Abortion – Population Matters-USA

The really bad news is that we have elected a misogynistic felon with a narcissistic personality disorder. Even worse news is that people have fallen for Trump’s lies.

There’s some good news, despite lots of disappointments. In my state, Colorado, almost 2/3rds of voters chose to amend our constitution to guarantee the right to safe abortion care. In addition, the state will start paying for abortions for women who are state and local government employees, and for those on Medicaid.

The state to our north, Wyoming, had abortion laws preventing almost all abortions. In November, a Wyoming judge ruled that the laws were against that state’s constitution. She wrote: “The abortion statutes suspend a woman’s right to make her own health care decisions during the entire term of a pregnancy and are not reasonable or necessary to protect the health and general welfare of the people.” Although the state will probably appeal this decision, for now women can obtain safe, legal abortion care in Wyoming.

Public health scientists have identified several causes why young children don’t flourish. Children may not do well if pregnancies are too close together. We also know that if a mother really, really doesn’t want to carry a pregnancy, but is forced to give birth, that the child may not fare well. Do children who result from unintended pregnancies also suffer?

“Yes” is the sad answer. Researchers looked at Demographic and Health Surveys from developing countries. Surveyed mothers rated their births as being desired, mistimed or unwanted. The endpoint of the research was infant mortality—the death of the child before age one year of age. What they found is that children whose pregnancies were described as unwanted or mistimed were more likely to die. This finding held for 41 of the 60 countries studied. Moreover, the effect was stronger in poorer, less educated places.

Unfortunately, there are over 120 million unintended pregnancies globally each year. These findings are the bad news. The good news is that now there is proof that contraception decreases infant mortality in impoverished areas.

Unfortunately, there is concerning news about two of the Long-Acting Reversible Contraceptive (LARC) methods. DepoProvera, has been associated with an increased risk of users developing meningiomas. These are benign tumors of the membranes covering the brain. Meningiomas are more common in women, and have been found to have receptors that respond to female hormones. However, the risk of developing a meningioma is very, very small, and it is still very small for users of Depo.

There are four IUDs containing a hormone. In addition to providing excellent contraception, they make periods less painful and lighter. Fortunately, they don’t seem to increase the risk of meningioma, but the latest information is that they may increase the risk of breast cancer.

It will take more studies to confirm (or refute) these concerns about LARCs causing tumors. In the meantime, it is the right of women to know of these possibilities. However, the risks of morbidity or mortality from pregnancy exceed by far the likelihood of a problem caused by any contraceptive method, if used properly. For women who desire long-term reversible birth control, the ParagardÒ IUD is a hormone-free LARC. It can provide excellent protection for 10 years—or possibly even longer.

Since the Dobbs decision, many states have made it very difficult to access safe abortion care. Furthermore, unintended pregnancies cause problems if the mother is forced to carry to term. Taken together, these facts make it all the more important to increase the availability of contraception.

©Richard Grossman MD, 2024

Image from the Plan C website.

“A safe abortion with pills requires only three things: accurate information, quality medications, and mutual respect and trust.” Doctors Without Borders

In the past there was a sharp division between safe (legal) abortions and unsafe (illegal) abortions. Recently that line has been blurred with Self-Managed Abortions (SMAs).

Even when abortion was legal all over the USA, there were occasional women who would try to abort a pregnancy outside the medical system. Most commonly they would use herbs or misoprostol, the prescription-only medication that is sometimes available on the black market. Here’s an example:

June, a 26-year-old woman, went to her doctor who only recommended that she continue her unplanned pregnancy to term. To paraphrase her quote in a study of SMA, “I did some stuff on my own because I didn’t think she would help me get the abortion I wanted.” She took antibiotic pills and ibuprofen after she had a positive pregnancy test, but ended up going to an abortion clinic when her SMA didn’t work.

Other women in the same small study tried to abort unintended pregnancies using: vitamin C, parsley tea, multiple contraceptive tablets, dong quai, black cohosh, gingerroot and alcohol. Sometimes bleeding started and sometimes it didn’t. Since not all of the women had taken a pregnancy test before trying SMA, it is impossible to know the effectiveness of their attempts to abort. Fortunately, none of the woman had a bad effect from their attempts at SMA. Oil of pennyroyal is known to be an effective abortifacient; however, it has also known to sometimes be fatal for the woman who takes it.

Fortunately, medication abortion using mifepristone and misoprostol is safe and effective. The combination was approved by the FDA in 2000. As more and more women used this combination it became clear that it is very safe—especially when compared to carrying a pregnancy to term.

Recently the combination has been approved for “telemedicine”. Contact between a woman with an unintended pregnancy and her healthcare provider can be by electronic means, similar to Zoom. The provider asks questions such as when the woman’s last period was, as well as about her general health. If the person is a candidate for medication abortion, the appropriate pills can then be sent to her, with clear written instructions how they should be taken. The instructions also tell the woman what to expect, and when she should seek emergency care.

How safe and effective are telemedicine abortions? In a study of over 6000 women who did not visit a clinic in person, they found no difference from women who had face-to-face contact with a healthcare provider. Only 2 of 1000 women had a serious adverse event, and the success rate of causing an abortion was almost 98%. These figures are similar to studies of medication abortion in which patients visited a clinic.

Telemedicine has reduced the cost to obtain an abortion—the interview can be done from the woman’s home so little time and no travel are required. The pills are shipped by a delivery service or mail, and will arrive in a few days, allowing the woman to choose when to start her abortion. But the real advantage of telemedicine is for people who live in states where this necessary part of healthcare is severely limited or illegal.

Doctors Without Borders has a series of videos on SMA, available at: https://www.doctorswithoutborders.org/latest/how-have-safe-self-managed-abortion. Although DWB mainly works in developing countries, this information also applies to some states in the US. The nonprofit Plan C supports SMA by providing information about access to abortion pills, including their cost.