This story is one in the Faithful Providers series published by Lauren Barbato in Conscience Magazine.
Carol Portmann, MD OB-GYN and Maternal-Fetal Medicine Specialist, Queensland Ultrasound for Women, Australia
As a teenager, I tried out many different religions—Catholicism, Buddhism, Bahá’í. I even went to an Evangelical church for a bit. Nothing really stuck until my boyfriend and I decided to get married.
We popped into a little Uniting church here in Brisbane, thinking it would be a lovely place for our wedding. The minister said, “Why don’t you also come one Sunday and join us?” We thought, “Why not?” We followed the minister’s suggestion and, more than 20 years later, we have been everything from elders to council treasurer and secretary.
Our Uniting church has always been supportive of me and my work in abortion care. Because I’ve held roles on the church council, I made sure our congregation and ministers were aware that I perform abortions. The last thing I wanted was for something about me to turn up in the papers and shock my church. I didn’t want my ministers saying, “We never knew you did that kind of thing!” We’ve cultivated a certain level of trust; they believe that if I choose to perform abortions, then I must feel it is right.
As a young medical-school graduate, I spent about six months at a clinic in New South Wales. The clinic provided public-funded abortions—something you won’t find in many parts of Australia. I was 25 years old at the time, and had never before encountered abortion. The procedure wasn’t talked about in medical school, and many of the hospitals in Queensland, where I did my training, were run by a Catholic health system.
I hadn’t heard much about abortion while growing up in Queensland, either. Admittedly, I had led a pretty sheltered life until then, and had never really thought about why someone would need an abortion. I told my colleagues that I was happy to sit in on consultations and the procedure, but that I wasn’t comfortable performing abortions myself.
I was well aware that abortion clinics in Queensland had a poor reputation. Queensland is arguably the most conservative Australian state when it comes to medical and political attitudes towards abortion. Abortion is still a criminal offense—for the patient seeking an abortion, the doctor who performs it and anyone who assists the doctor.
Abortions are only permissible for fetal abnormalities and to prevent “significant” risk to maternal life, which includes psychosocial factors, as well as medical complications. Public hospitals provide maybe one percent of all abortions in Queensland, and private clinics openly provide abortions under these provisions. These clinics and doctors are shunted to the fringes of medical society. You know how it is: People talk about how you “go to one of those clinics.” And when something happens, it’s always, “Oh, those doctors at that clinic.”
The farther into the country areas of Queensland, the worse this social stigma is. There may only be one or two general practitioners in a town—and these are towns where the receptionists and the nurses are everyone’s friend. If you go to your general practitioner for post-abortion care, the gossip can really spread; once someone identifies you as having had an abortion, you could be ostracized.
When I returned to Queensland after my time in New South Wales, I began working at a public hospital as a maternal-fetal medicine specialist. Even though abortion is rarely discussed in public hospitals, because of the patients I treated, I eventually learned to view abortion as part of my everyday job.
If I have to diagnose a fetus with a serious medical issue, such as having no kidneys or brain, then I must be able to give my patients options. If I can’t provide options, then I can’t successfully diagnose. I always make sure that I can give my patients a full spectrum of choices, so they can make the best decision for them and their families.
Soon after I started to practice, I connected with the local group Children by Choice, which introduced me to the social side of abortion—the women whose circumstances are often ignored and neglected. More and more, I realized that I was acting very similarly to other doctors, drawing lines for what I would let a woman do. That’s not the way it’s meant to work if you’re working with pregnant women. So, I advocated for abortions—not just for patients with fetal abnormalities and other medical issues, but also for victims of sexual assault and domestic violence and women living in poverty.
Over time, I tried harder to get public hospitals to be more open to seeing women in desperate psychosocial circumstances who wanted an abortion. We’re talking about hospitals that wouldn’t even let these women past the front door. The common refrain was, “We don’t do that here.”
I reached a brick wall in the public system. I couldn’t fully change the attitude that assumed: “We can tell a mother when she’s allowed to have an abortion.” I was appalled by that concept—that my patients needed my permission to terminate a pregnancy. It felt very paternalistic—a Victorian attitude persisting in the 21st century.
Australia isn’t a very Christian country. Christianity is not part of the average Australian’s everyday life. Yet, somehow, the idea that abortion is shameful was adopted in Australian society. It might be hard to comprehend, because we’re a liberal and relaxed country. When people envision Australia, they imagine people enjoying themselves in the sun and partying away. Underneath all of that, however, are these bizarre, oppressive leftovers of our colonial culture. It’s like we’re sticking our heads in the sand to stop us from being dragged into the present.
It’s not all about religion, though; you can have faith and be modern and open-minded, like my Uniting church. About a decade ago, my church invited me to lead a Sunday night session on why I provide abortions. Many people in my congregation knew abortions occurred in Queensland—and some were against it—but they had never thought about why people may choose to terminate a pregnancy and how difficult the decision might be. By providing examples and telling the stories of my patients, I was able to humanize abortion. At the time, most of my patients were terminating pregnancies because of fetal abnormalities, but I was also able to address psychosocial issues. There’s this idea that when a woman becomes pregnant with an unintended pregnancy, she is happy and joyful and jumping up and down, exclaiming, “Yeah, I can have an abortion now!” It’s not like that. No one wants to be pregnant just to have an abortion.
For many of my patients, there’s no choice at all. As a provider of later abortions, I am on the journey with the mother, because I’m the person who’s doing the physical deed. I’m the one performing a procedure that causes the baby to pass away. For these patients, not one of them would choose it. I made my fellow churchgoers recognize that you can’t separate the issue from the people who need help.
I am in a rare position here in Brisbane. I receive more respect than my fellow abortion providers because of my background in maternal-fetal medicine. Most doctors who provide abortions here are general-practitioner surgeons, so gynecologists or obstetricians at public hospitals look down on them. They see abortion providers as not being “specialized” enough—even though there’s no abortion training program in Queensland. Even when I started as a maternal-fetal health specialist, I had no formal training in abortion.
The private clinic I work at now provides roughly 4,000 abortions each year, and we do so without feeling overly threatened. There’s always that small chance that our clinic might get raided, but it doesn’t stop us from providing abortion services. There’s not enough scrutiny, I think, to shut us down. Doctors in the public system are not suspicious of us, but they do give us a snide, sideways kind of look. It’s almost as if they’re saying, “What do you expect? They’re just abortion providers.”
We’re still trying to change the general attitude that if you have an abortion, you must have done something wrong to begin with. I do have patients who are struggling not only with this social stigma, but also with a moral or spiritual conflict. I always remind them: “You need to look after yourself, but God is here for you.”
I have nothing but overwhelming love and support for the woman standing in front of me. I believe God does, too. He would want me to do everything I could to care for this person—and that doesn’t exclude abortion. Every patient is a person with a life who needs to be supported.