For most of my career, I have been able to care for women without fear of major complications or death from abortion. However, I have not forgotten those days when safe abortion was generally unavailable. I was delighted when I delivered my first baby in 1968. But at that time in our history, the exciting events of bringing babies into this world were often countered by the tragedies of illegal abortion. Continue reading
This week marks the 40th anniversary of the Roe v. Wade decision—the US Supreme Court ruling that protects a woman’s right to have an abortion. In the years since, state legislatures have been primarily responsible for the laws that have at times validated and secured this right, and at other times severely limited it. However, in recent years, there has been a troubling trend. We have seen an unprecedented number of legislative attempts by politicians and government officials to interfere with women’s reproductive rights and with medical practice.
According to the Guttmacher Institute, 17 states now mandate that women undergoing abortion be given factually inaccurate information such as links between abortion and breast cancer and abortion and mental health. Eleven states have seen bills that attempt to limit medication-induced abortion, including some that specify the dose and route of such services. These laws completely disregard the meticulous and thorough process of scientific investigation that has been the cornerstone of medical advancement.
At least two states have proposed or enacted legislation that allows physicians to withhold information from a woman about her pregnancy if they feel the information would result in her choosing to terminate, essentially permitting reproductive coercion by the physician, which I believe is a universally deplorable form of violence against women. At least 18 states have introduced some version of legislation that not only requires an ultrasound for women seeking abortion but often dictates who can perform it, how and when it is performed, and what the provider must say to the woman undergoing it.
No matter where you stand on the abortion debate, this invasion of politics into medical practice should concern you. This scripting of patient-doctor interaction is unacceptable. The commitment we made when choosing to become women’s health care physicians was to promote the health of women through the execution of the best science. Our education and training tell us that these laws have not been created in the spirit of promoting the health of our patients.
As we reflect on this anniversary, consider the burden these laws pose for the girls, women, and families we care for. I hope that the 41st anniversary will be marked with something to celebrate: widespread comprehensive sexual education, improved access to the most effective contraceptive methods, and, ultimately, a reduction in unplanned pregnancies.
Colleen McNicholas, DO, is a Family Planning Fellow at Washington University in St. Louis.
Ob-gyns are on the front lines of the effort to decrease the rate of unintended pregnancy, which accounts for half of all pregnancies in the US. Now, we have more information about how we can best accomplish this goal.
Recent findings from the Contraceptive CHOICE Project made news headlines, and for good reason. The project—which included more than 9,000 contraception-seeking adolescents and women in the St. Louis region who were at risk for unintended pregnancy—found that the rate of unintended pregnancy dropped with just two simple interventions. Women were given:
- A short contraceptive counseling session that covered all methods of reversible contraception and emphasized the superior effectiveness of long-acting reversible contraception (LARC) methods: intrauterine devices (IUDs) and hormonal implants.
- The contraceptive method of their choice for free.
Seventy-five percent of the women selected a LARC method. Among all the women, there were lower rates of abortion, including repeat abortion, and lower rates of teen births. These findings support ACOG’s recommendations on the use of LARC methods as first-line contraceptive options to reduce unintended pregnancy and highlight the benefits of providing women with no-cost access to contraception.
ACOG advises ob-gyns to:
- Provide counseling on all contraceptive options, including implants and IUDs, even if the patient initially states a preference for a specific contraceptive method
- Encourage implants and IUDs for all appropriate women, including those who’ve never given birth
- Adopt same-day insertion protocols. Screening for STIs may also occur on the day of insertion, if indicated
- Avoid unnecessary delays to LARC initiation, such as waiting for a follow-up visit after an abortion or miscarriage or waiting to time insertion with the menstrual cycle
- Advocate for coverage of all contraceptive methods by all insurance plans
- Support local, state, federal, and private programs that provide contraception, including IUDs and implants
The problem of unintended pregnancy in the US is not going away. As ob-gyns, we are uniquely positioned to help women avoid unintended pregnancies. Let’s work with our patients and help them make the best choices for their reproductive health.
Erika E. Levi, MD, MPH, is a Family Planning Fellow at the University of North Carolina at Chapel Hill.