On Abortion and Autonomy: A Letter to My Unborn Daughter

• abortion
• reproductive health
• contraception

Dear Sweetheart,

You don’t have a name yet, so I figure I’ll call you what my parents call me: Sweetheart.

I first started this letter when I was 14 weeks pregnant with you, and we were flying from our home in Massachusetts down to Tennessee. Other than some nausea and fatigue, I hadn’t felt you in my body at all. But your dad and I were thinking about you all the time. We wondered what you would look like, if you were going to be a good sleeper like me or a bad sleeper like him, if something I ate would harm you. You changed us so much right from the beginning.

I had wanted to write about my work traveling to provide abortions since 2019, but I felt unable to start. You see, even before you were on the way, I was already worried about you. I knew that I wanted you someday and I was scared that you might experience repercussions in the future just because your mom had publicly announced herself as an abortion provider. Funnily enough, now that you’re with me, I feel braver than ever. It turns out you’ve been a necessary part of the story all along.

This story about the importance of abortion access is about us in Massachusetts as well as my patients in Tennessee—about the right to bodily autonomy that you will get to have, and others will not.

I was 19 weeks pregnant with you when the supreme court decision overturning the constitutional right to abortion was released. I wasn’t shocked or surprised. The writing was on the wall. Many of my patients in Tennessee that month had driven hundreds of miles, across state lines, all so I could perform an unnecessary ultrasound, give them a mandated and medically inaccurate speech, and then tell them to call back another day to schedule another appointment for an abortion. Meanwhile in Massachusetts, all my primary care patients have to do is call us and we can deliver the abortion pills to their homes. So much had been lost in Tennessee already and losing the right to abortion entirely was just a matter of time.

On that day, I felt overwhelmed reflecting on the breadth and depth of my Tennessee patients’ experiences. Many of my patients were parents who shared, “I never thought I’d be here at the clinic,” but they were struggling to financially support their current kids. Some were survivors of rape or incest. Many didn’t give a reason—because they didn’t need to. Where would they all go now?

This question reminded me of another one that a 16-year-old had asked me. She and her mom had driven for over 3 hours from another state to come see me for a medication abortion. After I gave her the abortion pill, we talked about birth control. She and her mom both thought that the contraceptive implant that goes in the arm sounded like a good fit. I offered to insert it. She wanted it, but she had a big basketball game later that evening and didn’t want to miss it if her arm hurt because of the insertion. She asked, “Can I come back here another day?”

With new restrictions on abortion in her home state, I wondered, did she really ever make that long drive back again? Should I have told her that she needed to get the birth control then and there? Should I have warned her that we wouldn’t always be there for her if she wanted another abortion? I then worried about me. I am White and my young patient was Black. I see how easy it is for well-intentioned, White providers to slip into the pattern laid out by so many before us—to push things onto the bodies of people of color and poor people, justifying it because of a systemic and deliberately constructed relative scarcity.

This young woman’s mom and I were right when we answered that getting the implant was up to her. Who she is, her passion for basketball, her decision to put something in her body when she wants—it’s all more important than the fact that she can get pregnant. I hope she left the clinic internalizing that. She’s more important.

Well, my sweetheart, you will be one of the lucky kids who by virtue of where you live, your race, and how much money you have, you will get to go to your basketball games and go anywhere to get a safe abortion and get birth control any time you want. The same cannot be said for many in this country already. This disparity will only get starker.

As we look forward to your growing up, the truth is that your dad and I don’t want you to care about abortion in particular. We want you to have compassion and humility, to care about people and respect their bodies and decisions. We want you to see the systems of oppression around you and others and work to dismantle them.

We’re sorry that things are worse for your generation than when we were born. We hope that you find deep joy and meaning in fighting for what is right.

Love,

Mom

• Received for publication June 15, 2022.
• Revision received September 11, 2022.
• Accepted for publication September 27, 2022.

• © 2023 Annals of Family Medicine, Inc.