Las evidencias hablan por sí solas!

I attended a health conference yesterday and stopped by one of my favorite orgs, Ipas, to score some swag and some abortion news. I saw a small booklet entitled "Ten Facts About Abortion." Hooray! Now, I already knew those facts, could predict exactly what they would say and how they would be described, so I decided to challenge myself. I put it down and picked up "Diez Datos Sobre Aborto." Same info, but in Spanish! So I thought I'd share it with The Abortioneers, and also with our Spanish-speaking audience. It hadn't occurred to me just how much misinformation is out there to confuse and horrify non-English speakers that we simply aren't catching. So I present to any Spanish-speakers out there who are looking for information and not finding it:

Mito: El aborto ocasiona el “síndrome postaborto”.

Dato: El síndrome postaborto no es un diagnóstico psiquiátrico válido.

Mito: El aborto causa cáncer de mama.

Dato: No existe ninguna relación causal entre el aborto (ya sea espontáneo o inducido) y un aumento en el riesgo de que la mujer desarrolle cáncer de mama.

Mito: La anticoncepción de emergencia causa aborto.

Dato: La anticoncepción de emergencia evita el embarazo. Si la mujer ya está embarazada,

la anticoncepción de emergencia no tendrá ningún efecto en el embarazo y no causará un aborto.

Mito: El embarazo es más seguro que el aborto.

Dato: Los procedimientos

de aborto

efectuados por profesionales de la

salud capacitados, en condiciones

higiénicas, son mucho más seguros

que el embarazo y el parto.

Mito: La legalización del aborto no lo hace seguro.

Dato: Cuando las mujeres tienen acceso a servicios de aborto seguro, legal y a precios asequibles, se reducen drásticamente las tasas de muertes y lesiones maternas atribuibles al aborto inseguro.

Mito: Restringir el acceso a los servicios de aborto es la mejor manera de disminuir el índice

de abortos.

Dato: La mejor manera de disminuir el índice de abortos es reducir el número de embarazos no intencionales por medio de educación sexual integral, prevención de la violencia basada en género y acceso a métodos anticonceptivos eficaces centrados en la mujer.

Mito: El aborto con medicamentos es peligroso y puede causar la muerte de las mujeres.

Dato: El aborto con medicamentos

es una opción segura y eficaz para

la interrupción del embarazo en el

primer trimestre.

Mito: Si el aborto es legal, las mujeres lo utilizarán para el control de la natalidad.

Dato: Las mujeres que no tienen información y acceso a métodos anticonceptivos confiables se enfrentan con tasas más altas de embarazo no planeado y posiblemente recurran al aborto para interrumpir el embarazo, sin importar la legalidad del aborto.

Mito: El aborto es exportado por el Occidente imperialista a los países en desarrollo.

Dato: Desde el inicio de la historia documentada, las mujeres en todo el mundo han interrumpido embarazos no deseados. Esta práctica está bien documentada.

Mito: El aborto nunca es necesario para salvar la vida de una mujer.

Dato: El aborto para salvar la vida de una mujer o una niña es médicamente necesario en ciertas circunstancias y es muy aceptado por profesionales e instituciones como la Organización Mundial de la Salud.

The best thing about this resource is that it actually provides SCIENTIFIC EVIDENCE (DING DING DING!) to support these FACTS ABOUT ABORTION. Great empowerment for non-English speakers who may feel disenfranchised and under-informed in this country. Clinic workers/counselors/direct service Abortioneers, I encourage you to share this and other Ipas materials. Check their website!

Maybe you should ask, "Why did we make her wait so long?"

I'd wanted to write a good solid post expanding on my last one -- about why some women "wait so long" to have an abortion -- and connecting the dots to social justice. It is Martin Luther King day, after all, and while we ought to be carrying his goals of racial and economic justice in our minds every day, it always helps to describe the links aloud. But: I've been getting sick this weekend and today I woke up with puffy eyes and that underwater feeling in my head and it's making me feel dizzy. I'm going to limit this to my research summaries, because you're smart and insightful enough to connect the dots yourself, and because I can't see my keyboard very well. 

*

In 2008 researchers at ANSIRH published an unusual study of delay in obtaining abortion care [PDF]. For purposes of analysis, they divided the process into three stages -- between the first missed period and the first pregnancy test; between the first pregnancy test and the first call to an abortion provider; and between that first call and actually having the abortion -- and then identified the circumstances that were closely associated with longer time for each stage. The factors associated with delay varied based on stage. In the first stage, significant delay before the pregnancy test occurred for women who were obese, weren't sure of the date of their last period, were assessed as being in denial about pregnancy or "afraid of an abortion," abused drugs or alcohol, or had had a second-trimester abortion in the past. (A lot of these seem logical, don't they?) 

However, these were not significantly associated with delay in the second stage; rather, women had a longer stage 2 if they had had trouble obtaining MediCal (California's health insurance for low-income residents, which includes coverage for in-state abortion care), and if they had "had difficulty with their decision to terminate this pregnancy." In the third stage, delay in having the abortion itself was associated with (again) having had a second-trimester abortion in the past; having been initially referred to some other clinic than the study site; having an unsupportive partner; and having had difficulty coming up with the money to pay for an abortion. 

So logistical barriers emerge in stage 2 and 3, and especially economic ones. Social/emotional barriers are still present, but different from in stage 1. (Understandably you might delay your call to the clinic if you're having a hard time deciding what to do with your pregnancy; you might try to reconcile a reticent partner to your decision before you head to the appointment -- or your partner might be actively trying to prevent you from getting there!) 

(Additional interesting findings from the last stage: what shortened the time between calling a clinic and having an abortion? (1) Nausea and vomiting [heh, shocker]; (2) having had “difficulty deciding” to seek an abortion. That is, if a woman struggled with her decision, she was likely to have a longer time than other women between taking a pregnancy test and calling a clinic, and a shorter time than other women between calling a clinic and having an abortion.) 

*

From several of the same California researchers, a 2006 multivariate logistic regression study: "Delays in suspecting and testing for pregnancy cumulatively caused 58% of second-trimester patients to miss the opportunity to have a first-trimester abortion. Women presenting in the second trimester experienced significantly more delaying factors, with logistical delays occurring significantly more frequently for these women (63.3% versus 30.4%). Factors associated with second-trimester abortion were delay in obtaining state insurance, difficulty locating a provider, initial referral elsewhere, and uncertainty about last menstrual period." Interestingly, second-trimester abortion was associated with both having had a prior second-trimester abortion and never having had an abortion before. 

*

In 2006 the Guttmacher Institute published a study on timing and reasons for delay [PDF] as well. They broke the process into more steps, and measured median time for each. 

-From the last menstrual period to suspecting pregnancy: 33 days (which makes sense if you imagine the average 28-day cycle then add about a week for your first missed period); it was a week longer for minors than for adults (which also makes sense if you consider how irregular most young people's cycles are)

-From suspecting pregnancy to confirming pregnancy (pregnancy test or sonogram): 4 days

-From confirming the pregnancy to deciding to have an abortion: zero days

-From deciding to have an abortion to first attempting to obtain abortion services (calling to make an appointment): 2 days

-From first attempting to obtain abortion services to obtaining the abortion: 7 days

...So that's 48 days right there (and that's just adding up medians, meaning half of women have a longer delay in each of these steps), yet I think somehow a lot of people hear "seven weeks" and think that's a really long time to "wait." I saw an actual published writer write that abortions should only be legal up til six weeks because "forty-two days is plenty of time to decide to have an abortion." Reality to actual published writer, please come in. 

58% of women reported that they would have rather had the abortion sooner, and these women were asked about the reasons for the delay they experienced (women could give multiple reasons). Most commonly, these respondents said: 

-It took a long time to find out about the pregnancy: 36%

-It took a long time to decide to have an abortion: 39%

It took a long time to make arrangements: 59%. Poor women were about twice as likely to be delayed by difficulties in making arrangement. (This includes money, referrals, appointments, transportation, judicial bypass for minors, legally required waiting periods, etc.) 

Patients mentioned a lot of other reasons, including:

-As partial response to Frances Kissling's question, 0.2% stated they found out late about a fetal anomaly (but this isn't broken up by trimester or week; I still think the later abortion patients she was asking about would give this response more often). 

-Only 2% said they "didn't think it was important to have it earlier." (Granted, this doesn't include possible similar answers from the 41% of women who didn't say they'd have rather had the abortion earlier, but I imagine a lot of those 41% had theirs quite early. I wish I could see a full data set on this.) 

I highly recommend reading the rest of this article because it has a section on qualitative findings from in-depth interviews that I just couldn't do justice here. Among other things, it shares the words of women who "knew right away" that they were decided on seeking an abortion, and of  women who found it a "hard decision" and took longer to feel firm in their choice.** 

*

What about demographic characteristics? Poor women with no insurance coverage for abortion, black women, and young women are likely to have later abortions than other women. However, being poor and lacking insurance coverage disproportionately co-occur with being black and being young. In some studies, each of these effects persists even after controlling for the others; in other studies, they confound one another and only the poverty/insurance effect remains significant. 

I think you can guess what I was going to say about all that. To make a long story short: justice in healthcare access must include attention to reproductive matters. If you care about making a more just society, please express support for public funding for contraception and abortion; donate to your local abortion fund; work to reduce stigma against both abortion and pregnancy; combat racist, ageist and classist stereotypes of appropriate motherhood; and learn about domestic violence and sexual assault prevention. 

**If you want to read more about abortion decision-making, here are some articles to try [unfortunately a few only give the abstract for free]: 

2010: Kjelsvik M. Pregnant and ambivalent. First-time pregnant women’s experience of the decision-making process related to completing or terminating pregnancy – a phenomenological study. 

2005: Finer LB et al. Reasons US women have abortions: quantitative and qualitative perspectives.

1985: Faria G, Barrett E, Goodman LM. Women and abortion: attitudes, social networks, decision-making.

1984: Friedlander ML, Kaul TJ, Stimel CA. Abortion: predicting the complexity of the decision-making process. 

(And if anyone can find the following in English, let me know:) 

1999: Tornbom M et al. Decision-making about unwanted pregnancy.

1990: Ytterstad TS, Tollan A. The decision process in induced abortion. 

Transition

Doing some research at work on contraceptive prevalence in some developing countries to appease a lazy donor (duh, measuredhs.com), and we decide to give them some abortion data as well. The reasoning: if our programs increase contraceptive prevalence, then it also reduces abortion prevalence. Since the DHS doesn't capture abortion data (unclear on why; political issues?) we find some Guttmacher data. Initially I was concerned that this info might confuse our donors; since ab laws have been relaxed in many places over the last decade, abortion prevalence might increase and lead them to believe horrible things about contraception and the ineffectiveness of our programs. And it's not easy to talk a donor down from a ledge.

But check it! Worldwide, ab prevalence has actually gone down. From this particular data I can't say why, but of course we'll speculate that it has to do with increases in method use, especially long-term methods (IUDs and such). But read further: though overall abortion rates have fallen, rates of illegal/clandestine abortions have stayed the same!

ACK!

So the situation is actually pretty bleak. Because the most relaxed laws occur in the most developed countries, the women at greatest risk for complications from abortion are not granted access. This report mentions 19 countries have reduced restrictions, many in the developing world, but with the same access barriers and so on that have existed forever. God bless pro choice de jure.

With all the resource allocation and funding for ab in the states, what is the prognosis for that kind of support in the rest of the world? My org is not allowed to; which orgs are? Does anybody know of prospects for abortion access overseas? Is it too much of a hot button issue? I'm so confused. So many countries' women are dying and they don't care! How is it that the world has managed to (for the most part) get on board with HIV/AIDS within a decade, but has taken centuries to do so for ab? If you ask me HIV is as tricky an issue as ab, by which I mean it's not tricky at all. Give people things so they don't die.

SOUNDS PRETTY GOOD TO ME!

If I were Miss America, I wouldn't wish for world peace. I'd wish for world abortions.

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IN OTHER NEWS:

I just received an email stating the following:

"New rule from Dept. of Health and Human Services: women with pre-existing conditions like breast cancer, AIDS and diabetes will be banned from buying insurance coverage for abortion in
high-risk insurance pools. They won't even have the option to buy coverage with their own money. Outraged? So am I."

WHAT IN TARNATION?!?!?!

End the madness!

******************************

ALSO!

As long as I keep getting distracted at work by checking email and IMDB and other distracting sites, I found the following while reading the Wikipedia entry for Nick Cannon (don't ask):

"Cannon's music video for Can I Live? reveals that he was almost aborted by his mother, but she panicked in the abortion clinic and decided to have the baby."

Sigh. I love when people talk about this stuff as though it's an argument for abortion banning. Not that this entry was explicitly anti-choice in any way, but it reminded me of other instances in which "My mom almost aborted me and etc etc" comes into the discussion. Remember when it's "pro-choice" and not "pro-strapping-women-to-tables-and-forcing-things-between-their-legs"? Why would we not want women to have babies if they want to have them? Ack ack.