A day inside an abortion center
My morning shift at the Reproductive Healthcare (RH) Center had ended. I’d recently been transferred to the pre-abortion counseling room from the youth-only examination room across the hall, and it was time for lunch.
I’d set out for Vietnam from the US under the auspices of a research grant to understand the experiences of young people in accessing sexual and reproductive healthcare in Vietnam in its socio-economic, cultural, and legal context. It had made sense to begin my observations in the youth-only examination room in the only RH facility in Saigon catering specifically to women 24 years and under. However, as the weeks passed by, what started out as just a general ethnographic exploration of reproductive health turned into a focused interest in the “abortion epidemic”. I didn’t fully understand what the big deal was until I noticed that nearly half of my female patients came in for an abortion-related issue and for many, this was not their first time.
To provide some real numbers from my fieldwork so far, the center received 208 and 218 abortion cases respectively in January and February 2014. During those two months, young people aged 24 years and under accounted for one-third of those cases. Aggregating the data from the first six months in 2014, Hung Vuong Hospital had a monthly average of 1,321 medical abortion cases, where surgical abortions consistently accounted for nearly 25 percent of the total number. It has been previously estimated that in Saigon alone an average of 200 abortions take place every day.
After having lunch in the center’s cafeteria, I was walking upstairs when I noticed a young woman in tears, sitting alone on those blue waiting chairs outside the pre-abortion counseling room. I sat down next to her and asked her what was wrong. She replied, “toi dua be trong bung,” expressing her guilt about the baby inside her. I realized from her statement that she was about to have an abortion that afternoon. To protect her identity, I will refer to her as Lan.
Lan’s fetus was 11-weeks-old. Because medical abortions (the abortion pill) are not allowed after eight weeks at the center, she was going to have to be sedated and have a vacuum aspiration procedure. It’s exactly what it sounds like – she was going to have a suction machine empty her uterus.
In Vietnam, abortions can be performed legally up to the 22nd week, and only the major Ob-Gyn hospitals such as Hung Vuong Hospital and Tu Du Hospital are authorized to perform abortions in cases over 12 weeks. This center accepts abortions only within the first trimester.
I was surprised enough to find out that Lan was 17-years-old. But what shocked me more was her doctor’s decision to allow Lan to have an abortion without her parents’ permission. In Vietnam, anyone under 18 must have a parent with them to provide consent. I found out later that, specifically at this center, when the patient is 17 there tends to be a gray zone where the doctor in question may allow the procedure to take place depending on the patient’s circumstances. After learning more about Lan’s background, I understood the doctor’s decision. She had come all the way from Dong Nai Province alone. She had been living with her sick grandmother while her mother lived with her third husband in Taiwan. The whereabouts of her biological father was unclear, and his side of the family did not acknowledge her. The only person she knew who lived in Saigon was her 19-year-old boyfriend. They had been in a long-distance relationship for nearly six months. Most abortion patients are accompanied by their partners, but Lan’s boyfriend couldn’t get out of work that day and instead just gave her some money for the procedure.
Misconceptions About Contraceptives
Why did Lan wait nearly three months? She explained that her periods were usually irregular, so she didn’t think to take a pregnancy test after her first missed period. This is a common response given by many abortion patients. I learned that the couple had never used condoms. When asked why, she said she’d never really brought it up with her boyfriend and neither had he – another common response. Most of my female patients, whether seeking abortions or not, have expressed their hesitancy in negotiating condom use with their partners and many end up shifting that responsibility to the man. This means if their partner does not bring up the topic, the conversation will never happen. And of those who do raise it, their partners sometimes refuse to use them. As a result, many female patients abuse emergency contraception – sometimes at the behest of their partner, and sometimes without their partner’s knowledge. Not surprisingly, Lan had used emergency contraception after every time she had sex.
Why didn’t Lan use any of the hormonal contraception methods available, such as the IUD, the implant, the shot, or the pill? Like most patients I’ve encountered, she didn’t know what the implant and shot were and thought the IUD was only for married women with kids. She also believed in the widely-held misconception that hormonal contraception leads to sterility. Many of them have heard a combination of horror stories and misinformation – mostly from the internet and older women – and are understandably apprehensive about certain birth control methods.
Moreover, because of this “if it’s not natural, it’s harmful” belief and general ignorance about birth control, many of my patients experience reproductive coercion or birth control sabotage by their partners – a situation where a man attempts to adversely manipulate a woman’s use of birth control, undermining her efforts to prevent an unwanted pregnancy. I had a case where a young patient had to have an abortion because her partner didn’t tell her he ejaculated in her. He didn’t want her to use emergency contraception for fear that she would be sterile after usage. He also refused to use condoms. There was another case where the partner discovered that the condom broke but neglected to tell his girlfriend because he didn’t think it was a big deal.
The alarm rang, indicating that my lunch break was over. It was time for Lan to enter the pre-abortion counseling room. When she walked in, I saw the entire room looking at her with judgmental eyes. The midwives were surprised that she had no one at all to accompany her. In fact, they were quite hostile to her, something that I see happen to young female patients every day. They asked, “if something serious happens to you, who will take care of you?” I thought this was an ironic question considering she was at a medical center staffed with doctors and nurses – precisely the people charged to “take care” of someone when something medical goes wrong. The head midwife almost denied her the abortion for this reason until the doctor who was performing it gave the OK. That doctor was also the Director of the Center.
Lan signed the abortion agreement form, received information about the risks and possible side effects of the procedure and experienced a lackadaisical, 30 second contraceptive counseling session that consisted of the midwife routinely asking her which birth control method she would use after the abortion – instead of properly taking the time to explain her options. Intimidated and uncomfortable, Lan quickly replied she would use condoms, before slipping out of the door and heading towards the changing room.
The abortion procedure took less than 15 minutes. I went to visit her afterwards in one of the resting rooms and she seemed clearly tired and weak. I was outside the room when I saw a midwife and the Director standing by her bed. I saw the Director place some money in Lan’s hand to help her cover her hotel expenses. They recommended she stay at the center until closing and then walk to the nearest hotel and stay in Saigon overnight instead of taking a three hour ride back to Dong Nai. It was a rare and sincere moment of kindness that contrasted with the sour hospitality provided earlier by the medical staff. And for once, I couldn’t help but smile.
Images by Ngoc Tran