BMJ, doi: 10.1136/bmjusa.03040010, (Published 6 May 2003)

Filler

And the poor get children

From BMJ USA 2003;April:230

Even though I heard the lecture more than 57 years ago, I still remember Dr T Leon Howard's words on interstitial cystitis. In his delightful southern drawl, he began, "You've just fallen asleep, and somebody starts poking you in the back and saying, `Get up and go pee; get up and go pee' and that goes on all night long."

I remember other lectures not quite so earthily phrased: a dour pharmacologist on the convulsions of strychnine poisoning; an ill-tempered obstetrician on the mechanisms of labor; and a courtly internist on the signs and symptoms of aortic insufficiency.

I do not remember a single mention of abortion by any member of the faculty of the School of Medicine of the University of Colorado. I graduated in 1945 with a profound conviction that it was terrible to perform an abortion, except perhaps to save the life of the pregnant woman.

During my internship and residency I saw many seriously sick young women who had undergone botched abortions. As a general practitioner in Colorado Springs, I regularly saw young women who had complications from an illegal abortion, such as uterine bleeding from retained placental fragments. I don't think, however, that I ever saw any quite as tragic as those I witnessed later in Latin America.

In 1966, three of every four women admitted to the Maternal-Child Center in Bogota, Colombia, were there to deliver a baby, but the remaining admissions were for the complications of botched abortions. I remember a patient I shall call Luz. She was painfully thin and perspiring profusely, despite the chill of the Andean mountain air, and she was barely aware of my presence. She had been admitted to the hospital six weeks earlier after undergoing an abortion in the back alley of one of the city's slums. She was bleeding heavily and running a fever. A few days later, Luz seemed much better after receiving a transfusion, antibiotics, and a dilatation and curettage, but suddenly she began to run a fever again. A gynecologist performed a second operation and removed a large tubo-ovarian abscess. Again, she improved for a time but developed a fever, and the staff was considering a hysterectomy. I never saw Luz again, and I don't know whether she survived.

Shortly before contraceptive services became available in Chile, the first country in Latin America to institute a national family planning program, a young epidemiologist, Dr Mario Requena, undertook a study of the women of Santiago. He found that having an abortion was associated with the frequency with which a woman attended Roman Catholic Mass. Analysis of the data revealed that it was the poorest women who attended Mass with greatest frequency. It was they who were more likely to undergo an abortion than their more fortunate sisters. The middle and upper class women of Santiago probably had access to contraception from their physicians, while poorer women did not.

Many people, out of profound and sincere religious convictions, would like to have our society free of induced abortions. I would too, even though I do not share their views from religious convictions. I doubt, however, that a nation free of induced abortion is an option. Women throughout the world who are desperate on finding themselves pregnant will seek an abortion, even if they have to induce it themselves. Society chooses between having them clean or dirty. I am grateful that — for the time being at least — our country has decided to have them clean.

Donald W MacCorquodale, general practitioner, specialist in preventive medicine

Washington, DC. DOCTOR1MAC{at}aol.com

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