Categories
Abortion Reproductive Health

Grasp the Consequences of Making Abortion Illegal

The media have done a good job of describing the implications of the Supreme Court’s abolishment of Roe to individuals. However, I have read little about the effects this regrettable decision will have on society.

First of all, it means that as many as 140,000 people will not have desired abortions. This estimate was published by the Guttmacher Institute and is hopefully too high. People all over the country are working to help refer women to abortion services in states that still allow this important healthcare procedure. However, there are many who cannot afford the time away from home or money to travel that a referral would entail.

Let’s estimate what this might mean to our population growth. Currently there are about 4 million births in the USA. Let’s say that 40,000 women are able to travel to receive abortion services or otherwise end up not giving birth. This would mean that the number of births is increased by 100,000 or almost 3 percent. We need to decrease the number of unintended births, not increase them!

Other than increasing the growth rate of the USA, will these added births have any effect on society? This is difficult to know, but there is reason to believe that many of these new people will not turn out to be the best citizens.

Dr. Henry David studied unintended pregnancies in Czechoslovakia during the 1960s, with the help of Czech researchers. Those researchers did all the detective work to find the mothers, gain their permission to test their children, and continue to follow them for all those 30 years.

Abortion was legal but needed approval by a state agency. A woman could appeal if her request for an abortion was denied —however, some women were denied twice. David’ group looked at these unwilling mothers, their children and controls (mothers with wanted pregnancies), following them for over 30 years. The results are available in “Born Unwanted”, and are summarized: “The overall findings suggest that, in the aggregate, denial of abortion for unwanted pregnancy entails an increased risk for negative psychosocial development and mental well-being in adulthood.” The children of unwanted pregnancies had more brushes with the law, were less satisfied with their lives, had less education and more mental health problems.

Another project, the Turnaway Study, focused on women who wished to abort a pregnancy. These women were refused abortion care because their pregnancies were too far advanced for the clinic they attended. The Study looked at families after the birth of a denied abortion and found that they didn’t thrive well after the unwelcome addition. There was poor maternal bonding, and the mothers’ other children’s development suffered. Furthermore, these families were more likely to live below the federal poverty level than the mothers who received abortion care. I’ll write more about this revealing study in the future.

A possible cause of the decline in crime in the 1990s was popularized by freakonomics.com. Males from age 18 to 24 are most likely to commit crimes, and the theory is that the decrease in crime 18 years after Roe v. Wade in 1972 was due to increased access to abortion. The decrease in the births of unintended children may have resulted in better citizens and less criminal behavior as kids reached adolescence and adulthood.

As a young doctor, I took care of a toddler who had been scalded. I remember his young mother saying “I didn’t want him.” She told me that he was fussy and she thought a bath would help quiet him, but instead he became fussier. Out of desperation she turned up the hot water to punish her son. She deeply resented the baby who prevented her from doing normal teen things. 

The Freakonomics hypothesis is controversial. One analysis of the data suggests that the benefits to society were confined to the decline in teenage mothers. Certainly, my teen patient’s son had suffered from being unwanted. I have no follow up information on how he turned out, however.

Decreased access to safe abortion services will be a tragedy for some people and our society may suffer.

©Richard Grossman MD, 2022

Categories
Population

Liberate the Pill

            Do you think that a medication that kills more than 3000 people in the USA should be available without a prescription, even though it has health benefits? What about another medication that has many health benefits but doesn’t increase the risk of death?

            The first drug mentioned above is aspirin and can easily be bought without a prescription. The second is “the Pill”, or Oral Contraceptive Pills (OCPs), which need a prescription now. In the past women needed a yearly Pap smear which meant a visit to a doctor (or other health care provider) with the expense and embarrassment of a pelvic exam. As the amazing safety of the pill has been recognized, laws have been changed to allow women to purchase their OCPs in some states from a pharmacist with minimal hassle–and they can keep their clothes on!

            Perhaps you noticed that the first paragraph of this essay was making an unfair comparison. The people who die from aspirin are usually older than the women taking oral contraceptives. Furthermore, the study that found no increased mortality among women who had taken OCPs, found that there was an increase in deaths from breast cancer, but that was counterbalanced by a decrease in ovarian cancer and other causes of death.

            I had the unusual experience of getting a package OCPs for an elderly nun. Our Catholic hospital had a committee to consider requests for tubal ligations–usually women undergoing repeat Cesarean sections. The sister, a member of the committee, didn’t understand that a tubal ligation could be life-saving. Apparently, she wasn’t aware that women die from pregnancy complications. I showed the nun the insert accompanying every package of OCPs, which has information about the risks of dying with various contraceptive methods, or with none. The most dangerous was not using contraception, since every pregnancy carries a small risk of death. She was convinced of the importance of tubal ligations for women who desired no more children.

            When OCPs first became available 60 years ago they were quite different. Then the level of estrogen was more than twice what it is now. Over 50 years ago my wife and I visited a college classmate in the hospital where she had been diagnosed with a blood clot from OCPs. It took years to recognize that estrogen in OCPs increases the risk of clots–the more estrogen, the higher the risk. We now know that pills with less estrogen are safer, but still effective.

            Fortunately, there are already several ways OCPs can be bought without an examination. They include Planned Parenthood, where answering a questionnaire and blood pressure check are all that’s needed. In Colorado and some other states, a pharmacist can prescribe them. Also, there are Internet sites that provide prescriptions and sell OCPs inexpensively. Why not reduce the restrictions to make it easier and less expensive to get OCPs?

            Perhaps you remember a similar situation with Emergency Contraception Pills. It took years to convince the Food and Drug Administration of their safety. ECPs can now be bought in a pharmacy or even from Amazon without restrictions. Because ECPs are most effective in preventing pregnancy if they are taken within 12 hours after unprotected sex, it is suggested that people who are at risk keep a pack “just in case”.

The “Oral Contraceptives Over-the-Counter Working Group” advocates for OCPs to be available without prescription. They have worked for years to reduce hurdles for women. They have looked at pills’ safety record in other countries, where one can purchase OCPs without a prescription. Social scientists have been developing easy-to-understand wording to go with the pills since no provider will tell the woman how to take the medication.

Well, England has beat us to it! This month Progestin-Only Pills will be available without a prescription, after a brief consultation with a pharmacist. Since POPs have no estrogen, they are safer than the usual combined OCPs and can be used by many people who should not take estrogen.

Making contraception more available is not just a matter of convenience. Studies show that access to contraception increases young women’s chances of graduation from high school. Facilitating access to safe OCPs can help change teens’ lives for the better.

© Richard Grossman MD, 2021