Abortion Reproductive Health Women's Issues

The End of Roe Affects Colorado’s Neighbors

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 “” 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

Consumption Public Health Reproductive Health Women's Issues

Recognize Problems in Some African Cultures

Different types of Female Genital Mutilation

            I have often heard that the need to reduce population growth in African countries is less important than in rich countries because consumption is so much lower in Africa. It is true that the impact of a person in Africa is much less than someone in a rich country, however there are important but different reasons for Africans to reduce their fertility.

            Although the average footprint of a person in Africa is small, there are already more feet than the land can bear in some places. Slowing population growth there will help people be healthier, happier and more productive. Traditions exist that are harmful to women and also lead to high fertility. These injurious traditions may have had their function in the past, but they have no place in the 21st century.

            In the past I was a cultural relativist. I believed that the practices in other cultures shouldn’t be evaluated by our standards. When I learned about Female Genital Mutilation, I changed my mind. If one believes that girls and women deserve the same respect as boys and men, one cannot be a cultural relativist.

FMG is practiced by many cultures in Africa. It consists of removing part or most of the external genitalia of girls. It is usually done without anesthesia and often with a dirty blade.When the margins of the vulva are separated by the (brutal) slicing, acacia needles are used to hold them together. Think of the agony FMG survivors suffer! Some victims die from blood loss or infection. The pain returns during intercourse and childbirth if the vaginal opening has been sewn nearly shut. Fortunately, there are many organizations in Africa that are working to get rid of FMG. Often they substitute another, more benign, coming-of-age ritual for girls.

            Child marriage is another damaging custom of some African cultures. Typically, the girl’s arranged marriage is shortly after she starts to menstruate, and she is forced to wed a man many years older than she. A girlchild is considered a burden in many societies, so the best way to get unburdened is to marry her off. Worse, rape of a young girl is not uncommon. Since virginity is a requirement for marriage in many societies, the girl’s parents force their daughter to marry her rapist. The pitiable girl is thus dominated by her husband for the rest of her life.

            The psychological effects on a girl who is married as a young teen must be terrible, however the physical effects can be fatal. Her pelvis may be too small to give birth if she conceives before her bones have finished growing. Obstructed labor may kill the fetus—resulting in a stillbirth. Sometimes pressure of the fetal head against the girl’s pelvis blocks blood flow to the girl’s tissues. The dead flesh dissolves, forming a hole through which pee and/or poop can pour.

            You might think that child marriage and FGM don’t exist in the USA, but that is wrong. Some immigrants practice both. In addition, some non-immigrant groups have allowed early marriage, often in response to early teen pregnancies. Delaware was our first state to ban marriage before age 18, only 4 years ago. Women who marry young tend to have more children and seldom advance far in education.

            Both child marriage and FGM are means of subjugating women; so is cutting short their education. Another way power is taken away from women is the absence of something we take for granted—clean and safe toilet facilities at schools. Many girls quit school after their period starts because their school lacks adequate, private toilet facilities.

            Where girls and women are treated as inferior, they have little control over their lives. They don’t have power over what happens to the most personal parts of their bodies, nor when or whom they marry. They may not say when they have sex, nor limit the number of children they bear, nor use contraception if they want to.

            Many organizations work to empower African women by putting an end to child marriage and FGM. One favorite is the Population Media Center, which has made great advances in education about these evils.

            Although I am not an anthropologist and have spent only a little time in Africa, these seem to be some reasons that the population is growing so rapidly there. In the future I’ll write about religions which encourage large families, and about overpopulation causing famine—one of the Four Horsemen of the Apocalypse. 

© Richard Grossman MD, 2022