Friday, May 23, 2008

Harvey Karman, 84; invented device for safer, easier abortions

By Elaine Woo
Los Angeles Times

May 18, 2008

Harvey Karman, a flamboyant psychologist whose invention made a key contribution to women's reproductive health, particularly by making abortions simpler, cheaper and less painful, died May 6 at Cottage Hospital in Santa Barbara. He was 84.

The cause was a stroke, said his son Kenneth, of Los Angeles.

Activist, inventor, educator and rogue, Karman was drawn to the plight of women facing unwanted pregnancy in the 1950s, when abortion was illegal. While training in psychology at UCLA, he started an underground abortion referral service and eventually performed abortions himself, for which he was convicted and sent to state prison for 2 1/2 years.

In the early 1970s he developed a soft, flexible tube, or cannula, for a device that was widely adopted in the United States and developing countries to perform early abortions. He freely demonstrated its use for doctors and other medical professionals and in 1972 was part of a humanitarian mission to terminate the pregnancies of 1,500 Bangladesh women and girls who had been raped by Pakistani soldiers. His cannula is still widely used today.

"Harvey Karman did more for safe abortion around the world than practically any other person in the world," said Dr. Malcolm Potts, Bixby professor of Population, Family Planning and Maternal Health at UC Berkeley, who accompanied Karman to Bangladesh 35 years ago.

"Karman's name is not known, yet his ingenuity and to some extent his courage has made safe abortion available to literally millions of women around the world."

Doctors later found other applications for the Karman cannula, including using it in the diagnosis of uterine cancer, said Dr. Philip Darney, chief of gynecology and obstetrics at San Francisco General Hospital.

The tube, which Karman never patented, is so inexpensive and easy to sterilize and re-use that it has "dramatically reduced healthcare costs in treating uterine bleeding, one of the most common reasons women come to the emergency room," Darney said.

Karman also had many detractors, particularly because of his attempt to revolutionize second-trimester abortions with a device called the super coil, which was inserted into the uterus and expanded when exposed to moisture, causing a miscarriage. It caused serious complications, including hemorrhaging and infection, when it was used on about a dozen women in Philadelphia on Mother's Day in 1972.

"Harvey engaged in some very irresponsible experimentation on women's bodies," said Carol Downer, who co-founded feminist women's health clinics in Southern California in the 1970s.

The incident was investigated by the national Centers for Disease Control, where Darney worked at the time. Darney called the super coil a "bad idea" but added, "I don't think that offsets the importance" of Karman's other contributions.

Downer agreed, calling Karman "a real change agent" whose invention gave momentum to the abortion rights movement in the period before the procedure was legalized by the 1973 Supreme Court case Roe vs. Wade. "I would never take away from the importance of a lot of the work he did," she said.

Karman was born Harvey Walters on April 26, 1924, in the tiny northwest Oregon town of Clatskanie. He did not know his father, and his mother, who led a transient lifestyle, often left him in orphanages. When she married, he took the last name of his stepfather.

A high school dropout, he joined the Army Air Forces and was stationed in England during World War II. After completing his military service, he used the GI Bill to attend UCLA, where he earned a bachelor's in theater and a master's in psychology. He later became director of psychosomatic research at San Vicente Hospital in Los Angeles.

He became interested in abortion when he was conducting research at UCLA on the emotional aspects of therapeutic abortion. During this time a student with an unplanned pregnancy committed suicide and another died from a botched abortion. Karman responded by helping women obtain illegal abortions in Mexico. Unhappy with the high prices and poor care some of the women received, he began performing abortions himself.

His ultimate goal, according to Darney, who met Karman in the early 1970s, was to "make it possible for women to safely do their own abortions using the simplest possible equipment."

Working with Merle Goldberg, a medical writer and women's health activist, Karman developed a method for extracting menstrual blood during the first weeks after a missed period with a vacuum syringe and a flexible plastic tube about the width of a drinking straw.

The device could be manually operated and, because of the narrowness of the tube, caused less discomfort than the larger metal curets that were normally used in abortions.

The procedure Karman and Goldberg developed took a matter of minutes, leading some to call it the "lunch-hour abortion." Karman offered the procedure at his Community Service Center clinic in West Los Angeles. Studies found that complications were rare.

Some doctors were quoted expressing reservations about do-it-yourself abortions, warning of the risk of infection and other problems. Anti-abortion forces attacked Karman as an illegal abortionist. But Karman was undeterred and proceeded to train many mainstream doctors as well as paramedics and others, including Downer and other feminist healthcare activists.

In 1973, the New York Times reported that the method was available in 45 states and cost no more than $80.

After the Indo-Pakistan War of 1971, when Bangladesh gained independence, he was part of a five-member team of abortion experts invited by the Bangladesh government to perform abortions on rape victims and train native doctors and paramedics in his method. Most of the victims were between the ages of 10 and 16.

"Many victims were actually being driven from their homes and villages by husbands and families who felt disgraced. And many committed suicide," he told the Los Angeles Times in 1972.

He said the team visited outlying villages and taught midwives, village chiefs, young girls, "anybody who wanted to learn," how to use the cannula for an abortion. The method is still used widely there, although it is called menstrual extraction because abortion is banned.

Karman "is responsible for saving the lives of countless women throughout the world through this innovative technology," Vicki Saporta, president and chief executive of the National Abortion Federation, a professional association for abortion providers based in Washington, D.C., said in an interview last week.

Along with advances in local anesthesia and suction equipment, his little tube, she said, was one of three major innovations that dramatically improved abortion care in the 1970s.

Karman spent much of the late 1970s and early '80s in Bangladesh, India and China, where he championed women's rights and safe, easy abortions. He lived for some years in London, where he also had a psychotherapy practice. He retired in 1992 to Santa Barbara.

In addition to his son Kenneth, Karman is survived by three other children, Kathleen, Steven and Janice; and six grandchildren.

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