Thursday, July 29, 2010

Happy pills

The other day when I answered the phone at the clinic, a Spanish-speaker was on the other end of the line asking about "the pill that brings on your period." I've gotten used to breaking it down on the phone after chatting with clients who ask for a Pap smear, then end up incensed that the Pap didn't test for HIV because that's really what they wanted to check out, and what do you mean that "Pap smear" doesn't translate into "all things vaguely gynecological"? (But that might be another post for another day.) I asked her a series of questions about "Did you take a pregnancy test?" and "Is this the first period you've missed?" because maybe she really DID want to start birth control that would regulate her period. But no, she definitely was referring to the series of pills that would cause an early miscarriage and soothe the conscience into believing it's only a late period, not an abortion.

Women of all demographics are drawn to the RU486/Mifeprex & Misoprostol regimen because it's kind of like Abortion Lite, but women from conservative, Catholic countries where abortion is illegal and money is scarce especially like this route. And when they end up here, in a country where they don't speak the language and they don't have the time to navigate the laws of choice, they often do the familiar thing and buy the pills (usually only one type of pill--the cheaper one that doesn't really cause an entire abortion) on the street. Of course this is dangerous for a variety of reasons, and it ends up being pricey when they have to come to the clinic for a D&C, anyway. So, on the one hand, I appreciated this woman on the phone calling a clinic so that she could get the medication from a medical provider and be overseen by a doctor.

On the other hand, though, I struggled with the desire to give her accurate information and be straight with her with the lingo of "abortion," not "inducing a period" and also respecting her need for coping with this unintended and unwanted pregnancy in a way that she knew how, and especially, not scaring her off an into the streets where she would acquire the tablets from someone who would fully go along with her "bring on the period" plan. Women aren't dumb, and they know full well that a period of this type comes along with a fetus, but where does that leave as as providers and as advocates for women? Readers or co-bloggers, have you ever been faced with this situation? Do you fully disabuse the woman of this notion of the innocuous pill since eventually, they will end up having an ultrasound that clearly diagnoses a presence in the uterus? (That's what I ended up doing.) Or do you go along with the plan a little bit, allowing the woman to see the experience as she wants to see it?


  1. Having had a medical abortion with RU-486, I dislike the term "abortion lite" to describe that experience. I am aware that many women have mild cramping, but I'm also aware that many women have fairly severe cramping/pain. When I gave birth years after, the labor pains reminded me of the pains I felt after the second dose of pills. Would I do it again if I needed an abortion? In a heartbeat! But "abortion lite" does not describe my physical experience.

    More to the point of your post, I think it's interesting this woman thought of it as bringing on her period. This is how abortions used to be advertised in the late 1700's through the 1900's. Actually, even Ancient Greek and Roman writers refer to abortion as "bringing on the period". Abortion, it seems, was thought to only occur after the quickening. This makes me wonder about her family history--perhaps "inducing your period" was a euphemism for "abortion?"

    Excellent post.

  2. Interesting- when abortion was illegal in the UK in the 19th century and the first half of the 20th century, newspaper classified sections carried advertisements for medications or services that would "regulate your menstrual cycle" or "induce your period" etc- they used that kind of language as code for abortion.

  3. Personally, I think it is unwise to "go along" because the antis already accuse us of lying to women to "force" them to get an abortion. I feel like in the long run, this sort of semantics hurts us. I understand that the woman likely knows what actually happens, but I think it is unwise to assume such. Then again, I don't work in the field.

  4. @ Not Guilty--Agreed. And the more we talk in real terms, the less shame there will be. I was still concerned, though, that I would put this woman off and send her out to get an illegal abortion via pills, which is far from ideal.

    @ ContraWhit--I appreciate hearing your experience because as a provider, I don't get to have much of a part in the medical abortion experience, but I want to know individual stories. And I call it "abortion lite" ina tongue-in-cheek kind of way...I present it to clients realistically but unbiased, but if it were a friend of mine or if it were me, no way would I advise it. It's just that I've talked to so many women who say, "Can I just take that pill?" and don't realize it's not magic. They want it to be a quick, easy fix.

  5. In my research on stigma for the Abortion Care Network, I have found an article on conceptualizing abortion stigma from Kumara, Hessinia and Mitchell (2009. They write that “abortion stigma is neither natural nor ‘essential’ and relies upon power disparities and inequalities for its formation.” And this makes sense when you consider that “abortion stigma is a ‘compound stigma’, that is, it builds on other forms of discrimination and structural injustices. Stigma is dependent on the appropriation and use of different forms of power. Ultimately, abortion stigma serves to erase and disguise a legitimate medical procedure, discredit those who would provide or procure it and undermine those who advocate for its legality and accessibility.”
    So when you wonder whether it is appropriate to talk in real terms, I'd suggest that "telling it straight" would, in the long run serve abortion providers and clients. I say this because we can locate the origins of abortion stigma in the social constructs created by humans through power, language and beliefs—constructs that deserve to be dismantled. And these social constructs (cherished constructs like motherhood, femininity) won't be dismantled if we don't acknowledge and challenge them and the powers behind them.

  6. So interesting. I've always felt like you, D: that it's better for patients to get settled with the fact that it's an abortion they're seeking, BEFORE they have that abortion and risk feeling ambivalent later.

    Buta few months ago I met someone who's basically the foremost researcher in the field of medication abortion, and brought this up in a related conversation, and she basically said, "No way, why would we do that to someone? What I call it or what YOU call it is not particularly salient to what SHE needs, and meanwhile however she needs to think of it is going to help her handle the experience."

    So I've kinda come around, or at least am not so certain anymore. And, plus: When I insist on my version of the significance of the process, is it all that different from her sister defining it as a "miscarriage," or an anti defining it as "a murder"? In one big way, yes: it's factually accurate. But in the way that matters to her, maybe not -- why shouldn't she think of it the way she, and not anyone else, feels about it?

  7. Yeah, "bring on your period" is a common idiom in spanish-speaking countries. It doesn't necessarily imply a particular view of what's happening.

  8. @placenta sandwich - I was about to tell almost the exact same story! I counseled a woman once who very firmly told me, much to my chagrin, that she was so worried mife/miso wouldn't work and she would have to have an "abortion." I tried to tell her gently but firmly that the medications would actually cause an abortion as well, and it was important she understood that (not only because it very well COULD fail and she would have to have a surgical, and shouldn't she have come to terms with the fact of having an abortion before that point?) It really bothered me because I felt the reluctance to accept it as an abortion could be predictive of poor coping later, and as a counselor it was my responsibility to assess and help avoid potential poor coping. And wasn't it also my responsibility to provide informed consent, which means making sure the patient has full understanding of medically accurate information regarding the procedure? How could I not correct her description of the procedure as "not an abortion"?

    But I attended a training recently about options counseling, and brought up that counseling session with the staff trainer. She was very adamant about letting patients describe the experience however they want, and it is not up to us to make them accept our language or labels. She also told me that not considering an MAB to be an abortion was in no way predictive of poor coping later - but, like with any situation where their autonomy is taken away, forcing them to adapt to someone else's beliefs/understanding about the procedure may very well lead to worse coping. So it's definitely still something I feel uncomfortable about, but I'm doing my best to come around on. After all, I firmly believe in women's right to own their experiences however they see fit; why should this situation be any different?

  9. I'm not sure how I feel about this, to be honest. I mean, I often tell women that the MAB induces miscarriage: because that's what it does; however, in the same little "summary," I will refer to it as an abortion...never as a miscarriage.

    I suppose, however, this may not be too different from the debate of calling a fetus a fetus even when the client is calling it a baby. If I'm in a counseling session with a patient who is having a TAB due to a fetal anomaly and it was a very wanted pregnancy, and she's calling the fetus her baby (and by male/female), then I am going to do the same. Even if I'm talking to a client who is ambivalent about her decision, but I notice that she keeps talking about "my baby," and refers to it as a "him or a her," indicating her level of connection to the pregnancy, I'm going to call it a baby, too, when talking about the future, etc. 90% of the time, though, it's all fetus or embryo talk from me.

    Maybe it's not really the same thing though. I don't know. Hmm. Good questions and good things to think about!


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