I think it's time for safe, kitchen table vacuum abortions, instructions to be provided by Youtube.
THE GRANDMOTHER AND THE ABORTION KIT
By Cynthia Gorney
October 4, 1989
ORANGE COUNTY, CALIF. -- On the round kitchen table in a plain suburban Southern California house, the leavings of lunch have been pushed to one side to make room for a canning jar with some plastic things attached to it. The jar is not very big, about the size you might use to put up a cup of jam, and its mouth is blocked with a black rubber stopper. Two lengths of clear tubing run through the stopper and into the jar; at the opposite end of one tube is a syringe, and on the other is a Karman cannula, which is the medical term for a strawlike shaft made principally for insertion into the human uterus. A stocky gray-haired woman named Lorraine Rothman is arranging the parts, laying them out on the tablecloth, connecting them one to another. She lays one end of the cannula in a glass of water and pulls the syringe handle back. Instantly water lifts into the cannula, slides around the arc of the tubing and drops to the bottom of the canning jar. "The cannula end would go in through the cervix," Rothman is saying, her voice entirely matter-of-fact. "The syringe is going to suction it out, and is going to place it in the bottle, like so." Eighteen years ago, when Roe v. Wade had not yet reached the Supreme Court and abortion was still restricted across most of the United States, Lorraine Rothman put this device together and brought it, or one very like it, to a group of women who had begun meeting regularly in the front room of a Los Angeles book shop. Rothman had bought the jar in a grocery, the tubing in a tropical-fish store, and the valve and rubber stopper through laboratory supply houses; she cannot now remember where she obtained the syringe and the cannula, but the point is that she did. She obtained them. She was an elementary school teacher then, with four children of her own, and without any particular training in science or medicine she had put these parts together so that what they formed could be used to remove the lining of another woman's uterus. If the woman was not pregnant, then the name for this procedure was "menstrual extraction." If the woman was pregnant, then the name for this procedure was "abortion," but Rothman imagined it as a kind of abortion quite new to modern American society: No doctors would attend these procedures, and no hospital or clinic records would ever show they had taken place. "If I could put it together, other women could put it together," Rothman says. "Our idea was that it belonged to us. It belonged to women. So women could take care of the whole business." There is a videotape, a controversial and alarming videotape, now making its way around women's groups across the country. In the video Lorraine Rothman, who is 57 and for the last 16 years has not publicly spoken much about the menstrual extraction device, sits before the camera and talks. She says the device was designed for women to use together, that it was never meant to be used by a woman acting alone. She says some women have used it solely to withdraw the menses all at once, to cut short what would otherwise be five days of discomfort and inconvenience. Explicit footage is shown, part of it filmed many years ago at a menstrual extraction in California, and near the close of the video the camera turns to the face of a young woman who has been listening to an explanation of both menstrual extraction and the steps for inspecting her own cervix. "Thanks," the woman says. "I felt so helpless at the possibility of abortion becoming illegal, and now I feel like I've learned a skill that I can use when and if it happens." It is perhaps the word "skill" that startles most, and the women who made the video are direct about the response they mean to stir up by showing the country Rothman's menstrual extraction kit. The video's title is "No Going Back," and it was made last spring in anticipation of the U.S. Supreme Court ruling in Webster v. Reproductive Health Services; no step-by-step instructions for menstrual extraction are included, but anybody watching the video gathers quickly that if legal abortion were prohibited, step-by-step instructions would not be hard to come by. "Won't it be great to have the Supreme Court and state legislators get the news that women are showing this film openly and defiantly in living rooms, rented halls, or at your regularly scheduled meeting," read the open letter inviting orders for the video. "The message we want to send to them is simple -- there is NO GOING BACK. ... Women have the technology of abortion, and will share this technology so that, if necessary, 'underground railways' can be organized." The California Department of Health Services has already weighed in with its reaction: Officials watched the video, determined the menstrual extraction kit to be a "device" under the California health and safety code, and warned the film's producers that it is illegal to manufacture or sell any such device without formal approval by the state. At the National Abortion Federation, which represents licensed abortion providers, board members watched the video and declared its message both medically dangerous and politically misguided. And within the National Organization for Women and other groups whose most urgent mission this year is the preservation of legal abortion, "No Going Back" has set off some complicated internal debate about the merits of envisioning an underground run by untrained women who have decided to perform abortions whether doctors will help them or not. "I think it's the politics of it that bothers us the most," says Louise Tyrer, a New York obstetrician who serves as medical affairs vice president for the Planned Parenthood Federation of America. "Our major concern is the sort of spreading of the notion that abortion may become illegal again ... because when you put out that idea, it grabs hold of quite a few people who think it's about to become illegal, or it's already illegal, or in the minds of some, that it doesn't really matter if it becomes illegal, because women will have recourse to this other method." Nothing about the "other method" itself is intrinsically very different from the techniques most clinics now use for early abortion. First-trimester abortions in this country are generally completed with a vacuum aspirator, a machine that uses suction to withdraw the contents of the uterus through a cannula. It was known many years ago that adequate suction might also be generated by a hand-operated syringe, and in 1971 a group of women in Los Angeles began experimenting with a rudimentary syringe-and-cannula device they had obtained from an illegal abortionist in town. "We all looked at it and thought, oh, it's so simple," Lorraine Rothman says. "However, there's a problem. And I saw the problem right away." The device was dangerous, Rothman thought; a person handling it the wrong way might inadvertently push air into the uterus, which could form a life-threatening air embolism. She went home and began experimenting with jars and valves and aquarium tubing, and when she had satisfied herself that her redesigned device presented no possible embolism hazard, she brought it to her women's group and let them consider how it might be used. The context here is important to remember: It was 1971, two years before Roe v. Wade overturned all state prohibitions on abortion. Even in California, which was known for its liberal abortion policy, a woman had to obtain medical testimony that the abortion she wanted was necessary to preserve her mental health. The testimony was costly and eventually became so pro forma that in many locations it was viewed as an obligatory charade, and even when it was over the woman had to check into a hospital for her abortion. Many women found the entire process both hypocritical and demeaning, and some feminists had begun arguing that conventional American gynecology often demeaned women in other ways as well. The working name for the movement these women set off was "feminist self-help," and the most adamant of the self-help leaders had developed what then seemed scandalous departures from conventional gynecology -- group meetings, for example, in which women watched live demonstrations of the insertion of a vaginal speculum. What Rothman was suggesting fascinated some of the self-help women not only because it appeared to offer them the tools for abortion; if it worked, it might also present women with either symbolic or literal control over the menstrual period itself. The entire monthly ritual, with its traditionally complex messages about the distinctions between women and men, could be physically interrupted and reduced to half an hour, if menstrual extraction worked. That was why women were willing, without scientific testing and over the warnings of doctors who told them what might go wrong, to try out Rothman's syringe and canning jar themselves. "We made a deliberate decision to use our bodies experimentally, to see whether it would work, what the risks were and what the problems were," Rothman says. "We didn't even think in terms of giving it to the medical profession. ... The whole idea was to empower us to take care of our own business." Even among committed feminists, this was a loaded decision. "There was enormous debate," says Sheryl Ruzek, a Temple University health education professor who wrote a 1971 book about the women's health movement, and now serves on the Food and Drug Administration's obstetrics and gynecology devices panel. "The thrust of those criticisms was that this was simply another example of medical experimentation on women that hasn't been tested for safety and efficacy." The physical danger lay less in the menstrual extraction kit itself than in the decision to distribute the kits underground, where they could be used by women with no medical training. "The technique of abortion does require training," Planned Parenthood's Tyrer says. "Even when it's done by doctors, they have to be trained in the techniques of termination. Otherwise there's a considerable increase in incomplete terminations." In blunter language, that means part of the embryo or fetus has been left inside the uterus, which can cause infection that must immediately be treated by a doctor. An untrained person may not know how to measure a uterus properly, either, so that an abortion with a menstrual extraction might commence on a woman too advanced in her pregnancy to undergo a procedure like this. Or the instruments themselves might cause infection because of improper sterilization. Or the cannula might press through the wall of the uterus. Or the pregnancy might be ectopic, meaning that it has implanted outside the uterus and could kill the pregnant woman if left untreated. Rothman says those were dangers she and her colleagues had contemplated, but that the women who began working with these kits -- who used a word-of-mouth network to obtain either parts or instructions from the feminist self-help groups in Los Angeles -- were performing menstrual extractions in careful and politically committed groups. "What we found was infection is extremely small, extremely slim, far less so than in the abortion clinic setting," she says, "because we were working with ourselves, and knew our own health." There is no way to examine independently the medical complications menstrual extraction kits may have caused; no published records ever documented where and when the procedures were done, and women using the kits were probably operating in violation of both conventional medical practice and state law. "I felt totally confident that these people would be the first people to refer the woman for medical attention," Sheryl Ruzek says. "Because this was only being done in groups of women who had chosen completely voluntarily to engage in this practice, the likelihood that such a woman experiencing a side effect would not report it was virtually nonexistent." No one actually knew, in fact, how many of the devices were ever used. In the early 1970s Rothman traveled the country with feminist self-help advocate Carol Downer, the two of them explaining menstrual extraction to women who listened intently in states where abortion was still restricted or illegal. Downer, who is now director of the Los Angeles-based Federation of Feminist Women's Health Centers, says she has no idea how many of them went away to try it themselves: When she adds up the prepared kits that came from Los Angeles and the much larger number of similar devices she watched other women improvise on their own, she says she thinks several thousand menstrual extraction kits may have been put together since 1971. "From the time we introduced it, people right away started making their own," she says. "Women were always coming up to us with new and improved versions." Rothman actually obtained a U.S. patent on her kit in 1974; the two pages of small Patent Office type explain that "the present method and apparatus eliminate the uncertainty, discomfort, disability, etc., inherent in a normal period of menstruation." Neither pregnancy nor abortion is mentioned at all. By 1974 abortion was legal across the United States, of course, and Downer says that after the Roe v. Wade decision, their device had become the object of some curiosity but very little demand. It was not until this past year, when the Webster case and the realigned Supreme Court began to present the first real threat to Roe, that members of the Federation of Feminist Women's Health Centers decided to explain publicly how women once passed around the parts and instructions for a rudimentary kit that allowed them to perform abortions themselves. They produced their video only after considerable debate, Downer says, "realizing that it would pretty well knock us out as far as actually doing anything if abortion did become illegal. We'd be the focus of authorities. Should we get that message out there or should we be underground?" There are a lot of questions "No Going Back" does not answer, and that is only one of them. If abortion were outlawed in some states, and devices like these came into use again, would lone women try to get hold of menstrual extraction kits to abort themselves? If distribution of the kits proves illegal, how would the law regard independent distribution of large syringes, canning jars and aquarium tubing? Syringes and cannulas are normally available only to physicians, but determined lay people could almost certainly find them without great difficulty; besides, the federation's printed menstrual extraction kit explanation includes instructions on how to improvise sources of suction and shape one's own cannula from the kind of plastic tube that comes inside spray bottles. Diagrams like these would probably appall most physicians, but would drawing or distributing them be illegal too? "I think the First Amendment, which is one of my areas, is still paramount," says Mark Merin, a Sacramento attorney who is representing the Federation of Feminist Women's Health Centers in its dispute with state health authorities over the menstrual extraction kit. "If we can instruct people freely how to grow marijuana, how to process it, and build bombs and so forth, I'm sure we can tell people that if you want to remove a period, this is how you do it. And I think you can even illustrate it, tell them where to get the portions of the device, how to assemble it, and there's going to be no liability to anyone, as far as I can see, to doing that. Now, when Woman A performs it for Woman B, there may be some problems." Which raises the prospect of Woman A using a menstrual extraction kit on herself, something Rothman insists is both unwise and nearly impossible to manage, particularly since the sterile cannula must be inserted carefully into the cervix by someone who can see what she is doing. "I would never encourage a woman to even attempt it," she says. "Believe me. We've tried it, and it's just not safe." But if abortion were illegal, and either kits or instructions on how to make them were being passed along in defiance of the law, they would surely be used not only by what the Federation calls "underground railways"; lone women would find them, and groups of frightened teenagers would find them, and independent entrepreneurs would find them. "In the hands of someone who has no training, or no understanding, it becomes no more or less than a coat hanger," says Judy Widdecombe, director of the national abortion rights group Voters for Choice. "I certainly think there would be some increase in medical complications over what we see in legal abortions right now. ... But if people are trained, if people understand some physiology, then it is a relatively safe procedure." Widdecombe, who is a registered nurse, observes that a more sophisticated hand-operated suction kit has for some years been manufactured in the United States and distributed overseas to trained non-physicians who are taught how to use the kits for early abortion, which is sometimes described as "menstrual regulation" in countries where abortion is illegal. "My concern is more political than it is medical," she says. "I think if you begin to say, 'All right, if abortion becomes illegal, then we're going to take care of the situation,' then it removes the pressure from the political and legal system to keep pushing ahead." And a person morally opposed to abortion might look at Rothman's menstrual extraction kit and see in its collected parts the equivalent of a butcher knife or a homemade gun. Rothman is asked about that, as she begins disassembling the pieces to return them to her cabinets, and she barely even looks up. "I don't get pulled into the moral argument, because you can't argue it," she says. "Each of us personally will make whatever decisions we need to make, hopefully based on what we need at that time of our lives. We have no right to tell other women what to do at that time in their lives. And we don't want women to have to resort to killing themselves because of a lack of information, or a lack of access to abortion." Rothman stands, shakes the excess water from the clear plastic tubes and pulls the rubber stopper from the canning jar. "Because women get pregnant when they don't want to get pregnant," she says. "What we're saying is, if we don't get cooperation from our society to help us, and to provide for what is rightfully ours, we are forced to take matters into our own hands, because women will continue to get pregnant when they don't want to in our society. And we have no other choice but to protect ourselves. That's the way it's always been. If menstrual extraction is not the way to go, what can you offer me as an alternative, medical profession?" |
