Kate Clancy is one of my favorite bloggers. An anthropology professor at the University of Illinois, she studies the evolution of female reproductive anatomy. Her blog covers science I don't see anywhere else—the human evolution, cultural anthropology, and behavioral science behind ladybusiness.

So Clancy's blog was one of the first places I looked yesterday after reading about Missouri Rep. Todd Akin thoughtful commentary on female biology. In a long, well-written, and (fair warning) rather graphic post, Clancy talks about what we know about rape—think of it this way, you know way more people who have been raped than who have a gluten intolerance—and the way that emotional trauma affects conception and pregnancy.

First off, there is absolutely no difference in the rate of conception between women who have been raped and those who had consensual sex. Clancy breaks this down nicely in her blog post, and even offers a surprising tidbit from the research literature that all people should consider—at any given day in a woman's cycle (even days when she is supposedly "infertile") there's about a 3% chance of unprotected sex leading to a pregnancy.

The impact of stress on miscarriage is a lot messier. I've mentioned here before that we know very, very little about miscarriage, relative to a lot of other medical issues. To paraphrase my family practice doc, when you start talking about conception and miscarriage you very quickly wander past the small amount of hard evidence and straight into voodoo. And also into the counter-intuitive nature of reality. For instance, from reading Jon Cohen's excellent book on miscarriage science, Coming to Term, I know that one of the very few miscarriage interventions that's ever performed better than placebo in multiple trials is something called "Tender Loving Care". The idea: For whatever reason, women who have had recurrent miscarriages have a greater chance of carrying the next pregnancy to term if they have regular access to mental health services, stress-relieving practices like meditation, and doctors who listen and respond to their fears. But that's not the same thing as saying that stress, or a scare, or a severe mental trauma will, inevitably, cause a miscarriage. Here's Kate Clancy:

Yes, psychosocial stress is associated with fetal loss in some samples. That is not the same thing as saying that stress causes fetal loss. Some women are more reactive to stress than others, and this seems to be based on genes and early childhood experiences. As I pointed out in my post, it certainly isn’t something women have conscious control over. And so it is irrational to link the stress of rape, while awful and severe, to fetal loss, when we understand the mechanism of the stress response and its relationship to pregnancy so poorly, and when we know next to nothing regarding how variation in stress reactivity is produced.

Basically, while stress (and the associated hormones) are correlated with a higher risk of miscarriage in some (but not all) studies, that seems to have more to do with an individual's biological makeup than it does with the source of the stress. And, frankly, we barely know enough to even say that.

• Read the rest of Kate Clancy's post on the rape and pregnancy

• Read Clancy's earlier (excellent) post on miscarriage

• Read Jon Cohen's book, Coming to Term. (I keep recommending this, but, seriously, it's wonderful. And a hugely sane-making force in my life.)

About a month ago, I wrote here about my struggle to decide what to do after I found out that my pregnancy wasn't going to be viable. This morning, I went on New Hampshire Public Radio's Word of Mouth to talk about that decision, miscarriage in general, and some of the ways that this issue connects to larger discussions in the public realm.

Word of Mouth doesn't have embedding available, but you can go to their website and listen to the full interview. One of the key things that I got to talk about today that I didn't mention in my previous post is the way that anti-abortion laws have huge (presumably unintended) consequences for women who miscarry. Case in point: Fetal personhood. If you give a fetus all the rights of a living human from the moment of conception, how do you deal with the fact that some 50% of conceptions end in miscarriage? Today, if a living human being dies and we don't know why, there's an investigation into the nature of their death, to make sure it wasn't caused by foul play. Under some of these proposed laws, women like me would have to spend the incredibly painful weeks after a miscarriage attempting to prove that we didn't cause it. That gets doubly difficult when you consider the fact that, quite often, nobody knows why a specific woman miscarried. Around 50% of miscarriages are caused by random chromosomal mutations. But we have no idea why that happens (or why it happens to some women multiple times), and that also leaves a big, hard-to-diagnose group of women who would have no way of proving that they didn't cause their miscarriage.

In fact, being able to choose to have an abortion—to get a D&C procedure instead of waiting for the miscarriage to happen naturally—was actually what enabled me to know what caused my miscarriage. Having a D&C makes it easier for doctors to collect enough fetal tissue that they can run a genetic analysis on it. Last week, I got back the results of the chromosomal analysis performed on my fetus. Turns out, he had a mutation, Trisomy 16, that was completely incompatible with life. That trisomy is the most common genetic cause of miscarriage. It's also completely random. Basically, my miscarriage was bad luck. Knowing that makes me feel so much better. It's almost hard to describe the relief. And I owe that to an abortion.

Read my earlier post about my miscarriage

Listen to the interview on Word of Mouth

As I write this, it is 1:17 am on Wednesday, June 20th, 2012.

I am lying awake in bed, trying to decide whether or not to have an abortion.

Of course, we don’t call it an abortion. We call it “a procedure” or a D&C. See, my potential abortion is one of the good abortions. I’m 31 years old. I’m married. These days, I’m pretty well off. I would very much like to stay pregnant right now. In fact, I have just spent the last year—following an earlier miscarriage—trying rather desperately to get pregnant.

Unfortunately, the doctors tell me that what I am now pregnant with is not going to survive. Last week, I had an ultrasound, I was almost 6 weeks along and looked okay. The only thing was that the heartbeat was slow. It wasn’t a huge deal. Heartbeats start slow, usually around the 6th week, and then they speed up. But my doctor asked me to come back in this week for a follow up, just to be sure. That was Tuesday, yesterday. Still my today. The heart hasn’t sped up. The fetus hasn’t grown. The egg yolk is now bigger than the fetus, which usually indicates a chromosomal abnormality. Basically, this fetus is going to die. I am going to have a miscarriage. It’s just a matter of when.

Because of these facts—all these facts—I get special privileges, compared to other women seeking abortion in the state of Minnesota.

Nobody has to tell my parents. I am not subject to a 24-hour waiting period. I do not have to sit passively while someone describes the gestational stage that my fetus is at, presents me with a laundry list of possible side-effects (some medically legit, some not), lectures me on all the other options that must have just slipped my mind, or forces me to look at enlarged, color photographs of healthy fetuses.

Because I have health insurance, I can afford a very nice OB/GYN whom I chose and who does not exercise her right to deny me this option. Thankfully, I don't live in a state where she can legally lie to me about the status of my fetus, to dissuade me from having an abortion.

Most importantly, from my perspective, I have the privilege of a private abortion in a nondescript medical office. I will not have to go to an abortion clinic. I will not have to walk by any protesters—not even Charlie, the one guy who is paid to protest every day outside Minneapolis’ abortion clinic, where I have volunteered as an escort in the past.

Most of these privileges boil down to the fact that, as far as my doctor and my medical billing are concerned, this is not an elective procedure.

But here’s the thing. It is elective.

I don’t have to do this. I am making a decision. Plain and simple. An incredibly awful, heart-wrenching decision with positives and negatives no matter which option I choose.

Having an abortion would get this miscarriage over with quickly. That’s important, as I’m leaving for a speaking engagement this weekend and am rather apprehensive about the risk of miscarrying, all by myself, in Aspen, Colorado, in an environment where I am supposed to be on professional behavior. (Uncontrollable sobbing doesn’t really fit with the image of competent journalist.) Most likely, there would be less pain and less bleeding. That’s also a big deal. My last miscarriage happened at 4 weeks along. I woke up in the middle of the night wanting to scream and almost vomiting from the pain. I bled for nearly two weeks after that. My guess is that these effects are not weaker for a 7-week miscarriage. Finally, even if I wait this out, there’s still a pretty decent chance that I end up having to get an abortion after all. It’s not uncommon for miscarriages like this to take too long to start, or not finish completely on their own. With just enough bad luck, I might get to experience both options.

On the other hand, I’m scared. This is surgery. Surgery is scary. There are small but very real-feeling risks involved: Reaction to anesthesia, infections, and in rare cases some women develop scar tissue in their uterus that can make it hard to get pregnant again. That might be the biggest fear for me, honestly. It took 5 months to get pregnant the first time. It was a year after that miscarriage before this pregnancy happened. I know that, for the most part, this is random chance. I have bad luck. But part of me is terrified of anything that might make this process harder than it already is. Also: Psychologically, I’m still clinging to this pregnancy. I want the doctors to be wrong. I want to have one of those miracles where everything turns out to be okay and I am relieved to find that I haven’t actually lost everything.

Right now, at 2:06 am, I’m leaning towards a compromise. I think I probably want the abortion. I don’t think I want to have to jump from thinking I had a viable pregnancy to having an abortion in a span of two days. My husband has offered to cancel his own business trip and come to Aspen with me. Maybe I’ll take him up on that, and wait until I get home on Monday to do a final ultrasound and get the abortion. I have a list of questions to ask my doctor in the morning. This decision is entirely dependent upon her answers, but I think it’s the right one for me.

That was a lot of TMI, I know. But I am telling you this to press a point.

I am making a decision.

The only thing that makes my abortion decision different from anyone else’s abortion decision is that some people who are against abortion will think that my abortion is acceptable.

Some. Not all. Maybe not even most. I honestly have no idea. My life is not in danger, after all. I have not been raped. I merely think that I might not want to sit around, feeling the symptoms of pregnancy, for god knows how long, until a heartbeat stops and the ripping pain kicks in and the blood starts flowing on its own.

Let me be clear. I have options. It’s just that they all suck. That’s kind of how bad news related to pregnancy works.

If you are pregnant, and do not want to be, all of your options suck.*

If you cannot seem to get pregnant, and want to be, all of your options suck.**

If you are pregnant, and won’t be soon, all of your options suck.

There is no universal good option. There is no universal bad option. But for each individual there is an option that is the least bad. Here is why I am pro-choice. If someone has to make a decision and the best they can hope for is the least-bad option, I don’t believe I have any business making that choice for them.

My abortion is not a good abortion. It's just an abortion. And there's no reason to treat the decision I have to make any differently than the decisions made by any other woman.

*I’ve known women who had abortions, women who gave a baby up for adoption, and women who raised an unintended baby on their own. None of those options are easy. None of those options are any less painful, traumatizing, or side-effect filled than any of the others. They only seem that way to people who haven’t experienced them.

**Whether you try low-level infertility treatments, IVF and donors, start looking for an adoption, or accept a life of unchosen childlessness, you are going to experience a lot of stress and you are going to have to give things up and grieve. You will probably need to chat with a therapist. None of these options is easier than the others. It just looks that way to people who haven’t experienced them.

• This post isn't really about miscarriage, specifically. But part of why I wrote it was to break some of the silence surrounding what I like to call The World's Shittiest Secret Society. As many as 50% of conceptions end in miscarriage. Most likely, that's not because of any outside forces. It's just because of the way nature works. If this has happened to you, you are not alone. If you have had a miscarriage, and are struggling with processing this thing, then I really think you should read Jon Cohen's Coming to Term: Uncovering the Truth About Miscarriage. Cohen's wife had four miscarriages in a row before the birth of their second child. His book provides an evidence-based, sane-making perspective on what we do and don't know about miscarriage and it provides many, many reasons for hope. In particular, the fact that Cohen's wife's experience isn't extraordinary. Even if you have four miscarriages in a row, you've still got a greater than 70% chance of having a perfectly normal, healthy pregnancy the next time out. Miscarriage is weird, and it's horribly painful. If you're anything like me, learning as much as you can about it helps.