I recently attended the Association of Maternal and Child Health Programs (AMCHP) annual conference in Washington, D.C. While I learned a lot about what is happening at the state and local level to improve maternal and child health outcomes, I was surprised that abortion was not included in any of the breakout session titles or as a focus in any of the plenaries I attended. As the Guttmacher Institute notes, “Nearly half of pregnancies among American women are unintended, and about four in 10 of these are terminated by abortion.” A total of 3.95 million births took place in the U.S. during 2011, compared with just over 1 million abortions that same year. Why wouldn’t a conference about maternal and child health include a session on abortion?

I have two potential explanations for the absence of a discussion about abortion at the AMCHP conference. My first guess is that AMCHP (and many attendees) may face formal or informal restrictions related to training and advocacy around abortion due to the receipt of federal sources of funding. My second guess is that the silence around abortion may stem from a lingering but unvoiced misconception that abortion is somehow separate from the health of mothers and children—or a feeling that it should be separate. The reality is that abortion can be and frequently is an important strategy for promoting maternal and child health and wellbeing, and as such deserves to be an integral part of a conference focused on that topic. Whatever the reason for not including abortion as a topic, I acutely felt the absence of this conversation. If any attendees or organizers of the conference have information about this that I might have missed, please be in touch.

My experiences working and volunteering in the field of maternal and reproductive health have solidified my belief that abortion must be viewed as an essential part of holistic healthcare for women and their families. Several years ago when I lived in D.C., I volunteered regularly at a health clinic in Virginia where I supported patients during first trimester abortion procedures (the only kind allowed at that particular facility). I remember one woman in particular: she came to her appointment with her young son in tow. Her little boy was probably five or six years old and, as she explained to me during the preparation for her procedure, had developmental delays and was possibly on the autism spectrum. She expressed plainly that her presence at the clinic that day to have an abortion was entirely due to her love and devotion to this child. She knew her own capacity as a mother and feared that she would not be able to provide for her son if she had another baby at that time. Instead of holding her hand and providing the physical and emotional support that I typically offered to patients, I ended up playing with her son on the floor of the exam room while the doctor conducted her abortion procedure. She told me she was glad I was there to keep him busy so he could stay close to her throughout the procedure; even lying on the exam table, her first concern was that his day not be disrupted. Every abortion story is different, but available data suggest that this mother’s experience is not uncommon.

In the U.S. 61% of abortions are to women who are already mothers and three-fourths of women getting abortions “cite concern for or responsibility to other individuals” as a key reason for their choice. Abortions can also allow women to space their pregnancies out (a known way to improve infant health). Regardless of why abortion wasn’t a topic at this year’s AMCHP conference, silence around this issue only deepens the stigma around abortion. Some of the medical care providers attending the conference likely perform abortions or have women in their care who have had abortions, and yet I did not hear anyone talk about the social or political realities in their states that have curtailed women’s reproductive choices so dramatically in recent years. I did not get to learn more about how abortion functions as an integral part of a maternal health care system, supplementing robust access to sexual education and effective contraception to ensure that women who do not wish to carry pregnancies to full term have a safe and reliable way to end them.  

Access to safe and legal abortion is a well-documented strategy to improve both maternal and child health. Maternal and child health professionals should therefore expect to learn and engage on the topic of abortion at industry-specific conferences. What should the maternal and child health professional community do to ensure this topic is thoroughly explored at our professional development events? How will the field be held accountable for neglecting to talk about abortion-related issues? I would love to hear from attendees at this or other public health conferences where conversation about abortion was missing.

Update 5/2/16: I emailed the communications team at AMCHP and they explained that “no MCH topic is ruled out,” but they didn’t receive any proposals this year for a session about abortion. It’s great to hear there is no explicit ban on abortion-related discussions, but it makes me wonder again what the maternal and child health community needs to do to better include this topic at our professional meetings.