‘Men who came to our clinic had the same kinds of feelings and reactions that women had.’
The piece below was written by Seattle psychologist Valerie Tarico for Washington Initiative for Boys and Men. We are extremely honored to have been entrusted with publishing these reflections from Claire Keyes, former director of Allegheny Reproductive Health Center, and Christine Charbonneau, former CEO of Planned Parenthood of the Great Northwest.
In 1978, five years after the Roe v. Wade decision, Claire Keyes accepted what she thought was a short-term position as director of Allegheny Reproductive Health Center, an independent abortion clinic in Pittsburgh. She stayed for thirty years.
By nature, Keyes was a bit of a renegade. She had earlier quit a high-school teaching position she loved because, as she put it, “I was going to get into too much trouble for breaking the rules.” She completed coursework for a Ph.D. and then walked away when her life began moving in a different direction. She volunteered pre-Roe in a feisty street clinic that connected Pittsburgh women to abortions, mostly by traveling to DC and NY.
She remained a renegade in her role at Allegheny: In defiance of equally fierce, feminist peers, she refused to exclude men from abortion counseling and procedure rooms.
Even today, almost half a century later, Allegheny’s approach under Keyes — the focus on including men — would be an outlier. Many — perhaps most — abortion decisions are made by couples together. When they are not — when there is disagreement and the decision defaults ultimately to the person most affected, the woman — men still often play a role in supporting their female partner either way. All the while, they must contend with their own feelings, which may include shame, fear, loss, grief, relief, guilt, anger, inadequacy and more. But rarely are they offered services that support them through this time.
In this interview, Keyes discusses how and why she included male partners or relatives in pre- and post-abortion counseling, and allowed them into procedure rooms — always at the preference of female patients.
Tarico: Tell me a bit about those early years.
Keyes: I didn’t know what I was doing, really. Nobody knew what they were doing. Among us early providers, there wasn’t anything that was proscribed; we could do what made sense to us. My staff and I didn’t have anyone telling us what to do. Because we were an independent clinic, we had a lot of flexibility. So we were pretty much meeting patients where they were, listening to them, and moving with them.
The back staff — the ones assisting the doctors and patients through the procedure — get the credit for our decisions to include men. They kept telling the rest of us that many patients wished their partners could be in the room with them. So, we made it happen. We all were just following their lead.
I still get choked up decades later. We had the best of all doctors. They were open to whatever we suggested that might improve care. They were among the first to allow partners in the delivery room. When we presented the idea of including men, they said, “If you do the screening and coaching, I’m up for it.” So, we developed ways of honoring the men and their needs while never compromising the patients who were our reason for being.
Tarico: I’d forgotten that men weren’t allowed to be present during labor and delivery back then. My father missed out on five births. But at your clinic, when the patient desired it you invited men into the actual procedure room.
Keyes: Initially we didn’t have a protocol other than that the woman made the decision of whether he was with her. “He” could be a partner, a dad, a brother — even a boss, of all things. The men were always positioned at the patient’s head, so they weren’t directly viewing the procedure. A few expressed interest in viewing the procedure itself, but we let it be known that it wasn’t their role. Even positioned at the head, there were men who fainted — not from seeing but from feeling it.
Tarico: You took some heat for allowing this.
Keyes: I felt like a lone voice in the desert, not well received by other abortion providers. I was denigrated by some anti-male feminists for wanting to pay attention to men. There were times I was shouted at by other providers that I was abandoning women, that serving women should be our only mission, that we were not focused the way they thought we ought to be focused because women have always had to be at the hands of men in various ways. Which is true, but one doesn’t obviate the other.
Tarico: I see that still today in my work on reproductive health and rights. People act as if we are incapable of treating both men and women simultaneously as fully human — complicated and vulnerable. This doesn’t just apply to abortion. One time I was introduced by an international nonprofit to a couple from Brazil who had a zika baby, microcephalic. The mom spoke about the support she was getting from other moms organized by the same NGO. When I asked the dad about who was supporting him and how, he started to cry. There was nothing for dads.
In a very different circumstance, I was at a restaurant with my then college-age daughter and four of her male friends. I asked them whether they might like to be dads someday, and how they saw that — what they might like to do first. The responses were very different, but all four said nobody had ever asked them about their parenthood aspirations before — something we start asking girls in middle school or before.
When it comes to reproductive empowerment, even the most outstanding male-focused organizations — Men4Choice and the Emerge Lab at USC — often (though not always!) appeal to men as allies for women. Men can be strong, generous, loving, fierce allies. But they are also stakeholders — whole people with parenthood desires and life dreams of their own. The Male Contraceptive Initiative has expanded beyond allyship, to center on “reproductive autonomy for all.” But it can be challenging to bring along folks who are accustomed to thinking of reproductive rights or gender equality as women’s issues.
I can only imagine what it might have been like trying to address these complicated concerns in the course of providing a clinical service like abortion. Nobody had set the stage.
Keyes: Somewhere around 1990 I met sociologist Dr. Arthur Shostak, a prolific researcher at Drexel University. He had written a book that at the time was the only one about men and abortion (Men and Abortion: Lessons, Losses and Loves, 1984). He connected with me seeking permission to survey our patients and their male partners. As a result we had a long-time working relationship—though with very different needs and perspectives. Some of the more anti-men providers really didn’t like that I did anything with him. He was coming from a pro-choice perspective but he…a part of it was motivated by his own experience. When he was young, he partnered in an abortion decision and felt it was right, but he also felt like there was nothing out there for men who experienced grief or needed healing. I think he collected over 3,000 surveys over the years. I don’t think there was ever another book written by him, but he definitely wrote journal articles, and I used his statistics when I would do presentations at provider meetings.
Here is the way I had come to understand it: If we don’t pay attention to men, they leave here worse off. We don’t give them a chance to resolve their own internal strife or grief or questions or guilt. They might not even have a basic understanding of the procedure itself or what to expect after. We are doing them a disservice and doing women a disservice as well.
So, we tried a variety of ways to help men.
Tarico: I know that counseling was one of those ways.
Keyes: Men rarely ask for help or say I need to talk. First, we tried information sessions in the corner of the waiting room, so they at least knew what was going on. Some didn’t really want the information, but some were interested and grateful. Later, we tried incorporating men in the counseling sessions if the women wanted them there and we understood the motivations and dynamics. If she was uncertain, we wouldn’t bring him in. Sometimes, when two members of a couple weren’t aligned, it was better to talk with the man alone. We offered individual sessions on procedure day if our staff resourcing allowed it, but we would always make an appointment for him post-procedure if he wanted to come in. There weren’t many who did, but some did, and they were very grateful for it.
Another attempt to give men a voice was to have journals in the waiting room inviting anybody to write anything, and there were plenty of men who did. Sometimes a man would take the journal and sit there and write for an hour and tell his whole story. I kept those journals when I retired because I always thought I would do something with them. Reading their words reaffirmed that we were on the right track and doing what we could. Here are just a few quotes:
Let me tell you a little bit about my situation. I just turned 21 and I’m a high school dropout. I start a new job tomorrow that hopefully will lead to a better life for me and my girlfriend. She is still in high school, and is so smart and has so much going for her… When we do have kids, I want to have more than just love to offer them.
This choice is hard for me, harder for her. Wishing the time and situation was better. Already have 3, what would I do with 4? How could I be so stupid and not wear the gear.
As a man, I have an obligation to my two daughters.
This choice is the right decision for the long term. No regrets. Only all my love…
I really am sorry. If I had money and had a good job, you could be born. …Which do you like better. Japanese name or American name? Please re-born someday for us.
To your child you have to give your all, and dats what I wanna do…I would never bring my child to a life dats not prepared for he or she. Lord can I ask u to forgive me please.
This [torn paper] is a manly heart…Women don’t realize all the time but ½ of their pain is shared with some men. That is including me. Me and my girlfriend weren’t sure this was the Right thing at first but now its clearer that its ok because a decision was made by both of us and were going to get threw this together. I am 20 years old.
Tarico: So much pain and love and inner churn and guilt and deep desire to be a good dad. And so much of what my daughter calls “tonic masculinity” — a sense of responsibility, wanting to work and be a good caretaker, admitting pain yet forging ahead, stepping up for other people.
Keyes: What stood out most — what stands out still — is how those men were not heard. They would rarely talk to anyone — occasionally a brother — but often they didn’t let anyone know that they were involved in a pregnancy and then involved in a pregnancy decision — or not involved as they might have wished. Sometimes she was making the decision and he didn’t like it a bit, in which case all we could say is we will see you privately.
Men who came to our clinic had the same kinds of feelings and reactions that the women had and that the patients’ mothers had. Often the feeling was of it being a necessary loss. A lot of people knew intellectually that this was the better choice for them, but they sure didn’t like it. (Peg Johnson, the director of Southern Tier Women’s Services in Bingham, NY, developed all sorts of printed material that clinics could buy to hand out to their patients dealing with loss and grief or feeling better about yourself.)
Of course, there were women who couldn’t allow themselves to get connected to the pregnancy at all because they were too young or too old or too poor, and men had a lot of the same kinds of feelings. And then there were some factors that hit men especially hard because of traditional role expectations. When the decision was heavily financial, there was often terrible guilt that they weren’t man enough that the pregnancy could continue.
Tarico: You also offered support for what I might call a spiritual dimension to this process.
Keyes: Yes, we repurposed a broom closet and turned it into a sanctuary. It had an interior bench that accommodated two people who could go into this room before or after the procedure. It was a kind of spiritual thing. We designed it based on a fantasy of a James Turrell light. Across from the bench, the opposite wall was cut out in the middle with blue light and there was a bowl with little stones. Couples could go in there together or separately, and we never defined what they should do. Again, this idea came from patients. They didn’t say, I wish you had a sanctuary but rather, I wish there was someplace that I (or we) could be alone for a few minutes. I loved that little broom closet sanctuary because I think it gave permission to the patient or couple or a relative to feel whatever feelings they had.
I got flack about that too because there were plenty of people who felt that religion had no place in this work. I told them, “I’m an atheist, this isn’t about religion.” But I know of at least a couple of other clinics that developed sanctuary rooms like ours.
I never danced around the fact that we dealt with life and death. It was big stuff we were dealing with. Sometimes we had only minutes to talk with the patients. The majority of them had done a lot of thinking and talking already and didn’t need more by the time we saw them, but nevertheless I wanted to create a space where her decision and his decision would be respected.
Any time a patient asked to see the tissue we said yes. There weren’t very many who asked, but I was the one who did that. Then I would say, I’ll be outside. You knock on the door when you’re done. I loved doing that because it was giving them permission to participate in their own goodbye.
Tarico: Five years out from an abortion, relief appears to be the most common feeling looking back. Eighty four percent of women report positive or neutral emotions. Even so, many also say that it was hard and complicated at the time, and a small percent carry regret long term. I don’t know what these statistics might be for men.
We may look back with regret on any major life decision, a marriage, for example, or a divorce, or a job, or a move or even becoming a parent (called parental regret). But with abortion, additional factors come into play. Parenthood is one of life’s most cherished and consuming dimensions, and everything else gets tangled up in it. Also, pregnancy is imbued with religious and moral significance, and real harm can follow when people violate their own beliefs and values. This is one reason that those considering an abortion should be offered space to process both before and after and support for choosing other paths. Abortion counselor Charlotte Taft speaks beautifully about the depth and complexity of these decisions for some, including men.
Coming from my background in family therapy, it seems completely intuitive that men as well as women might need to be supported through this process. Surely we can do that in ways that respect bodily autonomy for pregnant people. Why do you think it was so difficult to make this dimension of the work a norm?
Keyes: I’ve been retired from this work for more than ten years. But during my time working in the field there were definitely clinics where the staff had less say-so and doctors were narrowly focused on the medical aspects. Addressing these broader dimensions does cost more. Nobody was making money on abortions. The rent and salaries and medical equipment were a given, but there were different kinds of owner arrangements, and the last thing they wanted was more expense and space for counseling rooms.
Tarico: Give me your thoughts about the political implications of this work.
Keyes: How can we expect men to be pro-choice when we didn’t invite them into education, information, question sessions? I felt this strongly, so we did our best around that. For a long time I continued proselytizing that it was something I felt was important not only for patients but also because we were losing political support.
Now, the society we live in is so oppositional, and so many people are coming into relationships unprepared. A lot of them come from families that weren’t happy households. I would like to see a society where men and women and others all just have some basic respect for each other and can communicate.
Just having gone through this ‘happy days are here again’ Democratic National Convention, all the right words were out there, after living with the hateful behavior that was so destructive to this country — and Trump might win anyhow. Men don’t feel valued. And they can’t get a job that will pay them enough to live on, and there’s no security. Sometimes where there have been initiatives to raise up girls (initiatives that leave out boys), there has been pushback for that: You are thinking of a different time or a different set of boys and men. It’s worth paying attention to. Because they really do have it tough.
When I first started running the clinic we used to see a real cross section of women — lawyers, doctors, professors. There was this great feeling of equality. As time went on, the wealthy women had private abortions elsewhere and the patient population got poorer and poorer. Over time it was really the poor who needed abortions rather than the wealthy. Maybe that is just because the country itself has gotten poorer and poorer, when you look at how $7.25 is still the minimum wage in some places.
Tarico: Another part of the class divide here is who has access to top tier contraceptives. I have a wealthy friend who once said, “My mother took my friends to get their abortions, whereas I took my daughter’s friends to get their IUDs.” But young people whose lives are harder may not have someone to help them navigate that or pay the upfront cost. Or they may be part of communities that are more wary of the medical establishment. So, they are using methods that have more pregnancy risk.
Is there anything else you might like to add here?
Keyes: I’m old; I’ve been doing this forever, and now I’ll be turning 82 in two months. But there are days out of the blue that I will wake up and say, “How was I so lucky to have the job of my life with those doctors and those staff?” So many of my staff ended up as educators or in the medical field. It’s like my progeny are out there carrying forward the same work from a similar perspective, beginning from a feminist environment and serving whoever they are working with — patients or students. Other than my kids it was the best thing that ever happened to me in my life.
Postscript: A response from Chris Charbonneau, former CEO of Seattle affiliate of Planned Parenthood
Chris Charbonneau, now Executive Director of Reprohub.org, directed the Planned Parenthood affiliate headquartered in Seattle for more than 30 years. Clinics in her organization served over 70,000 people annually for reproductive health care ranging from contraceptive counseling to STI testing, to abortion, to cancer screenings. I asked Chris to comment on my interview with Claire from the vantage of her own experience. Here is what she said:
I so related to what Claire Keyes said. As I was coming to the part about men being invited into the exam rooms, I was thinking — we did that too, but so many of them fainted! Then I read that she had the same experience. We finally said that men could come in, but we made them sit on chairs. Fainting while seated was less likely to cause injury and force a sudden scramble for staff, having now two patients on their hands. However, I think it revealed what a profound and emotional experience it is also for some men.
When men are involved, the whole process is smoother. They are experiencing a loss too, and the fact that he is involved at all says that whatever the experience means to this couple, they are going to go through it together.
The vast majority of the time when we saw men taking a different position about an abortion, it was because the couple was splitting up, and the pregnancy outcome was likely to be a part of the couple being adversarial with each other. Couples who were staying together decided together.
We never worried about the women mixing it up with the protesters, but the men did, whether they were dads or partners. I think that speaks to feeling helpless, angry, sad, and having nowhere to go with those emotions. Having someone yelling at his daughter/girlfriend/wife was just too much, and many of these guys lashed out verbally or physically.
Lastly, being able to access abortion or not impacts a man’s future too: his position in family creation, his finances, and finally his sense of himself as a man, however he defines that for himself.
Claire Keyes sounds like she ran a wonderful service. I see nothing inaccurate in your interview with her.
– Chris Charbonneau