly seems logical but might not play out in real life. As physicians we should think scientifically and critically about this issue.

    I will hunt down that data and post it here soon.

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  19. Oh, I get it: logically, it follows that every man who "whips it out and sticks it in" when a woman "spreads her legs" (sounds so crude) should also be prepared to be a father in case the birth control fails. That is, prepared to stop work and stay at home as soon as the child is born, for the next 5-6 years, until the kid is old enough for kindergarten. With no sex from the woman unless TTC again or until the wife hits menopause.

    What a fascinating world it would be if women only had sex when willing to TTC, whether by accident or design.

    At times like this, I almost envy my gay and lesbian friends. No birth control worries there.

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  20. Kelley's posts are too pretentious and politisized. Its like reading someone's political or religious campaign. Kelley is blessed that she can be there for her kids while someone is supporting them all. I had to provide for me and my family's piece of bread on the table forever. Never personally dealt with unplanned events, but carefully chose time for planning. I do not think people like me or Kelley have right to critisize another woman who is in tough circumstances. This debate should not happen in civilized country. This narrow-minded mentality is so easily imposed on people who I suspect just lack intelligence. Kelley - your kids will need you MORE when they start school, as public/private education is very poor, and there is a miriad of other issues that growing generation needs parents for. Do not fool yourself that you are so ready to spring into action and become a fabulous physician in just a year or two. Fabulous ones pursued this path since high school on, and did not postpone. Be at peace with where you are but do not impose your judment on others. As others may not have had a breadwinner/provider in their life.

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  21. MS3- thanks for bringing up that point. We all seem to assume that "more birth control = fewer abortions" but that may not necessarily be the case.

    Here's one recent article:
    http://download.journals.elsevierhealth.com/pdfs/journals/0010-7824/PIIS0010782410003276.pdf

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  22. Many European countries have much much lower unplanned pregnancy and elective abortion rates and much higher rates of long term, reliable birth control methods like the IUD.
    You can find the data on the guttmacher.org or pubmed.

    Look at the abortion rates in the former east block prior to reliable access to birth control.

    Religious ideology in medicine is truly scary. ..and dangerous.

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  23. MS3: I think you are referring to the recent article by Kirsten Powers, in which she made a factual error and has printed a retraction which said, in part, "I am deeply sorry for the error, which invalidates my piece."

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  24. Dr. Maggie: Did you actually read that article? I did. To quote: "Another reason for the increased abortion rate during the 10-year study period may be the rising immigrant population... In other studies, immigrant status seems to be an independent risk factor for induced abortion."

    The authors of the study were far from convinced that increased access to birth control universally = increased rate of abortion.

    Spain ain't the U.S.. If demographics were insignificant, epidemiologists wouldn't bother studying sample composition.

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  25. "Spain ain't the U.S."

    Let me guess, the author if this line is ...?Native Indian? Did not read the study but suspect ethnic group was South American immigrants (the author might know the answer why army of them is allowed in this country illegally). When I visited Spain I was driven by taxi drivers that wore white starched shirts and listened to classic music chanel. I doubt behavioral patterns in Spain lag behind the U.S. But for very sophisticated native american people Spain is the same as South America.

    Also yes, demographics are significant and are always included in study analysis. In fact, studies that exclude certain important ethnic groups are considered flawed.

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  26. "Spain ain't the U.S."

    Let me guess, the author if this line is ...?Native Indian? Did not read the study but suspect ethnic group was South American immigrants (the author might know the answer why army of them is allowed in this country illegally). When I visited Spain I was driven by taxi drivers that wore white starched shirts and listened to classic music chanel. I doubt behavioral patterns in Spain lag behind the U.S. But for very sophisticated native american people Spain is the same as South America.

    Also yes, demographics are significant and are always included in study analysis. In fact, studies that exclude certain important ethnic groups are considered flawed.

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  27. >>I doubt behavioral patterns in Spain lag behind the U.S.>>

    Sigh. No slight meant to the good people of Spain.

    One of the most significant differences betweeen the U.S. and Spain (immigration patterns) may partially explain the data from that one paper. Since the mid-1990s, Spain has been experiencing a huge influx of immigrants. According to our friends at Wikipedia, the foreign population of Spain jumped from 1.37% of the total population in 1996 to 12.2% of the total population in 2010. Huge change, no matter the country. Additionally, unlike in the U.S., immigrants from South America are automatically granted citizenship after two years, so the "foreign" population is actually significantly greater than 12.2%.

    >>demographics are significant and are always included in study analysis. In fact, studies that exclude certain important ethnic groups are considered flawed.>>

    That's exactly why it's not possible to extrapolate findings from one study done in Spain to the behavior of the population of the U.S.. Nor should we.

    It is telling that casual readers of the paper (or, more likely, just the title) seem far more confident of the results than the researchers who actually crunched the numbers.

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  28. Anonymous- I am not "confident" that the results of the study I linked to disprove a correlation between increased birth control use and decreased abortions. I posted the link to question the prevalent underlying assumption that more bc= fewer ab.

    Yes, I did read the article- and noted the increase in the immigrant population. I also noted the striking increase in education level between women in the two study groups (from 64.7% with secondary or university degrees to 88.4%), the decrease in the percentage of married women (from 64.7% to 45%), and the increase in the percentage of women employed outside the home (34.4% to 73.8%). Perhaps some of these factors have as much, if not more, to do with the results as immigration.

    I'm not trying to draw a definitive conclusion- only saying that we ought to look at the data. Ideology of any sort in medicine is scary.

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  29. Did you read the bit about immigration alone being an independent risk factor?

    >>Ideology of any sort in medicine is scary.>>

    Yes. I tend to be more disturbed when others' ideology impacts my world, however. If you never want to set foot in a Planned Parenthood: don't. Just remember, however, that one of your friends, sisters, daughters, nieces or granddaughters might be happy PP exists. Not that she'd ever tell you, though.

    I'm afraid I don't see how funding continued access to birth control is objectionable, unless the intent is to chip away at an organization that has the temerity to offer a complete range of womens' health services.

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  30. I am shocked by the notion that my unborn child and my physician dreams are equal in value and mutually exclusive. 
    I was also a surgical nurse before med school.  My now thirteen month old son was conceived the week I took mcat. We were surprised, but I'm just a med student with a 13 month old.   One of three moms in my m1 class.  Why in the world would I have needed to end his precious life bc I want to be a dr?
    I agree that "religious ideology" can be a dangerous thing when "religion" is simply a form of control or sanctioned hate. However, as a Christian whose beliefs are what have led me to medicine in the first place, I believe that faith has a wonderfully powerful role in medicine, allowing me to extend the love I've found in Christ to my patients in times when they need that love and comfort. I hope to work in missions, where faith and medicine often go hand in hand. And I fully intend to bring my dangerous ideology ( love for unborn babies included!) right with me and my active little toddler. 

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  31. Abortion is anti-woman when the child is a female, plus, that child (male or female) could serve a wonderful purpose if allowed to live. For those women who love self fulfillment. More than children (ironic) there is adoption. Let us not forget PP was once a tool of eugenics and " population" stabilization.

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  32. As somebody who grew up in the years before abortion was legal, PP is necessary. Period. They existed without federal funding in the past and will continue to now. The rest of you can go back to cutting welfare and bombing civilians.

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