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.