Reproductive Health – Population Matters-USA

Image courtesy of Plan C

Michael McLachlan walked up the steps of the US Supreme Court Building alone, with his mind set for the trial, while his family watched from the oval plaza outside. McLachlan was the Colorado Solicitor General in 2000, and was intent on keeping abortion access safe.

Colorado’s “safe access zone (SAZ)” law was at stake. It says that no one could approach closer than 8 feet of a patient without the patient’s permission. This applies when the patient is inside a 100 foot zone, based on the door of a clinic. This law, enacted in 1993, did not limit speech—it only limited unwarranted approach. The law was contested as interfering with the First Amendment right to free speech but was supported by the Colorado courts.

When I asked Barbara McLachlan, Michael’s widow, about the actual trial with the Supremes, she told me about one question asked by Judge Scalia:

“Why is the limit 8 feet?”

McLachlan was always sharp and ready for anything, so replied “Because that is the maximum distance a person can spit.” And Scalia laughed!

Colorado has been very supportive of access to abortion care. It was one of the first states to legalize abortion (1967), before access became legal nation-wide (1973). Although there have been several attempts to decrease this access, we recently provided protection to this right by passing an amendment to the Colorado constitution. It prohibits state and local governments from denying, impeding, or discriminating against that right to abortion. It also repeals the prohibition against using public funds for abortion services.

Unfortunately, many other states have limited access to abortion or completely prohibited this vital part of medical care. Many women are coming to Colorado for abortions. In addition, women are also receiving abortion pills by mail from Colorado-based telemedicine.

Some of the states that forbid abortion care try to keep their women from having abortions. Some laws try to forbid a pregnant woman to leave her state to go to a more liberal state. Nevertheless, abortion providers in Colorado and New Mexico see a lot of patients from Oklahoma and Texas.

Pills have caused a revolution in abortion care. Pills can be mailed to a pregnant person living in a restrictive state; organizations have been started for just that purpose. Plan C (www.plancpills.org) is one of the organizations started to inform women about the availability of abortion care by telemedicine. When contacted by someone who is pregnant and who desires an abortion, Plan C will ask them to fill out a form about their medical history, then (if they qualify) refer them to a site where they can purchase pills for an abortion. This system can be used by anyone in any state in the union, but people in restrictive states are most likely to use it.

The people who actually supply the medication are at risk of retaliation by authorities in restrictive states. Perhaps the worst example is Texas. It has an malevolent law the purpose of which is to intimidate non-Texans who provide medication abortion pills to Texan women. The law would levy a fine of at least $100,000 to someone who prescribes or mails abortion pills to a woman in Texas. This law encourages Texans to spy on each other and relies on fear. The differences of abortion laws in different states has incited interjurisdictional abortion wars.

Coloradans who prescribe abortion pills to people in restrictive states risk being indicted for breaking the law in the other state. Last spring the Colorado legislature voted for a law to offer them protection. The name of the prescriber must be left off the medication. In addition, The new Colorado law shields abortion patients and providers from actions initiated by other states.

©Richard Grossman MD, 2026

A woman came to me with a very sad and perplexing story shortly after I started practicing OB-GYN. She was in her late 30s and had 2 or 3 children. She told me that she had been raped at work in a janitorial closet, after all the other staff had left. She did not report the assault—in the mid 1970s there was no provision for the care of sexual assault survivors in our town.

This woman went to her family doctor, she told me, because her period was late. He told her that she shouldn’t worry—that she was still recovering from the trauma of what had happened to her. A month later she still hadn’t started her period and she returned to that doctor and requested a pregnancy test. He told her not to worry, and didn’t order the test. The third time he did what she wanted, and the test was positive. If I were she, I would be terrified of her coworker and outraged at the doctor.

There are three lessons here: Even good doctors are fallible. Pregnancy is common after rape, even though there is a false belief that it is rare. Do-it-yourself pregnancy tests are a good idea.

When I was in medical school the only pregnancy test involved injecting an animal with a sample of the woman’s urine—and waiting a couple of days for the result.

Tests had improved a few years later when I was in general practice. We had kits that the nurse would use. As I remember, it took a half hour for the test to develop, so we’d often call the patient when the result was available. Unfortunately, a positive result looked different with different brands of tests. When we switched brands we misinterpreted a few tests and made some embarrassed calls. “I’m sorry to say that what I told you yesterday was wrong. Your test result is negative, not positive.”

Now you can get tests at the store that are inexpensive, sensitive and quite accurate. We can thank Margaret Crane, a product designer at Organon who designed the first at-home test. It became available in 1971 in Canada, but not until 1977 in the USA.

What caused the lag in making it available in this country? The (male) executives of her company didn’t trust women to do their own tests. There might also have been some pressure from the medical community to not give up the income from pregnancy testing. This innovation required a woman with imagination, artistic ability and faith in womenkind to make the first model of a home pregnancy test.

Another heroine of reproductive health just died. Sharon Camp earned a doctorate in foreign relations, then spent years in D.C. as a lobbyist. She learned that Emergency Contraceptive Pills (ECPs) were available in Europe, but not in the USA. This seemed wrong to her, and she lobbied drug manufacturers to sell ECPs, but without success. Although she had no background in the pharmaceutical business, she started her own company to market Plan B, the first ECP in the USA.

At first the FDA required a prescription for Plan B. I told the local pharmacies that I was available to call in that prescription, and did so many times for women whom I never met. Later Camp lobbied the FDA successfully to make ECPs available without a prescription to women over a certain age, and eventually to women without any age limit.

Neither Crane nor Camp had medical training. However, both realized a need and were able to find a way to help women get the care they wanted. They found ways to lower barriers to reproductive health care.