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Contraception Reproductive Health Women's Issues

Promote Health

Quick, how many children does each of the presidential and vice presidential candidates have?

I knew that Michelle and Barack Obama have two daughters, but I had to search to find out about the other candidates. Joe and Jill Biden had four; two sons and two daughters, but tragically one daughter was killed in an accident. Ann and Mitt Romney have five sons, and Paul and Janna Ryan have two sons and one daughter.

Demographers have found that normal, healthy couples who don’t use any birth control will have an average at least eight children during their fertile years. In the past many of those children would have died, causing human populations to be stable. With modern health care (like all the candidates’ families have) fortunately almost all children will live to adulthood. Because of the small family size of all candidates, we can assume that they all have used contraception.

Yet some of these candidates wish to limit access to contraception. Vice presidential candidate Paul Ryan cosponsored H.R. 212, the “Sanctity of Human Life Act”, which is at variance with the medical definition of conception. This bill defines a human being’s life as starting at the unknowable instant sperm and egg unite. Courts could use this rule, if it were to become law, to prevent not only all abortions but also to outlaw the most effective methods of contraception. If it were to become law, H.R. 212 would be a public health disaster!

For centuries well-to-do people have had smaller families than the poor. Indeed, limiting family size has been a way that the rich have gained their wealth. Poor people currently have less access to birth control, unfortunately, and are less reliable in its use.

The United States of America was created on the premise of equal opportunity (“…all men are created equal….”) One way of increasing equality is to provide the means for all people to regulate their fertility. The Affordable Care Act is certainly one of the largest steps our country has ever taken toward equality.

We live in an outstanding nation. We have the richest economy in the world, but we are far from having the best health care in spite of spending more money per capita on health than any other nation.

Here are some health facts. Almost half (49 %) of pregnancies conceived in the USA are unplanned. This helps to explain why our abortion rate is so much higher than the rate in any other rich country. International statistics show that where abortion is illegal it is actually more common. Outlawing abortion, as some candidates promise, might increase its frequency, and women would suffer from illegal procedures.

The numbers are a bit out of date, but (according to the World Health Association) the USA is inferior to many poorer countries in the quality of its health care. We ranked number 37, behind Greece, Costa Rica and Dominica. Why is this? All of the world’s 25 richest countries have universal health coverage—except for the USA. Even our neighbor to the south, Mexico, recently instituted universal health coverage.

The rich can afford insurance and access to excellent health care in the USA. Unfortunately, our lack of universal health coverage leaves more than 48 million people in our great country without health insurance. Many of these poor people wait until too late to access care, and others inappropriately seek routine treatment through emergency rooms. It is no wonder that our health statistics are so bad.

Throwing more money at health cannot solve this public health tragedy. This point is proven by the fact that many countries with poorer economies have better health statistics. We need a new system of health care insurance with universal coverage.

One of our two presidential candidates has designed a health insurance system that will provide coverage to most people in our country. It will provide coverage for people with preexisting conditions, for young people before they have insurance through work and it will protect people with terrible illnesses from bankruptcy. The other candidate has promised to tear down universal coverage. If Mitt Romney is elected I expect that our health statistics will get even worse.

Please vote in this election. Please think about what will happen if women lose the reproductive rights that we have fought for. And please consider the state of our health care system when you are considering which candidates to choose for president and vice president. Our present lack of universal healthcare coverage is a national (and international) disgrace.

© Richard Grossman MD, 2012

Categories
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