Passionate Provider

Nothing too Sacred

2009-10-21T08:30:00.000-07:00

October is breast cancer awareness month. A time for pink ribbons, fund-raisers, and anti-choice extremists. Anti-choicers have always been eager to capitalize on any issue where women may feel vulnerable and helpless. What better approach than to blame one of the most common cancers on abortion?

Billboards, placards, ads, articles, and blogs are "informing" the public about their abortion-breast cancer hypothesis. Here is a sample of some particularly awesome letters-to-the-editor and articles published in the last few weeks:

“How many women has [abortion] put at risk for breast cancer?"

“There is also evidence that abortion raises a woman's risk of breast cancer.”

“obstetricians should tell women considering an abortion that it does carry a risk of cancer."

“When you talk to women that have had abortions they often times have a higher rate of breast cancer and they have emotional problems.”

Now let’s contrast that with...

The American College of Obstetricians and Gynecologists: “More rigorous recent scientific studies demonstrate no casual relationship between induced abortion and subsequent increase in breast cancer risk” (2009)

The Society for Obstetrics and Gynecology of Canada “A history of induced or spontaneous abortions is not associated with an increased risk of breast cancer” (2005) (pdf file)

The Canadian Cancer Society: “At the present time, the body of scientific evidence does not support an association between abortion and increased breast cancer risk.”

The National Cancer Institute: “newer studies consistently showed no association between induced and spontaneous abortions and breast cancer risk.”

The Lancet: a “collaborative re-analysis of 53 epidemiological studies including 83,000 women with breast cancer” concluded that “pregnancies that end as a spontaneous or induced abortion do not increase a woman's risk of developing breast cancer” (2004)

Despite the ever growing evidence and the firm statements from major medical organizations, the abortion-breast cancer myth persists. Several organizations exist with the sole purpose of spreading these lies to as many women as possible. This is repulsive on many levels. The research they cite is often so flagrantly distorted that it can only be published by the most obscure medical journals (This widely touted study was published in a journal with an abysmal impact factor of 1.0)* Seriously, this level of scientific rigor** wouldn’t even be allowed in junior high. Furthermore, it is insulting that they would use such a serious and debilitating disease as a scare-tactic to advance their anti-choice (and anti-women) goals.

Our breasts, our uteri, our choices, and our lives have been made into their battlefields. Nothing about us is too sacred to be exploited for their ideological gain. And yet they tell us that we lack respect for the sacredness of life. Perhaps the irony escapes them. More likely, though, they just don't care.

footnotes:

* impact factor is a measure of a journal's relative importance in the scientific community. The higher the number, the better.

** This"research" actually consisted of looking up abortion rates and breast cancer rates in different countries. Some countries with high breast cancer rates also had high abortion rates; therefore, the "logical" conclusion was that abortion is a risk factor for breast cancer!

Fighting Words

2009-09-16T07:35:00.000-07:00

The anti-choice movement has never really been about "saving babies" or "protecting women". At the very heart of their beliefs, motivations, and discourse has been distrust and disrespect towards women. It is one of the few places in society where blatant misogyny is still celebrated. This becomes very apparent when looking at the language used by the anti-choice movement in comparison to the pro-choice movement. Below are two Wordle images - one from an anti-choice site, the other from a pro-choice site. For those of you who are not familiar with Wordle, it is an online program which takes text from web pages and displays the most commonly used words in an artistic way. The bigger the word, the more often it was used on the website. Look at the results:

This first image was generated from the anti-choice website LifeBeginsAtConception

This second image was generated from the pro-choice website AbortionClinicDays

The results speak for themselves.

Copper IUD vs. Levonorgestrel IUD

2009-08-03T10:51:00.000-07:00

I have received a lot of questions concerning the differences between the copper IUD and the LNG-IUD (levonorgestrel, also known as Mirena). I made this chart in hopes of providing an easy comparison between the two. Please let me know if there is anything I am missing anything.

I love IUDs (and you should too)

2009-08-01T07:33:00.000-07:00

I am part of a growing number of health care providers who believe that an intrauterine device (IUD) should be the first-line contraceptive choice for women. IUDs are extremely safe, highly effective, and very convenient. Many of the doctors I work with call it "reversible sterilization" because it prevents pregnancy at a rate comparable to tubal ligation but it is completely and quickly reversible. New research shows that IUDs are a great choice women who have never been pregnant and adolescents. It can also be used for non-contraceptive purposes as well. Some IUDs reduce heavy periods and minimize menstrual cramping. They can also protect against endometrial cancer and they provide an alternative to hysterectomy for many women with perimenopausal bleeding.

I got my IUD as a young adolescent, well before I even started having sex. I had to see 4 separate doctors who told me that it wasn't a good choice, that I could not have one, and that it was very dangerous. I finally found an ob/gyne who knew the research and gladly helped me get my IUD. 7 years later, I am still raving about it, and that ob/gyne has become my teacher and mentor as a medical student. Together we have been working to combat the myths that exist amongst the public and within the medical community surrounding what we feel is the most awesome form of birth control.

There is plenty of info available online about IUDs, but, surprisingly, a lot of it is still inaccurate. Even progressive, feminist websites often have incorrect information about IUDs. I wanted to address some of these myths and misinformation in my next few blog posts. My hope and dream is that IUDs will one day become the most commonly used form of contraceptive.

Post Anti-Abortion Syndrome

2009-07-16T12:01:00.000-07:00

I made this poster in response to all the bullshit ads and websites about "post-abortion syndrome"

A Neglected Crisis

2009-06-13T09:14:00.000-07:00

Dr. Mahmoud Fathalla, former President of the International Federation of Gynecology and Obstetrics, stated, “pregnancy related deaths are the ultimate tragic outcome of the cumulative denial of women’s rights”. Nowhere is this truer than with the death and suffering of women who have had unsafe abortions. 13% of maternal deaths worldwide are the result unsafe abortion, which is defined as “a procedure for terminating an unintended pregnancy either by individuals without the necessary skills or in an environment that does not conform to minimum medical standards or both”.1 Documented methods include drinking bleach or turpentine, inserting sticks, bones, wires, or catheters into the uterus, using caustic herbs in the vagina, and jumping from the top of a flight of stairs on to the stomach.

Of an estimated 42 million abortions every year, 21.8 million are considered unsafe. In addition, there are approximately 25 million unsafe failed abortion attempts per year.1 The results of denying women access to this basic right are staggering; each year, 67 000 women die, 5 million are hospitalized for serious complications, 1.7 million become infertile, and 220 000 children are orphaned. 2

This tragedy is magnified by the fact that it is entirely preventable. In countries where abortion is legal, it is “one of the safest procedures in contemporary medical practice”.3 Contrary to popular opinion, legalizing abortion does not increase abortion rates. In fact, abortion rates are lowest in the places where it is freely and easily accessible to all women.2

The topic of abortion is mired in social stigma. We spend so much time tiptoeing around abortion as an “ethical controversy” that we miss out entirely on abortion as a global health crisis. Through our reluctance to be involved, we have merely perpetuated this injustice. Unsafe abortion will continue to be a neglected crisis until those of us in developed world, who have the resources and opportunities to create lasting change, refuse to remain silent any longer.

Sources:
1. Unsafe Abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003. 5th Ed. World Health Organization, 2007.
2. Facts on Induced Abortion Worldwide. Guttmacher Institute, October 2007.
3. Grimes et al., Unsafe Abortion: The preventable pandemic. World Health Organization – Sexual and Reproductive Health. October, 2006.

A Straight White Man's Guide to Stopping Abortion

2009-06-06T11:20:00.000-07:00

A Straight White Man’s Guide to Stopping Abortion

Stop raping women and molesting children
4.7% of adult women who have been raped will become pregnant
1-2% of women seeking an abortion report that their pregnancy was the result of rape and/or incest (significantly under reported)
Survivors of childhood sexual assault are significantly more likely to have unplanned pregnancies later in life and have a three fold increase in teen pregnancy.
Approximately 60% of women who became pregnant as teenagers had a history of sexual abuse.
11-20% of teen pregnancies are the direct result of sexual assault

Invent a form of birth control that actually works
Over 55% of women seeking an abortion had been using a form of birth control regularly
Women will experience 1.8 contraceptive failures (i.e. pregnancies) over their lifetime if using reversible forms of birth control (pill, patch, condom, diaphragm, etc)

Empower young people to be informed and in control of their sexual health
there is no evidence to date that abstinence-only education delays teen sexual activity. Moreover, recent research shows that abstinence-only strategies may deter contraceptive use among sexually active teens, increasing their risk of unintended pregnancy and STIs

Value women in the workplace
Up to 75% of women seeking an abortion believe that having a baby would jeopardize their career or education. They fear losing their job, being denied advancement in the workplace, not being provided the time off necessary to have a baby, and not having the support and schedule flexibility to raise a child while working

Start taking responsibility for your own children and support your female partners.
50% of women seeking an abortion either have an unsupportive or abusive partner or they do not have a partner at all and they fear single motherhood.

Increase the accessibility of emergency contraceptive
As much as 43% of the decline in abortion between 1994 and 2000 can be attributed to the use of emergency contraception

Support programs that provide education and resources to women in the developing world
Education level is the most important factor in predicting the number of children and pregnancies a woman will have in the developing world
Interventions which provide education and support to women in poverty decrease both the birth rate and the rate of abortion

Leave no sperm behind
Women with male partners who are active and open participants in the choice and use of birth control methods are less likely to face unexpected pregnancy
Condom use significantly decreases the likelihood of unplanned pregnancy – yet the main reasons why they are not more commonly used are “reduction in male pleasure”, “hassle to deal with”, “getting carried away in the moment” and “not having a condom available”

Quit vilifying women who do not comply to the “standard model” of motherhood
Single mothers, working mothers, mothers whose children are in childcare, mothers who have demanding careers, mothers in non-traditional relationships, mothers who struggle with addiction and/or health problems etc. all experience tremendous discrimination for their choices. Is it really a surprise then that many women are not willing to face this type of disparagement?

Improve social assistance and welfare programs
60% of women cite major financial concerns as being a significant factor in their decision to terminate their pregnancy.
The abortion rate of women living below the poverty line is four times as high as the rate for women 300% above the poverty line

Speak out against gender and racial inequity
There has been an estimated 10 million “sex-selective” abortions of female fetuses
Compared to white women, Black women are 3 times as likely, Hispanic women are 2.5 times as likely to have an abortion.
Aboriginal women have highest rate of abortion in Canada.

1. Perspect Sex Reprod Health. 2002 Mar-Apr;34(2):68-75
2. Boyer, D. & Fine, D. (1992). Sexual abuse as a factor in adolescent pregnancy and child maltreatment. Family Planning Perspectives,24,
3. Alan Guttmacher Institute, Induced Abortion, Facts in Brief, 2002. Web: www.guttmacher.org .
4. Center for Diseases Control Rape Fact Sheet 2/2000
5. Kirby D, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001;
6. A.G. Vishnevsky, "Family, Fertility and Demographic Dynamics," ibid., pp. 1-35
7. Reaney, Patricia. (2006-01-09). "Selective abortion blamed for India's missing girls." Reuters AlertNet. Retrieved 2006-01-09.
(credit for the title goes to a strong, articulate, inspiring woman I met in my first year of university)

I am Dr Tiller

2009-06-04T21:37:00.000-07:00

This is my submission to iamdrtiller.com

I am an abortion provider-in-training. I look forward to being able to offer such a vital service to my future patients. I have been continually inspired by the clinicians and staff members who have taught me how to provide abortions, and, more importantly, how to be an abortion provider. This is an important distinction. Providing abortions really isn't technically complicated from a medical perspective. Being an abortion provider, however, is a life-long commitment to believing in women, respecting their choices, and being a strong voice for justice, even when it may be unpopular or even unsafe. Dr. Tiller truly exemplified what it means to be an abortion provider. He will undoubtedly remain an important role model for all of us in the pro-choice community.

Being an abortion provider is a privilege. You are given the opportunity to take part in a woman's journey as she reclaims her body and her future. Regardless of her circumstances, the process is always one of great emotional intensity - sadness, relief, forgiveness, hope, love. The most meaningful experiences of my medical training have all taken place within an abortion clinic.

There is truly nothing more beautiful or more real than what happens within the clinic walls. There is an incredible moment during every procedure when the woman's nervousness and anxiety fades into a state of calmness. You can see the precise moment on her face, in her eyes. The entire atmosphere of the room changes. This is the moment when she realizes her own strength and resiliency. This is when she reclaims her body, her sense of self, and her future. And while there is often still sadness, it is a different kind of sadness, a sadness not defined by helplessness and despair. There is so much emotion within the short span of a few minutes that it is almost overwhelming. You, too, become transformed.

People often ask me how could I possibly want to provide abortions as a career. My answer, how could I possibly not.

I am Dr. Tiller.

Squicked out, Pissed Off

2009-05-19T09:40:00.000-07:00

It is pervasive and inescapable. I find it in my web browser, in my subway station, on the placards they hold outside the clinic, at large displays on campus or downtown, on a roadside billboard, and even posted on a truck which drives around the conferences I attend. They use it as an argument, a primitive tactic which uses shock and disgust as a replacement for meaningful discourse. It is a mockery of our intelligence and an assault on our senses.

Mangled, dismembered fetuses, in a pool of thick blood and tissue, reaching their hands skyward as though seeking salvation. This is both the mascot and the secret weapon of the anti-choice industry. And it seems to work fairly well, too. It evokes a deep, guttural reaction and tries to guide us to the conclusion that if we find these images uncomfortable then we must also be uncomfortable with abortion. Faulty logic, but nonetheless very powerful. Some pro-choicers argue that these pictures are hoaxes, misrepresentations, or over-dramatizations. While this is likely true, it shouldn't matter. I would like to argue that even if abortion is truly as "gory" as they would have us believe, that does not make it wrong. Visual aesthetic is not a requirement for something to be ethically defensible, and, as explained below, repulsion is an illegitimate measure of virtue.

The human response to blood and gore is universally one of disgust. This is the reason why we feel grossed-out at the site of a deep wound or when watching surgery on TV shows, why some of us become queazy at the mere sight of blood, why many of my fellow medical students feel ill after the first day in the cadaver lab, and why well-meaning partners often faint in the delivery room. The response has nothing to do with right or wrong - it is merely a natural, physiologic reaction. To our evolutionary ancestors, the sight of blood meant almost certain danger and it was actually advantageous for us to become frightened, faint, or even ill. This response primed us for "fight or flight" and prepared our bodies for imminent injury by lowering our blood pressure to avoid massive bleeding or even causing us to "play dead" by fainting onto the ground. Anti-choicers have harnessed the potency of this vestigial reflex to instill doubt and outrage. While many of us see the inherent flaw in this method, it is often difficult to explain why.

Enter the word "squick"

I was recently introduced to the term "squick", and fell in love with it instantly. Squick refers to the physical sensation of repulsion, but does not imply a moral component. It allows one to describe a feeling of discomfort that is entirely separate from any form of judgment. Squick is a noun, but can be used as an adjective (squicky) or a verb (squick out or squicks). It is believed that this word developed within the BDSM community as a way of communicating "I find this personally unappealing but I don't see anything wrong with it".

Squick is a word that the anti-choicers don't want you to know because it completely dilutes the power of their fetal pornography. It reinforces the idea that our instinctual, biological responses do not define nor reflect our internal beliefs and ethics. It allows us to express discomfort without compromising on our convicitons.

And while they may be able to force their images into our lives, we can force the meaning out of their images.

A Kiss is not a Contract

2009-05-15T12:14:00.000-07:00

I recently started watching the Flight of the Conchords, which is absolutely brilliant. The episode "Girlfriends" is a clever social commentary about gender roles and myths surrounding sexual assault. One of the main characters, Bret, starts dating a woman who only wants to have sex with him. Bret would rather take things more slowly. Bret's friends tell him that part of the problem is that he is leading her on by showing too much "arm". They help him find a less "slutty" outfit which covers his arms. At another point in the episode, the perp lady states that Bret has to have sex with her because of the common known fact that once a woman is aroused, she can develop serious health problems unless she has an orgasm.

The absolute best moment of the episode is the following song, called "A Kiss is not a Contract":
http://www.youtube.com/watch?v=9iSlPoQm2XY

Anyways, I can't stop smiling because of this show. I recommend watching their other episodes too.

Sex-based abortion

2009-05-15T07:39:00.000-07:00

There has been growing discussion among pro-choicers and anti-choicers alike regarding sex-selective abortions. You often hear about "The Missing Girls" in many areas of the world. The knee-jerk reaction is to blame abortion rights and race for this tragedy. Even pro-choice people squirm at this issue.

However, this issue is not as simple as it might seem. Female foeticide, as it is often called, has nothing to do with abortion. It is merely a symptom of our world's pervasive injustice towards women. Eliminate patriarchy and you will eliminate the disproportionate abortion of female fetuses. It's that simple. On a cultural level, blaming a particular race is a gross oversimplification of why some regions of the world seem to have higher rates of sex-selective abortion. Gender discrimination exists in many forms across all cultures and pointing the finger is at the very least hypocritical and often merely reinforces the cycles of disempowerment in marginalized populations.

On another level, I feel that it is very dangerous to start assessing the legitimacy or morality of the myriad reasons why a woman chooses an abortion. If we decide that we should not allow women to have an abortion based on the sex of the fetus, we make it permissible to question the rest of her motives as well. Is the woman's age a legitimate reason? What about her relationship status? Her career? Her ability to care for her other children? Her health? Her desire to have children if and when she wants them? This is a conversation that we do not want to have. The proverbial "slippery slope" could put all of women's reproductive freedoms in jeopardy. Furthermore, how would you ever go about proving what her motivation is?

Finally, a recent case in Sweden highlighted another important issue - the idea that women will use abortion to build their "perfect" family by selecting sons or daughters desired - not because of patriarchy but simply out of personal preference. This actually seems a bit ludicrous to me. In my many years working in this area, I have not come across this issue. And again, the answer to this (hypothetical) problem is not in restricting abortion. If we, as a society, challenge gender roles and gender-based identities, there will be essentially no significant difference between having a son or having a daughter - problem solved.