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No on Amendment 48

The article below may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at:


No on Amendment 48

© Richard Grossman MD, 2008



“Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof….” First Amendment to the Constitution of the United States


            “I am sorry, Mrs. Folk. There is nothing I can do.” I am in my office, holding ultrasound pictures. The Folks are sitting in front of me, looking dumbfounded. Two of their three children are present; the oldest is at school.

            “These pictures show a tubal pregnancy. It is very early, but we can still see the fetal heartbeat. It is clearly outside of your uterus.” Mrs. Folk is crying now.

             “In the past we used to treat ectopic pregnancies with surgery, or even just medicine. That is not possible now. Your chances of dying from this pregnancy are about fifty-fifty.”

            Approximately one pregnancy in 200 is in the wrong place. Although a woman’s uterus is wonderfully adapted to nourishing a developing fetus, her tubes are not. When a pregnancy grows in the tube, it tears the fragile tissue, causing pain and internal bleeding. Women still die of tubal pregnancies.

            Is the above scenario some sort of science fiction, set in some remote hard-hearted future? No, not if proposed Amendment 48 passes this November election. This scenario could happen right here in Colorado next year.

            Clearly 48 was drafted to stop all abortions in Colorado (even after rape or incest). It is short—and extremely deceptive. Nicknamed the “Personhood Amendment”, 48 reads: “As used in sections 3, 6, and 25 of article II of the State Constitution, the terms ’person’ or ‘persons’ shall include any human being from the moment of fertilization.”

            Section 25 of the Colorado Constitution states: “Due process of law. No person shall be deprived of life, liberty or property, without due process of law.” If a developing fetus (or even a newly fertilized egg) is defined as a person, then anyone who interrupts a pregnancy, no matter if it is potentially lethal to the mother, could be punished. The woman herself would be an accomplice. This would mean that anyone, including a physician who does surgery to save a woman’s life because of a tubal pregnancy, would be subject to the same penalties as a first degree murderer. Would the police have to investigate women who have miscarriages, too?

            The proposed amendment is so extreme that, if 48 were to pass, it would create legal havoc in our state. It would take years and millions of dollars to work out the legal implications.

            This amendment would not only prevent abortion, but it might also prevent many forms of contraception. Antiabortion people claim that hormonal birth control and IUDs cause abortions. Their evidence for this is weak, and is at odds with the majority of medical experts including the American College of Obstetricians and Gynecologists—my professional organization.

            The sad fact is that the amendment would probably increase the number of abortions! Making abortion illegal doesn’t stop women from trying to interrupt pregnancies—it makes them use desperate means. For instance, when abortion became legal in Norway, the abortion rate didn’t increase. Women did get better care, however. Remember that the best way to prevent abortions is with access to good contraception.

            Moreover, proposed Amendment 48 would prevent couples from taking advantage of many infertility treatments. In vitro fertilization would be banned because of the risk of losing an embryo—defined as a person.

            The people who wrote this proposed amendment (and the 131,245 people who signed petitions to put it on the ballot in November) appear to be honest, God-fearing Coloradoans. Their website lists physicians who support the amendment, but very, very few live in Colorado! In fact, they are outsiders testing the waters in our state to see how they can control women’s reproductive lives. Because of their efforts to impose their strict religious beliefs on everyone, they are the closest thing we have in the USA to the Taliban.

            This proposed amendment would punish parents and physicians who believe that all children should be planned and loved. It has been centuries since people were punished so severely for trying to help women control their fertility. There is strong evidence that the motivation to seek out and kill “witches” in Colonial times was to eradicate women who held the secrets of contraception. This was one way men could retaliate against women who knew more than they did.

            Don’t let religious zealots control women’s lives in Colorado. Vote “NO” to proposed Amendment 48. Go to for more information.


Published October, 2008

Contraception Durango Herald Family Planning Medical Women's Issues

Wear the Implanon Contraceptive Implant

Did you know that a new contraceptive just became available in Durango? Implanon was approved for use in this country over two years ago, but its manufacturer has been very cautious in making it available.

Almost all women can safely use Implanon. It is effective for up to three years, and can be removed easily when the user wants. Best of all, once it is in place, it requires no action on the woman’s part to provide essentially perfect protection against pregnancy. Compliance is not a problem with this contraceptive method.

The availability of effective contraceptive methods is one of the three most important factors in helping to lower fertility rates in poor countries. (The other two factors are education of girls and lowering child mortality rates. Thanks to almost universal literacy and modern pediatric care in our country, we don’t have to worry about these two factors.) The sad fact is that half of pregnancies conceived in the United States are unplanned. Can a method that is reliable and simple to use help lower this statistic?

Implanon is similar to Norplant in some ways, but has significant differences. You may remember that Norplant consisted of six flexible plastic rods filled with a hormone. Although it was initially well received, a problem forced it off the market a number of years ago.
Many women were keen on Norplant, but doctors weren’t. It had to be inserted properly, so each of the rods was right under the skin of the woman’s arm. Norplant was difficult to remove if it were placed too deep. Bad insertion technique is what got Norplant into trouble. Too many were inserted by people who weren’t properly trained, so doctors attempted removal and ran into difficulties.

The similarities between Implanon and Norplant include the hormonal makeup, which has no estrogen. Both Norplant and Implanon just use a progestin, making them safe—especially for women with blood clotting disorders or migraine headaches. Both systems cause menstrual irregularity; most women using them either have irregular menstrual bleeding. Both offer very reliable contraception, with failure rates of just a fraction of a percent. Both have the hormone in one or more flexible plastic rods that are implanted under the skin of a woman’s arm. Implanon has only one rod, which makes insertion and removal much easier than Norplant’s six.

Learning from the Norplant fiasco, the manufacturer of Implanon has taken precautions to prevent it from getting misused. Implanon will only be available to doctors (and other medical providers) who have completed a comprehensive training program. I attended such a program in Durango in August with a dozen other providers. After practicing the technique on plastic models, we were all impressed with how easy Implanon is to insert and remove. In real people insertion or removal is done with a bit of local anesthesia and takes just a minute or two.

How do women like Implanon? According to the manufacturer, women like it very much. They advised us, however, to warn women before getting this contraceptive method that it will mess up their menstrual cycles. Almost all women will have some spotting or irregular bleeding with Implanon. After a period of adjustment, however, some women will stop bleeding entirely. Skipping periods is entirely safe. Fewer periods helps prevent anemia and PMS, and is the goal of some new birth control pill formulations.

An Implanon wearer should not be aware of its presence. The implant is placed under the skin of a woman’s upper arm. The rod is small and flexible, so an observer cannot see it hidden below her skin. A health care provider (or the woman herself) can find it easily by touching in the correct place.
Implanon works in two different ways. Most important is that the hormone stops ovulation. Without an egg, pregnancy cannot begin. An additional action is that the hormone makes cervical mucus impenetrable to sperm. These two actions make it very reliable, with only one failure per year per thousand women using it.

When a woman wishes to conceive, her fertility should return quickly after Implanon is taken out. Likewise, if a woman doesn’t like the method (for instance, if the irregular bleeding gets to her), the side effects are rapidly reversed as soon as it is removed.

Implanon might not be the contraceptive answer for all couples, but it provides another method that will be safe and effective for some. I am glad that we can now offer it in Durango!

© Richard Grossman MD, 2007

[The article above may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at:]