Khoury clarifies purpose of abortion demonstration

In speaking about abortion, it is important to remain clear in words and spirit. Often, in an attempt to alleviate anxiety regarding the procedure, we speak of its technical simplicity. The process of terminating a pregnancy, however, is far from easy. As health care providers-in-training in the age of biopsychosocial medicine, we are actively learning to provide women with comprehensive and unbiased care. At a time when 85% of counties in the United States have no identified abortion provider, it is time for us to step up to the plate. We are advocates for women at a difficult juncture in their life, when biology leaves them bearing the product of unprotected sexual encounters in a way that men can never imagine.

The goal of our talk on Monday night commemorating Roe v. Wade was twofold: an overview of the epidemiology of abortion as a medical option for women with unintended pregnancies, and a technical description of the procedures, medical and surgical, involved in pregnancy termination.

Every year, 49 percent of US pregnancies are unintended and 20 percent end in abortion (Finer LB, Henshaw SK. Perspect Sex Reprod Health. 2006). Of those who choose abortion, 61 percent have access to information and care early enough to abort in the first 8 weeks of pregnancy. Less than 1 percent of women have an abortion after 21 weeks. As stated in our talk, this figure reflects desired pregnancies that are aborted for fetal anomalies, often incompatible with life (and diagnosed later in pregnancy), as well as disparate delays in access to care. As we stressed, prevention is key. Prevention includes: early sex education, early and comprehensive contraceptive access, early identification of pregnancy, and early, supportive discussion of options including abortion.

The focus of the remainder of our talk was Manual Vacuum Aspiration (MVA). This is part of the “surgical abortion” option offered to women between 5 or 6 weeks and 14 weeks of gestation. MVA is 99 percent effective at pregnancy termination and can be done in the outpatient setting. The aspirator itself is safe, clean, easily transportable and reusable. It is also cheap, reducing cost barriers to reproductive care and the disparities those barriers create. We concluded the talk with a demonstration of the MVA on plastic pelvic models as well as papaya fruits to allow participants to practice and demystify, not trivialize, the procedure. When I was asked what the contents removed from the uterus with the aspirator looked like, I said “blood and mucus,” referring to products of conception, which are then carefully studied in a separate room to ensure the gestational sac and fetal parts (if old enough), are present, ensuring that the procedure was carried out successfully.

We presented anecdotal cases highlighting the experience of three different women with abortion: a woman in her mid 40s in an abusive relationship, a 30-year-old mother of three unprepared for another and a recent college graduate in a short-term relationship. These were meant to illustrate the fact that women across the age, race and economic spectrum at various points in their life may make the difficult decision to terminate a pregnancy. We stressed the role of providers and support staff in ensuring the woman has every resource available to her, from someone to hold her hand and drive her home to psychosocial support offered by the doctor, physician assistant, nurse, administrative staff and most importantly, society.

Do women “take this procedure lightly”? The truth is that women, like all patients, have a range of reactions to invasive procedures. The predominant sentiment expressed is relief. But anyone who has had their body instrumented understands relief at the end of an unsettling period is not without a queasy sense of invasion and at times loss, no matter how sound their decision. When we fail to prevent these unintended pregnancies we must wholeheartedly support and empower women with choice.

To disarm the myth that legalized and safe abortion leads to an increased abortion rate I refer you to the excellent report: “Induced Abortion: Rates and Trends Worldwide,” published by the Guttmacher Institute and the World Health Organization (WHO) in the Oct. 13, 2007 issue of The Lancet.

And I invite you to join us at the Medical Students for Choice Annual Meeting: April 5-6, 2008 in St Paul, MN, where you can meet and be inspired by choice providers across the medical spectrum. Their perseverance brings hope.

Rasha Khoury is a student at the Yale School of Medicine and a member of Yale Medical Students for Choice.

Comments

  • Anonymous

    It's too late I'm afraid… I'm still far too offended…

  • Anonymous

    Thank you for further explaining your point of view.

  • Anonymous

    http://www.johnstonsarchive.net/policy/abortion/wrjp333pd.html

    Abortion is highest in countries where it is legal and paid for by the government.

  • Anonymous

    Absolutely abominable! If it is not wrong to kill a baby--in the author's own words "with arms and stuff"--then NOTHING is wrong.

  • Anonymous

    "Arms and stuff." Thanks, Rasha. You just can't get better pro-life ammo than that.

  • Anonymous

    I'm all for people clarifying things, but has there been some explanation of why the original article is no longer online?

  • Anonymous

    "products of conception, which are then carefully studied in a separate room to ensure the gestational sac and fetal parts (if old enough), are present, ensuring that the procedure was carried out successfully"

    These words as chilling. Regardless what one thinks about the morality of abortion, this utterly cold, clinical way of speaking about such a difficult matter is indicative of a deficit of basic humanity. To think that people like Rasha will be charged with providing "psychosocial support" to the women who feel driven to this "difficult decision"…

  • Anonymous

    utter filth.

    Rasha and her ilk don't realize that they are self-aborting their own constituency.

    Unborn-Infant girls are far more likely to be targeted for sex selective abortions (not to mention infanticide).

    This is sex eugenics at work!

  • Anonymous

    I agree that some of her statements such as "arms and stuff" lack humanity, but we have to be subjective to the matter whether or not we are with abortion.

  • Anonymous

    i'm sorry. "arms and stuff" may sound dehumanizing, but that's what the procedure is like. and she did say her goal was to give an idea of how the procedure is actually performed. it may not be pretty, but your not wanting to hear about it will not make it any different.

  • Anonymous

    I believe the abortion debate is linked to the distrust of science in American society. You say that to speak clinically is "cold" whereas I say that to speak clinically (to say "products of conception" instead of "baby") is to provide a safe environment that doesn't impose ideology on women who are facing a difficult decision. Doctors are trained to speak clinically and that's a good thing, because you want them to be able to speak in language that is unbiased. Being able to describe a medical procedure in medical terms does not mean a physician doesn't also know how to be compassionate and caring. If you truly believe that "clinical" and "humane" are two mutually exclusive categories and one person cannot exhibit one or the other depending on that context, then your worldview lacks complexity.

  • Anonymous

    re: http://www.johnstonsarchive.net/policy/abortion/wrjp333pd.html

    That site reports percentage of pregnancies ending in *legal* abortions, so of course the percentage is lowest in countries where abortion is *illegal*.

    Studies looking at total (legal + illegal) abortions show that the rate is pretty constant across countries and is lowest in countries that have the lowest rate of inintended pregancies.

    If you want to end abortion, promote contraception.

  • Anonymous

    It enrages me when men are taken out of the debate entirely. But even more it enrages me when the very negative and life long affects of abortion on the woman's physical, emotional and mental health are completely swept under the rug.

    Does it ever occur to you that men, as fathers, might be very traumatized by the thought of a woman aborting their child without their consent? I think this is worse crime than rape actually.

    We have laws in society that make us stop for a jaywalker, so as to spare their life. Why can't we put things on hold for 40 weeks to spare a baby's life?

    Also, enough with that nonsense about contraception - it is a red herring. In this day and age middle school kids can get free contraception. If someone lacks access to contraception, it does not suddenly change the morally of abortion.

  • Anonymous

    1) "very negative and life long affects of abortion on…physical, emotional and mental health"

    Abortion is safer than childbirth. Late term pregnancy and childbirth put a woman at risk for hemorrhage, uterine prolapse, post-partum depression and psychosis, seizures, damage to the perineal body, renal failure, hypertension, among other things. If you want to say abortion is immoral, that's fine, but don't use the woman's health as your excuse for opposing it.

    2) Contraception is not a red herring. 99% of abortions are because the pregnancy was unintended. If every sexually active person in America was on a 100% effective form of birth control 100% of the time, America's abortion clinics could close. Isn't that what you want?

  • Anonymous

    Thank you #14! Abortion is not moral, but women's health is not an effective argument. Contraception is something both sides promote and should agree on, since contraception reduces abortions and increases the health of women.

  • Camille

    @#13: "Does it ever occur to you that men, as fathers, might be very traumatized by the thought of a woman aborting their child without their consent? I think this is worse crime than rape actually."

    The thing about roping people into a game of Oppression Olympics is that no one wins; but the person trying to play the game (i.e. you) automatically loses. "My problem sucks more than your problem" as a debate tactic ended in third grade.

    Speaking of cold and clinical, discussing the pros and cons of different types of domination over a woman's body and health--forced pregnancy vs. rape--on an internet discussion board is more pervy than anything a med student could have been doing with those papayas.

  • Anonymous

    What is disturbing about the "clinical" view of abortion in political discourse is that it represents a denial or the moral seriousness of the abortion issue. In doing so, the author avoids the real debate entirely, limiting themselves to the world of the extremist 20% or so who support unrestricted abortion (and maybe not even all of THEM)

    The vast majority of Americans see abortion as a tough moral call, a trade-off between women's rights and some recognition that the fetus, while maybe not a full-fledged human life, does have some value. Khoury and her group should join the real debate or continue to preach irrelevantly to the choir.

  • Bekka

    Thank God I survived Roe vs. Wade! I was the third child. Almost aborted. But because Roe vs. Wade hadn't been invented yet, I was spared! I have a right to be here! Not even my Mom should be able to kill me!

  • Hieronymus

    #18
    A moving and human point, and one well worth considering by many among us.

    My mother-in-law pushed the idea of abortion with regard to my family's third child, now a wonderful, vivacious two-year-old without whom life would be diminished.

  • Hieronymus

    Addendum: relating to the "circumcision" forum: how many boys, given the opportunity, would choose circumcision FOR THEMSELVES?

    Reasonable analog (barring the difference in magnitude).

  • Crystal

    I am really against qbortions. The most important thing is that if you don't want any kids for any reason then i think that you should be on some sort of birth control and second if you are younger then 17-18 years old i don't think you should be having any sex, because you are to young!!!!! You are not letting your body grow the way it's suppose to. We'll having abortions is stupid, your are just not going to kill a baby just because you are to young or can't support her/ him. Think about what you are doing before you have sex. Think about the pro's and con's of having a baby.