Categories
Population

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: https://youtu.be/lqPjPOPdgQE

            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

Categories
Abortion Reproductive Health Women's Issues

Revisit Menstrual Extraction

Image courtesy of IPAS

            Before Roe v. Wade, and before pregnancy tests were easily available, there were ways a woman could get her period started if it was late. This is called “Menstrual Extraction” (ME) or “menstrual regulation”. Without knowledge if she were pregnant or her period was just late, ME was not considered an abortion.

            ME can be done with herbs, medicines or instruments. In Indonesia a doctor told me about “EM Kapsuls”, which are advertised on TV. Kapsuls are used to ease menstrual cramps, plus they are advertised to start a late period.

  “Emmenagog” is the word for herbs or medicines that are used to start a woman’s period. Herbal emmenagogs are used in many cultures and have a long history. One of the most used emmenagogic plants, pennyroyal, is mentioned in Aristophanes’ play, Peace, written in 421 BCE! Although pennyroyal is apparently effective both in starting menses or causing an abortion, it is also toxic; it can cause severe liver damage and death. Tansy and rue are two other plants with similar effects—and toxicity.

            Dr. Karmen, a psychologist, developed a MR technique using instruments: a flexible cannula and a syringe for suction. It is fast, simple and safe in the hands of an experienced person. That technology is still used for early abortions and incomplete miscarriages. I used Karmen cannulas until the office nurse pointed out that patients seemed to have more problems with that type of cannula than with the conventional, rigid cannula.

            In general, Islam is against abortion—although there are exceptions. For instance, abortion is illegal in Bangladesh, a Muslim country, but ME is acceptable. It was introduced to decrease maternal mortality associated with unsafe abortion. A doctor can legally perform MR up to 12 weeks from the onset of a woman’s last menstrual period. 

In addition to using herbs or suction to remove the tissue in the uterus, ME can be done with the same tablets, mifepristone and/or misoprostol, that a woman can take for a medication abortion. These medicines are even available in some countries without a prescription. They are also available in some states of the USA for ME through the Period Pills Project.

What are the dangers of ME? There is a risk that pregnancy, if indeed the woman is pregnant, may continue. Rarely the pregnancy isn’t in the uterus, but in a tube. A tubal pregnancy may have the same symptoms as a normal pregnancy, but it can tear the tube as it grows and cause internal hemorrhaging.

Performing an ultrasound before an abortion is wise for 2 reasons—to determine the pregnancy’s location and its gestational age. However, MR may skip the ultrasound if it’s done outside of the medical system. This means an ectopic pregnancy could escape detection, or that a pregnancy might be too far advanced for safe MR. Fortunately, the possibility of a continuing pregnancy can be excluded if the woman has a negative pregnancy test a week or two after she has had the ME.

Is MR going to make a comeback in US states where abortion is severely limited or entirely illegal? That is difficult to predict. However, there are studies suggest that women are interested in the idea. 

An old video, No Going Back, shows how ME is done with the Karmen cannula. Unfortuately, it neglects to mention sterile technique and other precautions, so I don’t recommend it. Nevertheless, do-it-yourself ME might be safer than a back-alley abortion.

I searched and could only find information about the efficiency of ME using a combination of mifepristone and misoprostol, which are very effective. There doesn’t seem to be any study of the success rate of either a single medication or of herbal products. A study is being done in California to test misoprostol; it will be interesting to find its results.

            The recent Dobbs decision by the Supreme Court has limited access to safe abortion care. However, ingenious women can find ways to get around the law. I just hope they can do so without compromising their safety.

© Richard Grossman MD, 2022