There are three ways your average 16-year-old sexually active girl approaches gynecological care. There are those who sit down with their mothers and discuss their sex lives. Then they visit the family doctor. This does happen, but not often.
Those in the second group do nothing. They are believers in luck and the efficacy of standing up afterward. Many of them get pregnant.
The third group go to Planned Parenthood. This was true when I was 16, and it is true today.
In the South Bronx, Planned Parenthood has a center called The Hub, which serves 6,000 women a year. Nearly all are poor, are black or Latino and live in a neighborhood that has the distinction of having one of the highest teen-age pregnancy rates in the nation. Some of them come for birth control. Some come for prenatal care. And some come for abortions.
Although it has now become folk wisdom among middle-class white Americans that poor teen-agers of color spend all their time having babies so they can live in luxury on public assistance, The Hub center gives the lie to that notion.
About 80 percent of those who discover they are pregnant there decide to end the pregnancy.
Dr. Irving Rust has been The Hub's medical director for 12 years, and on Tuesday he watched from the gallery at the U.S. Supreme Court as he became part of history. The case is called Rust vs. Sullivan, and it challenges regulations barring family planning clinics that receive federal funds from providing patients with any information _ ANY information _ about abortion.
Rust's clinic receives a quarter of its funding from the federal government. So, no matter what a woman's situation, state of health or state of mind, he's supposed to say nothing about abortion.
Actually, that's not entirely true. The regulations do provide for this boilerplate response: "The project does not consider abortion an appropriate method of family planning."
Rust vs. Sullivan is a case about free speech sold out for political expediency. It has long been manifest that George Bush has no strong feelings about abortion; he does, however, have strong feelings about winning elections. His support of these regulations, proposed during the Reagan years, is meant to convince those opposed to abortion that the president is a true believer.
This is also a case about medical responsibility. Justice David Souter seemed dissatisfied when the solicitor general said that a federally funded clinic could not even recommend abortion to a woman whose health would be threatened by pregnancy. "You are telling us that a physician can't perform his usual professional responsibility," Souter said.
But ultimately this is a case about spitting in the face of the law. The government demands that doctors like Irving Rust trade free speech and professional responsibility for scarce federal funds. It has not yet managed to make abortion illegal, so it has decided merely to behave as if it were.
Rust remembers when it was. He was a resident in a hospital in the Bronx, and he remembers performing hysterectomies on women who had tried to abort themselves. He remembers the women who came in with septic shock and wound up in the morgue.
Now the government says that when this man hears a woman, no matter how young, how poor or how desperate, say, "Doctor, I really need an abortion," he is supposed to say nothing.
"I couldn't do that," says Rust. "It would be wrong."
Finally, a sincere answer.
New York Times News Service