30 years after Roe v. Wade, doctors reflect on its impact

The landmark decision legalizing abortion has been considered by some as an important advance for medicine and society and as an unmitigated disaster by others.

By Victoria Stagg Elliott, amednews staff. Jan. 27, 2003.

In 1967, Maureen Paul, MD, MPH, was a scared 18-year-old who desperately wanted to end her pregnancy. First, she tried to get an illegal abortion. She was supposed to meet up with a man at midnight and give him several hundred dollars. In return, he promised to take her to an illegal abortion clinic. But she couldn't raise the money.

Ultimately, her parents stepped in and took her to a local hospital that provided "therapeutic abortions" for women whose lives were endangered by pregnancy. She spent a day being poked and prodded, but in the end was told "no." She carried the baby to term, against her will, and gave it up for adoption.

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"I cried for joy when Roe v. Wade happened because no other woman would have to go through that," Dr. Paul said.

Her story is just one example of the passions and strong opinions some physicians associate with the landmark decision.

For every perspective like Dr. Paul's, of course, there is another one that offers a different view on the impact legalized abortion has had on women's health. It's always been a dicey subject. But what is clear now is that even the passage of time -- the 30th anniversary of this ruling is being observed this month -- has not altered the polarized circumstances in which physicians deal with the question of abortion.

Dr. Paul, chief medical officer of Planned Parenthood Golden Gate in San Francisco, says hers is exactly the kind of situation the legalization of abortion eliminated. In her opinion, it saved women from the emotional trauma of unwanted pregnancy and the physical dangers associated with illegal abortion. Many doctors agree, sometimes characterizing the decision as one of the most positive steps of the 20th century in terms of improving women's health.

Doctors call abortion the best thing, and the worst thing, to happen to women's health.

"The legalization of abortion stands out along with immunization and the development of antibiotics as one of the really sentinel achievements of the era," said David Grimes, MD, an ob-gyn in Chapel Hill, N.C.

And those in this corner offer evidence. For instance, several published papers have connected the legalization of abortion with significant drops in hospital admissions for pregnancy-related complications and improvements in maternal mortality. Some even point to a benefit in terms of children's health -- pointing to studies suggesting that unwanted infants are more likely to be abused and to die in their first year of life.

Interestingly, some physicians even relate a change in the practice of medicine and the delivery of health services. They point out that abortion was not taken in by mainstream medicine as activists hoped after the decision. Instead, it remained in the purview of specialized clinics at a time when few procedures were handled on an outpatient basis. But this may have become a model for other unrelated services.

"It was a revolution in how outpatient services were provided," said Dr. Grimes. "The clinics demonstrated that you could do abortions in an outpatient clinic and do them better and cheaper than in the hospital. And it became the prototype for a whole range of ambulatory services. This might have happened anyway, but it would not have happened nearly as quickly if the abortion clinics had not been out there showing it could be done and done well."

"Not a benign procedure"

The patient came to Joseph DeCook, MD, an obstetrician-gynecologist based in Holland, Mich., severely depressed and infertile.

"She had two legal abortions, and they messed up her tubes." he said. "Abortion is not a benign procedure. Every woman in the world would be benefited if we could stamp [it] out."

For some doctors, legalization of abortion was among the worst things that could happen to women's physical and mental health. This viewpoint, combined with ethical, moral and religious objections, continues to fuel their opposition to it.

"The early possible complications are bleeding, laceration of the cervix, inflammation, bladder and bowel infections, but the long-term complications are far more important," said Carolyn Gerster, MD, vice president of medical ethics for the National Right to Life Committee.

Anti-abortion physicians who practiced before legalized abortion say they did not see the large numbers of women experiencing the ill effects of illegal abortion that pro-abortion activists often talk about.

"The back-alley coat hanger thing was largely a figment of the imagination of the activists in 1972," said Dr. DeCook, who is also vice-president of the American Assn. of Pro Life Obstetricians and Gynecologists. "You can't do an abortion with a coat hanger. That's stupid."

These physicians say their patients who have had abortions are depressed and have gynecological problems that they connect with the procedure. They, too, cite evidence for their positions. For instance, Finnish population studies of childbearing-aged women have associated childbirth with significantly lower rates of suicide than in the general population and abortion with significantly higher rates. Some small studies have found a slight increase in infertility linked to abortion. In addition, many also are advancing concerns about a possible link between abortion and breast cancer, although this has yet to be borne out in large-scale studies.

"The incidence of preterm labor and breast cancer has increased immensely in the past 30 years. And then there are the mental health issues of depression and suicide," said Dr. DeCook. "There are millions of women out there who have had an abortion -- some have had two -- and they're really suffering from the aftereffects."

ADDITIONAL INFORMATION:

Weblink

CDC abortion surveillance reports (http://www.cdc.gov/nccdphp/drh/surv_abort.htm)

AAPLOG, the American Assn. of Pro Life Obstetricians and Gynecologists (http://www.aaplog.org/)

Planned Parenthood fact sheet on medical and social health benefits in the post-Roe v. Wade era (http://www.plannedparenthood.org/library/abortion/healthbenef.html)