Medical Public Health Reproductive Health Women's Issues

Update on Abortion

Many years ago I worked for three weeks in Swaziland, South Africa. A memory still haunts me.

Most mornings we saw one or two young women through the emergency ward. Almost all of these women were from surrounding communities, were “visiting an auntie” and they hadn’t eaten breakfast. All were carrying early pregnancies and reported bleeding. Indeed, on examination there was blood and the cervix had started to open.

Bleeding and cervical dilatation in pregnancy usually ends up as a miscarriage, and can lead to a serious infection unless a D&C is done to empty the uterus.

Another doctor told me this pattern had been happening for a long time. We surmised that some doctor in this city was using instruments to make it appear that these patients were about to miscarry. It would be easy to instrument the cervix, tell the young woman to go to our hospital in the morning—and to skip breakfast. “I hope all goes well tomorrow at the hospital. And have your boyfriend wear a condom next time,” I can imagine that doctor saying.

In Swaziland abortion is only legal to save a woman’s life. The physician who opened the cervix was taking a big risk, allowing him to charge an outrageous fee.

Don’t laws that prohibit abortion decrease its frequency? No, apparently not. Norway, known for its excellent medical statistics, found that the incidence of abortion did not rise when it was legalized in 1978. This finding was borne out by a recent article in the world’s premier medical journal, Lancet.

The study looked at all the world’s countries. 84 have liberal abortion laws; the remaining nations (like Swaziland) prohibit abortion, with few or no exceptions.

Outlawing abortion does not prevent women from terminating unwanted pregnancies. Where it is illegal, however, women are subjected to unsafe procedures and risk their health and very lives. Surprisingly, this study found the incidence of abortion is higher in places where it is outlawed. This may be because these are also places where women are not esteemed, and where contraception is difficult to obtain.

Wherever laws permit safe abortion, two observations are made. Maternal mortality from unsafe abortions decreases drastically, and women are treated with more respect.

More surprises are to be found in another research paper from England. It is an exacting review of the psychological effects of abortion. Although many studies in this field are of poor quality, the researchers found 44 high quality studies.

To reduce the possibility of bias and to ensure transparency, the reviewers sent out a request for comments. Several anti-abortion (as well as pro-choice) organizations responded, and their comments influenced the final report.

The questions the multi-faceted panel of experts set out to answer are: How prevalent are mental health problems in women who have an induced abortion? What factors cause poor mental health outcomes after an abortion? Are mental health problems more common in women who have an abortion compared with women who deliver an unwanted baby?

The report’s findings are summarized:

•            Unwanted pregnancies are associated with an increased risk of mental health problems, and the rate of problems is the same whether women had an abortion or gave birth.

•            The most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion.

•            There are additional factors associated with an increased risk of mental health problems specifically related to abortion, such as pressure from a partner to have an abortion and negative attitudes towards abortions in general.

The study recommends:

“…it is important to consider the need for support and care for all women who have an unwanted pregnancy because the risk of mental health problems increases whatever the pregnancy outcome. If a woman has a negative attitude towards abortion, shows a negative emotional reaction to the abortion or is experiencing stressful life events, health and social care professionals should consider offering support, and where necessary treatment, because they are more likely than other women who have an abortion to develop mental health problems.”

We are lucky in La Plata County to have wonderful assistance for women carrying unintended pregnancies. The Pregnancy Center supports women who plan to deliver, while Planned Parenthood provides access to safe, compassionate abortions. I am concerned, however, that the people who demonstrate outside Planned Parenthood may not provide accurate information to women who are considering abortion. The demonstrators may have a negative influence on those women who are at risk for mental health problems.

© Richard Grossman MD, 2012

Family Planning Population Reproductive Health Women's Issues

Watch this Legislation

Watch this Legislation—2-2011

© Richard Grossman MD, 2011

What is this country coming to? Even if you are not concerned about population issues, you should be concerned about various legislative actions that are gestating now. These bills, if they become law, will be serious steps backwards for the rights of half of our voting population—women.

If they were to become law, the infrastructure of health care for women (and for some men) would be destroyed. Many children will suffer, too.

The efforts at a federal level to restrict access to reproductive health care are in the “spending bill”, H.R. 1. During this economic downturn it makes sense to cut funding, but women and children seem to be getting the short stick.

The federal WIC program (Special Supplemental Nutrition Program for Women, Infants and Children) provides healthy food to pregnant women, their babies and children up to five years of age. Over six million children receive food through this program, as well as more than two million pregnant and breastfeeding women.

One of the strong points of WIC is that the program encourages women to breastfeed. Remember that nursing is healthier for the baby and for the mom, and that nursing also is an effective means of child spacing.

The proposed budget would cut more than a tenth of WIC funding. What will happen to those unfortunate mothers and their children if the WIC program is not available to them?

Another federal program, Title X (ten), provides family planning services to millions of women. It has become even more important since the economic downturn; the number of Americans without health insurance has risen to over 50 million! This program also pays for services such as cancer detection and the diagnosis and treatment of reproductive tract infections. From a purely financial standpoint it is well known that contraception pays for itself in the long run. Every dollar invested in family planning saves more than four dollars in obstetrical and pediatric services. Title X is one of the best programs to save the taxpayers’ money!

Nevertheless, some legislators are trying to take away all funding from Title X in H.R.1 and rwith H.R. 217. Apparently this is to remove support from Planned Parenthood, which administers much of the funding. Although Planned Parenthood does provide abortion care for many women, it carefully observes the laws that prevent using federal funds for abortions.

Furthermore, family planning services have been shown over and over to decrease the demand for abortion. If Title X is canceled there will be an increase in unplanned pregnancies and requests for abortion—just the opposite of what the antiabortion legislators (and you and I) want!

Earlier this month the House of Representatives passed the Pence amendment to H.R. 1 (the spending bill) aimed directly at Planned Parenthood. In addition to taking away Title X moneys, it will prevent any federal money from going to this organization. Fortunately, the Senate (with its Democratic majority) will probably prevent this bill from becoming law.

As a doctor who performs abortions, I take special note of South Dakota HB 1171. It is titled “An Act to expand the definition of justifiable homicide to provide for the protection of certain unborn children”. Just what the bill means, and how it will be interpreted if it becomes law, are uncertain. Perhaps the bill might as well be called the “The abortion doctor assassination authorization act”. Remember that the US Supreme Court declared abortion legal in 1973. Since that date the number of women suffering and dying from abortions has plummeted.

If this bill were to become law it is likely that the few doctors who do perform abortions in South Dakota will stop doing so. Where safe medical abortion services are not available, nonmedical people are ready to take over. Poorly trained people, without proper instruments or sterile technique, worked in the back alleys before 1973. Once again we will see victims of illegal abortionists in our hospitals and morgues.

There is other miserable legislation afoot, but these—H.R.1, the Pence Amendment and South Dakota HB 1171—are among the worst. Keep an eye on them, and let your legislators know that you still respect women and women’s right to have safe and legal abortions. A good source of information about bills before Congress is, which not only provides information but also makes it easy to email legislators.

Call our federal legislators and let them know what you think about these bills: Representative Scott Tipton—202.225-4761 Senator Mark Udall—970.247-1047 Senator Michael Bennet—970.259-1710