As the election approaches in a time of intense polarization, I feel compelled to write about women’s reproductive rights.
Humans are mammals whose females give live birth and produce milk to nurse their young.
The female reproduction system is a complex and nuanced system prone to menstrual imbalances for 40 years and diseases of the organs involved (breasts, ovaries, uterus, cervix, and vagina) for a lifetime. Women suffer more dire consequences from most sexually transmitted diseases (STDs) than men. STDs, if contracted while pregnant, can also affect an unborn child.
At puberty, sex hormones are triggered by the hypothalamus and pituitary gland, which direct the ovaries to begin their biological job for the species. The same hormones that prepare the eggs and uterus for fertilization also drive sexuality. Biology drives consensual and non-consensual sex, either of which can result in pregnancy, desired or not.
Unintended and unwanted pregnancy is the cause of abortions.
Women’s rights are intricately tied to reproductive rights.
Woman’s Rights Timeline:
1820 – Most abortions in the US are outlawed
1920 – 19th Amendment Ratified officially giving women the right to vote
1959 – Birth control pills became available to married women and those with menstrual disorders in some states; within 2 years, half a million women mysteriously developed menstrual disorders
1966 – The National Organization for Women (NOW) was established to work against sex bias and for the civil rights of women
1970 – Our Bodies, Ourselves, the seminal book on women’s health, sexuality, abortion, birth control, and childbirth was published by the Boston Women’s Health Collective
1973 – Roe v. Wade was passed by the Supreme Court. It extended a woman’s right to privacy under the 14th Amendment in the decision to have an abortion to the point of fetal viability
1973 – 10 million women are using ‘the pill’
1974 – The Equal Opportunity Act allowed women to obtain a credit card in their name without the requirement of a man to cosign
1975 – It became legal for women to serve on federal juries
1993 – Marital rape became a crime
2016 – The first woman, Hilary Clinton, ran for President
2021 – The first woman, Kamala Harris, became Vice-President
2022- Roe v. Wade overturned, leaving abortion access to the states. Since then, abortion has been banned in 13 states.
In the 1950s and 60s, there were 1.2 million illegal abortions yearly.
Safe methods were available to those with the means to obtain an illegal medical abortion. The rest were attempted by dangerous methods such as objects inserted into the vaginal and cervix, caustic substances, and ineffective or dangerous herbs. Complications were serious and life-threatening. 17% of deaths associated with pregnancy and childbirth were due to illegal abortions. Some hospitals had entire wards dedicated to septic (infectious) abortion in those times.
Legal abortions became widely available. The complication and death rate was lowered 8-fold.
Currently, ~600,000 legal abortions are performed annually in the US.
57% of women are in their 20s, .2% < age 15, and 3.7% older than 40. 60% have had prior live births.
Pregnancy is a 40-week ‘condition’ divided into 3, 13-week trimesters. Women typically become aware of possibly being pregnant after their first missed period, which is ~6 weeks gestation.
93% of abortions are completed in the first 13 weeks, with 81% in the first 9 weeks.
More than half of abortions are performed medically, with one or two oral medications (i.e. pills) that very reliably cause a miscarriage.
The complication rate (most of which are minor) of medical abortion is .3% of cases, making it 13 times safer than childbirth in the US.
.9% of abortions are performed at greater than 21 weeks. 24 weeks is considered the age of fetal viability. The later an abortion is performed the higher the complication rate (albeit still under 2% and minor). Later abortions are more likely to be performed surgically by aspiration or dilation and curettage, both of which are invasive and painful.
Contrary to one of the presidential candidates' claims, abortions are rarely, if ever, done in the 3rd trimester (26 weeks and beyond).
Abortion remains legal in Washington. It is a woman’s choice to decide what she wants to do with an unwanted pregnancy.
Around 19,000 abortions were completed in WA in 2022, with 700 of those coming from out of state (over half are from Idaho, with one of the strictest anti-abortion laws in the country).
774 abortions were completed in Thurston County as determined by the WA Department of Health’s Sexual and Reproductive Health Network Family Planning Title X Data Sheets.
We are fortunate in Thurston County to have two clinics that work with women experiencing unwanted pregnancy.
Planned Parenthood’s Olympia Health Center provides comprehensive women’s health and reproductive services in their downtown Olympia Clinic. It is a fully staffed medical clinic that provides services from birth control to abortion to prenatal and post-partum services, STD testing and treatment, and more. They work to provide services to all women regardless of their ability to pay. Their website is comprehensive Birth Control, STD Testing & Abortion - Olympia, WA.
The Communications Manager for our area shared that in their 15 health centers across Western Washington, they served more than 50,000 patients in 2023.
Since Roe v. Wade was overturned, University of Washington Medicine reported a 10-fold increase in sterilization requests and a rise in requests for long-term contraceptive methods (such as IUDs) due to uncertainty over future access to abortion services.
Options Pregnancy Clinic is a faith-based pregnancy resource center that provides free services to women and men around reproduction and sexual health. Last year they served 580 patients and provided 1093 visits. A local volunteer OB/GYN and radiologist provide indirect consultative services, standing orders, and interpretation of ultrasounds. They employ one RN and have 6 RN volunteers, an onsite lab, diagnose and treat STDs, and are HIPPA compliant.
In speaking with their executive director, Mary Tipps Smith, MBA, CPH, I learned about their comprehensive approach to women who seek their support. Many come with serious non-reproductive issues that will affect their pregnancies, including poverty, homelessness, depression, and substance addiction. Care is offered via a team approach led by an RN and Patient Advocate, all of whom receive special training. Options partners with and refers to local agencies including Safe Place, WIC, and DSHS for Medicaid coverage, Food and Clothing Banks, and more. Though they do not refer for abortions, they respect and will continue to support those who choose this route.
They are an independent local organization supported by local donors. Their affiliation with national organizations such as CareNet and Heartbeat International, is through small grants for their RN salary, use of their answering service, and for staff training.
Both these organizations exist to support women with unintended pregnancies, albeit with one offering abortions and the other support for continuing a pregnancy.
Unwanted pregnancy is the result of biology and sexuality, consensual or not. Religious conviction or none. Financial resources or none.
It has been shown that availability and access to effective contraception reduces unwanted pregnancies and abortions. Eliminating unwanted pregnancies is not biologically possible.
Legal restriction and reduced access to abortion will return us to pre-1973 history with the advent of medication options for illegal abortions. Drastic changes are already happening and being followed in states where abortion is illegal. In those states, women and their doctors also risk their legal safety.
Vote locally, statewide, and nationally for candidates that will support our state’s current laws that allow any pregnant woman, intended or otherwise, to decide for herself how to deal with her pregnancy. Who you vote for in this election matters to women and those who care about them.
We need not all agree on each other’s choices. It is, after all, that individual liberty lies at our country’s foundation.
Movies
TV Series
Call the Midwife is a beautifully and engagingly portrayed BBC 13-season series on the history of women’s reproductive issues from the years after WW2 until the 1970s. It covers every issue about marriage, sexuality, family, pregnancy, childbirth, motherhood, and love. Shown are the effects of illegal abortion, and how the advent of reliable contraception has changed history. Beware: witnessing childbirth is a part of every episode and a good one to remind all viewers what it takes for a woman to go through that process for the species.
The Department of Health’s Comprehensive Website on Abortion
Abortion | Washington State Department of Health
Debra L. Glasser, M.D., is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com
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