Population Matters-USA – working for a sustainable world

Image from the Plan C website.

“A safe abortion with pills requires only three things: accurate information, quality medications, and mutual respect and trust.” Doctors Without Borders

In the past there was a sharp division between safe (legal) abortions and unsafe (illegal) abortions. Recently that line has been blurred with Self-Managed Abortions (SMAs).

Even when abortion was legal all over the USA, there were occasional women who would try to abort a pregnancy outside the medical system. Most commonly they would use herbs or misoprostol, the prescription-only medication that is sometimes available on the black market. Here’s an example:

June, a 26-year-old woman, went to her doctor who only recommended that she continue her unplanned pregnancy to term. To paraphrase her quote in a study of SMA, “I did some stuff on my own because I didn’t think she would help me get the abortion I wanted.” She took antibiotic pills and ibuprofen after she had a positive pregnancy test, but ended up going to an abortion clinic when her SMA didn’t work.

Other women in the same small study tried to abort unintended pregnancies using: vitamin C, parsley tea, multiple contraceptive tablets, dong quai, black cohosh, gingerroot and alcohol. Sometimes bleeding started and sometimes it didn’t. Since not all of the women had taken a pregnancy test before trying SMA, it is impossible to know the effectiveness of their attempts to abort. Fortunately, none of the woman had a bad effect from their attempts at SMA. Oil of pennyroyal is known to be an effective abortifacient; however, it has also known to sometimes be fatal for the woman who takes it.

Fortunately, medication abortion using mifepristone and misoprostol is safe and effective. The combination was approved by the FDA in 2000. As more and more women used this combination it became clear that it is very safe—especially when compared to carrying a pregnancy to term.

Recently the combination has been approved for “telemedicine”. Contact between a woman with an unintended pregnancy and her healthcare provider can be by electronic means, similar to Zoom. The provider asks questions such as when the woman’s last period was, as well as about her general health. If the person is a candidate for medication abortion, the appropriate pills can then be sent to her, with clear written instructions how they should be taken. The instructions also tell the woman what to expect, and when she should seek emergency care.

How safe and effective are telemedicine abortions? In a study of over 6000 women who did not visit a clinic in person, they found no difference from women who had face-to-face contact with a healthcare provider. Only 2 of 1000 women had a serious adverse event, and the success rate of causing an abortion was almost 98%. These figures are similar to studies of medication abortion in which patients visited a clinic.

Telemedicine has reduced the cost to obtain an abortion—the interview can be done from the woman’s home so little time and no travel are required. The pills are shipped by a delivery service or mail, and will arrive in a few days, allowing the woman to choose when to start her abortion. But the real advantage of telemedicine is for people who live in states where this necessary part of healthcare is severely limited or illegal.

Doctors Without Borders has a series of videos on SMA, available at: https://www.doctorswithoutborders.org/latest/how-have-safe-self-managed-abortion. Although DWB mainly works in developing countries, this information also applies to some states in the US. The nonprofit Plan C supports SMA by providing information about access to abortion pills, including their cost.

©Richard Grossman MD, 2024

The Truth about Abortion

Dr. C. Everett Koop was President Ronald Reagan’s Surgeon General for most of his 2 terms. An excellent pediatric surgeon, Dr. Koop had very strong anti-abortion beliefs, consistent with Reagan’s.

Reagan asked Koop to research the psychological and physical harm that abortion does to women. When Koop did not find the substantiation he had expected, he refused to publish his findings. He is reported to have commented about the value of studies done by antiabortion people, mentioning ”… the poor quality of their research evidence….”

When the report was made public, Koop stated: ”There is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material.”

The world needed to wait more than 30 years to get good scientific evidence about abortion’s lack of psychological damage to women. Dr. Diana Greene Foster and a team of social scientists at the University of California, San Francisco, have finally done the research that was needed to determine the sociological and psychological safety of abortion. Their findings are good news for women.

The physical safety of abortion had already been determined. Despite what some people think, having an abortion is much, much safer than giving birth. It was only the psychological and economic effects that were in question in Koop’s era.

The work of Dr. Foster and her group is outlined in a short TED talk, “What Happens When We Deny People Abortions?” In addition, her book The Turnaway Study (2020) is very readable; it intermixes their findings with short case histories of study women.

What is the best way to investigate the effect of abortion on women? You need to compare two sets of women. One group would be women with unintended pregnancies who had abortion care. The other group would also want to abort their pregnancies, but not be able to do so. Foster and her group found these two groups, and carefully followed each woman for 5 years. They recruited women from abortion clinics all over the USA. Each clinic has a gestational limit. Members of the first group were just under that limit; women had their desired abortions. Women in the control group were less fortunate. They were just over the limit, so could not have an abortion, and the nearest clinic where the abortion could be performed was too far away for them to travel. They were turned away and later delivered.

The findings were conclusive:

Most women who have an abortion do not regret having had it.
Having an abortion did not tend to cause psychological harm.
Women who wanted an abortion, but did not receive it, had an increase in poverty.
Being denied an abortion makes it more likely that a woman will stay with an abusive partner, and more likely that a woman will be a single parent without family support.
Children born as a result of abortion denial are more likely to live below the federal poverty level and experience poor maternal bonding.
More than half of women who seek abortions are already parenting children. This study found that the financial wellbeing and development of these older children are negatively impacted when their mothers are denied abortion.

Let’s hope that there will be no more deceit about abortion. Not only does abortion help women, but it also helps the children who preexisted the aborted pregnancy, or who were born after. The saddest finding of the Turnaway Study is that two of the women who were forced to carry unintended pregnancies died as a result of those pregnancies.