In Kayley’s presentation a few weeks ago, we discussed all the different barriers to abortion. In some countries and states, abortion is legal, or decriminalized in Uruguay’s case, but not without barriers. Some barriers include limiting training for providers, cost, age requirements.
Yonah’s presentation regarding decriminalization of first trimester abortions in Uruguay made me think about what we sometimes take for granted here in the US. While much of our government here in the US and Georgia is trying to restrict women’s reproductive freedom, Uruguay seems to be going the opposite direction slowly. Barriers Yonah mentioned include requiring 4 visits for an abortion. I can’t remember if this was medical or surgical, though. In the US, it is typically 2, sometimes 3, visits–one or two for the procedure, one for a follow up. Although I am happy to see that it is decriminalized, it makes me sad to hear there are still barriers.
What should reproductive freedom fighter Uruguayans focus on next? Should they focus on expanding abortion services to a later gestation (second trimester)? OR should they focus on breaking down current barriers for this first trimester abortion? Obviously, real life has many shades of gray and is not an either/or situation. If I had to choose one main focus, I would probably focus on breaking down current barriers. Once a first trimester abortion becomes more of a surgical or medical procedure and less of a moral action, then maybe activists can begin to convince people that second trimester abortions can head the same way.
Here is a good short, less recent piece on Uruguay that I found: http://popdev.hampshire.edu/projects/dt/77
Although it may be more tedious to have numerous follow up visits if a woman intends to have an abortion, it may be possible that these visits are intended to ensure the safety of the woman after the abortion procedure. These required visits may, in fact, be established to maintain the health and safety of the patient after the procedure had been completed. It may be more difficult for women to continue to return to the clinic, but it is important to remember to put the patient’s health before her need to travel back to the clinic.
Yes–patient safety always comes first, but I think the procedures that are 4-5 visits might be more related to barriers than ensuring that all the tissue is out of the uterus. Perhaps with time, Uruguay will become more progressive and help eliminate any inefficiencies.
I only say this because if the woman comes for a follow up visit and the tissue is not out of the uterus, it would be best for her health if aspiration occurred right then and there.
For the mifepristone/misoprostel (M&M) medical abortion, I definitely understand the need for a third check-up visit. BUT I envision it to be like this now:
1st visit: counseling, education, choices, ultrasound to see if the woman qualifies
2nd visit: take the mifepristone in office
3rd visit: take misoprostel in office
4th visit: make sure it’s out. If not, aspiration may be necessary.
5th visit: If aspirated after failed M&M, then a follow up is necessary.
I envision Uruguay will get to the day where counseling/education/choices/ultrasound and initially taking the mifepristone will be in one visit. Maybe right now they send a woman home to “think about it” and hope the woman doesn’t come back. Additionally, Uruguay may get to the day (or may already be doing this) where non-fake misoprostel is sent home with the woman so she can do it at home herself. With respect to surgical abortions, the number of visits should be even less than that of a medical abortion.
I want to see Uruguay get to the point where post-M&M, there really should only be one visit to ensure all tissue is out. If not, aspirate.
We’ll never know what the actual visits are. Maybe I will email Yonah and ask! Thanks for making me think that they could possibly be aftercare visits and not pre-surgery or pre-pill visits. Good thoughts, Eric.
Thank you for your post Chau. I really enjoyed it. I would also choose to focus on breaking down current barriers for the first trimester abortion. I think it would be necessary to steer abortion away from being a moral action and towards a medical procedure first before expanding it beyond the first trimester. In the article you shared we can see that although abortion in the first trimester was legalized in Uruguay it was still a criminalized and stigmatized act. Women denied a requested abortion would be punished for committing a crime if they sought an abortion elsewhere after the first trimester. Abortions were also still illegal if they did not occur within a medical institute by a doctor. Before reading this article, I did not realize how many barriers the women faced even after it was legalized. Focusing on these barriers, before expanding, may speed up the legislation of abortions after the first trimester once it is set in motion. Its obvious that Uruguay had made significant strides in legalizing abortion but it is also still clear that it has a long way to go. It will be interesting to follow how this country progresses on abortion; especially when, as you said, the U.S. government is trying to restrict women’s reproductive health.
Uruguay is a prime example of how access is an extremely relative term. Just because abortion is legal within a country does not mean it is a fully utilized medical procedure– an extremely disappointing statement. We like to think the US is more “civilized” than the hemispheric South, but in reality, our barriers to safe abortion are just as prevalent. Both countries face the dilemma of changing cultural attitudes towards abortion from a morality issue to a medical issue. As new legislation is passed, it will be interesting to see if America regresses towards the “less-advanced” nations that we usually pride ourselves on being above.
Okay, so I emailed Yonah to get more info about the visits that are required for a woman. This is what I got:
“1. Telling the clinician you want to terminate your pregnancy (may be at the visit when you find out you’re pregnant)
2. Sitting with a gynecologist, a social worker, and a psychologist to get information about what to expect, get connected with resources that may be helpful to support the patient in economically being more prepared to parent this pregnancy — in case economics is the reason the patient wants to terminate….
3. Then, after a 5-day reflection period, getting the prescription for misoprostol. The patient then gets the prescription filled and takes the medication at home. In rare cases, surgical methods (electric or manual vacuum aspiration, with or without curettage) are used — but only when clinically indicated.
4. Following up with the clinician to ensure abortion is complete, no signs of infection, no retained tissue.”
I think visit 1 is necessary if the woman doesn’t know she is pregnant and ends up somewhere for care. Oftentimes, women tell us they found out they were pregnant because they went to the emergency room due to nausea/vomiting. It’s more common than I thought. In my mind, I always assumed an at-home pregnancy test. You can or cannot count this toward a “barrier visit” for an abortion. I don’t think it is–it’s a discovery visit unless the provider who gives the medication requires the test to be from his/her personal office. Visits 2 and 3 will hopefully be combined one day in Uruguay. It seems like these things are done in-person and that no appointments are made over the phone. Visit 4 is always necessary in any case.
In Georgia, you have to make an appointment at least 24 hours in advance. When I was in Vietnam, you could walk in off the street and get it done in the same place that will tell you your thyroid hormone levels and cholesterol levels. Very interesting how every place handles it differently.