Saturday, February 09, 2008

Self-induced abortion: A response to a search

Somebody was searching for "self induced abortion". I checked their search results and found this:

Self-induced abortion in a bulimic woman

It's a case from New Zealand. Here's the abstract:

We report the case of a woman with bulimia nervosa, several personality disorders, and a past history of anorexia nervosa who deliberately induced an abortion via self-imposed starvation and vigorous exercise. Her history reveals severe obsessive-compulsive and narcissistic personality disorders as well as a lifelong pattern of denial of affect and illness.

Closer to home for me, is this one from Southern Medical Journal, July of 1983: Use of quinine for self-induced abortion

Here's the abstract:

4 cases in which quinine was used in recent attempts at self-induced abortion in Charleston, South Carolina, are described, and the pharmacology, toxicity, and abortifacient efficacy of quinine are described. A 28-year old indigent, unmarried woman with 3 children was seen 1 day following ingestion of 16 quinine capsules. 3 weeks later she had suction curettage of an 8-week size uterus at which time it appeared that incomplete abortion had already occurred. 5 months previously, the woman had taken a similar dose of quinine to abort a previous unwanted pregnancy. A suction curettage was done and the pathology report showed products of conception. The other 3 cases were a 26-year old woman with 1 child who was 13 weeks pregnant when first seen, 3 weeks after ingesting 4 quinine pills; a 23-year old pregnant for the 1st time who came to the emergency room approximately 22 weeks pregnant a day after taking quinine in an attempt to induce abortion; and a 33-year old woman with 3 children who was 14 weeks pregnant and who 6 weeks earlier had taken 4 quinine tablets of unknown strength along with several tablets of Humphrey's Number 11 in an attempt to induce abortion. The 4 women experienced side effects including tinnitis, diminished hearing, blurred vision, nausea, vomiting, chest pain, dyspnea, tachycardia, abdominal pain, back pain, leg weakness, irritability, and a feeling of impending syncope. The latter 3 women were delivered of live infants at 35 weeks or later. The abortifacient efficacy of quinine is unclear. There are no well controlled studies and the majority of cases are unreported. Most references deal with the complications of quinine use. Of 70 cases identified in the literature in which quinine was used to abort a known or suspected pregnancy, at least 11 resulted in maternal death, and at least 41 offspring had congenital anomalies for which quinine was suspected as the etiologic agent. Abortion was achieved without maternal death in only 3 cases. 4 grams of quinine usually causes toxic effects and 8 grams is the average fatal dose for adults. These 4 cases suggest that belief in the abortifacient efficacy of quinine persists despite questionable evidence.

Very illuminating, but I wish this abstract had included this little snippet from the first abstract I read on that article (emphasis mine):

Literature review suggests that quinine is an ineffective abortifacient, even when taken in toxic doses. Adverse effects of quinine include cinchonism, potentially fatal renal failure, and possible teratogenesis. Quinine is available over-the-counter, but it has few legitimate medical indications. Health care personnel treating women with undesired pregnancies should be alert to the signs and symptoms of quinine toxicity.

There's stuff from my own web site I'd like to refer to here, but for some reason the stupid server is acting up and won't load my page! My main point being that legalization didn't get rid of dangerous self-induced abortion attempts. Some women know what they're doing is dangerous and do it anyway (like the bulemic woman in the first cite). They're doing what they're doing because they have a mental illness, which is something that an abortion won't cure and will probably only exacerbate. Other women probably have been told by "helpful" friends that what they're intending to do is perfectly "safe" and "natural". Kris Humphrey, for example, died persisting in trying to perform a "safe" and "natural" pennyroyal abortion on herself. Plugging abortion as "safe" and "natural" isn't going to help these women.

Then there's Risky choices: the dangers of teens using self-induced abortion attempts

Here's the abstract:

The introduction to this article on the existence and dangers of self-abortion attempts among adolescents in the US notes that in 1992 more than 134,000 US adolescents sought legal abortions, while an unknown number attempted illegal or self-induced abortions. The article goes on to describe a case in which a 19-year-old almost died after ingesting 1.5 g of quinine in a self-abortion attempt. Next, the article reviews the literature on methods used to attempt self-induced abortion and points out that 70 cases of attempted quinine induced abortion resulted in three abortions and 11 maternal deaths. A table lists other methods of self-induced abortion, including use of drugs, instrumentation, cervical dilation, and trauma. After noting that adolescents may be particularly susceptible to such attempts because of their limited resources and limited access to legal abortions, the article describes reasons for self-induced abortion attempts. Next, recommendations are made to help nurse-practitioners recognize the symptoms of self-induced abortion attempts and prevent the occurrence of self-induced abortion by accessing risks and providing adolescents with the education and support needed to prevent such attempts.

Since I only have access to the abstract, not the full article, I don't know how far back the literature search goes to find the 11 self-induced abortion deaths. I'll have to look it up back stateside next month.

I like that they work to alert nurse practitioners to the signs of attempted self-induced abortions, but I worry that their "prevention" might be entirely focused on sending her to the local Hodari or Hayat rather than helping her get past the initial abortion ideation, which has been shown to be normal in early pregnancy. (Again, I can't search my site for the links I want!)

Now we go from social and medical research into la-la land:

"In fact, most women who died pre-Roe, died from self-induced abortion."

Of the pre-legalization illegal abortion deaths I found, that I've sorted so far:

  • 2 were self-induced
  • 8 were unclassifed (perpetrator not identified)
  • 9 were by people with some medical training (nurse, midwife, etc) who were not doctors
  • 24 were performed by people with no formal medical training
  • 59 were performed by physicians

Total: 102

Now, I'll have to go do a more thorough search and tweak my numbers once I can get back into my site, but preliminary results indicate:

  • 2% self-induced
  • 8% unclassified
  • 9% by people with medical training
  • 24% by people with no formal medical training
  • 58% by physicians

While I don't have all illegal abortion deaths, by a long shot, I do have a representative sample of those reported by the newspapers and investigated by the coroner's office. We can't draw rock-solid conclusions, but we can get a ballpark idea of what was going on.

Even if we assume that the unclassified were all self-induced, that gives us 10 self induced deaths out of 102, for about 10%. This is in keeping with research by Nancy Howell Lee and Mary Calderone into pre-legalization abortion, which found that over 90% of illegal abortions were done by physicians, and the bulk of the remainder by non-physicians with formal medical training. Amateur and self-induced abortions would, of course, be over-represented among the dead because they'd be performed by the people with the least skill in performing the abortion, and in detecting and treating complications.

So, a reminder:

  • Self-induced abortion attempts do persist, despite the availability of legal abortion, for a variety of reasons
  • Medical professionals need to be aware of at-risk women and be ready to help them get real help
  • Promoting do-it-yourself abortions isn't help

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