In absence of Roe v. Wade, an abortion doctor dwells on all the patients she does not see

Last year, just a few months after the Supreme Court’s reversal of Roe v. Wade ended the constitutional right to abortion in the United States, Christine Henneberg published a memoir on two simultaneous life-defining experiences: carrying her first pregnancy during her first year performing abortions.

This was long after another transformative journey: traveling and living in a rural Indian village at the foothills of the Himalayas when Henneberg first wanted to be a writer. There, she encountered public health in ways that resonated with the legacy of the global health pioneer Paul Farmer and sparked her interest in women’s health.

“This sounds cliche now, but … these [were] the impressions of a 19-year-old: children brushing their teeth in the little trickle of water that ran down the gutter outside their homes,” Henneberg told STAT. “And pregnant women, who looked so different from what pregnancy looked like to me in America.”

Henneberg attended medical school shortly afterward, graduating from a joint program through the University of California, Berkeley, and UC San Francisco in 2013. Her rotation at an abortion clinic in San Francisco — especially the empathy she witnessed — cemented her desire to work in this space.

Henneberg’s book, “Boundless: An Abortion Doctor Becomes a Mother,” grapples with motherhood, reproductive care, and the privilege of choice. With a more restrictive reality for abortions and greater public attention toward reproductive justice since she first began practicing medicine, Henneberg spoke to STAT via Zoom on her reflections as an abortion doctor in California.

Excerpts from the conversation are below, lightly edited for clarity and length.

When did you first become interested in this work?

Interest in abortion care really emerged when I was already in my medical training. I think I didn’t have a lot of strong feelings about abortion, perhaps because I had not encountered it personally, or the need for one personally. But I had, through my education and my interest in women’s bodily autonomy — just trusting women to make decisions about their own bodies — a sense, through some medical care I’d had as a young woman, that that was not the norm.

So when I had the opportunity to visit an abortion clinic as an early medical student, I remember being just fascinated. I wasn’t doing procedures. I was watching things I didn’t yet know at that time that I had an interest in working with my hands. I mean, [a big part of what] they did was basically talk to women about what it was they wanted or needed to do, and sometimes help them figure that out, although for the most part, by the time women show up at the clinic, they’d already figured it out.

It was like this whole different role of the doctor where you weren’t there to come in with your expertise and say, “OK, this is what I think we should do for your situation.” The situation was very clear. It was just a matter of what the woman decided to do, and then the doctor was just there to treat her with respect and kindness and empathy as she went through with that decision. So then I returned for an elective at that clinic, when I was a little bit further in my medical training.

What was it specifically about the way doctors interacted with the women that resonated with you?

There was this excellent counselor in the clinic — she had written a book about abortion counseling, and I watched her do her counseling with some of the women. I remember this one conversation where the woman was very closed off. The woman didn’t have to open up. She could still get her abortion. But you could just see there was some hardness that she was holding onto.

Then — I don’t remember if it was an exact question, or something the counselor said, I think it was just her demeanor and that kind of utter openness and respect for whatever it was the woman was bringing into the room. They were talking about some detail of the procedure and what it was going to be like. And the woman said, “You know, actually, the last time I gave birth the baby died.”

She was wondering whether there was going to be anything about the procedure that would remind her of that child that she had wanted and carried to term and then lost. I was just blown away by the idea that this was the place where she could talk about this — probably there were not very many places where she could — and how much was coming up for her. What would it mean to a woman who’s already lost a child, who is now choosing, for whatever reason, to terminate another pregnancy. The whole scope of the work opened up for me in that moment of how deep and important and complicated it is.

With public attention on the anniversary of the Roe v. Wade reversal, I wonder if you have any thoughts about the significance of recognizing this event.

There’s certainly meaning to it. The thing that has bothered me from the beginning — when it became clear that this was actually happening — is that for all the attention, the stories that we are not hearing are the ones that I think about the most and feel the most sad about. You hear these stories of the lengths that women have to go to get an abortion, and the barriers that get in their way. It is important that we hear those stories and the fact that those people ultimately got their abortion, no matter how many hurdles they had to jump through.

But I think it can be a distraction from the silenced women for whom nobody knows their story, because they’re just the pregnant woman you see walking around and don’t know. She’s [the woman] who never got to an abortion clinic. She never even got to tell someone what her feelings were about keeping this pregnancy or not, because she knew there was no way for her to make that decision for herself. I think about these women everywhere, all over this country, living that reality.

Since the Roe v. Wade reversal, there have been some California laws related to reproductive rights, including Proposition 1 [which enshrined a fundamental right to reproductive freedom in the state] and another law that allows nurse practitioners to perform first-trimester abortions in California without the supervision of a doctor. Are there any accompanying changes you’ve noticed in the culture of reproductive care within the medical institution?

I think one positive thing — though it may be frustrating to many of us who have been aware of this — is a recognition that abortion, in 99% of procedures, is not that technically complicated. Particularly medication abortion, but also first-trimester aspiration abortions. So nurse practitioners and physician assistants have been getting more training and licensure to perform first-trimester procedures. They’re already widely performing medication abortion in California, and that’s good. But that should have happened a long time ago. There is no reason that nurse practitioners should not have been doing those procedures with adequate training for many years. So it’s good, because demand will continue to go up as women come from other states, and it’s important to have the workforce to address that. But it can also be a little grating when suddenly there’s this new pressure. That pressure should have been there all along.

Is there anything about the language in reproductive care that has resonated with you even more since your book came out?

I am always learning about the power of language, and how intentional we need to be with it. But I think what I also try to talk more about these days is not just being intentional or “careful” around speaking about abortion, but being honest. It’s [important], talking about the fact that you’ve had one, that you would have one if you needed one. Or that you haven’t had one and you still think it’s really important and you want it to be available to you or your sister or your friend, I mean this for men as well as women.

So many people have been so careful to either not talk about abortion, or that when you talk about it you have to use these very special words, and you can’t use other certain words, and you think, “I’m not really sure what those words are, so I better just not talk about it.” That is a trap, and it’s a trap set intentionally by the anti-abortion movement that claims certain words as its own and uses other words against the abortion rights movement. I actually want people to be less “careful” when they talk about abortion and lean more toward frankness and honesty. That’s what’s needed right now.

Could you speak to the greater public awareness and challenges around reproductive justice you’ve witnessed in recent years?

The terms reproductive justice and abortion rights or even pro-choice get used interchangeably a lot now. [But] reproductive justice is a very specific movement and set of ideals that is bigger than abortion rights.

As a white doctor, when I think about reproductive justice, it’s about moving away from where I originally trained as looking just at the patient in front of me — which is, of course, important — but moving toward an awareness of all the patients who are not in front of me.

And when I do look at the patient in front of me, not just seeing a patient who “chose” an abortion. There are multiple dimensions to what we call reproductive choice and they are not the same or equally accessible to all women. That includes the decision to have an abortion or the decision to have a child and the opportunities or the freedoms to raise a child and a society that supports you in doing that.

And what are your hopes for the future of reproductive justice?

My first thought is of my own daughter, and thinking bigger than that, [my hope] is that I raise her to be aware of the different choices people make and the different constraints on those choices. That she’s part of creating a world where awareness lies at the root of our definition of justice … [not with] how our definition of justice lies now in our current Supreme Court.