This first piece was initially written by Seattle psychologist and ReproHub board member Valerie Tarico for Washington Initiative for Boys and Men. While often seen as a “women’s issue,” being able to access abortion also impacts a man’s future. The reflections below are from Claire Keyes, former director of Allegheny Reproductive Health Center.
An Interview with Clinic Director Claire Keyes
Pre-Roe, Claire Keyes volunteered in a feisty street clinic that connected Pittsburgh women to abortions. In 1978, five years after the Roe v. Wade decision, 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. In her role at Allegheny, and in defiance of equally fierce, feminist peers, she refused to exclude men from abortion counseling and procedure rooms.
Today, almost half a century later, Allegheny’s approach under Keyes — the focus on including men — is 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 pregnant person — men often play a role in still supporting their partner. All the while, they must contend with their own feelings, which may include shame, fear, loss, grief, relief, guilt, anger, inadequacy and more. 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.
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. 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.
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…
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.
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.
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. 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 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. I loved that little broom closet sanctuary because I think it gave permission to the patient or couple or relative to feel whatever feelings they had.
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 all people just have some basic respect for each other and can communicate.
Right now, 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.