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


Listen to the Complexities of Abortion

Screenshot from Kim Wallach singing “Freedom to Choose”

            Even though I’ve written many essays about aspects of population, a friend mentioned that I’ve never included songs on the subject. Fortunately, she also pointed me in the right direction. “Freedom to Choose” was written by Bob Blue and Kim Wallach. Kim inspired Bob to write the lyrics after she told him the story of a protester at an abortion clinic. The protestor took her daughter to the same clinic ,when she didn’t want the daughter to have a baby. Unfortunately, Bob is singing in heaven.

            Since it is difficult to get much of a tune from this blog, please listen to Kim sing this song at:

            Freedom to Choose

In a clinic on Main Street in Washingtonville

Lost in thought by a window stood Mary McGill

When her eyes met the eyes of a woman outside

Was it rain on her glasses or tears she had cried?

            Outside on the picket line Rosemary Flynn

            Felt the rain on her face and the anger within

            As she stared at that face inside, gentle and warm

            That seemed almost to beckon her in from the storm.

And the two women found themselves staring awhile

Recognition, awareness, but never a smile

And there seemed to be some kind of truce in that stare

Until Rosemary Flynn recalled why she was there

            Then she held up her sign that said, ”Thou shalt not kill”

            And she pointed directly at Mary McGill

            And Mary McGill, before starting to turn

            Gave a nod to acknowledge Rosemary’s concern

That day Mary counseled a child named Michelle

Who tried hard to seem calm in her personal hell

Mary spoke to Michelle with the tone of a friend

And her gentleness brought Michelle’s calm to an end

            Michelle told her story with pain hard to hide

            Of her mother and John and the new life inside

            She had meant to show love, she had meant no one harm

            But her mother felt anger, and John felt alarm

But the new life inside was a life, it was real

With a brain and a heartbeat she wanted to feel

And she wanted that child, she would love it so well

She would build it a heaven to make up for this hell

            But she’d end the new life for her mother and John

            “I’ll do it,” Michelle said, “for my mother and John.”

            These words had an emptiness Mary saw through

            “If you do it,” said Mary, “Please do it for you.”

Michelle looked at Mary through the pain and the tears

And Mary saw all of Michelle’s sixteen years

And she thought she saw something of several years more

Or perhaps she had seen Michelle’s face once before

            Michelle only murmured the word, “I don’t know”

            And she stood, and she turned and she started to go

            When Mary made one last request of Michelle

            With her parting words, “Take time to think this out well”

That night Michelle’s mother stormed into the place

Not hiding her anger, yet hiding her face

“My daughter came here with a purpose” she said

“Not to have you put foolish ideas in her head

            “She’s too young, she’s a girl and the father’s a boy

            “And she thinks that a baby is some kind of toy

            “Your job was to teacher her, to straighten her out

            “Not confuse her, and send her home riddled with doubt”

“My job,” explained Mary, “was not to confuse

“But to make her aware of her freedom to choose

“My job is to make sure the options are known

“You are right she is young, but her life is her own”

            Then Mary saw something in this woman’s face

            And remembered the person, the time and the place

            This woman had labeled abortion a sin

            The face in the picket line, Rosemary Flynn.

People often accuse and are quick to condemn

When the issue is safe, and does not affect them

I don’t envy the job facing Mary McGill

I don’t know all the meanings of “thou shalt not kill”

            It’s a conflict more simply prevented than solved

            But the choice must belong to the woman involved

            And I think that the answers come, not from above,

            But from us, and our consciences, tempered with love.

Lyrics © Kim Wallach and Bob Blue