“Our first patient is 11-years-old.”
That’s the first thing I heard when I walked into clinic the last week of June. It was a few days after the Dobbs decision and the beginning of a new era in the U.S.: Roe v. Wade had been overturned—the constitutional right to abortion had been revoked. In California, it was unclear how much the Supreme Court decision would impact our patients’ lives. At the same time, I could sense the quiet agitation in the hallways, the apprehensive feeling as I walked to my desk.
The 11-year-old—I’ll call her Maria—was pregnant. Scanning through her medical record, I opened an encounter from a county hospital four months prior labeled: Child Sexual Abuse. Maria’s mother, Luz, had taken her there after she disclosed that an adult family friend had tried to put a finger in her underwear. The note claimed Maria, “pushed him away before he could do anything.” Seeing that Maria was less than five feet tall, I wondered if that was true. At that visit, Maria’s physical exam was normal, besides “possible erythema at the left periurethral area.” When palpated, the clinician described this region as non-tender. Maria reported no pain or bleeding. Screening for sexually transmitted infections was performed, yet strangely, no pregnancy test was run that day. Maria said she’d never had intercourse, so perhaps the clinician thought it unnecessary—or perhaps a pregnancy test was negative that day and just never got documented. It may have been too early to show up anyway.
When Maria pulled up her shirt so I could perform her ultrasound, there were already coffee-colored stretch marks creeping up her lower abdomen. Luz sat quietly in a chair in the corner; I wondered if she’d realized Maria’s body was changing or if Maria had noticed it herself. The ultrasound put her at 17 weeks 2 days. Maria did not want to continue the pregnancy but asked to see the ultrasound—a common request. I turned the screen towards her, so she could view the image of a curled-up fetus. When I asked her how she felt, she responded, “Sad.”
“That makes sense,” I replied, not sure what to say honestly.
“It’s so cute,” she smiled, pointing towards the screen.
Maria was bilingual, but Luz had a difficult time understanding English. In Spanish, I explained that based on Maria’s gestational age, she would require a two-day procedure: the first day to prepare her cervix, the second for the actual abortion. Since they’d driven two hours from the Central Valley, they would stay overnight at a nearby hotel. Even in California, people must often travel many miles to find an abortion provider.
My job was to help prepare Maria’s cervix by inserting small osmotic dilators inside. Overnight, these dilators would absorb moisture and gently stretch her cervical canal. I’d never done cervical prep on someone so young and so far into a pregnancy before—I hoped it wouldn’t be too difficult, that Maria wouldn’t suffer more than she already had.
Before starting Maria’s cervical prep, we gave her intravenous sedation to decrease pain and anxiety. After the nurse pushed both medications, I asked Maria if I could begin her exam—I explained that I would insert two fingers inside her vagina and press on her lower abdomen, a technique to determine uterine size and position.
“Yeah,” she nodded.
“Take a deep breath in through your nose, then exhale through your mouth,” I instructed, taking the breath with Maria—I needed it too. I kept thinking about the last time Maria experienced pressure inside her vagina, how horrific that must have been. Was I going to awaken that trauma for her?
“Are you okay?” I asked her, palpating the outline of her uterus.
She giggled. “I feel like I’m on a big swing!”
The nurse gently squeezed her hand, “That’s the medication we gave you.”
“Do you have any pain?” I asked, inserting the speculum.
“No,” she replied. “I don’t feel anything.”
I was able to complete the cervical preparation in ten minutes. Maria never expressed any discomfort. Everything went as well as it could. She would return the following morning for her procedure.
Just a week later, a pre-teen made headlines by being denied an abortion in Ohio. In this case, a 10-year-old had been raped by a 27-year-old man. Ohio had a strict 6-week abortion ban in place, and she was 6 weeks 3 days into her pregnancy. The 10-year-old was forced to travel to Indiana to secure a legal abortion. Many abortion bans are passed with the pretext that they make abortion safer or prevent psychological injury (Foster)—in the case of this pregnant Ohio pre-teen, that justification seems pretty unconvincing.
Prior to Dobbs and the overturn of Roe v. Wade, Ohio’s state legislature frequently introduced bills aimed at decimating abortion rights. Ohio state representative Jean Schmidt said, “It is a shame that [people get impregnated by rape], but there’s an opportunity no matter how young or old she is…” The Washington Post ran a piece on the conservative lawmaker’s defense of her anti-choice bill, the headline of which read like a parody from a satirical newspaper: “Ohio lawmaker calls pregnancies from rape an ‘opportunity’ for victims.”
A few months later, the sardonic digital media outlet, The Onion, published a short article: “Ohio 5th Graders Annoyed That Friend Forced To Give Birth Only Talks About Baby Stuff Now.” Mocking the cruelty of Ohio’s abortion laws that have no exceptions for rape or incest, the article concluded that the new young mother “had been super weird ever since her stepdad got arrested a few months ago and went to jail”—suggesting an unpleasant truth: that most of the youngest pregnant people have been raped, quite possibly by someone in their family or someone close to them.
Maria came back for her procedure the following day. Before the doctor could see her, she experienced strong cramping and went to the bathroom. It was there that she passed the pregnancy in the toilet. Afterwards, a brief uterine aspiration was performed to remove blood clots and placental tissue. Maria was discharged in good condition. Luz drove them both home that afternoon and Maria likely returned to her sixth-grade classroom later that week.
If Maria had been in Ohio or other conservative states, she wouldn’t have been able to get an abortion so “easily.” Without the ability to travel, she may have been forced to carry her pregnancy to term and become a mother before her twelfth birthday. Had this happened, The Onion offers a short piece on “What To Tell A 10-Year-Old Who Has Been Denied An Abortion.” As the days post-Dobbs march forward, it becomes increasingly hard to discern satire from reality.
*Names, physical characteristics, and other identifying information have been changed to protect patient privacy. Verbal consent was obtained from patient and her family prior to writing piece.
Dobbs v. Jackson Women’s Health Organization, 597 U.S. (2022).
Rudavsky, Shari & Fradette, Rachel. “Patients head to Indiana for abortion services as other states restrict care.” The Indianapolis Star. 1 July, 2022. https://www.indystar.com/story/news/health/2022/07/01/indiana-abortion-law-roe-v-wade-overturned-travel/7779936001/
Edwards, Jonathan. “Ohio lawmaker calls pregnancies from rape an ‘opportunity’ for victims.” The Washington Post. 29 April, 2022. https://www.washingtonpost.com/nation/2022/04/29/ohio-rape-bill-opportunity/
“Ohio 5th Graders Annoyed That Friend Forced To Give Birth Only Talks About Baby Stuff Now.” The Onion. 1 September 2022. https://www.theonion.com/ohio-5th-graders-annoyed-that-friend-forced-to-give-bir-1849485853
Foster, Diana Greene. The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion. Scribner, 2021.
“What To Tell A 10-Year-Old Who Has Been Denied An Abortion.” The Onion. 26 October, 2022. https://www.theonion.com/what-to-tell-a-10-year-old-who-has-been-denied-an-abort-1849695666