Tracy A Weitz, PhD, MPA
Director
Advancing New Standard in Reproductive Health (ANSIRH)
Bixby Center for Global Reproductive Health
University of California, San Francisco
January 25, 2010
This document provides guidance for healthcare providers on safe abortion care. It discusses the importance of providing women with information and counseling to allow for informed decision making about abortion. A medical history should be taken and physical exam conducted to determine pregnancy duration and check for any conditions that could impact the abortion procedure. Contraceptive options should also be discussed to help prevent future unintended pregnancies.
This document summarizes guidance on improving access to safe abortion services. It discusses the context and impact of unsafe abortion in Asia. Over 34,000 women die each year in Asia from unsafe abortion. The document reviews international agreements that recognize unsafe abortion as a major public health issue and call for making abortion safe and accessible. It discusses clinical services, management issues, and overcoming barriers to access based on WHO guidance. The goal is to promote understanding of unsafe abortion and measures to make legal abortion services safe and accessible.
Counselling For MTP by DR ALKA MUKHERJEE NAGPUR M.S. INDIAalka mukherjee
Pre-procedure counselling Pre-procedure counselling is important for the following reasons: l It helps the woman to decide about the termination of pregnancy l It helps the woman to choose the method of termination l It ensures that the consent for the procedure is given after receiving complete information about the procedure and understanding its implications l It helps the woman to adopt a contraceptive method after the procedure
Important notes for the counsellor on post-abortion contraception l Roughly 75% women ovulate and 6% conceive within two to six weeks after abortion, if they are not using contraception l All modern contraceptive methods can be safely provided immediately after the first trimester abortions (caution to be taken for second trimester abortions) l The continuation rate for post-abortion insertion of IUCD is good. Insertion of IUCD immediately after the first/second trimester abortions is not associated with a higher risk of expulsion, infection or bleeding l Abdominal tubectomy can be safely performed concurrently with MTP. Laparoscopic ligation should be done only after the first trimester abortions
Critical steps during post-procedure counselling: l Continue to ensure privacy and confidentiality and an empathetic attitude l Enquire from the woman how she is feeling and reassure her in case of any problems l Inform her that she should avoid intercourse till bleeding stops or condoms should be used l Repeat the information about post-procedure care and ensure that the woman understands it fully Inform her that she should return to the hospital in case of: l Severe abdominal pain l Heavy vaginal bleeding l Fever, fainting, abdominal distention or severe vomiting Call the woman for a follow-up visit in a week’s time and counsel her again if she had not accepted any form of contraception
This document provides guidance on improving access to safe abortion services in Africa. It discusses the context of unsafe abortion in Africa, including the high rates of maternal death from unsafe abortion procedures. It outlines international agreements that recognize unsafe abortion as a major public health issue and call for making abortion safe and accessible to the full extent of the law. The document also addresses the legal status of abortion in African countries and barriers to accessing safe abortion services. It provides guidance on clinical abortion services and management practices based on World Health Organization standards.
The document provides an overview of abortion worldwide, including definitions, types, and legal status of abortion. It discusses methods for measuring abortion incidence, conditions under which women have abortions, and the impact of unsafe abortion on maternal health. Unsafe abortion remains a major public health issue, and reducing unintended pregnancies through access to contraception is key to also reducing abortions.
The document summarizes key aspects of abortion law in India under the Medical Termination of Pregnancy Act, 1971. It defines abortion and the different types. It discusses who can perform abortions and the conditions required like gestational limits and medical opinion. The Act allows abortion up to 20 weeks of pregnancy with two doctors' consent or to save the woman's life. It also discusses related cases that have challenged aspects of the Act. In summary, the MTP Act of 1971 governs abortion law in India and allows termination of pregnancy up to 20 weeks under certain conditions.
The document summarizes the procedure for infertility treatment using intrauterine insemination (IUI). It involves stimulating a woman's ovaries to produce multiple eggs, preparing sperm by separating normal from abnormal sperm, and placing the sperm directly into the uterus. Success rates are 10-20% per cycle and depend on factors like the woman's age. Potential risks are rare infections, but careful technique can prevent issues. The procedure takes 15-20 minutes and patients can resume normal activities after.
IUI is a fertility treatment where sperm is placed directly in the uterus in order to facilitate fertilization and pregnancy. It is a simple, minimally invasive procedure that is often the first treatment for infertility. Factors like the woman's age, the cause of infertility, and the stimulation protocol used can affect the success rate, which typically ranges from 5-30%. The process involves ovarian stimulation, monitoring follicle development, sperm preparation using techniques like density gradient centrifugation, and then precisely timing insemination around ovulation to increase the chances of conception.
This document provides guidance for healthcare providers on safe abortion care. It discusses the importance of providing women with information and counseling to allow for informed decision making about abortion. A medical history should be taken and physical exam conducted to determine pregnancy duration and check for any conditions that could impact the abortion procedure. Contraceptive options should also be discussed to help prevent future unintended pregnancies.
This document summarizes guidance on improving access to safe abortion services. It discusses the context and impact of unsafe abortion in Asia. Over 34,000 women die each year in Asia from unsafe abortion. The document reviews international agreements that recognize unsafe abortion as a major public health issue and call for making abortion safe and accessible. It discusses clinical services, management issues, and overcoming barriers to access based on WHO guidance. The goal is to promote understanding of unsafe abortion and measures to make legal abortion services safe and accessible.
Counselling For MTP by DR ALKA MUKHERJEE NAGPUR M.S. INDIAalka mukherjee
Pre-procedure counselling Pre-procedure counselling is important for the following reasons: l It helps the woman to decide about the termination of pregnancy l It helps the woman to choose the method of termination l It ensures that the consent for the procedure is given after receiving complete information about the procedure and understanding its implications l It helps the woman to adopt a contraceptive method after the procedure
Important notes for the counsellor on post-abortion contraception l Roughly 75% women ovulate and 6% conceive within two to six weeks after abortion, if they are not using contraception l All modern contraceptive methods can be safely provided immediately after the first trimester abortions (caution to be taken for second trimester abortions) l The continuation rate for post-abortion insertion of IUCD is good. Insertion of IUCD immediately after the first/second trimester abortions is not associated with a higher risk of expulsion, infection or bleeding l Abdominal tubectomy can be safely performed concurrently with MTP. Laparoscopic ligation should be done only after the first trimester abortions
Critical steps during post-procedure counselling: l Continue to ensure privacy and confidentiality and an empathetic attitude l Enquire from the woman how she is feeling and reassure her in case of any problems l Inform her that she should avoid intercourse till bleeding stops or condoms should be used l Repeat the information about post-procedure care and ensure that the woman understands it fully Inform her that she should return to the hospital in case of: l Severe abdominal pain l Heavy vaginal bleeding l Fever, fainting, abdominal distention or severe vomiting Call the woman for a follow-up visit in a week’s time and counsel her again if she had not accepted any form of contraception
This document provides guidance on improving access to safe abortion services in Africa. It discusses the context of unsafe abortion in Africa, including the high rates of maternal death from unsafe abortion procedures. It outlines international agreements that recognize unsafe abortion as a major public health issue and call for making abortion safe and accessible to the full extent of the law. The document also addresses the legal status of abortion in African countries and barriers to accessing safe abortion services. It provides guidance on clinical abortion services and management practices based on World Health Organization standards.
The document provides an overview of abortion worldwide, including definitions, types, and legal status of abortion. It discusses methods for measuring abortion incidence, conditions under which women have abortions, and the impact of unsafe abortion on maternal health. Unsafe abortion remains a major public health issue, and reducing unintended pregnancies through access to contraception is key to also reducing abortions.
The document summarizes key aspects of abortion law in India under the Medical Termination of Pregnancy Act, 1971. It defines abortion and the different types. It discusses who can perform abortions and the conditions required like gestational limits and medical opinion. The Act allows abortion up to 20 weeks of pregnancy with two doctors' consent or to save the woman's life. It also discusses related cases that have challenged aspects of the Act. In summary, the MTP Act of 1971 governs abortion law in India and allows termination of pregnancy up to 20 weeks under certain conditions.
The document summarizes the procedure for infertility treatment using intrauterine insemination (IUI). It involves stimulating a woman's ovaries to produce multiple eggs, preparing sperm by separating normal from abnormal sperm, and placing the sperm directly into the uterus. Success rates are 10-20% per cycle and depend on factors like the woman's age. Potential risks are rare infections, but careful technique can prevent issues. The procedure takes 15-20 minutes and patients can resume normal activities after.
IUI is a fertility treatment where sperm is placed directly in the uterus in order to facilitate fertilization and pregnancy. It is a simple, minimally invasive procedure that is often the first treatment for infertility. Factors like the woman's age, the cause of infertility, and the stimulation protocol used can affect the success rate, which typically ranges from 5-30%. The process involves ovarian stimulation, monitoring follicle development, sperm preparation using techniques like density gradient centrifugation, and then precisely timing insemination around ovulation to increase the chances of conception.
This document provides information on intrauterine insemination (IUI), including definitions, rationale, indications, contraindications, procedures, and factors affecting success. IUI involves directly transferring processed semen into the uterine cavity near the time of ovulation. It is indicated for conditions like mild male factor infertility or cervical hostility. Success rates are highest when IUI is used with ovarian stimulation and when the inseminated motile sperm count is over 1 million. Precise timing of insemination relative to ovulation is important. The procedure involves sperm preparation, monitoring follicle development and the ovulation process, and then inseminating into the uterus using a catheter.
This document provides information about intrauterine insemination (IUI) from Dr. Anand K. Shinde, including why IUI works, why controlled ovarian hyperstimulation is used with IUI, typical success rates for IUI, contraindications for IUI, indications for IUI, possible complications of IUI, considerations around doing multiple IUI in one cycle, post-IUI support, required surveillance, and difficult situations that can arise for IUI patients.
Assisted reproductive technology (ART) refers to various medical techniques used to help with fertility and conception, including in vitro fertilization (IVF), artificial insemination (AI), and surrogacy. Infertility, which affects up to 15% of couples, can be caused by factors in either partner such as sexually transmitted diseases, obesity, genetic defects, or damage to the reproductive organs. IVF involves fertilizing an egg outside the body in a laboratory and then transferring the embryo to the uterus, while AI involves inserting sperm directly into the uterus or fallopian tubes. Surrogacy involves a contracted woman carrying and delivering a baby for an infertile couple. Though ART has enabled successful pregnancies for many, there are
This document discusses infertility investigations and treatments. It recommends referring couples for investigations after 1 year of unprotected sex if the woman is under 36, or earlier if she is over 36 or there is a known cause of infertility. Common causes of infertility include male factors, female tubal issues, ovulatory disorders, and unexplained causes. Recommended initial investigations include a semen analysis, HSG, and progesterone test. Treatments discussed include IVF for moderate to severe tubal disease or other complicating factors, and laparoscopic surgery for mild tubal disease. The document provides guidance on investigating and treating various conditions that may cause infertility such as PCOS, hyperprolactinemia, and ovarian failure.
This document discusses various assisted reproductive technologies (ART) used to help couples conceive who are unable to naturally. It describes ART procedures like in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), gamete intrafallopian tube transfer (GIFT), zygote intrafallopian transfer (ZIFT), and surrogacy. Infertility affects 7-26% of couples worldwide, and these technologies aim to increase the chances of fertilization and pregnancy through surgical egg and sperm manipulation and placement in the body. The document outlines the steps for common procedures like IVF, ICSI, IUI, GIFT and ZIFT. It also
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
This slide has been prepared for educational purpose using various standard medical books. This is prepared by medical student and if any mistakes are there please comment.
Abortion is a personal and unique choice in every woman, you decide on your body and your future, but make it safe.
http://www.medicacenterfem.com/en/abortion-clinic/abortion/
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
This document discusses assisted reproductive technologies (ART) such as artificial insemination, in vitro fertilization, and intracytoplasmic sperm injection. It describes the various types of ART, including artificial insemination using donor sperm or partner sperm, IVF which involves fertilizing eggs outside the body then transferring embryos, and ICSI which is used when sperm count is low. The document outlines the basic process of IVF and discusses alternatives like GIFT and ZIFT. It also notes ethics concerns and the lack of comprehensive regulation in India.
THE ASSISTED REPRODUCTION TECHNOLOGY REGULATION RULES, 2010
Members of drafting committee11 members
1- Sr Advocate Supreme Court of India
2 – Public Interest Legal Support and Research
3 – Dept of Family Welfare, M of Fam Wel and Research
5 – experts from the field of Reproductive Medicine
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...DR SHASHWAT JANI
Dr. Shashwat Jani is a consultant assistant professor in Ahmedabad, India who specializes in infertility treatment. The document discusses various factors related to infertility, treatments for different conditions, and guidelines for selecting patients for assisted reproductive technologies (ART) like in vitro fertilization (IVF). It covers female factors like tubal and uterine issues, ovarian problems, and endometriosis; male factors such as semen abnormalities; and treatments for different types of infertility including IUI, IVF, ICSI, and use of donor gametes.
This document discusses reasons why IVF cycles may fail and provides guidance on learning from failed cycles. It defines recurrent IVF failure and recurrent implantation failure. Common causes of failure discussed include embryo quality, endometrial factors, and uterine issues like polyps or hydrosalpinx. Investigations like hysteroscopy and salpingectomy are recommended to address correctable causes. Other potential factors explored are endometrial thickness, scratching, and refractory endometrium. The goal is to identify avoidable causes and improve outcomes in subsequent cycles.
Diagnosis and management of basic infertilityArchana Tandon
This document provides guidance for general gynecologists on evaluating and managing basic infertility. It highlights that a thorough history and physical exam should be done before starting any workup. The workup should generally start after 6 months of trying unless certain risk factors are present. Key parts of the initial workup include a semen analysis, confirming ovulation with a mid-luteal progesterone test, and checking tubal patency with HSG or sonohysterography. Empirical clomiphene citrate therapy is not recommended. IUI is only appropriate if the gynecologist understands patient selection and timing of referral for more advanced treatments. Lifestyle changes should be the first approach for overweight PCOS patients.
This document provides an overview of safe abortion care. It discusses the types of abortion, including threatened, inevitable, incomplete, complete, missed, and septic abortion. It outlines the symptoms, signs, and physical exam findings for each type. It also reviews the history of induced abortion practices from ancient times to the present. Additionally, it summarizes global and national scenarios regarding abortion rates and unsafe abortion. Key aspects of India's Medical Termination of Pregnancy Act are highlighted, including gestation limits, eligibility criteria for registered medical practitioners, and required forms.
Here are the key points about hCG:
- hCG is a hormone produced in pregnancy that helps maintain the corpus luteum to support early pregnancy.
- It is used to induce ovulation by mimicking LH and causing follicles to rupture and release eggs, increasing chances of pregnancy.
- Indications for use include anovulation, PCOS, and irregular periods.
- It is administered via intramuscular or subcutaneous injection in dosages of 5,000 to 10,000 IU when monitoring shows a mature follicle after ovulation induction treatment.
- By mimicking the LH surge, it helps the mature follicle release its egg, supporting the process of induced ovulation. Its role is to help
Women's rights over her body by Ms Urshita SaxenaGovindGoyal13
The document discusses women's autonomy over their reproductive rights from an international legal perspective. It summarizes several landmark court cases that established privacy rights and legalized abortion. These include Griswold v. Connecticut, Roe v. Wade, and recent Indian cases recognizing women's reproductive autonomy. However, it notes that in some cases, courts have overridden women's decisions, citing responsibilities to potential life. The document also examines domestic laws around abortion and arguments regarding expanding access. Overall, it analyzes the tension between women's right to choose and restrictions imposed in the name of fetal rights or population concerns.
Dissecting the Reproductive Health Law Policy ProcessAlbert Domingo
Slides intended for interactive discussion on the policy process behind the Philippines' Reproductive Health law (RA 10354), following the framework of Walt and Gilson (1994)'s health policy triangle and the legislative threshold of Gray (2004).
This document provides information on intrauterine insemination (IUI), including definitions, rationale, indications, contraindications, procedures, and factors affecting success. IUI involves directly transferring processed semen into the uterine cavity near the time of ovulation. It is indicated for conditions like mild male factor infertility or cervical hostility. Success rates are highest when IUI is used with ovarian stimulation and when the inseminated motile sperm count is over 1 million. Precise timing of insemination relative to ovulation is important. The procedure involves sperm preparation, monitoring follicle development and the ovulation process, and then inseminating into the uterus using a catheter.
This document provides information about intrauterine insemination (IUI) from Dr. Anand K. Shinde, including why IUI works, why controlled ovarian hyperstimulation is used with IUI, typical success rates for IUI, contraindications for IUI, indications for IUI, possible complications of IUI, considerations around doing multiple IUI in one cycle, post-IUI support, required surveillance, and difficult situations that can arise for IUI patients.
Assisted reproductive technology (ART) refers to various medical techniques used to help with fertility and conception, including in vitro fertilization (IVF), artificial insemination (AI), and surrogacy. Infertility, which affects up to 15% of couples, can be caused by factors in either partner such as sexually transmitted diseases, obesity, genetic defects, or damage to the reproductive organs. IVF involves fertilizing an egg outside the body in a laboratory and then transferring the embryo to the uterus, while AI involves inserting sperm directly into the uterus or fallopian tubes. Surrogacy involves a contracted woman carrying and delivering a baby for an infertile couple. Though ART has enabled successful pregnancies for many, there are
This document discusses infertility investigations and treatments. It recommends referring couples for investigations after 1 year of unprotected sex if the woman is under 36, or earlier if she is over 36 or there is a known cause of infertility. Common causes of infertility include male factors, female tubal issues, ovulatory disorders, and unexplained causes. Recommended initial investigations include a semen analysis, HSG, and progesterone test. Treatments discussed include IVF for moderate to severe tubal disease or other complicating factors, and laparoscopic surgery for mild tubal disease. The document provides guidance on investigating and treating various conditions that may cause infertility such as PCOS, hyperprolactinemia, and ovarian failure.
This document discusses various assisted reproductive technologies (ART) used to help couples conceive who are unable to naturally. It describes ART procedures like in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), gamete intrafallopian tube transfer (GIFT), zygote intrafallopian transfer (ZIFT), and surrogacy. Infertility affects 7-26% of couples worldwide, and these technologies aim to increase the chances of fertilization and pregnancy through surgical egg and sperm manipulation and placement in the body. The document outlines the steps for common procedures like IVF, ICSI, IUI, GIFT and ZIFT. It also
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
This slide has been prepared for educational purpose using various standard medical books. This is prepared by medical student and if any mistakes are there please comment.
Abortion is a personal and unique choice in every woman, you decide on your body and your future, but make it safe.
http://www.medicacenterfem.com/en/abortion-clinic/abortion/
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
This document discusses assisted reproductive technologies (ART) such as artificial insemination, in vitro fertilization, and intracytoplasmic sperm injection. It describes the various types of ART, including artificial insemination using donor sperm or partner sperm, IVF which involves fertilizing eggs outside the body then transferring embryos, and ICSI which is used when sperm count is low. The document outlines the basic process of IVF and discusses alternatives like GIFT and ZIFT. It also notes ethics concerns and the lack of comprehensive regulation in India.
THE ASSISTED REPRODUCTION TECHNOLOGY REGULATION RULES, 2010
Members of drafting committee11 members
1- Sr Advocate Supreme Court of India
2 – Public Interest Legal Support and Research
3 – Dept of Family Welfare, M of Fam Wel and Research
5 – experts from the field of Reproductive Medicine
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...DR SHASHWAT JANI
Dr. Shashwat Jani is a consultant assistant professor in Ahmedabad, India who specializes in infertility treatment. The document discusses various factors related to infertility, treatments for different conditions, and guidelines for selecting patients for assisted reproductive technologies (ART) like in vitro fertilization (IVF). It covers female factors like tubal and uterine issues, ovarian problems, and endometriosis; male factors such as semen abnormalities; and treatments for different types of infertility including IUI, IVF, ICSI, and use of donor gametes.
This document discusses reasons why IVF cycles may fail and provides guidance on learning from failed cycles. It defines recurrent IVF failure and recurrent implantation failure. Common causes of failure discussed include embryo quality, endometrial factors, and uterine issues like polyps or hydrosalpinx. Investigations like hysteroscopy and salpingectomy are recommended to address correctable causes. Other potential factors explored are endometrial thickness, scratching, and refractory endometrium. The goal is to identify avoidable causes and improve outcomes in subsequent cycles.
Diagnosis and management of basic infertilityArchana Tandon
This document provides guidance for general gynecologists on evaluating and managing basic infertility. It highlights that a thorough history and physical exam should be done before starting any workup. The workup should generally start after 6 months of trying unless certain risk factors are present. Key parts of the initial workup include a semen analysis, confirming ovulation with a mid-luteal progesterone test, and checking tubal patency with HSG or sonohysterography. Empirical clomiphene citrate therapy is not recommended. IUI is only appropriate if the gynecologist understands patient selection and timing of referral for more advanced treatments. Lifestyle changes should be the first approach for overweight PCOS patients.
This document provides an overview of safe abortion care. It discusses the types of abortion, including threatened, inevitable, incomplete, complete, missed, and septic abortion. It outlines the symptoms, signs, and physical exam findings for each type. It also reviews the history of induced abortion practices from ancient times to the present. Additionally, it summarizes global and national scenarios regarding abortion rates and unsafe abortion. Key aspects of India's Medical Termination of Pregnancy Act are highlighted, including gestation limits, eligibility criteria for registered medical practitioners, and required forms.
Here are the key points about hCG:
- hCG is a hormone produced in pregnancy that helps maintain the corpus luteum to support early pregnancy.
- It is used to induce ovulation by mimicking LH and causing follicles to rupture and release eggs, increasing chances of pregnancy.
- Indications for use include anovulation, PCOS, and irregular periods.
- It is administered via intramuscular or subcutaneous injection in dosages of 5,000 to 10,000 IU when monitoring shows a mature follicle after ovulation induction treatment.
- By mimicking the LH surge, it helps the mature follicle release its egg, supporting the process of induced ovulation. Its role is to help
Women's rights over her body by Ms Urshita SaxenaGovindGoyal13
The document discusses women's autonomy over their reproductive rights from an international legal perspective. It summarizes several landmark court cases that established privacy rights and legalized abortion. These include Griswold v. Connecticut, Roe v. Wade, and recent Indian cases recognizing women's reproductive autonomy. However, it notes that in some cases, courts have overridden women's decisions, citing responsibilities to potential life. The document also examines domestic laws around abortion and arguments regarding expanding access. Overall, it analyzes the tension between women's right to choose and restrictions imposed in the name of fetal rights or population concerns.
Dissecting the Reproductive Health Law Policy ProcessAlbert Domingo
Slides intended for interactive discussion on the policy process behind the Philippines' Reproductive Health law (RA 10354), following the framework of Walt and Gilson (1994)'s health policy triangle and the legislative threshold of Gray (2004).
This document discusses pain, fetal development, and laws relating to abortion. It summarizes that the medical consensus is that fetuses are unlikely to feel pain before 27 weeks due to brain development. While laws limiting abortion after 20 weeks cite fetal pain, they affect a small percentage of procedures and have a larger symbolic impact by promoting ideas of fetal personhood. The document argues these laws are primarily about political values rather than established science on fetal pain.
Health Law Roe v Wade Analysis of Abortion and Reproductive RightsRichikDadhich
This document analyzes reproductive rights and abortion in light of the landmark US Supreme Court case Roe v. Wade. It discusses how Roe v. Wade legalized abortion and established a precedent, though reproductive rights debates continue. The recent overturning of Roe v. Wade eliminates federal abortion standards and allows states to restrict access, which will disproportionately impact women of color and likely increase unsafe abortions and maternal mortality rates. Reproductive rights are essential for women's autonomy and health.
Abortion is a controversial issue with arguments on both sides. The document discusses the various abortion procedures available up to certain gestation periods. It also outlines some of the risks of abortion as well as the psychological and physical impacts it can have on a woman's future pregnancies. Both sides of the abortion debate are presented, with pro-life arguing it is ending a human life while pro-choice advocates say it is a woman's right to choose. The author ultimately believes abortion should be legal but with strict regulations and only used as a last resort.
The document discusses fundamental rights regarding medical treatment and experimentation. It summarizes key court cases that established the right to refuse treatment or die, but not a right to assisted suicide. It also discusses the Abigail Alliance case, where terminally ill patients argued for access to experimental drugs, but courts affirmed the FDA's role in determining drug safety and efficacy. The document advocates that individuals should have more autonomy over their medical treatment and the right to try to save their own lives through experimental means when facing terminal illness.
Elucidates the governing laws (U.S., Canada, U.K), restrictions and extensions of the advance-directives (living wills) in obstetrics. DOI: 10.13140/RG.2.1.3671.4321
Fetal screening and selection medical dogma or parental preferenceKatharine Perry
This document discusses fetal screening and selection, and whether women's decisions to terminate pregnancies based on fetal abnormalities are truly autonomous. It notes that medical practitioners have significantly more positive views of terminating pregnancies for disabilities compared to patients. This difference in views threatens patients' autonomy during genetic counseling. The document examines discrepancies between medical and patient attitudes, how prenatal testing has advanced, and abortion rates after diagnoses. It argues that the medical community's tendency to over-medicalize and view disabilities as defining traits influences their support for fetal screening and selection in a way that can undermine patient consent.
Stem cells can develop into many cell types and may help treat diseases. Therapeutic cloning uses stem cells from cloned embryos to generate patient-matched cells for transplantation without immunorejection. While this research offers medical benefits, it also raises ethical concerns and some argue it undermines human dignity. Views on funding and regulating this research differ, as seen in debates around related bills in the U.S. Congress and state legislatures. Public opinion polls show most support therapeutic cloning if it is not tied to embryo destruction.
From self-driving cars to an iPhone screen that unlocks when you look at it, advances in technology can happen fast and often have a big impact on peoples’ lives. Not surprisingly, the law does not always keep pace—often leaving important legal questions in the wake of fastadvancing technologies. What is to be done with cryopreserved embryos upon the dissolution of
a marriage is one such important legal question where innovation in the law has become necessary to address innovation in technology.
Chapter 2
Contemporary
Ethical Dilemmas
No right is held more sacred, or is more carefully
guarded, by the common law, than the right of
every individual to the possession and control of
his own person, free from all restraint or
interference of others, unless by clear and
unquestioned authority of law.
—Union Pac. Ry. Co. v. Botsford
Learning Objectives (1 of 2)
• Describe various historical events that have had
an impact on the resolution of ethical dilemmas.
• Describe common ethical dilemmas and the
various ethical issues that have in many
instances divided many segments of the
population. Topics include:
– Abortion
– Sterilization
– Artificial insemination
Learning Objectives (2 of 2)
• Topics include:
– Surrogacy
– Organ donations
– Research, experimentation, and clinical
trials
– Human genetics
– Stem cell research
– AIDS
Ethical Dilemmas
• Ethical dilemmas arise in situations where a
choice must be made between unpleasant
alternatives.
• Occur when a choice involves giving up
something good and suffering some bad.
– Should I choose life knowing an unborn child
will be born with severe disabilities?
Noteworthy Historical Events (1 of 11)
58,000–68,000 BC: Neanderthal burial sites
(evidence of belief in an afterlife)
1932–1972: Tuskegee Study of Syphilis
1933–1945: Holocaust
1946: Military Tribunal for War Crimes
1949: International Code of Medical Ethics
1954: Guidelines on Human Experimentation
First kidney transplant
Noteworthy Historical Events (2 of 11)
1960s: Cardiopulmonary resuscitation
1964: WHO guidelines for biomedical research
1968: Harvard Ad Hoc Committee on Brain Death
1970: Patient as a Person
1971: Kennedy Institute of Ethics established
1972: Informed consent (Canterbury v. Spence)
1973: Women’s right to abortion (Roe v. Wade)
Noteworthy Historical Events (4 of 11)
1974: National Research Act
1975: First successful cloning of frogs
1976: Substitute judgment (Karen Ann Quinlan)
First living will legislation enacted
1978: Commission for the Study of Ethical
Problems in Medicine
Noteworthy Historical Events (5 of 11)
1980: Hemlock Society formed to advocate for
physician-assisted dying.
1983: First durable power of attorney legislation
Compassion and Choices
1987: Unethical experiments on children
Noteworthy Historical Events (6 of 11)
1990: Patient Self-Determination Act
Cruzan could have feeding tube removed
Kevorkian assists terminally ill patients in
suicide
Timothy Quill and prescription for death
Derek Humphry’s book Final Exit
Radiation experiments on unknowing
human
subjects
Noteworthy Historical Events (7 of 11)
1993: Patient’s wishes honored
1994: Oregon’s Death with Dignity Act
Michigan makes physician-assisted suicide
illegal
1996: HIPAA
Cloning of Dolly
Fourteenth Amendment and the terminally ill
Noteworthy Historical Events (8 of 11)
1997: Physician-assisted suicide
Kevorki ...
The document summarizes an article about a new law in Arizona that defines pregnancy as beginning two weeks before conception. The bill bans most abortions after 20 weeks of pregnancy, but calculates gestational age as starting from the first day of the last period, which is typically two weeks before fertilization. While doctors commonly use this method of calculating gestational age due to its convenience, there is disagreement in the medical community around whether pregnancy begins at fertilization or implantation. The new Arizona law's definition of gestational age effectively bans abortions two weeks earlier than the bill claims.
The document summarizes an article about a new law in Arizona that defines pregnancy as beginning two weeks before conception. The bill bans most abortions after 20 weeks of pregnancy, but calculates gestational age as starting from the first day of the last period, which is typically two weeks before fertilization. While doctors commonly use this method of calculating gestational age due to its convenience, there is disagreement in the medical community around whether pregnancy begins at fertilization or implantation. The new Arizona law's definition of gestational age effectively bans abortions two weeks earlier than the bill claims.
This document provides information about Roe v. Wade and the overturning of this landmark Supreme Court decision. It discusses what abortion is, why women seek abortions, and why the issue is controversial. It then details the history and significance of Roe v. Wade, establishing a woman's right to choose. However, the recent Dobbs v. Jackson ruling overturned Roe, eliminating the federal right to abortion. As a result, many states immediately banned abortion or will ban it in the coming weeks. The document concludes by discussing the fears and concerns of women, especially in states like Texas, now that access to abortion has been stripped away.
The document discusses induced abortion and provides information on the topic. It notes that about 1/4 of pregnancies worldwide end in induced abortion, making it a common method of fertility control. In the US, there are approximately 1 million legal abortions performed annually, with 1/3 being on teenage women. The document evaluates patients requesting abortions and notes they may do so for various social, economic, or medical reasons, with the ultimate decision resting with the pregnant woman.
The document discusses induced abortion and provides information on the topic. It notes that about 1/4 of pregnancies worldwide end in induced abortion, making it a common method of fertility control. In the US, there are approximately 1 million legal abortions performed annually, with 1/3 being on teenage women. The document evaluates patients requesting abortions and notes they may do so for various social, economic, or medical reasons, with the ultimate decision resting with the pregnant woman.
The document summarizes key aspects of the Pre-Conception and Pre-Natal Diagnostic Techniques Act (PCPNDT Act) of 1994 in India. [1] It aims to stop female feticide and regulate pre-natal sex determination. The Act prohibits clinics and doctors from conducting tests to determine sex without cause. It also bans advertising related to sex selection and selling ultrasound machines to unregistered entities. Violations are punishable as offenses. The Act seeks to curb misuse of technologies like ultrasound for sex-selective abortion and promote ethical practice of pre-natal diagnostics.
Planned Parenthood Great Northwest, Hawai‘i, Alaska, Indiana, Kentucky, Whole Woman’s Health Alliance, Women’s Med Group Professional Corporation, All-Options, Inc., and Dr. Amy Caldwell filed a lawsuit challenging Senate Bill 1, signed into law last month by Gov. Eric Holcomb.
Similar to In Trying to Find Common Ground, Do We Hurt Abortion Rights? (20)
This document summarizes self-care initiatives for sexual and reproductive health. It discusses the WHO definition of self-care, and examples like the Caya diaphragm introduced in Niger through the EECO project. Over 600 diaphragm kits were sold or distributed there from 2019-2020. The DOT app was marketed in India to help women track their periods and fertility. Looking ahead, more evidence is still needed on specific self-care interventions and how to evaluate them, while building advocacy and addressing regulatory questions. COVID-19 also impacts future self-care work.
- The SASS Project aimed to assess how well California high schools complied with the California Healthy Youth Act (CHYA) standards for comprehensive sex education, from the perspective of students.
- Students at 13 LAUSD high schools completed an anonymous online survey assessing their sex ed classes' coverage of CHYA standards and classroom environment.
- Results showed a range of compliance across schools, with strongest coverage of HIV topics and weakest coverage of gender/sexuality and contraception. Classroom environment also varied, with teachers generally comfortable but time limited.
- The findings could help identify areas of improvement, but LAUSD had not yet decided to formally incorporate the student surveys or provide feedback to schools.
This document discusses the persistence of electronic fetal monitoring (EFM) despite evidence that it does not improve neonatal outcomes for low-risk pregnancies compared to intermittent auscultation. While EFM was introduced to screen for fetal distress and reduce cerebral palsy rates, multiple studies have found it does not achieve these goals. However, EFM continues to be used in 85% of deliveries and has led to increased cesarean rates and costs without clear benefits. The document examines possible explanations for EFM's persistence, including the influence of law and economics, and calls for more randomized trials before new medical technologies are widely adopted.
This document provides information about the Durbar intervention for HIV prevention among sex workers in Kolkata, India. It summarizes the evolution of the intervention over time from community mapping and advocacy in 1991 to establishing community organizations and microfinance opportunities for sex workers in 1995. Key aspects of the intervention included community mobilization, empowerment training, peer health workers, and addressing structural barriers faced by sex workers. The document also summarizes a replication study conducted by UCLA which found that the Durbar intervention was successful in increasing condom use and empowerment outcomes among sex workers compared to standard STI clinic care alone. Factors like education level, employment status, and age predicted which sex workers benefited most from the additional community structural intervention components.
This document provides an overview of challenges in implementing sexual and reproductive health rights in Southern Africa, using examples from Botswana, South Africa, and Eswatini. It discusses how international law establishes these rights but they still face challenges in practice. Key issues include lack of legal protections, socio-cultural norms that discriminate against women, and lack of resources. While countries have laws incorporating international standards, discrimination and harmful practices still undermine equal access to healthcare and decision making. Ensuring sexual and reproductive rights requires addressing both legal frameworks and social attitudes.
Justice Oagile Key Dingake, who has had a distinguished career as a judge in Botswana and is now a judge in Papua New Guinea and Sierra Leone, will be giving a lecture at UCLA on gender discrimination in sexual and reproductive health rights. Justice Dingake received his LLB from the University of Botswana and LLM and PhD from universities in the UK and South Africa. He is recognized as a leading scholar in sexual and reproductive rights and has held prominent roles in judicial organizations in Africa focused on health, HIV/AIDS, and social justice. The introduction praised Justice Dingake for his progressive opinions on gender equality that have made him equivalent to U.S. Supreme Court Justice Ruth Bader
UCLA, Bixby Center Lecture
"From horror to humor: Abortion on American television"
Gretchen Sisson, PhD
Advancing New Standards in Reproductive Health (ANSIRH)
UCSF Bixby Center for Global Reproductive Health
Bixby Center Lecture
"Homeless and Vulnerable Youth in Los Angeles: Sexual and Reproductive Helth Challenges"
November 29, 2017
by Carrie Mounier, LCSW
This document discusses transformative approaches to sex education and violence prevention programs for youth. It outlines effective programs that seek to reduce risks and promote healthy relationships through gender transformative approaches. One such program is Program H, which uses a socio-ecological model to help boys and young men critically examine masculinity and promote gender equality, empathy, sexual health, and reduce dating violence. The document notes challenges in measuring the impact of such programs and how policies and funding can undermine social justice goals.
This document summarizes the Creating Space lactation accommodation project at UCLA. The project aims to improve support for breastfeeding mothers on campus by investing in lactation rooms, education, and support services. A needs assessment found few appropriate lactation spaces and a lack of support services. The project works to map and improve existing rooms, train lactation educators, and provide counseling services on campus.
KIHEFO is a local non-profit organization in Kabale District, Uganda dedicated to community development. It operates a medical clinic, HIV/AIDS clinic, nutrition center, and other projects focused on healthcare services and community development. Adolescent reproductive health is a major issue in Uganda, as 25% of the population is between 10-19 years old. Issues include lack of awareness, peer pressure, poverty, and cultural norms. Sexual activity begins early, and coercion, unwanted pregnancies, and STIs are problems. KIHEFO aims to address the integrated problems of disease, poverty, and lack of education through an integrated approach of healthcare services and community development projects.
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In Trying to Find Common Ground, Do We Hurt Abortion Rights?
1. Access to Second Trimester Abortions:
A Public Health Perspective
Tracy Weitz, PhD, MPA
Director
Advancing New Standards in Reproductive Health (ANSIRH)
Bixby Center for Reproductive Health Research & Policy
University of California, San Francisco
2. Today’s Presentation
Overview of 2nd trimester abortion
Current barriers to provision
A recommitment to 2nd
trimester
abortion care
3. What is 2nd Trimester Abortion?
1st
Tri 2nd
Tri 3rd
Tri
ACOG’s Committee
on Coding and
Nomenclature
LMP to
< 14 wks
14 -28 wks 28 wks +
Roe v Wade
LMP to
12 wks
13-24 wks 25 wks +
4. 2nd
Trimester Abortion in Practice
Generally
Abortions between (14) and (24) weeks LMP
Involves use of Dilation and Extraction (D&E)
Can be done with medications as an induction
Providers vary on to what gestational limit
they do abortions
CPT Codes distinctions
59840: By D&C –Any trimester
59841: By D&E -- 14 weeks 0 days up to 20
weeks 0 days
59841-22: By D&E -- 20 weeks 0 days or more
6. Many Women Need Care
10% of 1.3 million is still a lot of women
130,000 procedures in the 2nd
Trimester
26,000 women over 21 weeks LMP
Women who need care
Access barriers
Social barriers
Diagnosis barriers
Life circumstances
Health care disparity and human rights
issue
7. Who Needs 2nd
Trimester Abortions
Greater likelihood for women who
are:
Low income
Non-Hispanic black
Geographically isolated
Young
8. What factors delay abortion
Funding needs
Only 17 states still allow for Medicaid
funding
Significant factor in use of 2nd
Ti
Late diagnosis of pregnancy
Late diagnosis of medical need
Logistics
Difficulty finding a provider
Referral from a prior clinic
10. Lack of Providers
Graying of the Abortion Provider
Concentration in High Volume Outpatient
Clinics not in Hospitals
Lack of Training
In Residencies
For the Practicing Physician
Inadequate Compensation
Out-of-Pocket Services
Medicaid Restrictions
Insurance Prohibitions
11. A More Complicated Story
# of providers is an inadequate
measure
MFM physicians may do procedures for
fetal abnormalities
Separating “Good” from “Bad” Abortions
Newer providers unwilling to do such
high volume
requirements are cost without
compensation => specialization
12. Increasing Federal and State
Regulation of 2nd
Trimester Abortion
“Partial Birth Abortion” Bans
“Fetal Pain” Consent Bills
Targeted Regulation of Abortion
Provider (TRAP) Laws
14. What is “PBA”
Not a medically recognized term
Introduced into the public after a 1992
presentation by Martin Haskell at the
National Abortion Federation (NAF)
meeting was leaked to anti-abortion
activists
Supposedly describes the dilation and
extraction (D&X) technique
where the fetal body is brought through the
cervix intact and then the skull is compressed
to safely move it through the cervix
There is no bright-line distinction between
D&E and D&X
most appropriately called intact D&E
15. Why Perform an Intact D&E?
Reduce instrumentation of the
uterus
Fetus presentation necessitates
Result of dialation of cervix with
laminaria or misoprostol or other
cervical preparation technique
Process of fetal loss
Preserve the fetus for post-
procedure examination
16. Early Efforts to Ban PBA
Federal legislation to ban PBA
passed by Congress in March 1996
and again in October 1997
President Bill Clinton vetod both bills
Override votes passed in the House of
Representative but failed in the Senate
Many states began to pass PBA
bans
17. State-based “PBA” Bans
26 states have bans on PBA that apply throughout pregnancy
18 bans have been specifically blocked by a court
7 bans remain unchallenged but are presumably unenforceable
under Stenberg because they lack health exceptions
Ohio’s ban has been challenged and upheld by a court
5 states have bans that apply after viability
Utah’s ban has been specifically blocked by a court because it
lacks a health exception
Montana’s ban remains unchallenged but is presumably
unenforceable under Stenberg because it lacks a health exception
3 bans are currently in effect
4 states have bans that include a health exception
2 states broadly allow the procedure to protect against physical or
mental impairment
2 states narrowly allow the procedure to protect only against
bodily harm
27 states have bans without a health exception
19 bans have been specifically blocked by a court.
8 bans remain unchallenged.
18. State-based PBA Bans
Found unconstitutional in Stenberg v Carhart
[2000]
Challenge to the state of Nebraska ban on so-
called “Partial Birth Abortion”
Found unconstitutional on 5-4 decision
Stevens, Breyer, Souter, Ginsburg, O’Connor:
Four separate dissenting opinions were filed:
Rehnquist, Scalia, Kennedy, Thomas
Must have a health exception
In spite of this- Congress passed a the 2003
Partial Birth Abortion Ban without a health
exception
20. What Does the Law Say
“An abortion in which the person
performing the abortion, deliberately and
intentionally vaginally delivers a living
fetus until, in the case of a head-first
presentation, the entire fetal head is
outside the body of the mother, or, in the
case of breech presentation, any part of
the fetal trunk past the navel is outside
the body of the mother, for the purpose
of performing an overt act that the
person knows will kill the partially
delivered living fetus; and performs the
overt act, other than completion of
delivery, that kills the partially delivered
living fetus.”
21. Immediately Challenged
3 Legal Challenges
Planned Parenthood v. Ashcroft
San Francisco
National Abortion Federation v. Ashcroft
New York
Carhart v. Ashcroft
Nebraska
Temporary Injunction
Who is covered?
22. Planned Parenthood v. Ashcroft/Gonzales
Challenged by Planned Parenthood, joined by the
City and County of San Francisco on behalf of San
Francisco General Hospital
Subpoena to obtain medical records
Federal District Judge Phyllis Hamilton struck
down the law on 3 grounds (6/1/04):
Because it places an 'undue burden' (i.e., "a
substantial obstacle in the path of a woman seeking
an abortion of a nonviable fetus") on women
seeking abortion
Because its language is unconstitutionally vague
Because it lacks constitutionally-required provisions
to preserve women's health
Upheld by 9th
Circuit (1/31/06)
23. NAF v. Ashcroft/Gonzales
Challenged by the ACLU Reproductive
Freedom Project on behalf of the National
Abortion Federation (NAF)
New York District Judge Richard C. Casey
(8/26/04)
found the Partial Birth Abortion Ban Act
unconstitutional
ruled that the act must contain exceptions to
protect a woman's health
Very inflammatory language reg the fetus
Upheld by 2nd Circuit (1/31/06)
24. Carhart v. Ashcroft/Gonzales
Challenged by the Center for
Reproductive Rights on behalf of a
Nebraska physician Carhart
U.S. District Judge Richard Kopf (9/8/04)
“The overwhelming weight of the trial evidence
proves that the banned procedure is safe and
medically necessary in order to preserve the
health of women under certain circumstances.
In the absence of an exception for the health
of a woman, banning the procedure constitutes
a significant health hazard to women."
Upheld by the 8th Circuit Court of Appeals
(7/8/05)
25. The Supreme Court
2 cases (Planned Parenthood &
Carhart) heard 11/8/06
Expect opinion at end of term
What do we expect
Will depend on Kennedy’s dissent in
Carhart?
Has science and evidence changed
What is undue burden
26. Kennedy’s Strong Opposition
states should be able to outlaw
“a procedure many decent and
civilized people find so abhorrent
as to be among the most serious
of crimes against human life”
dissent in Stenberg v Carhart, 2000
27. Implications of Reversal
Could ban all 2nd
trimester abortions
Impose criminal sentences on
physicians who violate the ban
Chilling effect on 2nd
tri provider
Fundamentally change the meaning
of abortion right articulated in Roe
Restrict abortion in states with more
liberal laws
28. What Will Providers Do?
Survey of 2nd
Trimester providers
attending the 2006 meeting of the
National Abortion Federation
N = 46 (US only)
Average gestation limit 21wks LMP
range [16-27+]
Median gestation limit 23 wks LMP
29. If PBA is upheld will you:?
alter the way you use misoprostol for
cervical ripening
use digoxin at earlier gestational ages*
reduce the gestational age to which you
perform abortions
stop performing intentionally intact D&Es
change who you allow in the procedure
room
change the clinical technique for
performing D&Es
30. Use Digoxin at Earlier Gestation Age?
What is Digoxin (“Dig”)
A feticide injected into the fetal heart to
stop fetal cardiac activity
Change clinical practice
Yes: 11 (24%)
No: 28 (61%)
No Answer: 7 (15%)
31. Why Isn’t Dixogin the Answer?
Scientific evidence demonstrates does not
increase safety or ease of procedure and
has medical risks
Drey, E. A., L. J. Thomas, N. L. Benowitz, N.
Goldschlager, and P. D. Darney. 2000. "Safety
of intra-amniotic digoxin administration before
late second-trimester abortion by dilation and
evacuation." Am J Obstet Gynecol 182:1063-6.
Jackson, R. A., V. L. Teplin, E. A. Drey, L. J.
Thomas, and P. D. Darney. 2001. "Digoxin to
facilitate late second-trimester abortion: a
randomized, masked, placebo-controlled trial."
Obstet Gynecol 97:471-6.
32. Other Complicating Factors
Increased difficulty
at reduced gestation age
with obesity
Cost
What is “fetal death”
How prove?
33. Where is the “Pro-Choice Movement”
Wavering support
Discomfort with the “techniques of abortion’
A desire to “not focus on the issue”
Belief that we lose when we discuss the issue
Belief that few women will be hurt by these
bans
Focus on “reframing” and terminology
rather than real understanding
34. Implications for Health Care Beyond
Abortion
Legislate a particular medical
technique
What does this mean to the
concepts of informed consent?
36. “Fetal Pain” Counseling Reqs.
Require a doctor performing an
abortion at 20 or more weeks to
read to the woman a statement
saying that the fetus may
experience pain and to offer to give
the fetus anesthesia
In place in 3 states and under
consideration in others
37. What is Pain
Pain is a feeling – a subjective
sensory experience – and as such,
an individual must possess some
level of consciousness or awareness
in order to perceive a stimulus as
unpleasant. To be conscious and
capable of experiencing pain, an
individual must have a functional
cerebral cortex.
38. Inconsistent with Science
Systematic review published in JAMA,
2005
Pain vs Movement
No “pain” prior to 29 wks gestation
“Wiring is in place but lights don’t come on”
Even if pain, no means for fetal anesthesia
Increased risk to the pregnant woman
Other concerns
Informed consent and notions of risk
Mandated physician speech
39. Shouldn’t Women Decide?
I can understand why we shouldn’t
require fetal analgesia/anesthesia
for all abortions, but why shouldn’t
we allow the woman to chose for
herself whether she wants fetal
analgesia/anesthesia during an
abortion?
40. How to Answer the Question
Patient autonomy is undoubtedly a consideration
of primary importance. However, there is no
known safe and effective fetal
analgesia/anesthesia to offer in the context of
abortion.
Additionally, patients should be advised that such
measures are unnecessary because science does
not support that fetuses feel pain before the third
trimester.
The goal of quality patient care is to inform
women of the most up-to-date scientific
information. Requiring that women be offered
care that is not needed nor demonstrated as safe
violates that goal.
42. What are TRAP laws?
Targeted Regulations of Abortion
Providers (TRAP)
TRAP laws = Purported health
facility regulations that apply only
to facilities in which abortions are
performed
43. TRAP laws often include:
Licensing and inspection provisions
Authorization for searches
Administrative requirements
Minimum training requirements for
staff
Physical plant specifications
44. TRAP laws are different than other
abortion laws
Other abortion specific laws attempt
to influence the pregnant woman’s
decision
premise to protect potential life
TRAP regulate the medical aspects
of the abortion procedure
premise is to promote health
45. How prevalent are TRAP laws?
Over half of all states have TRAP
laws, all deal with 2nd
Trimester care
Legal challenges have failed to
reverse TRAP laws
Before 1992, many TRAP laws were
struck down as unconstitutional
Since Casey when the Supreme Court
established the undue burden standard,
almost impossible to prove
46. Not regulated like similar care
Procedures with magnitude and risk
greater than abortions up to 20 wks that
are not regulated in the outpatient setting
hysteroscopy
surgical treatment of miscarriage
diagnostic dilation & curettage
endometrial biopsy
ovum retrieval
sigmoidoscopy
vasectomy
What about after 20 wks?
47. What are the implications of TRAP laws?
TRAP laws
segregate abortion from the general
practice of medicine
deter physicians from becoming
providers
unnecessarily raise the cost of
abortions
Results in reduced access to and
quality of abortion
increasing disparities particularly for
low-income & rural women
49. Clever TRAP Laws
Regulate clinic as an outpatient
surgical center
Requires that physician have
admitting privileges at the local
hospital
Physicians are flown in from out-of-
state
No hospitals would grant privileges
Essentially outlawed 2nd
Trimester
Abortion in Mississippi
50. “It is the women with resources who
continue to be able to get abortion.
And it is the low-income women,
people in marginalized populations,
people that live in rural areas, who
just don't have good access to legal
abortion and turn to very unhealthy
alternatives."
Jones, 2006
51. Despite This Reality
Very little attention by the
“Pro-Choice Movement”
Search of “Mississippi” and “Abortion”
focuses on the overt ban not the
convert ban
Failed legal challenge by the Center
for Reproductive Rights
Desperate need to study the effects
of this reality
52. Ensuring Access
Women’s Option Center, San Francisco
General Hospital
Medical Director: Eleanor Drey, MD, EdM
ACCESS/Women’s Rights Coalition
Executive Director: Parker Dockray, MSW
54. Serving the Most Acute Need
Primary referral site for medically
complicated patients
Only provider in Northern California
that accepts “emergency” Medi-Cal
after 20 weeks in pregnancy
Fee $1000 for 2nd
trimester
procedure
55. Turning Women Away
Caring for 23 wks patients first
Rescheduling 21-22 wk patients
1-2 patients a week
Turning away patients who are >23
weeks and one day
A new study to look at health outcomes
58. Mission
ACCESS exists to make reproductive
health and freedom a concrete reality -
not just a theoretical right - for ALL
women
ACCESS is a project of the Women's
Health Rights Coalition, founded in 1974
as the Coalition for the Medical Rights of
Women, a network of activists,
consumers and health care professionals
59. The ACCESS Hotline
Provides free and
confidential information,
referrals, peer
counseling and
consumer advocacy
about all aspects of
reproductive health
Connects women with
public insurance
programs
Refers to organizations
that help with other
issues such as IPV,
sexual assault, drug
addiction, homelessness,
or child-care
60. Practical Support Network
The Practical Support Network ensures
that women can obtain abortions and
other urgent reproductive health care
without isolation or delay
The network of over 125 volunteers
provides the transportation, overnight
housing, child-care and other support
women need to actually get to their
appointments
ACCESS can also pay for hotel rooms and
bus tickets when women must travel
great distances to find a provider
61. Meeting Only Some of the Need
Approx 600 calls per month
Resources to help between
150-200 women
English and Spanish only
62. Raising Awareness
“The Other Abortion Battle:
Abortion may be legal in California –
but that doesn't mean you can
actually get one”
Tali Woodward
The Bay Guardian
10/10/06
63.
64. Working Together to Ensure
Access and Care Provision
The Medi-Cal Reimbursement Project
65. Medi-Cal in California
Estimated 90,946 Medi-Cal funding
induced abortions
Approx. 39% of all CA abortions
(n=236,000)
66. The Challenges for Medi-Cal Recipients
Approximately 38% of reproductive aged
CA women are eligible for Medi-Cal
based on their income level
Only 20% of practicing CA Ob/Gyns
accept Medi-Cal
56% of Medi-Cal beneficiaries stated that
finding doctors in close proximity who
accepted Medi-Cal even for routine
medical care was difficult or very difficult
Medi-Cal Policy Institute. Speaking out: What beneficiaries have
to say about the Medi-Cal program. March 2006
67. Locating a Medi-Cal Abortion Provider
Review of the 148 publicly-
advertised CA abortion providers
defined as all providers listed under
abortion services in the yellow pages
53% accept Medi-Cal through the 1st
trimester
20% accept Medi-Cal into the mid-
second trimester (up to 20 weeks
gestation)
Only 4% accept Medi-Cal past 21
weeks
68. Acute Provider Shortage
Of the 23 abortion providers who
provide abortions past 20 weeks
only 3 accept Medi-Cal through 24
weeks
10 don’t take Medi-Cal at all
69. Acceptance of Medi-Cal by Second Trimester Abortion Providers (21-24 Weeks)
16 18 20 22 24
1
3
5
7
9
11
13
15
17
19
21
23
AbortionProviders(N=23)
Gestation (in weeks)
Medi-Cal
Accepted
Abortion
Peformed
70. Not All Medi-Cal is Alike
Medi-Cal Categories
Full Scope Fee-for-Service
Full Scope Managed Care
“Emergency” Pregnancy-related
Medi-Cal
May accept one and not the other
Impossible to acertain
71. Survey of Abortion Providers
A survey of abortion providers
who perform abortions through
24 weeks but no longer accept
Medi-Cal
Conducted by ACCESS
Revealed that reimbursement rates for
2nd
Trimester Abortions are too low to
cover the expenses associated with the
procedure
Accepting Medi-Cal seen as not
financially feasible
72. Estimating Cost v Reimbursement
Freestanding clinics that provide abortions past
20 weeks report
an average of $467 in total reimbursements from
Medi-Cal for the procedure, ultrasounds, tests, and
medications and supplies
providing these 2nd
trimester abortions costs a clinic
an average minimum of $637
leaving an estimated deficit of at least $170 per
procedure
For a hospital to perform the same procedure is
much more costly
the average 2nd
trimester abortion is reimbursed
$581
total related hospital costs are approximately
$1,860
leaving a deficit of $1,280 per 2nd
trimester abortion
73. Advocacy Project
California Coalition for Reproductive
Freedom
Proposal to State Office of Medi-Cal
Increase reimbursement for later
second trimester abortion
?--How deal with the
“We take Medi-Cal but not for that”
74. Second Trimester Abortion as a
Public Health and Human Right
Reverse the Provider Shortage
Provide Medically Appropriate Care
Ensure Access to Those Most in Need
Stand Up for 2nd
Trimester Care
75. Frances Kissling, CFFC
“a new era in prochoice advocacy—one that
combines a commitment to laws that affirm
and enhance the right of each woman to
decide whether to have an abortion or bear
and raise a child with an expressed
commitment to human values that include
respect for life, recognition of fetal life as
valuable and a concern for fostering a
society in which all life is valued”
Is There Life After Roe?: How to Think About the Fetus,
Conscience, Winter 2004-05
76. William Saletan
“Maybe that six-month window made
more sense in 1973 than it does
today. Maybe, if we spend the next
10 years helping women avoid
second-trimester abortions, we won't
have to spend the next 20 or 40
years defending them. Maybe the
best way to end the assault on Roe is
to make it irrelevant.”
Life After Roe, Washington Post, 3/5/06;B01
77. Other Warning Signs
NARAL Prochoice America refused
to oppose the Unborn Pain
Awareness Act
Many public opinion polls ask
questions only about 1st
trimester
abortion
Advocates warn about “bringing up
the fact that abortion is legal in the
2nd
trimester”
78. Standing Up
DO NOT sacrifice the human rights
of the women who need them most
in the name of “keeping abortion
legal for everyone”
DO NOT sacrifice the health of
women who need abortion care
simply because it is too difficult to
talk about that care
79. The Illogic of It All
Restricting 2nd
Trimester Abortion
Does not:
lead to increase prevention
make people not have sex
Does
Make people parents who do not want to
be
Medically risk the lives/health of women
Shift the burden to women of color, low
income women and geographically
isolated women
It is important to remember that few abortions occur in the late second trimester and beyond. Almost 90% of abortions are performed in the first trimester of pregnancy (in the first 12 weeks after the first day of the last menstrual period). More than half of abortions are performed before 9 weeks after the last menstrual period, or within 5 weeks of the first missed period. The proportion of abortions performed very early in pregnancy (at 6 weeks or before) increased from 14% in 1992 to 22% in 1999. Fewer than 2% of abortions are performed after 20 weeks. An estimated 0.08% of abortions are performed after 24 weeks, when the fetus may be viable
But data alone can not explain the political power of the PBA debate. This picture is worth a thousand words. Here the Republican leadership watches on as Bush signs the Ban into law. I ask you, who is making health care decisions for women.
So what can we expect if the ban is upheld. First it is likely that the ban would apply to all or most 2 nd trimester abortions. It would impose criminal sentences on physicians who violate the ban and thus is likely to create a serious chilling effect on 2 nd tri providers who are not likely to continue to offer services. More importantly a decision in favor of the ban would fundamentally change the meaning of abortion right articulated in Roe. It would also impose abortion restrictions nation-wide thereby limiting abortion even in states with more liberal abortion laws, i.e. California, NY.
Another law under consideration now is the Unborn Pain Awareness Act. This law, called “The Medical Intrusion Act” by its opponents, would require that Would require a doctor performing an abortion at 20 or more weeks to read to the woman a statement saying that Congress has determined that the fetus will experience pain and to offer to give the fetus anesthesia.
Although such a law on face value seems like a fair thing-we all want women to have more information it is medically and scientifically inaccurate. A systematic review of the state of the science was published in JAMA in 2005 concluding that no evidence supports the existence of pain in the fetus before the 29 th week, well into the 3 rd trimester and that use of anesthesia to address this nonexistent pain increases the medical risk for the woman with no known clinical benefit. What is hard for many people to grasp is that the fetus does move under stimulation from the abortion but that movement is not pain. A way to think about this is that the “Wiring is in place but lights don’t come on.” Opponents of the law are concerned that physicians will be mandated to tell patients things they do not believe are true and to offer care that they can not in good conscious consent their patients for.
Examples: Although the Health Department is empowered to license and regulate health clinics, that authority does not extend to "the residence, office, or clinic of a physician or association of physicians . . . unless ten or more abortions are performed in any one calendar week in such residence, office, or clinic." Neb. Rev. Stat. §§ 71-2017.01(9) "'[Health] Department inspectors shall have access to all properties and areas, objects, records and reports [of the abortion facility], and shall have the authority to make photocopies of those documents required in the course of inspections or investigations." S.C. Reg. 61-12 § 102-F Licensed facilities must establish and maintain a written "quality assurance program," run by a quality assurance committee of at least four staff members, who must meet at least quarterly. 25 Tex. Admin. Code § 139.8(a) "The abortion facility nursing service shall be under the direction of a legally and professionally qualified registered nurse." Missouri Min. Stds. of Operation for Abortion Facilities § 301.3 Abortion procedure and recovery rooms shall have a minimum of six air changes per hour, and "all air supplied to procedure rooms shall be delivered at or near the ceiling" and must pass through "a minimum of one filter bed with a minimum filter efficiency of 80 percent." 10 N.C. Admin. Code 3E.0206
Talk about abortion as having two essential aspects – the medical procedure aspect and the termination of potential life aspect Law like waiting periods and parental consent laws address potential life aspect of abortion Contrast with TRAP laws which address things like room dimensions or nurse’s degree etc
States with 1 st Tri – AL, AR, CA, CT, FL, KY, LA, MI, MS, MO, NE, OK, NC, PA, PR, RI, SC, TN, TX, WI States that have 2d tri TRAP schemes but not first tri – AK, GA, HI, IN, MN, NJ, SD, UT, VA (NOTE that some states that have first tri schemes also have an additional scheme applicable to 2d tri – these are AR, MS, NC, PA, RI)
Because TRAP laws impose general health standards that address things like staffing, physical facilities, administrative procedures, etc the question of comparability must also focus on these factors. Thus, if abortion is comparable to some other procedure with respect to the procedures’ needs regarding staffing, physical plant, administrative procedures, etc, then the procedures are comparable in all respects relevant to the law. Note, some of these procedures are comparable to first trimester abortion, some to abortions up to 20 weeks – I don’t have data on comparability for abortions past 20 weeks.
Segregation: contributes to problem of abortion not being integrated into provision of other health care services. It also creates an impression that abortion is not part of the practice of medicine and is not a medical procedure. Deterance: By subjecting abortion providers to civil and criminal penalties, exposing them to harassment, subjecting them to searches of their offices and records, micromanaging their practice of medicine instead of allowing them to exercise their professional judgment, etc – some physicians who would consider providing abortions within their medical practice will be deterred from doing so by the burdens of being regulated by TRAP laws. The small number of abortion providers in this country is already a public health problem as it reduces women’s access to the procedure. This lack of easy access to an abortion provider causes some women to delay their abortions until later in pregnancy when the procedure carries greater risks. TRAP laws impose requirements that are costly to comply with yet provide no corresponding health benefits – such requirements include requiring facilities to use licensed nurses instead of medical assistants, to install sophisticated air ventilation systems, etc. These costs get passed on to patients, some of whom face significant diffulties in raising those additional funds. Abortion price increases therefore cause some patients to delay abortions until later in pregnancy, when the risks of the procedure are greater.