Abortion Action Public Health

How to Laugh at a Senator

            Have you ever wanted to slap an elected official with whom you disagree—or do something more than just slap them? Well, some AIDS activists made a big splash when they rebelled against a legislator.

            Jesse Helms was a conservative US senator from North Carolina who opposed gay rights and access to abortion care. His stance against HIV research angered campaigners to take an extreme and humorous action. In 1991 they inflated a huge condom over Helms’ house! On the side of Helms’ condom was this writing: A CONDOM TO STOP UNSAFE POLITICS: HELMS IS DEADLIER THAN A VIRUS.

            Helms was no friend of reproductive rights. In 1973 he wrote an amendment to the Foreign Assistance Act; it prohibits the use of foreign assistance funds to pay for abortions. This amendment was in response to the Roe v. Wade decision that same year, that made abortion legal throughout the USA. Unfortunately, his Amendment forced many people to seek dangerous “back alley” abortions. By limiting access to safe abortion care, Helms caused thousands of maternal deaths. 

            There is another even worse policy that limits access to reproductive health. It amplifies the Helm’s Amendment, and then extended limitations to the U.S.! The Mexico City Policy, also known as the “Global Gag Rule” (GGR), was passed in 1984 and goes a step further than the Helms Amendment. The GGR bans foreign aid to any nonprofit that provides any aspect of abortion care. It prohibits informing women about abortion or making referrals to abortion providers. The GGR even prohibits advocating for decriminalization of abortion or working to expand safe abortion services.

            Ronald Reagan initiated the GGR in 1984 by means of a presidential memorandum. Since it was established by executive order, it can also be undone in the same way. Indeed, every Democratic president since then has rescinded the GGR, which then was reestablished by the next Republican president. Fortunately, the GGR is not in effect now since our president is a Democrat.

            Two brave Democrats, Cory Booker (New Jersey) in the Senate and Jan Schakowsky (Illinois) in the House introduced bills named “Abortion is Health Care Everywhere Act”. They started in 2020 and then reintroduced the same bills every Congress since then. These Acts could repeal the Helms Amendment and substitute language stating that U.S. foreign assistance can be used to provide abortion as part of comprehensive reproductive health care.

            Although these bills seem to be lost in committee, it would be wonderful to see them passed and eventually become law. I realize that this is very unlikely in today’s political climate, but I have hope that people will rise up and once more safe abortion care will be legal in every state.

Although not all obstetricians and gynecologists are prochoice, the large majority of my specialty is. Our professional organization, the American College of Obstetricians and Gynecologists (ACOG) has a policy which supports access to abortion care. I would like to end this essay with the words at the end of the ACOG policy:

“ACOG supports every person’s right to decide whether to have children, the number and spacing of children, and to have the information, education, and access to health services to make these decisions. Individuals seeking abortion must be afforded privacy, dignity, respect, and support, and should be able to make their medical decisions without undue interference by outside parties. ACOG advocates to improve access to full-spectrum reproductive services, to integrate abortion as a component of mainstream medical care, and to oppose and overturn efforts restricting access to abortion.”

© Richard Grossman MD, 2023

Abortion Reproductive Health Women's Issues

Investigate Illegal Abortion

In the early 1990s I read about women who were using a medication to cause abortions without visiting a doctor. Brazilian women had found that misoprostol (CytotecÒ) was available without a prescription, and would cause strong uterine contractions that could expel an early pregnancy.

Since then, this knowledge has spread to all corners of the globe. Misoprostol is now approved by the US Food and Drug Administration for use in conjunction with mifepristone to be prescribed for legal abortions. This combination has been found to be both very effective and very safe. Recognizing the safety of this combination, the FDA has decreased restrictions on mifepristone. The combination can also now be prescribed by telemedicine. However, misoprostol is almost as effective when used alone.

The original indication for misoprostol had nothing to do with abortion. Instead, it was found to protect the stomach lining in people who had irritation from NSAIDs, such as ibuprofen. It has other uses, including induction of labor (in a teeny dose) and is a lifesaver for treating postpartum hemorrhage.

A Honduran friend sent me the transcript of a BBC News Program, “Inside Honduras’s abortion pill black market.” Abortion is illegal under all circumstances in this Central American country—the most restrictive law in the world. Having an abortion is punishable by 6 years in prison. Although “back ally” surgical abortions may still occur, this excellent piece of investigative journalism is about medication abortion. Only misoprostol is available in Honduras, not mifepristone. Unfortunately, this article doesn’t give any follow up on women who use the medicine. There are risks, and some women end up in the hospital.

One of the risks is that the pregnancy will continue; misoprostol alone is only about 90% effective. Follow up is needed to detect the one in 10 women who doesn’t abort. If the first dose doesn’t work, she should use a second dose or she may go to term. Sadly, a fetus exposed to miso early in pregnancy may be affected with serious congenital anomalies—one of the risks of unsafe abortion.

Back to Honduras. The reporter, Laura, first spoke with a young woman who didn’t use protection during a one-night-stand and was 2 months pregnant. She bought 4 tablets of misoprostol on the black market. José, the black-market supplier, charges on a sliding scale. He gets from $70 to $270—depending on what he thinks the woman can pay. In this country they might cost $10, with a prescription. José has to pay off his ex-girlfriend who works in a hospital and supplies the prescription. He may also keep the police happy with bribes.

Honduras’s largest public hospital is in the capital, Tegucigalpa. It treats around 60 women each week for bleeding during pregnancy, either from miscarriage or induced abortion. The UN estimates that there are about 70,000 unsafe abortions in Honduras each year. Making abortion illegal doesn’t prevent desperate women from having unsafe abortions. Without sexual education teens don’t know how to prevent pregnancies; Honduras has the highest rate of adolescent pregnancies in Central America. Could these facts reflect the unrealistic religious teachings in a country where 48% of people are evangelical Christian and 34% are Roman Catholic?

What lessons does Honduras have for the USA? Outlawing abortion doesn’t prevent women from obtaining abortions, but they may be unsafe, expensive and exploitive. Similarly, US states that have acted to restrict or outlaw abortion are among those with the highest teen pregnancy rates, the least sex ed and the poorest support for mothers and children. Many also have high maternal mortality rates, which will probably rise as desperate women take abortion into their own hands.

©Richard Grossman MD, 2023