PATRICK YURKEVICIUSWOMEN’S HEALTH

SUMMER SESSION I I

Chapter 13- Abortion

Introduction

More contraceptive options than ever before None are 100% effective

Reproductive health information unevenly distributed

Inequality, coercion, violence occasionally make it impossible to decide when to have sex

Almost half of all American pregnancies are unintended

47,000 women die each year due to lack of safe abortion services

Making Personal Choices

Women should be able to choose based on personal choice or what the individual deems best for their given circumstances… not the government, no religious institution, or any other individual.

Part of being in control of one’s life is having personal choice and control over one’s own body.

Who?

“…women who have abortions cannot be put into a single category.” ¼ pregnancies end in abortion 1.21 million in U.S. in 2008 1/3 women have an abortion by 45 61% obtained by those who already have at least

one child Caucasian women – 36% African American – 30% Hispanic – 25%

Common Reasons for Abortion

Inability to care for anotherNot able to affordInability to provide child with a “good” lifeInterference with career or schoolingNot wanting to be a single parentDifficulties with partnersMedical Issues/ History

Available Services

Planned ParenthoodThe National Abortion FederationNational Network of Abortion Funds

Be wary of “crisis pregnancy centers” Often run by anti-abortion groups giving out false

information attempting to persuade or lie so a woman keeps the pregnancy

Avoid websites that claim to sell abortion pills

Which Procedure?

Depends on a number of variables: Dr.’s Choice or Personal Preference Treatment Facility/ Regional Availability Legality Personal Medical History Gestational Age

Medical AbortionVacuum AspirationDilation and EvacuationInduction Abortion

Medical Abortion

Up to 9 weeks

Mifepristone - First pill at doctor’s office Blocks Progesterone (hormone maintains lining of

uterus) Causes shedding of the lining

Misoprostol – 24 to 48 hours after initial pill Prostaglandins (causes contractions in uterus

expelling embryo)

Mifepristone and Misoprostol

Common Side Effects: Nausea, cramping, clots, prolonged bleeding, indigestion, fever, chills, fatigue

95 – 98% effectiveAllows for privacyNon-IntrusiveFailure means that Vacuum Aspiration must

be used

Vacuum Aspiration (D & E)

Up to 12-14 weeksInstruments used to remove embryo

Uterine contents removed by thin tube inserted into the uterus which is connected to a source of suction (see next slide).

5-10 minutes99% success rateLight bleedingAnesthesia/ numbing agents may cause side effectsInvasive/ needs to be performed by licensed

individual

Vacuum Aspiration (D & E)

Dilation and Evacuation

Most common method used in 2nd semester abortions

Similar to Vacuum AspirationFew hours for early semester to 2 or 3 days

for later abortionRequires dilation of the cervix

Osmotic dilators Misoprostol

Dr. removes contents by aspiration, forceps, or curette (see next slide)

Dilation and Evacuation

Induction Abortion

Medications cause uterus to contract and expel pregnancy

Around 24 weeksSeveral hours to a day of painful contractionsMay require overnight hospital stayOsmotic dilators to prepare cervixProstaglandins inserted into vagina every few

hoursMild cramps become more intenseSedatives/ regional anesthesia to help pain

Abortion Aftercare

Normal to experience some bleedingAntibiotics/ medication given in some casesAvoid putting anything into vagina for at least

5 daysAvoid strenuous exercise to allow for

recovery“Listen to your body and use common sense”Follow up appointment 2-3 weeks after

procedureNormal to have range of emotions/ feelingsCheck with Dr. to see when birth control can

be used

History and Oppression

Legal in U.S. until 1880Backlash against growing movements for

women suffrage and birth controlMany wanted women to “stick to their roles”

as child bearer and house keeperMid wives were seen as a threat to the male

medical establishment

History

Women turned to dangerous methods because of “criminalization of abortion” Knitting needles Coat hangers Douching with lye Swallowing poisonous chemicals Taking various/ potentially fatal drugs

Health complicationsInfertilityChronic illnesses and painDeath

History – Taking Chances

Before legalization, some practitioners and other well trained individuals risked imprisonment, fines, and loss of medical license to help women obtain abortions

Underground group of women in 1960’s called the Abortion Counseling Service of the Chicago Women’s Liberation Union provided more than 11,000 safe abortions over 4 years… safety record was comparable with today’s practitioners.

History – 1960’s

Women’s liberation movement made visible the millions who were willing to “break the law and risk health and death to obtain an abortion.”

1967-1973 – 1/3 of states reformed abortion laws and regulations

Roe vs. Wade – Supreme court found women’s right to abortion in first 14 weeks protected under 14th Amendment. “If life/ health in danger, she would not be forced to

continue pregnancy at any stage.”

History - Violence

Opposition has since picketed and blocked entrances to clinics providing abortion services

Bombings, anthrax threats, arson, acid attacks, even murder

Opposition attempts to harass and deface those providing services

Opposition

20 state Medicaid programs do not fund abortion under any circumstances

Some states convinced to adopt “waiting periods” for procedures so that the individual has time to look at state provided information (often biased or filled with false information)

Some must obtain permission from a judgeSome need to cross states lines to find

servicesT.R.A.P. laws make procedures more

expensive and troublesome for the providers causing clinics to close

Reproductive Rights and Justice

Opposition has created “an atmosphere that is stigmatizing, threatening, and too often violent.”

Millions continue to fight for reproductive rights. So can you. Be visible – Talk with those close to you Stay informed – The more you know, the more you can

do Show support – Join groups or volunteer for

organizations Take action – Organize a peaceful demonstration Break the silence

For Thought

“Women have always needed abortions and will always need them. A very few need abortions late in pregnancy. Rather than empathizing with these women and respecting their difficult decisions, society vilifies them and the providers who care for them…”

“…women are capable of struggling with complex ethical problems and arriving at the best decision for themselves and their families.”