Pro-Woman Practice and Policy

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For most of my medical career, I worked in family planning, providing contraceptive care so that children could be planned, loved, and supported. I also performed abortions when contraception failed. For forty years, I have been supported in this work by my Quaker beliefs.

As the child of a white, middle-class family in the fifties, I knew nothing of the “real world” until I attended college and medical school. In the latter, I first encountered the social and economic inequities of our country, and I also began to learn about women’s issues – inequality, patriarchy, and misogyny.

“She won’t talk to any of us (men). Maybe she’ll talk to you,” the obstetrics resident said as he sent me, a brand-new third-year student, to a patient’s room.  The woman was twenty-two, three years younger than me. She worked in a fast food restaurant, the single mother of a two-year-old. Pregnant and deserted by her partner, barely able to care for her son, she had undergone an illegal abortion, and now had a serious infection. And she did talk to me, several times. After hearing her whole story, I found myself converted from being vaguely and intellectually pro-woman and prochoice to being passionately and thoroughly pro-woman and prochoice.

A few years later, I started attending Multnomah Friends Meeting – to learn about the faith of my Quaker fiancé. I distinctly remember walking into meeting for the first time, noting the pamphlet rack on my right as I entered, selecting a pamphlet called “Quakers and Women,” and being reassured by what I read. After just a few meetings, I knew I had found my religious community.

As I continued in my training and developed in my career as a women’s reproductive health specialist, the words of many patients affected my approach to reproductive care:

“I want another child, but this is the wrong time.”

“I’ve tried every method I could find, but each one either had horrible side effects or it failed.
Can you help me?”

“I can barely take care of the three children I already have. It wouldn’t be fair to them to have another baby.”

 “There’s hardly enough food to go around now; how can I add another mouth?”

As a mother as well as a physician, I felt visceral reactions to these predicaments. I could not turn away from these needs. Of course, I worked very hard to find an appropriate birth control method for every patient. But any method can fail, even with proper and consistent use, and then abortion may be the only choice.

Every woman I met was saddened by the need to choose an abortion. Every one wished there were an alternative that would work for her. And every one knew that her family – her dependent children, her ill spouse or parent – and her future depended on her having that abortion. It is not a decision made lightly. Family values, personal commitments, and spiritual beliefs are all involved in such decisions.

Some important facts about birth control need to be more widely known: Effective contraception is not always available to women, and no method works 100% of the time, even if used perfectly. Contraceptive failure is more common that most people realize: almost half of U.S. pregnancies are unintended. One in three women in the U.S. will have an abortion sometime in her life. Throughout history, women have tried to avoid forced pregnancies by taking toxic substances, subjecting themselves to physical trauma, and allowing untrained or ill-trained “healers” to invade their bodies. They have often died or lived with disabilities as a result. I believe it is more compassionate to provide proper contraceptive and abortion care to women, to preserve their lives and health, than to deny them these professional services.

To expose the truth about misogynistic organizations and to share the truth about women’s healthcare needs, public education and advocacy are required. I believe we need a more knowledgeable populace and a better-informed political leadership in our country. Before retirement, I had little time for public education and advocacy, even though this was always on my “to do” list. Now that I am retired, I am making more time for emails and phone calls to legislators, as well as scheduling personal visits with them, to ensure that they are hearing pro-woman, prochoice views on matters of public policy. This year I joined one of the many citizens’ action groups that sprang up after the Woman’s March in January, serving on a women’s
rights subcommittee.

My most satisfying activity of the last eight years has been serving on the board of the New Mexico Religious Coalition for Reproductive Choice, one of twelve affiliates of the National Religious Coalition. (Colorado and California also have affiliates.) The prochoice, pro-woman messages of this spiritually based organization are important counterweights to the Religious Right’s often radical, anti-woman rhetoric. The organization also provides me with opportunities to directly help women in need, which satisfies that part of me that misses working with patients. It is good work.

I have always believed that my work has been consistent with and supported by Quaker values. And the words that Quakers have spoken to me in support of my work have meant more to me than I can express, especially when anti-choice demonstrators were directing venom and recriminations at me. I was enormously pleased last year when Intermountain Yearly Meeting passed a minute of support for Planned Parenthood.

Quakers believe in equality. Women cannot be equal if we must endure forced pregnancies and motherhood, if we cannot make our own decisions about whether and when to have children. Pregnancy and motherhood can be welcomed and joyous; but when they are forced, they become emotional and physical burdens that deter women from achieving autonomy and equality. Parenting is a fulltime job, usually falling primarily on women, who then cannot complete equally with men in the workplace. In this country, a man cannot be forced to donate a kidney to his dying child. No woman should be forced to continue a pregnancy.

Those who oppose equality for women often try to disguise that agenda by saying that they wish to “protect women.” So they pass laws and regulations limiting access to contraception and abortion that have no basis in accurate medical fact.   Of course, they are implying that, as women, we can’t make our own decisions, that we lack the intelligence, will, or moral strength to make choices that fit our lives and circumstances.  (They are also assuming that medical providers lie and deceive their patients but only in the area of reproductive health care.)

Quakers value community. Families and communities cannot be strong and healthy without thoughtful reproductive decisions. Healthy communities need women who can contribute and participate to their fullest, where children are desired and loved and receive everything they need to thrive. In healthy communities, energy and resources are sufficient because motherhood and parenting are undertaken with thoughtfulness and love.

Quakers also value stewardship of the earth. One of humanity’s biggest environmental problems is that we have too many of us. Our planet cannot survive if human beings reproduce beyond the earth’s capacity to support us. Birth control that is more effective and more easily available is a vital component of stewardship of the earth.

I know that not all Quakers agree with me that abortion is consistent with our peace testimony. While I think that most (maybe all) Quakers support the use of contraception, I suspect that some see abortion as an act of violence. In my view, most acts of healing involve some elements of violence, yet the overall goal of the practice of medicine is healing, not violence. Abortion is no exception. It is an act of healing when it is undertaken thoughtfully, when it allows women and their families to thrive. Protecting unborn life is good, but it is not the only good to be considered. Sometimes the lives of those already present must take precedence over a life that might be.

For me, religion requires actions in support of beliefs. “Be the change you wish to see in the world” as Gandhi said. I have been the most fortunate of women, having a profession in which I could work daily for equality, community, and stewardship of the earth. My work at family planning clinics, and the education and advocacy activities that I engage in, have always felt Spirit-led.  ~~~

Diana Koster settled with her family in New Mexico in 1980. She has three children and three grandchildren, and is a member of Albuquerque Meeting (IMYM).