“Mommy, Mommy! There’s a baby in my tummy!” my 4-year-old daughter declared recently, pointing to the lump under her T-shirt where she’d stuffed her favorite doll. “Oh look!” she shrieked, dropping the doll on the floor. “It’s coming out my vagina!”
My 2-year-old son, who parrots his sister’s every move, squatted and dropped a Spider-Man action figurine from under his shirt. “Oh look!” he crowed. “It’s coming out my vagina too!”
So far, this has been my kids’ understanding of pregnancy and childbirth: that a baby grows inside its mother’s body and eventually comes out of her vagina. It seemed to me like a good enough start—until recently.
I’m an abortion doctor. This spring, as I watched my kids play, I suddenly felt a new urgency about explaining pregnancy and reproduction to them in terms they could understand. They had already started hearing the word abortion more frequently over the preceding year. In an almost inevitable post-Roe world, I expect them to encounter messages that seek to demonize and even criminalize abortion providers like me. I want them to be able to make sense of those messages when they come.
So, even at their young ages, I decided to figure out where to start.
On Mother’s Day this year, my best friend and I took a walk through the streets of her neighborhood in Oakland, California. It had been less than a week since the leaked draft of a Supreme Court decision that would overturn Roe v. Wade. We’d left our kids with our husbands to get this time together—to mourn the imminent loss of our reproductive rights (or what’s left of them in this country) and discuss what to do next. We were both planning to attend local rallies the following weekend with our preschool-aged kids. “How are you talking to them about all this?” she asked me. “How will you explain what the rally is about?”
I admitted that I haven’t yet talked to my kids about “all this.” They barely understand the concept of pregnancy, I told her. And when I use words like justice and autonomy, their eyes start to glaze over.
She pointed out that in anti-racism education, which is a big part of her work, adults are encouraged to use simple concepts (like skin color and fair/unfair) as building blocks with young kids, to construct more nuanced concepts (like racism and justice/injustice) as the kids get older. I began to think about the building blocks I could use to introduce my kids to the concepts of abortion and, more broadly, reproductive justice.
The first building block occurred to me right away. That very morning, my daughter had wandered into the bathroom just as I was about to change a tampon. Not normally shy in front of my kids, I found myself hesitating to pull out a blood-soaked pellet of gauze in front of her. I thought of all the questions it would provoke, the discomfort and even fear it might cause her.
As I thought about it more, I saw how silly my hesitation was. If I want to introduce my daughter to my work and to her body, then ovulation and menstruation are the most fundamental building blocks of all—and relatively easy to talk about, since they involve concepts that are already familiar to a 4-year-old.
Nearly every preschooler knows that a baby chick hatches from an egg. It’s a simple next step to explain that some human bodies also have eggs inside of them. (An excellent children’s book by Cory Silverberg, What Makes a Baby, uses simple, inclusive language to break this down for kids.) When a human egg has everything it needs to grow—including sperm, but this isn’t a crucial point for young kids who aren’t yet asking about sex—the egg can become a baby. Most eggs, however, fall out of the body and never become a baby. When the egg falls out, some blood comes out with it.
I tried this out on my daughter a few days ago. A habitual scab picker, she nodded appreciatively when I explained that the egg that falls out is like a scab: Some blood comes out with it, but the bleeding soon stops on its own.
Armed with these simple concepts, a bloody tampon doesn’t seem like such an inexplicable or frightening thing. Mommy’s egg is falling out. It bleeds like a scab, but it will stop.
From there, it’s a small jump to introduce the idea of miscarriage: that an egg can start to grow, but if something goes wrong, the egg falls out of the vagina, along with some blood; the pregnancy is over. The medical concept of an abortion takes just one more step: If someone doesn’t want to be pregnant, a doctor or nurse can give her pills to make her bleed, or we can use a small, clean straw (an accurate, easy-to-visualize picture of 90 percent of abortion procedures) to reach inside her body and take the baby out.
As I was thinking through all of this out loud with my friend, she interrupted: “I thought you weren’t supposed to use the word baby when you talk about abortion.”
She’s right—mostly. When I counsel my abortion patients, I always begin by using the terms embryo or fetus, or often simply the pregnancy, which are the medically accurate terms for what she carries in her body. But, I told my friend, I have no problem using the word baby if that’s the word that makes the most sense to a patient. If she calls it her baby, then it feels elitist or even callous for me to keep insisting on calling it something else. For the most part, I’ll use the word she uses, out of respect for her experience and understanding.
Another way of saying this is that as a doctor, I try to take my patient’s lead when choosing my words. As a parent, I do the same. (We all do. This comes quite naturally when talking with young children.) If the point is to introduce my kids to abortion in terms they can understand, then baby seems like the right word to use, at least for now. As they get older and start learning higher-level concepts—think basic elementary school science like tadpoles and frogs—I’ll introduce the words embryo and fetus.
But I know these words are not going to protect me from the hard questions that will come eventually: Is it really a baby? Is the baby alive? Is abortion the same thing as killing a baby?
I can’t avoid those questions, nor do I want to. As far as I’m concerned, that’s where the real, useful conversations start.
A colleague of mine, a mother of two teenagers, told me recently that her kids started posing these hard questions around age 12. “It wasn’t until puberty, when the stuff I was saying at home and the stuff they’re hearing at school, and seeing their bodies changing—that’s when it all becomes kind of real. And at precisely the same time, their brains go from being very concrete to allowing more abstract thinking.”
She and her family live a few blocks from a Planned Parenthood clinic, where, from a young age, they would frequently see protesters waving signs on the sidewalk. Her kids would ask about the pictures on the signs and, once they could read, about the words. “And so I would have to explain the signs to them, and what they were about,” my colleague told me.
Years later, her daughter now says she doesn’t remember any of these early conversations. “So it’s an iterative process,” my colleague said, “and a repetitive conversation over time. You think you’re making these magical connections, but most of the time you’re missing them. And occasionally, it’s clicking.”
This colleague also happens to teach a short unit on abortion to sophomores at her kids’ (private) high school. After giving them some brief introductory materials, she lets the students direct the curriculum with their own questions. They ask everything from how the procedure works (she brings in her handheld equipment to show them) to how she feels when she sees and handles an aborted fetus. “They want to know, ‘What is it to you? Is it a baby? Is it a life?’ ”
She answers them as best she can. But it seems to me that the genius of her approach lies in letting the students come up with the questions themselves, rather than imposing her own agenda. I can think of no better way to demonstrate the principles of abortion care to young people than this: making it a conversation about their priorities, their values, their decisions.
There are no easy answers to the thorny questions, the deep emotional complexities and ethical dilemmas that abortion presents. As my colleague taught me, it’s OK to answer these questions with “I don’t know” or, even better, “What do you think?” It’s not my job to help my children land on one side or the other of the morality of abortion. I will be absolutely fine if my daughter eventually decides that abortion feels morally wrong to her, as long as she understands that she gets to decide only for herself—not for anyone else.
That conversation isn’t really about abortion, though. It’s about reproductive justice.
When it comes to talking to kids about justice, my best friend in Oakland has much more experience than I do. A former public school teacher who now works to advance education equity in California’s school districts, she is the one I turned to a few years ago when I first started seeking out resources for talking to kids about race and racism.
These same resources have a lot to offer on why and how to talk to kids about reproductive justice. The salient points are: Silence is a message. If adults don’t talk about race and racism, or miscarriage and abortion, kids will make up their own stories to explain what they see and hear in the world around them. The goal isn’t to ask young children to grapple with exceedingly complex or nuanced concepts. The goal is to show them that we, the adults they trust, aren’t afraid of these difficult topics, and to assure them that they can ask us questions when they arise—as they inevitably will.
Discussion of reproductive justice can start with the same principles. Very young kids understand fair and unfair. We can teach them that when some people are treated differently than others, this is unfair. When the law tells women what they can and can’t do with their bodies, including when they can and cannot have children, this is unfair. Every person should get to decide when and whether they have children, and every person should have the right to raise their children in a safe, healthy community. This is fair.
In 2021, the author Carly Manes and illustrator Emulsify created a children’s book called What’s an Abortion, Anyway? I came across it because the authors sent a copy to every abortion clinic in the country, with the idea that kids waiting with their mothers in the lobby could pick up a beautiful, factual, nonjudgmental resource about the events and emotions they were witnessing in their lives. Although it touches on some facts about reproduction and abortion, What’s an Abortion, Anyway? is really a kids’ primer on reproductive justice: “No matter the reason, everyone should be able to make this decision for themselves,” it reads. “No matter how someone feels about their abortion, they deserve to be treated with love and respect.”
As I left my walk with my best friend, I made a Mother’s Day resolution to begin talking and reading books with my kids about what I do—and more importantly, why. Why do I provide abortions? Why do I care about abortion as a fundamental human right, which should be accessible and legal for everyone? These aren’t conversations about sex or science. They’re conversations about justice.
I encourage all parents to start these conversations now: not just what an abortion is but why it matters. On the eve of the overturn of Roe, abortion rights supporters are looking at a long-haul legislative fight. It may take generations to accomplish any kind of pendulum shift. Now is the time to prepare children to understand and eventually to vote on abortion as a matter of reproductive justice—so that they will, in five or 10 or 15 years, insist that their government representatives do the same.
Above all, the lesson I want to teach my kids is summed up in the final line of What’s an Abortion, Anyway?—and is the guiding principle of my work as a doctor and as a mother: “We can never really know what it is like to be someone else.”