1. Abortion

2. Options counseling Lucy presents to your office for an annual exam and when you take the menstrual history, she reports that her last period was 7 weeks ago. You astutely obtain the history that she is sexually active using no contraception, and obtain a pregnancy test which is positive.

3. Options You are an OB-GYN morally opposed to abortion. How would you talk to Lucy?

4. Options You are an OB-GYN not morally opposed to abortion. How would you talk to Lucy? After counseling, she decides on an abortion. What do you do next?

5. How do you do an abortion? Medical abortion Surgical abortion

6. Complications Sylvia just underwent uterine aspiration at 10 weeks. At the time of placing the suction cannula, brisk bright red bleeding began. Bleeding continues. – Differential? – Management?

7. Complications Melanie had a medical abortion. She placed the misoprostol 24 hours ago and had bleeding and cramping that peaked 20 hours ago. She now has severe abdominal cramping, no fever. – Differential? – Management?

8. Complications Mariam presents to the ER in Bamako, Mali, with severe abdominal pain and fever. On physical exam, there is bowel coming out of the vagina. – Differential? – Management?

9. Legal abortion is safe Sources: All births and abortions: Grimes DA, 2006; Abortion by gestation: Bartlett et al., 2004 (1988–1997 data) Deaths per 100,000 abortions Abortions by gestational age

10. Safety of Abortion Abortion is one of the safest common surgical procedures for women in the United States. Abortion is safe over the long term and carries little or no risk of fertility-related problems, cancer or psychological illnesses. Laws criminalizing abortion make abortions unsafe, but do not eliminate them.

11. Complications of unsafe abortion Five million women hospitalized annually – Hemorrhage – Sepsis Complications from unsafe abortion – 13% of maternal deaths – 67,000 deaths per year. 220,000 children lose a mother every year because of abortion-related deaths. Singh, 2006; WHO 2007; Grimes 2006

12. Ethics Is it moral to require an individual to participate in an abortion? An OB-GYN? What if the woman’s life is in danger and there is no one else to perform it?

13. Ethics Answering a phone call from a patient who wants an abortion? Getting a speculum out of the Pyxis for an abortion? Talking to a patient who has had an abortion in the past?

14. Ethics Is it moral to be against legal abortion?

15. The legal status of abortion does not predict its incidence The lowest abortion rates in the world—are in Europe, where abortion is legal and available. – < 10 per 1,000 The US is in-between – 21/1,000 In Africa, Latin America and Caribbean, where abortion law is most restrictive – 30 per 1,000 women Sedgh et al., 2007

16. Abortion rates in countries where it is illegal or highly restricted Source: Boonstra, 2006 Abortions per 1,000 women 15–44

17. Percentage of Maternal Mortality Worldwide Due to Unsafe Abortion Source: WHO, 1998 (Estimates for 1995–2000) Unsafe abortion Other causes

18. Efforts to provide medical services by videoconference, a notion known as telemedicine, are expanding, but Planned Parenthood of the Heartland in Iowa is the first in the nation, and so far the only ones, experts say, to provide abortions this way. Advocates say the idea offers an answer to an essential struggle that has long troubled those who favor abortion rights: How to make abortions available in far-flung, rural places and communities where abortion providers are unable or unwilling to travel. Abortion Drugs Given in Iowa via Video Link 93% of counties in Iowa have no abortion provider

19. Pregnant Iowa Woman Arrested for Falling Down BY ROXANN MTJOY ROXANN MTJOY CATEGORY: REPRODUCTIVE RIGHTS REPRODUCTIVE RIGHTS PUBLISHED FEBRUARY 12, 2010 @ 06:00AM PT Share141 9959 Views -Patient thought about abortion in 1 st trimester and decided to continue the pregnancy. -Fell down stairs 2 months later, in 2 nd trimester, and went to the hospital. Told nurse about earlier ambivalence about the pregnancy -Arrested and spent 2 days in jail for violating the Iowa “attempted feticide law: “to intentionally terminate a human pregnancy, after the end of the second trimester" - Not prosecuted since she was in the middle of the 2 nd trimester, not the end…