Category Archives: Abortion

Title X – Free Speech Under Fire. Again.

It’s deja vu all over again, as the current administration, borrowing a never-implemented move from the Reagan administration, attempts to gag physicians who provide reproductive care to women.

New proposed regs would forbid Title X funded providers from freely providing information about abortion to their patients, limiting such conversation to the provision of a list of names to women who have already decided to have an abortion.

Given that close to 50% of pregnancies in the United States are unplanned and that a significant proportion of women with unplanned pregnancy are unsure what they will do at the time of diagnosis or presentation to their doctor, the ruling is effectively a gag rule for any encounter around unplanned pregnancy. Or a planned pregnancy that goes wrong. Or that occurs in a woman with medical issues placing her health in danger during pregnancy. Or anytime when a pregnant woman is unsure what she wants to do regarding her pregnancy.

There’s more to the ruling that just the gag, much of it targeting Planned Parenthood, which provides reproductive health services to 41% of Title X clients.

By imposing extensive physical and financial separation requirements, the proposed rule effectively excludes from Title X any safety-net health center that provides abortion using non-federal funds. Specifically, Title X-funded entities would have to maintain separate accounting records, physical spaces (such as waiting and exam rooms, entrances, and exits), workstations, phone numbers, email addresses, staff, patient health records, educational programs, and signs.

The Ruling also lowers the bar and redefines family planning to allow Title X Funds to flow to programs that don’t actually offer medically approved contraception, but instead focus only on fertility awareness (rhythm), adoption or abstinence.

If you, as I do, oppose the proposed Title X changes, then I urge you to submit a formal comment and make your voice heard.

You’ll be joining the AMA, AAP, ACOG and ACP and almost 600 bipartisan elected officials in opposing this attempt to limit the free flow of healthcare information to women seeking to make choices among legal medical options. If you’re not great with words, head over to PRH Website for some more freely given text.

Here’s the comment I submitted today. Feel free to share, copy and paste.

Dear Secretary Azar, Senior Advisor Huber, and Deputy Assistant Secretary Foley:

I am writing you at this time to express my strong opposition to the proposed changes to Title X funding rules, which would limit Title X-funded providers in dispensing information or referrals for abortion services.

The proposed rule effectively gags both health care providers and their patients, limiting free speech within the patient-provider relationship.

Many, many women at the time of pregnancy diagnosis are unsure of their plans for that pregnancy, and wish to discuss their options with their provider. Limiting abortion discussion and referrals to women who have already decided to have an abortion is tantamount to malpractice, as women who are unsure of their options are not provided by their clinician with the critical health information they need to make a choice between the legal options available to them.

As a practicing physician I vehemently oppose this attempt to dictate medical care. Abortion is a legal medical procedure, safer than carrying pregnancy to term when performed by qualified providers, and information about it must be freely available to women, who need unbiased, factually correct, evidence-based information to make the choices that are safest and best for themselves and their families.

The proposed regulations unfairly and unconscionably impacts low income women, who frequently have no other options for reproductive health care other than that provided by Title X providers. The proposed rule changes create a two tiered system of reproductive education and care – one for women of means, who are given the information and counseling they need to make decisions about their reproductive health, and the other for poor women, from whom information about legal, safe reproductive options is deliberately withheld. If the legislation has its intended impact, women will lose trusted providers such as Planned Parenthood, which currently provides care to 41% of Title X patients.

Finally, the government cannot, though its funding mechanisms, require physicians to deliberately withhold information about completely legal health care options from our patients.  This violates our free speech, promotes unethical behavior and violates the patient-physician relationship.

I urge you to withdraw the proposed changes

Thank you for allowing me to comment.

Sincerely,

Margaret Polaneczky, MD

_________________________________

More reading

On Abortion, Jail, Parental Responsibility & Bad Judgement

scales abortion vs safetyJennifer Whalen, a 39 year old mother of three from rural Pennsylvania, is serving a 9-18 month jail sentence for purchasing and dispensing abortion-causing medications to help her teenage daughter abort an unplanned pregnancy.

The case is being used as an example of the lengths that women will go to to end a pregnancy when abortion is not immediately and freely available.

And perhaps it is.

But it’s also an example of just how easy we expect everything to be, and how those expectations are leading us to do things that are really, really stupid.

Because make no mistake. What Whalen did was stupid, irresponsible and dangerous.

Abortion is legal in Pennsylvania.

It was available to Whalen’s daughter with parental consent (which she clearly had) at a safe facility 75 miles away. That’s about an hour and 15 minute ride. Not the end of the world.

Yes, Pennsylvania has an absolutely ridiculous law requiring a 24 hour waiting period, meaning Whalen might have had to take time off from work to get her daughter an abortion. Or not – because the abortion facility nearest them has Saturday hours.

And yes, Whalen and her husband had just one car. And no health insurance for the $400 procedure.

I get it.

I really do. This was not going to be something easy.

But this is an abortion. A medical procedure that, while exceedingly safe, needs to be done by someone who knows what they are doing. Whalen, while not a licensed RN as previously reported, works in a healthcare facility as a nurses aide. So I’m sorry, but she should have known better. And I don’t quite buy it that she did not know that buying abortion pills online without a prescription was illegal.

And I won’t get into the ethical issues of aborting your daughter’s pregnancy, but it raises so many concerns about coersion that I know the docs at Geisinger Medical Center were right to report the case to the authorities after Whalen took her daughter to their ER during her induced miscarriage.

So, in case it’s not obvious by now…  

I’m not jumping on the “Poor Jennifer Whalen, she had no choice, she was ignorant, she was scammed by online sellers of abortion pills and sent up the river by those mean doctors in the ER” bandwagon.

Yes, I’m pro choice. Yes, I abhor the rash of abortion restrictions being passed by state legislatures across this country. And yes, I truly wish that abortion were freely available at every doctor’s office in every small community everywhere.

But it’s not.

And in this reality we have, parents like Jennifer Whalen have to make choices – to do the right thing, even when it’s the harder thing, or to do what’s easy.

She chose the easy route, and I think by now she knows that she made a bad judgement.

Now, do I think Whalen deserves a 6 month prison sentence? 

Of course not.

Whalen was not setting herself up as an abortion provider. She was not selling her services or posing as a health professional.

One time, she purchased medication over the internet for her daughter, who by all accounts took the medication freely and of her own accord. The medication, thankfully, worked as advertised.

But rather than come up with a way to turn this case into something positive for Whalen, her family and the community of women at large, Montour County DA Rebecca Warren and Judge Gary Norton chose instead to criminalize a mother for making the wrong choice in a very tough situation.

Warren says this case is not about Abortion Rights , but about “endangering the welfare of a child“.

Because sending a mother to prison is really good for her children, right?

Talk about bad judgement.

No, It’s Not Within Your Parental Rights to Perform Your Daughter’s Abortion

scales abortion vs safety

I’m as pro-choice as a person can be, but this story about a mother purchasing medical abortion meds online and administering them to her daughter gives me the chills.

There are those who will use this story to claim that abortion restrictions are leading to illegal abortions.

With clinics closing across the country, illegal medication abortions are and will continue to be a growing reality. This latest case is a red flag that anyone can be arrested as aiding a patient, regardless of age or relationship.

We all fear that at some point this could happen, but this was not the case here.  Abortion is legal in Pennsylvania, and an adolescent can obtain an abortion with one parent’s consent.

I think we need to be very, very careful that in supporting a woman’s right to choose, we also support the protections necessary to ensure that women’s lives are not endangered.

Pro-choice does not mean that we need to have an abortion provider on every corner.   It does mean that we need to have abortion that is safe, accessible and affordable.  For now, at least in Pennsylvania, we have this, and this mother and her daughter certainly had it.

All this mother needed to do was to drive her daughter to Planned Parenthood in Wilkes Barre or any of the other legal and safe family planning providers in central Pennsylvania, most less than an hour away.  I know this area of rural Pennsylvania very well, and pretty much everything, including the mall, is almost an hour away. This is not an unthinkable reality or an unreasonable barrier to care.

Though I do not agree with Pennsylvania’s parental consent provision, it did not pose a barrier to this woman’s daughter obtaining an abortion.  What worries me more is whether this mother’s unwillingness to use the medical system was so she could control the outcome and be sure the abortion happened.  

What this woman did for her daughter was not safe. She claims to be a nurse, (turns out she is a nurse’s aide, not a nurse) which makes what she did even more egregious. She bought drugs over the internet without a prescription, practiced medicine without a license, and endangered her daughter’s health.

What she did was stupid, and what she did was illegal.

When the Pope Plays Doctor, Women Die

A pregnant woman presents to an Irish hospital with ruptured membranes and cervical dilation at 17 weeks of pregnancy.

This is called an inevitable abortion.

When the mother begins to develop fever and abdominal pain, infection has set in.  The treatment – antibiotics and delivery of the baby, no matter what the gestational age or viability of the fetus. Delaying delivery risks maternal sepsis and death.

There is no debate about how to manage this clinical situation.  There are clear standards. Even in Ireland.

In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, (italics mine) while making every effort to preserve the life of the baby.

(HT to @scanman for finding these Irish regulations.)

An yet, for some unknown, god-awful reason, doctors responsible for the care of Savita Halappanavar decided that in their “Catholic” country, they were required to wait until the fetal heartbeat had stopped before terminating her non-viable, life-threatening pregnancy.

“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.

“The next morning I said she was so sick and asked again that they just end it, but they said they couldn’t.”

At lunchtime the foetal heart had stopped and Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”

At 11 pm he got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”

Mr Halappanavar took his wife’s body home on Thursday, November 1st, where she was cremated and laid to rest on November 3rd.

What Savita’s husband is describing is medical malpractice, pure and simple, committed by doctors practicing medicine according to the standards of the Pope rather than the profession to which they belong and the country in which they are licensed to practice.

It is tragedy and an abomination.

Were these doctors practicing out of fear and ignorance of the laws, or out of their own religious beliefs?  Did they think they had no legal recourse but to ignore clear medical standards, or did they deliberately ignore them?

We will need to await the results of the investigation into this tragic case to learn the answers to these questions, but one thing is clear.

When the Pope plays doctor, women die.

Doctors Must Speak Out Against Anti-Abortion Legislation that Threatens the Legal & Ethical Practice of Medicine

Kudos to Alabama pediatrician Pippa Abston for publicly speaking out for all doctors and their patients against legislation that violates women and forces doctors to choose between violating professional ethics or breaking the law. (HT to Rh Reality Check for their fabulous reporting on this issue)

In addition to posting the above video on You Tube (Let’s make it viral, folks…) Dr Abston has co-authored legislation that will protect doctors from being used as pawns by the anti-abortion movement. The bill is called the  “Right to Professsional Medical Judgement Act” and is short and sweet, written unemotionally and unambiguously –

No physician or health care provider licensed to practice in the State of Alabama shall be forced by state or local regulatory authority to perform any medical service or component of medical service if the service or component of service is not medically necessary or would be harmful to the patient and the patient does not desire the medical service. The right to practice within the scope of a medical license supersedes any existing or future legislative act.

Where are our Medical Societies?

I wish the AMA and ACOG would speak out more publicly on this issue. I hope they are lobbying, but working the back room is very different from speaking out publicly for the rights of both women and their physicians who are providing a legal medical procedure.  The Daily Kos has a petition circulating to the AMA asking them to speak out publicly.  I encourage you to sign it.

When the Pennsylvania Medical Society spoke out against the ultrasound law in that state, the legislators promptly backed down.

The Pennsylvania House postponed a scheduled March 12 vote on the bill. House Majority leader Mike Turzai, a Republican, said the debate was cancelled due to “concerns raised by the medical community, among others,” Philly.com reported. The Pennsylvania Medical Society, which has no official position on abortion, opposes the bill because it would potentially interfere with the physician-patient relationship.

We all must speak out together against these bills that attempt to legislate medical care. As I’ve said before –

This is not just about abortion. Or women’s rights. 

It’s about the practice of medicine and the rights of our patients. It’s about physician-patient privacy and the authority of doctors to practice medicine without the fear of breaking the law.

It is also about free speech.

The way these laws are written, physicians who perform abortion are being forced to read scientifically false information to patients.  They are being forced to tell women that an abortion will increase their risk of breast cancer – which is simply not true.

“I’m so sorry that I have to do this,” the doctor told us, “but if I don’t, I can lose my license.” …When the description was finally over, the doctor held up a script and said he was legally obliged to read me information provided by the state. It was about the health dangers of having an abortion, the risks of infection or hemorrhage, the potential for infertility and my increased chance of getting breast cancer.

All physicians and patients, whether they are male or female, pro-choice or pro-life, Republican or Democrat, should be outraged. Our medical societies and our patient advocacy groups  – every single one of them, whether related to reproductive care or not – should be fighting these laws, and engaging physicians and patients everywhere to fight back. Publicly and vocally. Or, as blogger Palmd implores us –

When it comes to the latest abortion bills we cannot afford to remain apart.  We must all speak out against this violation of our ethics and our patients’ rights.

What Can You Do?

  • Contact your state medical society and ask them what they are doing to protect the practice of medicine and the rights of women in your state
  • Write, phone and E-mail your state and national representatives to let them know you oppose any proposed legislation that threatens women and their doctors.
  • Petition the AMA to speak out publicly on this issue.
  • Speak out! Pick a medium, any medium –  be it you blog, e-mail, Facebook, Twitter, You Tube, Pinterest, Tumblr, or the latest and greatest social media network I haven’t heard about yet. Make your voice be heard.

Tomorrow, I’ll be highlighting physician bloggers who are speaking out. Stay tuned -and if you know of a blog post I need to highlight, email me.  I’ve got a list of about 10 so far.

Thank you, Rush Limbaugh

I mean it.

What Rush and his women-hating, slut-calling, reproductive rights bashing cronies have done is the best thing that could have happened for women in this election year.

I know you think things are horrible, what with us now having to fight the battle for reproductive rights all over again, and on 50 different fronts.

But don’t you see? That battle has been going on for years – you just weren’t really aware.

Rush and his pals who oppose reproductive rights were all here last year, when you thought your reproductive rights were safe. They were here in 2010, when Arizona became the first state to limit insurance coverage of abortions. They were here when the Hyde Amendment was cemented into law and when George Bush, Jr reinstated (and Obama reversed) the Global Gag Rule limiting family planning funding across the globe. They were here when 20 our 50 states passed laws regulating ultrasound use prior to abortion, while others mandate counseling (often including erroneous health information) prior to abortion or limit insurance coverage of this legal medical procedure.

During all this time, if you did know they were there, you thought they were just against abortion – you did not realize that they were also against birth control. You thought their agenda was pro-life, not anti-woman. You thought you and they shared common ground, but now you know that ground is filled with landmines targeting women’s rights and your ability to plan your own family.

Thanks to Rush, we’ve finally started the conversation about reproductive rights in America that we should have been having for the past decade.

Like a family with a secret that is finally coming out, that conversation is exceedingly uncomfortable. Fine – let’s have at it. But don’t talk amongst yourselves – make sure your local, state and federal representatives know what you think.

Because what Rush and his buddies don’t realize is that what they’ve actually done is wake up a sleeping giant. That giant is the 98% of Catholic women who have used birth control, the one in five American women who has used Planned Parenthood’s services at some point in their lives and the 40% of women who has had an abortion. That giant is the majority of Americans who support the provision of contraception as part of preventive healthcare – every woman and man who recognizes the value of a society where every child is wanted, loved and born to parents with the resources to care for them. And that understands that spending on contraception makes sense financially for us as a nation, because cutting back on contraceptive prescription coverage ultimately results in women and their partners using less effective over the counter contraceptives, resulting in higher rates of unplanned pregnancy and abortion.

So thank you, Rush, for waking us up.

Now if you’ll excuse us, we’ve got a lot or work to do.

__________________________________________________________

In 2011, states passed 92 restrictions on abortion, and many are also targeting family planning services. Where does your state stand? Do you know who represents you and how they stand? How about the Presidential candidates?  

New Hampshire Abortion Legislation Mandates Health Misinformation and Threatens Doctors’ Safety

The latest salvo against abortion comes from the New Hampshire House of Representatives, who have passed a bill requiring, among other things, that women be told that there is “a direct link between abortion and breast cancer”. Using the worst of pseudo scientific logic, the writers of the bill start with an accepted fact – that pregnancy lowers breast cancer risk – and then proceed to weave a theory linking abortion to breast cancer that, to the lay reader, might sound quite scientific,  but in fact makes no sense given what we actually know about hormones and pregnancy.  There is no link between abortion and breast cancer – this has been shown in multiple well-done scientific studies.

An even more concerning aspect of the bill that has not received much press coverage is that doctors must certify that they gave women the educational materials and that the number of certifications a doctor has submitted is to be made available to the public. The fanatic and violent anti-abortion crowd would love to get their hands on a comprehensive list of every doctor out there performing abortions, and with this law, they would get it in New Hampshire.  This bill is a direct threat to the safety of doctors who provide abortions in new Hampshire, and is clearly designed to intimidate them.

The woman who introduced the bill also claimed that birth control pills cause prostate cancer via environmental contamination by hormones. There is no proof of such a claim.

This bill has passed the New Hampshire House, but not the  Senate. The good news is that New Hampshire’s governor is expected to veto the bill if the Senate passes it. But if I lived in New Hampshire, I wouldn’t count on my governor’s veto. I’d be calling and emailing and writing both my state senator and my governor, and telling everyone I know in New Hampshire to do the same.

Virginia Senate is Wrong in Continuing to try to Mandate Sonograms Before Abortion

Great news, folks – Virginia’s governor has backed down on the forced ultrasound issue.

Facing an issue that could redefine his political legacy, Virginia Gov. Robert F. McDonnell (R) retreated from a measure that would require women to have invasive ultrasounds, performed by inserting a probe into the vagina, before receiving abortions.

“No person should be directed to undergo an invasive procedure by the state, without their consent, as a precondition,” McDonnell said Wednesday.

Not to be dissuaded, the Virginia Senate (115 of the 140 are men, by the way) turned around and amended the bill to mandate transabdominal sonograms instead.

Wrong move, gentlemen. Here’s why –

1. While transvaginal sonograms are invasive, transabdominal sonograms can actually be even more difficult to endure. In order to do the transabdominal study, one has to drink 32 ounces of water and sit and wait, sometimes up to an hour, until your bladder is full almost to overflowing. Then another person presses on your very full bladder for about 5-10 minutes to take pictures of your uterus. And in case you didn’t know, the urge to urinate with a barely filled bladder is one of the first and more common symptoms of early pregnancy.

2. Transabdominal sonograms are not as good as transvaginal sonograms . Transvaginal is far superior for confirming gestational age and excluding ectopic pregnancy in early first trimester pregnancies.  The law makes no sense clinically.

3. State legislators are ordering a medical test without a medical indication. And that’s bad medicine.

4. The issue of informed consent applies for any procedure, whether it’s vaginal or not. You cannot force a person as a condition of informed consent, to undergo a procedure without her consent.

Finally, the biggest argument of all –

5. Mandatory ultrasounds have little to no impact on abortion choice. In fact, they can have other than their intended effect, by reassuring women having very early abortions just how small the pregnancy is. Before 6 weeks, an embryo is not even visible within the gestational sac.  And on transabdominal sonogram, later but still early embryos will be even less visible, as will the heartbeat.

In one of the few studies of the issue — there have been none in the United States — two abortion clinics in British Columbia found that 73 percent of patients wanted to see an image if offered the chance. Eighty-four percent of the 254 women who viewed sonograms said it did not make the experience more difficult, and none reversed her decision.

That generally has also been the case in Alabama, which enacted its law, the first of its kind in the United States, in 2002.

“About half of women opt to view them,” said Diane Derzis, who owns the Birmingham clinic. “And I’ve never had one patient get off the table because she saw what her fetus looks like.”

In some instances, the ultrasounds have affected women in ways not intended by anti-abortion strategists. Because human features may barely be detectable during much of the first trimester, when 9 of 10 abortions are performed, some women find viewing the images reassuring.

“It just looked like a little egg, and I couldn’t see arms or legs or a face,” said Tiesha, 27, who chose to view her 8-week-old embryo before aborting it at the Birmingham clinic. “It was really the picture of the ultrasound that made me feel it was O.K.”

Enough. We are  spending our time and energy on fruitless attempts to limit access to a legal medical procedure.  If we were to spend a tenth of that energy working together to increase contraceptive use by both men and women, we actually might be able to reduce the need for abortions.

____________________________________________

Read the Va proposed legislation.

Laws Mandating Ultrasound Before Abortion Threaten Physician & Patient Rights

Part of me just shrugs my shoulders at the new laws being promulgated by state legislatures that require ultrasound prior to performing an abortion.

After all, in most practices, getting an ultrasound before doing an abortion is pretty much routine already. Doctors who do abortions don’t want to be surprised by an unexpectedly advanced gestational age, a uterine anomaly, an erroneous diagnosis or an ectopic pregnancy. Since most Ob-Gyns have an ultrasound machine in their office, the sono is fast and easy to do. Those docs who don’t have their own sono machines will refer out. And higher volume providers may employ a radiologist or sonographer to do the sonos in their practices.

So if we’re all doing ultrasounds anyway, what’s the big deal?

This is not about abortion – It’s about the practice of medicine and the rights of patients

The big deal is that patient and physician rights are being violated by legislators with an agenda that has nothing to do with the public health and everything to do with restricting access to a legal medical procedure.

We are not talking about a doctor ordering a radiologic test. We are talking about state legislators mandating that a patient undergo a medical procedure without her consent.

It’s not only invasion of privacy, and the physician-patient contract,  it’s assault on the patient. It’s mandating that “as a component of informed consent”, a woman undergo a procedure without her consent. (Amendments that require the woman to consent for the ultrasound were voted down.)

 

HC 462 – The Virginia Ultrasound Law

Abortion; informed consent.  Requires that, as a component of informed consent to an abortion, to determine gestation age, every pregnant female shall undergo ultrasound imaging and be given an opportunity to view the ultrasound image of her fetus prior to the abortion. The medical professional performing the ultrasound must obtain written certification from the woman that the opportunity was offered and whether the woman availed herself of the opportunity to see the ultrasound image or hear the fetal heartbeat. A copy of the ultrasound and the written certification shall be maintained in the woman’s medical records at the facility where the abortion is to be performed. This bill incorporates HB 261.

Do you see the legal precedent being made here?

Forget for a moment that this is about abortion.

Imagine instead that there is a law requiring you to get a chest x-ray before you can be treated for pneumonia. Or mandating that as a doctor, you order an MRI and show the patient the images before treating a headache. Or forcing a male patient to undergo a rectal exam before being treated for urethritis.

We’re not talking about whether or not these are things that are happening anyway as part of the current practice of medicine. We’re talking about a law requiring them to be done as a condition of treatment. The doctor must order the test and the patient must undergo the procedure. Or the doctor is breaking the law.

This is not just about abortion. Or women’s rights. Or Planned Parenthood.

It’s about the practice of medicine and the rights of our patients. It’s about physician-patient privacy and the authority of doctors to practice medicine without the fear of breaking the law.

All physicians and patients, whether they are male or female, pro-choice or pro-life, Republican or Democrat, should be outraged. Our medical societies and our patient advocacy groups  – every single one of them, whether related to reproductive care or not – should be fighting these laws, and engaging physicians and patients everywhere to fight back. Publicly and vocally.

With the passage of Virginia HB 462, eight states now have laws mandating that a woman have an ultrasound prior to an abortion.

How soon before it’s your state? Or your specialty? Or your practice? Or your body?

Unwanted Pregnancies, Not Abortion, Linked to Mental Health Issues in Women

I don’t know how many more studies need to be done to prove once and for all what those of us providing reproductive care to women have always known – that abortion does not cause mental illness.  But just in case, here’s yet another one, this time  “the most comprehensive and detailed review of the mental health outcomes of abortion to date worldwide” conducted by the UK National Collaborating Centre for Mental Health.

Data from 44 studies showed women with an unwanted pregnancy have a higher incidence of mental health problems in general. This is not affected by whether or not they have an abortion or give birth…Usually, a woman’s risk of suffering common disorders such as anxiety or depression would be around 11-12%. But the researchers said this rate was around three times higher in women with unwanted pregnancies.

How much better the British Health Services limited budget would have been spent in providing direct reproductive and mental health services to women.

Can we please just stop trying to prove the obvious to those who will never believe the data and spend our energies helping women and their partners prevent unplanned pregnancy?

Abortion does not cause mental illness

Yet another study showing that abortion does NOT lead to future psychiatric problems.

In Denmark, where termination of pregnancy is legal and freely available until the 12th gestational week, we found no significant increase in the incidence rate of psychiatric contact in the 12 months after an induced first-trimester abortion as compared with the 9-month period before the abortion. The incidence rate of psychiatric contact was higher among girls and women who underwent an abortion than among those who underwent delivery, but this relationship was evident before the abortion or childbirth occurred. On the basis of these results, it seems likely that girls and women having induced abortions constitute a population with higher psychiatric morbidity. We interpret this as a selection phenomenon rather than a causal association, since the observed difference in psychiatric morbidity between girls and women having abortions and girls and women delivering antedated the abortion or delivery.

Can we please talk about something else? Like maybe how to help these young women with the issues and unmet contraceptive needs that led to unplanned pregnancy in the first place?

Abortion on the Web

In countries where abortion is illegal, a group called Women on Web is offering medical abortion over the Internet. (via National Women’s Health Report)

Clients complete an online questionnaire and are then contacted by a doctor who prescribes the medications that are then taken at home to induce abortion. The medications are mifepristone (RU-486) and buccal Misoprostol. (Buccal is holding the medication in your cheek till it dissolves.) The vaginal route for misoprostol is avoided so that no evidence of pills is left to implicate a user.

The group has published outcomes on 484 women from 33 different countries who received their services in 2006-7. Follow up was obtained via e-mail or phone for 367 women.

About 8% of the women never took the medication. For those who did, outcomes were reasonable for the method used – Between 6 and 12% reported having to have a D&C for bleeding or incomplete abortion, which presents as an early miscarriage and can be treated safely in a medical setting. Continuing pregnancy rates were less than 2%.

These results are similar to those reported in the initial clinical trials of mifepristone here in the US.

The Royal College of Obstetricians & Gynecologists has released a statement saying that it “neither approves or disapproves” of the work provided by Women on the Web. More from that statement –

The results from the study demonstrate that Early Medical Abortion is safe and acceptable to women, confirming other studies including the recent pilot study conducted by the Department of Health in May. The study also shows that women are capable of safe self-administration of drugs provided they receive good and clear instructions, are aware of the possible side-effects and the nature of complications which indicate that further medical attention is required.

And more from the BBC on the UK reaction.

What are the legal issues?

Women on the Web claims its services are legal, even in those countries where abortion is not, since the receipt of medications for home use does not violate customs laws. They do not offer the service in countries where abortion is legal.

The Women on the Web Site

I went to the site, and have to say that I am quite impressed with the quality of the service.

Women are told to go have an ultrasound if it is available to confirm their gestational age before using the service. (Ultimately 80% do so, an impressive percentage) For women where ultrasound is not available, instructions are given to determine gestational age, which prior research has shown to be accurate in most cases.

All cases are reviewed by a doctor for contraindications before medication is released. (I wish they had reported how many women were refused medication for medical reasons or referred elsewhere so I could get a handle on this aspect of the care.) Women are told to seek care for complications in a medical setting. Warnings about undiagnosed ectopic pregnancy, probably the most serious risk of this procedure, are clear and frequent.

The site uses idealized data from other clinical trials in their information about complications. (Now that they have their own data on outcomes, I would urge the group to use that info to guide women in their decision as to whether or not they wish to use this service.)

The site also asks women to post a photo and /or their experience on the site, in an attempt to remove the shame surrounding the procedure. For women who don’t want to use their own photo, the generic photo up there is used. The photo is a sexy, braless blonde in a mini dress. …what’s that about?

How do I feel about this?

Uncomfortable is probably the operative word. I like to see medicine practiced face to face whenever possible. Plus, I’m a law abiding citizen, whether I like the law or not.

But I know that I feel this way because I practice medicine in a country where abortion is safe and legal (for now, at least). If I were practicing in one of the countries where abortion is illegal, and seeing the consequences of those laws in the lives and health of my patients, I might feel very differently. As a physician, I’d probably prefer to handle the miscarriages that result from an early Internet-based medical abortion over the complications from a botched curettage.

Mostly what I hope is that someday, contraception will be free and available to all women so that few women have to seek abortion, legal or illegal.

Common Ground in the Battle over Abortion

I posted earlier this week about the recent Guttmacher Institute study on worldwide abortion rates which showed a decline in abortions worldwide, due in large part to increasing use of effective contraception. The study also found that anti-abortion laws do not lower rates of abortion, only drive it underground. At the end of my post, I expressed hope that those of us on opposite sides of the abortion debate would find common ground in promoting the use of effective contraception.

I think this Christian blogger has met me in that common ground. If she is the voice of young pro-life Christians, then there is indeed hope that one day abortion will become as rare as we all want it to be.

Mandi, let’s keep this conversation going (and growing)..

Abortion – Changing the Conversation

In a landmark paper published this week in Lancet, researchers at the Alan Guttmacher Institute reported that abortion rates are down worldwide, due in large part to increasing use of effective contraception. The decline in developed countries was most marked in Eastern Europe, an area that until recently did not have widely available contraception.

I think the data are very real. I have seen many patients over the years who emigrated here from the former Soviet Union and who had upwards of 5 abortions, because, they told me, this had been their only available form of birth control. Here in the US, these women are using effective contraception, and not having abortions.

Another important finding from the study was that abortion rates were the same regardless of abortion laws. Again, I am not surprised. Abortion is not like drinking or gambling, a viceful pleasure that needs to be regulated by the state. It is a woman’s desperate response to an unplanned pregnancy, and desperate women do desperate things, regardless of the laws. But give these same women easy acccess to effective contraception, and the need for abortion disappears.

Unfortunately, the proportion of abortions that are unsafe increased from 44 to 48% in the same time period. According to an interview in the NY times with one of the study’s authors;

Generally, where abortion is legal it will be provided in a safe manner..And the opposite is also true: where it is illegal, it is likely to be unsafe, performed under unsafe conditions by poorly trained providers.

I am greatly encouraged by the media play on this study, and hope that it will help drive the battle over abortion into the common ground between the two sides – contraception.

In this regard, I read a very encouraging post in a The Mirror of Justice, a blog on Catholic legal theory that seems to be getting a lot of play on the internet (it’s number 4 when I googled “abortion rates” and “Lancet”…)

Here’s my question. If this study were true, and if it were the case that making abortion illegal would most likely only drive it underground, without having much effect on its actual incidence but making it far more dangerous for women to have an abortion, would that be a reason to rethink the Church’s teachings, not on the morality of abortion, but on the tight connection between abortion’s (im)morality and its legality? I’ve tried to get this conversation off the ground a few times at MOJ, but I feel like we often get side-tracked onto the question of abortion’s morality or into the empirical question whether studies like this one are actually correct.

If this is how the Catholics are starting to think, then there may be hope that one day abortion will become, as many of us hope, legal but rare.

Update – the conversation’s starting…

Verizon and Free Speech

From today’s NY Times…

Saying it had the right to block “controversial or unsavory” text messages, Verizon Wireless last week rejected a request from Naral Pro-Choice America, the abortion rights group, to make Verizon’s mobile network available for a text-message program. But the company reversed course this morning, saying it had made a mistake.

Darn right, it was a mistake. And the reversal came just in time. I was about to cancel my phone service…