Categories
Reproductive Health

Two Reproductive Health Heroines

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.

©Richard Grossman MD, 2025

Categories
Abortion Reproductive Health Women's Issues

Investigate Illegal Abortion

In the early 1990s I read about women who were using a medication to cause abortions without visiting a doctor. Brazilian women had found that misoprostol (CytotecÒ) was available without a prescription, and would cause strong uterine contractions that could expel an early pregnancy.

Since then, this knowledge has spread to all corners of the globe. Misoprostol is now approved by the US Food and Drug Administration for use in conjunction with mifepristone to be prescribed for legal abortions. This combination has been found to be both very effective and very safe. Recognizing the safety of this combination, the FDA has decreased restrictions on mifepristone. The combination can also now be prescribed by telemedicine. However, misoprostol is almost as effective when used alone.

The original indication for misoprostol had nothing to do with abortion. Instead, it was found to protect the stomach lining in people who had irritation from NSAIDs, such as ibuprofen. It has other uses, including induction of labor (in a teeny dose) and is a lifesaver for treating postpartum hemorrhage.

A Honduran friend sent me the transcript of a BBC News Program, “Inside Honduras’s abortion pill black market.” Abortion is illegal under all circumstances in this Central American country—the most restrictive law in the world. Having an abortion is punishable by 6 years in prison. Although “back ally” surgical abortions may still occur, this excellent piece of investigative journalism is about medication abortion. Only misoprostol is available in Honduras, not mifepristone. Unfortunately, this article doesn’t give any follow up on women who use the medicine. There are risks, and some women end up in the hospital.

One of the risks is that the pregnancy will continue; misoprostol alone is only about 90% effective. Follow up is needed to detect the one in 10 women who doesn’t abort. If the first dose doesn’t work, she should use a second dose or she may go to term. Sadly, a fetus exposed to miso early in pregnancy may be affected with serious congenital anomalies—one of the risks of unsafe abortion.

Back to Honduras. The reporter, Laura, first spoke with a young woman who didn’t use protection during a one-night-stand and was 2 months pregnant. She bought 4 tablets of misoprostol on the black market. José, the black-market supplier, charges on a sliding scale. He gets from $70 to $270—depending on what he thinks the woman can pay. In this country they might cost $10, with a prescription. José has to pay off his ex-girlfriend who works in a hospital and supplies the prescription. He may also keep the police happy with bribes.

Honduras’s largest public hospital is in the capital, Tegucigalpa. It treats around 60 women each week for bleeding during pregnancy, either from miscarriage or induced abortion. The UN estimates that there are about 70,000 unsafe abortions in Honduras each year. Making abortion illegal doesn’t prevent desperate women from having unsafe abortions. Without sexual education teens don’t know how to prevent pregnancies; Honduras has the highest rate of adolescent pregnancies in Central America. Could these facts reflect the unrealistic religious teachings in a country where 48% of people are evangelical Christian and 34% are Roman Catholic?

What lessons does Honduras have for the USA? Outlawing abortion doesn’t prevent women from obtaining abortions, but they may be unsafe, expensive and exploitive. Similarly, US states that have acted to restrict or outlaw abortion are among those with the highest teen pregnancy rates, the least sex ed and the poorest support for mothers and children. Many also have high maternal mortality rates, which will probably rise as desperate women take abortion into their own hands.

©Richard Grossman MD, 2023