Saturday, February 16, 2008

Unsafe abortions - The silent pandemic

published: Sunday | February 17, 2008
Heather Little-White, Ph.D., Contributor
Click here for article

As advocacy for increased access to safe, legal abortion continues in Jamaica, arguments for or against it are usually well presented. Unplanned or unwanted pregnancies are a reality of life, so Sheronbelieves that abortion should be made legal so that it can be safe for those who need to have one done. Sheron, 38, a victim of unsafe backdoor abortion, tells her story.

"I remember visiting the country at age 20 to visit my ailing grandmother. My grandmother had to be hospitalised and most times I was alone in the house. One day my uncle came home from work early, to my surprise. He always had 'eyes for me' but I used to tell him how disgusted I was with his behaviour. Later that day as I was taking a shower, I heard the bathroom door open, it was my uncle, naked as the day he was born ... he pushed me against the shower, and forced himself on me, raping me despite my pleas to stop. I could not fight him off with my small frame as he was a tall, heavyset man.

"I felt dirty and ashamed. Days later, I eventually found the courage to tell my mother, who did not believe me and accused me of telling lies on her brother. I cried even more. Weeks passed, I missed my period and realised that I was pregnant, I decided that no way could I carry a child for my uncle ... when my mother discovered that was I pregnant, she was alarmed and offered to take me to a 'doctor' in town.

"I remember ascending a flight of stairs to a dusty room where I was asked to lay on a table behind a black curtain. Today the visit is still vivid in my mind. I was given a cup of warn drink and soon felt drowsy. Later, the middle-aged 'doctor' asked me to spread my legs, he pressed my stomach hard, asked me to take a deep breath and I could feel a cold instrument being inserted into my vagina, then a piercing pain, after about an hour or so I was released in pain and blood, the bleeding continued for three days despite the doctor's promise of a couple hours. I realised that I had an abortion which resulted in infections and my inability to conceive later in life and the psychological effect is like a nightmare."

Sheron's story concurs with similar stories from an estimated 20 million women around the world who have unsafe abortions annually (Allan Guttmacher Institute, 1999). However, some victims of unsafe abortion do not live to tell the tale. Anti-abortionists argue that women should not find themselves in the position where they end with unplanned or unwanted pregnancies, even though these may occur for a number of reasons.

Like Sheron, pregnancy could result from incest or rape or from failure to use contraceptive, pressure from a partner not to use contraceptive, contraceptive failure and changes in circumstances that make a pregnancy unwanted, such as abandonment, relationship problems with husband or partner, risks to maternal health and financial difficulties. Women may also want to pursue educational or career goals and will want to postpone childbearing. The number of unplanned pregnancies illustrates the unmet needs of family planning.

Unsanitary conditions

The World Health Organisation (WHO) defines an unsafe abortion as a procedure to terminate an unintended pregnancy by untrained persons who are styled as 'doctors', and usually in unsanitary conditions that do not conform to medical standards. In the United States, a slang term for unsafe abortions is back alley abortions, characterised by the use of a coat hanger. The magnitude of unsafe abortions in the United States led to Roe vs Wade Supreme Court decision 1973 to legalise abortion in America.

In developing countries, unsafe abortion places women at risk because abortion is highly restricted by law, or where it is legally permitted safe abortion is not easily accessible. According to WHO, an estimated 20 million unsafe abortions are performed each year with 95 per cent in developing countries. Simply put, unsafe abortions are performed at a rate of eight per hour.

Bitter concoctions

Unsafe abortion use self-induced methods which are crude, dangerous and even fatal. These include taking teas and herbal remedies, such as boiled avocado or basil leaves, wine boiled with cinnamon and raisins, boiled celery water with aspirin and bitter concoctions; ingesting alcohol and toxic solutions such as turpentine, detergent solutions, bleach and acid; pushing objects into the uterus, such as a stick, wire, coat hanger, knitting needle, ballpoint pen, bicycle spoke, rubber tubing; air blown in the vagina by a syringe and physical damage such as an abdominal or back massage, lifting heavy weight or falling or jumping from the top of stairs or roof when there is no other way to end an unwanted pregnancy. Pharmaceuticals administered include uterine stimulants, such as misoprostol or oxytocin, and quinine or chloroquine used for treating malaria.

On the contrary, safe abortions are performed by trained professionals in sterile conditions using safe methods like pharmaceuticals, suction curettage and induced labour. When performed in sanitary conditions, legal abortions are one of the safest procedures in contemporary medicine. However, the cost of safe abortions is usually prohibitive, which causes poor women to delay getting an abortion until later into the pregnancy when the risk is greater. Regardless of the legal status of abortion, the data show that poor women are at greater risk for undergoing unsafe abortions using primitive, unsafe methods for self-induced abortions.


Morbidity complications resulting from unsafe abortions include incomplete abortion, infection (sepsis), haemorrhage and trauma to the cervix, vagina and uterus and injury to internal organs, such as puncturing or tearing of the uterus. Long- term damage includes chronic pain, pelvic inflammatory disease (PID) and infertility. Death is also a consequence of unsafe, illegal abortions. Globally, WHO estimates that 68,000 women die each year from unsafe abortions. Teenagers comprise a significant proportion of victims of unsafe abortion because they tend to wait to seek abortion later than do older women and are at greater risk of complication.

Abortions conducted in unsafe conditions put the lives of many women at risk and present a grave public health problem to governments. Consensus from the IV World Conference of Women in Beijing 1995, posited that the majority of deaths, injuries and abortion-related health problems could have been prevented with improved access to health services, including safe and effective methods of birth control and gynaecological care.

Public health issue

At the 1994 International Conference on Population and Development (ICPD), nations around the world agreed that societies must ensure high-quality, compassionate treatment for complications resulting from unsafe abortions; provide access to family planning; reform restrictive laws that limit the availability of safe services and trained professionals and ensure safe abortion services. Public health record indicates that safe, legal accessible abortion improves health. The ICPD conference resolved that governments should work to eliminate unsafe abortions by an integrated, comprehensive approach involving health workers, policymakers and advocates.

Name changed for privacy

Friday, February 15, 2008

Abortion is here to stay

Sam Rowlands
Published 15 February 2008
New Statesman
Debating the abortion rate is futile - we need to focus on providing information and contraception

Recourse to abortion is a feature of all societies and is as old as humanity. Women have abortions regardless of the legal situation in their country. It’s clearly much safer for a woman to have an abortion in proper medical surroundings than as a clandestine procedure performed by untrained personnel. Younger generations need to be told and older generations reminded of the results of backstreet abortion: death and permanent injury from sepsis, mechanical trauma and chemical burns.

Globally there are about 42 million abortions annually, of which nearly a half are unsafe. 68,000 deaths occur annually from unsafe abortion, almost exclusively in the developing world.

It’s true that in the past, in countries like the former Soviet Union, because of almost complete lack of access to contraceptives women used abortion as a primary means of fertility control. This is not so nowadays in the West. But women clearly use abortion as an adjunct to contraception in the event of non-use, incorrect use, inconsistent use or failure of contraception. The most commonly used methods, the pill and condoms, have substantial failure rates in everyday use. This is why there is a current push from the National Institute for Health & Clinical Excellence for wider adoption of long-acting reversible methods (injections, implants and intrauterine devices).

Emergency contraception (pills or intrauterine devices administered after unprotected sex) have the potential to make inroads into the abortion rate. So far though, its use is not widespread enough to make any detectable difference.

An estimated 108 million married women in developing countries have an unmet need for contraception. So, there is potential here for reducing abortions in these countries. Availability of contraception in Eastern Europe has improved and abortion rates have fallen, but rates remains much higher than in the rest of Europe with more abortions than births.

Countries such as Belgium, Germany, the Netherlands and Switzerland have low abortion rates. High use of contraception and universal sex education almost certainly play an important part there. The specifics of their abortion laws and how they operate in practice will be relevant too. Abortion rates are determined by a complex range of factors including family size intentions, confidence in the safety of contraceptives, amount of sexual activity in adolescents and where the country concerned is in its demographic transition.

There has been a continuing decline of the abortion rate in the United States since it peaked in 1981, although it remains well above that of Western Europe. Increased use of contraception has contributed to this decline. Much of the decline took place in eight states in which efforts have been made to deliver good sex education, not the Bush administration’s abstinence-only approach. One suspects some of the decline is due to restrictive state laws causing delays or preventing some women altogether from having an abortion. These restrictions unfortunately have a disproportionate effect on the poor. And such a decline is not a unique trend - it may be part of a global decline which has been measured between 1995 and 2003.

In Britain the abortion rate has increased year on year since legalisation in 1968, but after 1998 this increase has been slower. There are signs that women’s desire to control their fertility is now being met by service availability.

Abortion is here to stay. There is little point debating whether our abortion rate is too high. What we should be concentrating on is making sure that women requesting abortion are supplied with evidence-guided information on which to base their decision. They should all be offered medical abortion: in this respect England and Wales are lagging behind Scotland. All women should be offered screening for infection. And all women should be offered contraception, including long-acting methods. Further research is needed on factors that detract from consistent use of contraception and from this possible effective interventions can be developed.

Dr Sam Rowlands is a freelance specialist in contraception and reproductive health and a Visiting Senior Lecturer at the University of Warwick.

Thursday, February 14, 2008

What is The New York Times' problem with abortion?

In These 'Times'
The newspaper of record's squeamishness about abortion.

By Debbie Nathan
The New Republic
Published: Thursday, February 14, 2008

What is The New York Times' problem with abortion? The editorial page consistently supports sex education, birth control, and the right to legally end unwanted pregnancy. The rest of the Times, however, often seems uncomfortable with concrete applications of these principles. Not a season goes by that a news item or magazine feature doesn't imply that women who get abortions are acting with egotism, unhealthiness, and cruelty.

The most recent instance of this is Annie Murphy Paul's "The First Ache," in last Sunday's Magazine. "When does the experience of pain begin?" the subtitle asks. "Anti-abortion activists aren't the only ones to argue that it may be in the womb."

Paul's article, which runs over 5,000 words, begins with a doctor in Arkansas claiming that fetuses as immature as 20 weeks after gestation suffer agonies when prodded and cut during, say, prenatal surgery. And--the point of the piece--when they're aborted.

But then other doctors start discussing the Arkansas physician's claim, and their opinions are all over the map. One insists that fetuses feel no pain until at least 29 weeks. Another pushes the pain date all the way forward to 18 weeks. Someone else says that even born babies can't feel pain until they're one year old. Clearly, there's no consensus on the issue. But the lack of agreement is lost amid the article's looming intimation that women who end their pregnancies are hurting their fetuses. Paul never specifies that the vast majority of abortions--more than 96 percent--are performed before 18 weeks' gestation, the earliest date being claimed for the beginning of fetal pain. Nor does she mention that American women are getting abortions earlier and earlier in their pregnancies: The rate occurring in the first eight weeks has increased sharply in recent years, with many now done in the sixth week of pregnancy or earlier. Without these statistics, the article's main effect is to make female readers feel guilty and confused about abortion.

Paul's is not the only problem piece to run in the Sunday Magazine. Another, by Slate senior editor Emily Bazelon, appeared last January and looked at "post-abortion syndrome" (PAS). A takeoff on PTSD (post-traumatic stress disorder), PAS is not recognized by the psychiatric or psychotherapy establishment because there's no scientific evidence it exists. But moral conservatives out to overturn Roe v. Wade have popularized the purported malady among women who've had abortions. And last year, the Supreme Court cited affidavits submitted by people claiming they've suffered from PAS. The court said the risk to women of contracting the risk of "severe depression and loss of esteem" was one reason to ban "dilation and extraction"--better known as "partial birth" abortion. If for no other reason than this politicking, PAS is well worth exploring.

Problem is, Bazelon skips lightly over politics, focusing instead on fuzzy profiles of self-described PAS sufferers. One is Rhonda Arias, an evangelical minister who runs PAS-support groups in Texas women's prisons. Bazelon follows Arias as she holds forth in one facility, reading from the New Testament, playing gospel music, and handing dolls to inmates who weep as they mourn their aborted offspring. Then Arias asks these prisoners to send her testimonies about their PAS to her so she can submit them to places like the Supreme Court.

To be fair, Bazelon spends a long time discussing the piled-up scientific evidence showing that PAS doesn't exist, with many interviews from respected researchers illustrating the consensus that it's just a right-wing talking-point. Still, Bazelon writes that Arias's audience members "drink in [her] preaching," and about how Arias "ministers from the heart" with her face "alight." We read that Arias conducted a study with data culled from prisoner reports of psychological trauma from abortion (which she later sent to the Supreme Court). But Bazelon does not remind us that prison inmates are considered a terrible source of data for psychology studies. They are a captive population at great risk of saying whatever they think people in authority--including researchers--want to hear. Nor are we told that one facility where Arias does her PAS data collection has been cited by inmates as lacking access to work and substance abuse programs. Another prison houses all nine women on Texas's death row and is among the state's ten most violent prisons. No wonder inmates might exchange PAS testimonials for hugs and music.

And Bazelon only glances over the Justice Foundation, a Texas group that funded the collection of those PAS affidavits for delivery to the Supreme Court. The article calls the foundation "a conservative law center," but doesn't say that it was founded by, and gets its money from, James Leininger, a Christian right winger and one of the richest people in Texas. Leininger has used the Justice Foundation and other groups, also funded by him, to pack the Texas school board with members who oppose sex education and favor censoring textbooks. He has bankrolled political campaigns in which candidates who don't toe his line have been smeared with charges that they promote illegal drug use and homosexuality to school children. And he is staunchly anti-choice: Using the Justice Foundation, he almost single-handedly has enabled the gathering of PAS affidavits to erode Roe v. Wade. Rhonda Arias would be a nobody without this man's fortune and political designs. He's as important as she is--if not more so--to understand the PAS push.

Magazine articles aren't the Times's only problem. News stories also sometimes issue strange and conflicting messages about abortion. Last spring, for instance, a long piece appeared on the front page: "Today's Face of Abortion in China is a Young, Unmarried Woman," by Jim Yardley with Lin Yang contributing. The article's point seemed to be that, back when China coerced married women to have only one child, it wasn't their fault they had to get abortions--but now, single young women are obtaining them voluntarily. And this is bad.

Why bad? The article reeks with veiled references to selfishness and irresponsibility. The first paragraph says, "it was her second abortion in 18 months." Indeed, most patients sitting at a clinic with this woman have already had an abortion; one is on her sixth! And how did they find the clinic? The article notes that private abortion clinics proliferate in China now, and newspapers there run "sensational" ads promising "Painless Abortions." (The reporters seem unaware that ethnic papers in New York City, such as El Diario, are stuffed with identical ads, and that most abortions in this country are done at private facilities.)

Again, numbers are used out of context. The Times cites the number of abortions per year in China, and the number in this country: 7.1 million there, 1.29 million here--an alarming differential until you recall that China's population is over four times that of the US. The article never mentions this basic data.

A headline was the problem in another front page story, which ran on January 31. The article reported that Shanghai Hualian, a big pharmaceuticals manufacturer in China, made a contaminated leukemia drug that sickened patients in that country. The same firm produces all the RU-486 distributed in the U.S. (the drug is used to induce non-surgical abortions). But the FDA said the company's RU-486 factory had passed many inspections and is safe. The Times reported this at length. So why was the articled titled "Tainted Drugs Linked to Maker of Abortion Pill"?

To be sure, Times stories are not always pursed-lipped about abortion. Spring 2006 saw a national scare about a deadly bacterial infection associated with RU-486 abortions. In a follow-up article in May, reporter Gardiner Harris pointed out that infection with the same bacteria might be a risk for pregnant women who intend to have their babies. Harris even quoted two New York woman who'd had multiple abortions, some done surgically and some with RU-486. They discussed the pros and cons of each procedure, and one woman allowed publication of her name: Anne Hawkins. The whole thing was refreshingly matter of fact and devoid of cryptic moralizing. But the article was buried near the back of the A section.

Then there was the disturbing flap at the Magazine two years ago, after a cover piece about illegal abortion in Latin America reported on a woman in El Salvador who supposedly was criminally convicted for aborting her 18-week fetus. Post publication, it turned out the woman was actually judged guilty of murdering her newborn, full-term baby. The reporter had never bothered to read the court records, and the Magazine's fact checkers hadn't either. In its eagerness to champion abortion rights in a country that has none, the paper had gotten sloppy. And on its own national turf, where long-established rights are being chipped at, sloppiness runs in the other direction.

So, what's going on at the Times? Maybe only what's happening in the whole culture. Liberals and even feminists have bought into the reasoning that abortion is basically immoral, and if women could just be educated and dosed with birth control, we wouldn't have to terminate any pregnancies. Bill Clinton's famous formulation, that abortion should be "safe, legal, and rare," has become conventional wisdom.

It's the line on the Times editorial page. In other sections, awkward reality intrudes, making reporters and editors skittish. Women--particularly young and poor women--don't take their contraceptives, and when they get pregnant many wait to go to the abortion clinic. Then they get pregnant again. Their behavior seems mysterious and threatening. They become scapegoats, not just for the Right, but for older and more educated liberals, too. That's the demographic who work at the Times, and a good percentage of its readership. But the Gray Lady is powerful way beyond New York liberal circles. And by making anti-woman moral judgments and obsessing over "problems" with no good evidence they exist, she's abusing her nation and the world.

Debbie Nathan is a New York City-based journalist. Her latest book, Pornography (Groundwood Press), explains the subject to teenagers and young adults.