Categories
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 Indeed, every Democratic president since then has rescinded the GGR, which then was reestablished by the next Republican president.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

Categories
Public Health Reproductive Health Sterilization Women's Issues

Prevent Ovarian Cancer

Ovarian cancer is a terrible disease!

SHAPESHIFTER

I have to make you sick to make you well,

            The oncologist says, five months

we’ll scour each cell of your abdomen clean.

INTRAPERITONEAL CHEMO

It always burns, multiples thousands of bone splinters

stinging cells, murdering nerves, dulling

my mind, my spine alive, a drawn bow

aimed at heaven, sprouting agony’s three stingy feathers.

                        Both from Refugee; poems by Pamela Uschuk

When I first learned that our friend Pamela Uschuk had ovarian cancer, I despaired for her life. Ovarian cancer is one of the worst killers. By the grace of God, and the Mayo Clinic, she is still alive and well 10 years later.

Unfortunately, there is no screening test, like the Pap smear, for this terrible disease. Ovarian cancer has usually spread widely by the time that it is detected, so heroic treatment is required. Despite medical advances, most women who get ovarian cancer are killed by it.

Mysteriously, the risk of getting ovarian cancer is reduced by using birth control pills, by tubal ligation or by hysterectomy. Even more puzzlingly, about a decade ago it was discovered that most ovarian cancers actually start in the Fallopian tubes.

Ovarian cancer is not that rare—about 1 in 80 women will develop it. Some women are at higher risk because they carry a genetic mutation such as BRCA, but they only account for about one tenth of the people who develop this disease. Pamela was at normal risk; she is BRCA negative.

Now, rather than just blocking a woman’s tubes to prevent pregnancy, it is recommended to consider removing the tubes entirely (salpingectomy). The final word isn’t in because the recommendation is too new, but bilateral salpingectomy has the possibility of preventing hundreds of cases of ovarian cancer, saving many lives annually!

If a woman has a planned Cesarean with what she intends to be her last child, why not have a salpingectomy at the same time? After all, her tubes are exposed and this procedure only adds 5 minutes to the surgery.

Regrettably, that may not be possible in some hospitals under Catholic control. They must abide by the “Ethical and Religious Directives for Catholic Health Care Services” of the United States Conference of Catholic Bishops. This document states:

“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present or serious pathology and a simpler treatment is not available.”

This statement has unintended consequences. Many women have hysterectomies in Catholic hospitals because the simpler, safer and less expensive tubal ligation is prohibited. Worse, this policy leads to unplanned pregnancies and abortions. Remember, the most effective way of preventing abortions is with effective contraception!

Of course, there is the option for the new mother to go to another hospital at a later time for her tubal surgery, but that means a second anesthesia, additional cost, plus more pain and recovery time. What mother wants to leave her newborn child and not be able to breastfeed?

All healthcare institutions should endeavor to prevent illness and death. A study examined the number of women having tubal ligations at the time of cesarean birth and calculated that over 900 cases of ovarian cancer and 550 deaths every year in the USA could be prevented by doing salpingectomies for women who want sterilization at the time of cesarean.

Let’s look at this issue from a different viewpoint. What if it had been shown that vasectomy decreased the risk of testicular cancer (it doesn’t, unfortunately). Do you think that the Catholic patriarchy would deprive their priests and other men of this potentially life-saving surgery?

Preventing sterilization, especially salpingectomy, at the time of cesarean is a case of religious doctrine standing in the way of good medical care.

© Richard Grossman MD, 2022