Abortion – Page 5 – Population Matters-USA

Signe Wilkinson Editorial Cartoon used with permission of Signe Wilkinson
and the Cartoonist Group. All rights reserved.

Jennifer and Jake are newly-weds. The couple met in graduate school at Texas Tech University in Lubbock, Texas. She is working toward a degree in engineering and he is studying to be a nurse practitioner.

They were doubly cautious about contraception. Although they want at least one child in the future, first they want to meet their educational goals. In addition to using condoms, they avoided sex when she thought she might be most fertile. Then they had a condom break. Jennifer kept an online menstrual diary “mymonthlycycles.com” and the next morning was horrified to find that she might have been fertile at that time. When her period was late and breasts started to be tender, she was sure she was pregnant.

Since online calendars can be monitored by the “Texas abortion police”, one of the first things she did after she stopped crying was to delete that information. Next, she asked a friend who had had an abortion where she could go. She contacted all the New Mexico clinics, but they were either too busy or the availability of appointments conflicted with their student responsibilities. Finally, she made an appointment at the Durango Planned Parenthood clinic. Jake had an afternoon class on Monday, but if they slept a bit and left Lubbock before midnight, they could reach Durango in time for the 10:30 appointment.

The couple was greeted by people yelling and waving signs outside Planned Parenthood’s parking lot. The armed guard just inside the door was much more friendly, but said that Jake needed to wait outside in the car, and Jennifer would join him in 2 or 3 hours.

An hour later she woke exhausted Jake to tell him good news. “I fell asleep while filling out the forms, but the first thing they did” she said, “was a pregnancy test. It was negative—I’m not pregnant!” Jennifer was so frightened by the new Texas laws that she was afraid to buy a pregnancy test. Instead, she took the evidence of pregnancy that her body gave her, not realizing that women can have anovulatory cycles which mimic pregnancy.

This narrative recounts the stories of real patients, but the names and situation are fictional.

Only 2 of 40 countries that have changed their abortion laws since 2000 are more restrictive; Nicaragua and the USA. The other 38 have increased access to safe abortions services. Ethiopia reformed its abortion laws in 2004 in response to the high death rate of women having illegal abortions. Its maternal mortality rate now is less than half of what it was before the legal reform. Already too many women are dying in the USA from pregnancy complications, but that figure will skyrocket as desperate women seek care where abortions are illegal.

It took the high-profile death of a woman for the law to be changed in Ireland. This very Catholic country had banned all abortions with an amendment to its constitution. In 2012 Dr. Savita Halappanavar was sick with an infected miscarriage. She requested a D&C, but was told that she couldn’t have it as long as the fetal heart was beating. It was too late when the fetus did die; the mother perished from sepsis shortly after.

For me, the overthrow of Roe v. Wade by the US Supreme Court wasn’t a surprise. Politicians, in league with churches using abortion as their rallying cry, had been pushing to make abortion illegal for decades. All the articles I’ve read have decried the tragedy to human rights, but none has mentioned that the subsequent increasing human population will have global repercussions. What can we do? Support people coming for abortion care from antiabortion states. Donate to Planned Parenthood, the National Network of Abortion Funds, Cobalt ProChoice Colorado. Most important, vote for prochoice politicians; we need laws and constitutional amendments to guarantee access to safe abortion care. Please remember, the majority of Americans are prochoice.

©Richard Grossman MD, 2022

Advocate for LARC (Long Acting Reversible Contraception)

This is a picture of an IUD in a mockup of a uterus.

The potential of LARCs (Long Acting Reversible Contraception) is so great that I am advocating that all voters advocate for them to be paid for by government. The savings–both financial and in terms of human potential–are enormous!

Your doctor tells you that she can prescribe either of two treatments, but that one is 20 times as likely to fail as the other. Which would you choose?

Over a quarter of women in the USA use birth control pills, which fail much more frequently than Long Acting Reversible Contraception. LARCs, as they are nicknamed, are amazingly effective yet not used as frequently as one might hope.

IUDs (Intrauterine Devices) are the most commonly used LARCs. There are four available now; they are all made out of flexible plastic in the shape of a â€œTâ€. Three emit a tiny amount of hormone into the womanâ€™s uterus, where it is most effective. The fourth IUD uses copper to gain effectiveness. IUDs are usually well tolerated, although sometimes they can increase cramps or change menstrual flow. The best medical knowledge is that IUDs do not work by aborting pregnancies.

IUDs can stay in place for a maximum of 3 to 10 years, depending on which type. Since there is a string attached, they are usually easy to remove. The string also allows the woman to check that it is in the correct place. The pregnancy rate is vanishingly smallâ€”only a couple of LARC users in 1,000 will conceive each year. This statistic for â€œthe pillâ€ is much higherâ€”almost 50 per thousand will experience an unplanned pregnancy. Apparently the high failure rate of oral contraceptives in the USA is due to noncompliance. In Europe the failure rate is significantly lower; European women take their birth control pills more regularly.

There are two major drawbacks to both IUDs and the implant: they are expensive and they need to be placed by an experienced clinician. IUDs have a further drawbackâ€”bad press.

It used to be that only women with health insurance or a plump checking account could afford LARCs, but that is changing. Thanks to the Affordable Care Act (â€œObamacareâ€), any woman with insurance, including Medicaid, can get her chosen birth control without copay. In addition, one IUD, Liletta^Â®, is priced much lower than the others. Here in Colorado there is a program that provides contraception, including LARCs, at little or no cost.

Placing an IUD is not difficult for a trained practitioner. The opening of a womanâ€™s cervix may be tight is she hasnâ€™t borne a child, but a little local anesthesia and gentle dilatation will help with the insertion.

The other type of LARC is the implant, Nexplanon^Â®, which is as effective as an IUD. It is a thin plastic rod that is inserted under the skin of the womanâ€™s arm, where it can stay for up to 3 years. It emits a hormone that is very effective in preventing pregnancy. Although it is in a very low level in the womanâ€™s blood, it is sufficient to change menstrual patterns; most women with Nexplanon^Â® will have spotting or breakthrough bleeding. Perhaps this is why less than 1% of women in the USA choose an implant, whereas about 6% use an IUD.

Unfortunately, reproductive health has become a political football. Here in Colorado a grant demonstrated that access to LARCs can give young women a better chance in life by decreasing teen pregnancies. By taking away the consideration of expense, the use of LARCs expanded 4 fold. Nevertheless, the false fear that IUDs might abort pregnancies kept our legislators from continuing funding to provide this effective contraception. The best way to prevent abortions is with effective birth control!

Ohio took a tip from Colorado with a program to provide LARCs. Part of that stateâ€™s motivation is to lower their infant mortality rate. They are targeting young teens and women who have just had a child, since these two groups are at high risk of having an infant die if they were to get pregnant. They also note that the state saves almost $6 for every dollar invested in LARCs.

Ohio has been proactive in another way. Some healthcare providers have misconceptions about IUDs. They think that they should only be used if a woman already has delivered a baby, or that an IUD makes a woman more susceptible to sexually transmitted infections, or teens shouldnâ€™t use IUDs, or that IUDs can lead to sterility. All of these perceptions are wrong! Indeed, almost every woman can safely use an IUD, and start her family as soon as it is removed.

Safe, effective contraception is an important step in empowering women. We should advocate for making LARCs available to all women!