Not the Ducks! – Abortion and State Mandated Quackery

Miri from Brute Reason has asked me to snork her work. It’s a post calling for a veto of a proposed abortion bill in Ohio. And I figured I could expand on what she wrote and write something educational… and then snork it.

[warning]Trigger Warning – Medical Descriptions of Abortion[/warning]

Now this Bill doesn’t “ban” abortion.

It just makes it much more convoluted. This will do two things.

  1. Abortion Providers who don’t meet the new rules will shut down. If one said “All abortions have to be performed by a left doctor”, you would be in the same ballpark as these kind of rules. They are designed to frustrate and make abortions less easy to perform resulting in a dearth of suppliers.
  2. It will drive the costs up. It will make an abortion a bigger burden on those who need it. Clinics that can follow the rules will have to pass on the extra costs to the customer. 

In short? It’s designed to harm the supply and punish monetarily the buyers of abortions.

But here is the thing. If the supply of abortion does not meet the demand, the numbers of abortions do not drop.

There are between 40 to 45 million abortions per year across the world.

50% of those are unsafe and done in unsanitary conditions by non-medical professionals.

This results in around 70,000 maternal deaths per year and 5 million hospitalisations. By contrast? The skilled termination of pregnancy by a doctor ranks among the safest procedures.

Medically speaking? Abortions are classified according to why you chose them. Elective abortions are done at the choice of the mother. Therapeutic abortions are where a condition forces the choice of abortion in order to save the mother.

There are many reasons for a therapeutic abortion. To save the life of the pregnant woman; prevent harm to the woman’s physical or mental health; terminate a pregnancy where indications are that the child will have a significantly increased chance of premature morbidity or mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.

As for elective? Also many reasons. The most common one is responsibility and monetary reasons. The woman (and her partner) decide that they cannot responsibly care for a child at this point and time and that the child born out of this pregnancy may not receive the highest quality of care that the parents are capable of providing. Economics? Well that is simple. You can only afford to have x no. of kids and x + 1 child would cause an economic destabilisation of your family.

AKA I have to work 2 jobs to put food on my kids plates and even then they are eating junk. So why do people do this for economic reasons? In the simplest terms “When you have food for 4 people but you need to feed 5, then 5 people starve”. It’s hard to understand why this occurs, but if you thiink carefully as to how families eat. Food is split between members. So if 5 people eat 4 people’s food  then all 5 are technically starving. Not all starvation is the acute starvation that we associate with Africa. Chronic starvation is bad too. But I digress.

Before we move on to the “types of abortion” we must look at one more type. The “natural” abortion or a miscarriage. Depending on individual  between 30 to 50% of all conceptions make it to implantation. The biggest cause of abortion is ironically conception. In order to give the world a population of 7 billion, there would have been around 7 billion miscarriages.

The thing is at an early stage this is so “eventless” that most people never notice. In fact the Christian argument of ensoulment at conception and the often ludicrous claims from the very hippyesque Crunchy Parent brigade about feeling the presence of their child at conception is laughable in light of this fact. That in some cases more zygotes and foetuses die without the parents even realising it. That the biggest abortionist is “god” and that crunchy mums who claim to have “been communing with their baby” probably weren’t communing all that much with the zygotes that didn’t make it. It’s sad to think about but that’s unfortunately how nature works.

The human uterus is not a masterpiece of form and function, it is an evolutionary product of “It works well enough”. Our K-Selected nature means that a reduced fertility rate is actually of benefit to us because when children are spaced out they learn better and survive better.

Abortion is classified as “Safe” and “Unsafe”.

When we discuss abortion in the developed world we are discussing safe abortion.

Let’s look at Medical Abortions.

In the majority of the developed world the norm for abortions is a MEDICAL abortion. So when pro-lifers claim it’s all doctors cutting up foetuses and using vacuum cleaners with funky attachments up the cervix, they are kind of “lying”.

Roughly 90% of abortion in the UK occurs within the first trimester and is usually done via medical methods. In fact it is a testament to the lack of availability of these to American women because the US rate of first term abortion is far lower than other nations.

The usual method is using Mifepristone (hormone competitor) or Methotrexate with a Prostaglandin Analogue. They are effective for around 9 weeks of gestation. In very early abortions, up to 7 weeks gestation, medical abortion using a Mifepristone–Misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration), especially when clinical practice does not require examination or collection of tissue. Regimens using Mifepristone, followed 24–48 hours later by buccal or vaginal Misoprostol are 98% effective up to 9 weeks. It is also the first line of treatment for second trimester abortions and if this fails a surgical option may be taken.

It is cheap, effective and above all less invasive for the woman.

Surgical wise?

Upto 15  weeks the procedure of choice is aspiration either electric or manual suction is applied to remove foetus and placenta. The basis is the same the apparatus varies.

The other welll known one is called a D&C in medical parlance. It stands for Dilatation and Curretage. This is the “standard” WHO abortion. It is done for a variety of other issues such as testing for malignancy and examination of Abnormal/Dysfunctional Uterine Bleeding. The walls of the uterus are scraped with a sharp bladed instrument that removes the walls of the uterus. Now you may wince at this, but the walls of the uterus are not supplied with pain fibre so this does not hurt.

A Simms Currette

Above the 15th week till the 26th the technique of choice is D&E (Dilatation and Evacuation) which is the opening of the cervix, rupture of the membrane and removal of contents via surgical instrumentation. Premature labour and delivery can be induced by prostaglandin and amnion injections of saline or urea solutions. 

This is where the most controvertial procedure exists. IDX or Intacct Dilation and Extraction. Or to the American Infidels who read my blog? Partial Birth Abortion. We won’t go into too much detail, but it involves the rapid delivery of the foetus. There are some advantages to this procedure. It is rapid and the foetus is delivered in one piece with little trauma to the woman and with low usage of anaesthesia. This makes it an ideal procedure for use during emergency abortion for women of unknown “work up status” and also for women who wish to hold their child.

We will digress here to quash a major notion that mothers don’t wish to hold their child. This is a late term abortion procedure. The head of the foetus is reduced or collapsed in utero to a more passable size and labour is induced causing the foetus to be expelled. The foetus is effectively destroyed in utero and removed in one piece. The difference between this and D&E is that the foetus has to be dismembered in order to be removed. Some mothers want to bond with even a dead child. I have made enough footprints of miscarried, still birth and aborted children to know that.

It is banned in the USA. It is the bogeyman of abortion. If one listened to the pro-lifers you would think every abortion is this. It’s not. In it’s heyday in the USA around 0.17% of all abortions were this procedure. It is primarily an emergency procedure to save the mother’s life. A friend of mine had this done, her baby could not urinate and his bladder had swollen to the size where it crushed his heart preventing pumping. The foetus was delivered via this method. She held him, had footprints done to remember him and even had a funeral. This would not have been possible had they done a D&E and would not have helped her with closure and had the emergency procedure to save her life take more time.

The other options include Hysterotomy. This is the most dangerous of the methods used and basically is the same procedure as a C-section. It’s no longer done except in cases of Placent Accreta (A serious condition where the placenta attaches to the muscle wall of the Uterus rather than just the surface layers. This can kill the mother during the birth.

Per Vaginal Delivery of foetus can also be done. The two methods of abortion during “late” term are the IDK and Hysterotomy. Less than 0.2% of all “abortions” are these. They are tragic rarity done in cases of severely disabled children, incest, rape.

As for Unsafe Abortion?

Many women across the world who either cannot afford an abortion or cannot access one opt for unsafe abortion. I wrote about experiences in the Philippines quite early on in my piece “The Rise of the Backstreet Abortionist“. This can lead to severe complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.

The usual methods are by using “herbal” abortifactents, trauma to the abdomen (I met a woman who hurled herself from a window to cause an abortion) and by rupturing the uterine membrane with a sharp object (the infamous “Coathanger abortion”).

Now that we have the brunt of the physiology done we can look at some stuff…

Banning abortion does not reduce abortions.

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. Simple provision of contraception would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide. Provision of safe abortion would drop those deaths further.

So what does this mean for Ohio?

With thiis basic knowledge in hand let us look at what Ohio’s “regulations mean”.

Doctors must explain to patients seeking abortion how their foetus’ nerves develop, and to tell them that, even in the first trimester, a foetus can feel pain.

There is no scientific evidence that foetuses can feel pain. In fact, pain responses are often “less” in new born babies than in older ones. There is no evidence to suggest any of this and this is “bunk science”. In fact the most WIDELY accepted rational figure for pain is around 29 to 30 weeks and even then it’s not fully developed.

Doctors must also tell patients that abortions are linked to breast cancer.

There is no scientific evidence for this and there is no logical reason why this would be the case. It’s like claiming that shaving your beard causes testicular cancer. You may as well claim that abortion empowers Moon Nazis and be done with it for all the validity this statement has. The uterus is an effector organ. The ovaries and pitutary gland are responsible for hormonal imbalances that promote BRCA1 gene  related breast cancer. To make this claim is to not understand the basic physiology of pregnancy, the uterine cycle and how cancer occurs.

Abortion providers in Ohio must be within 30 miles of a private hospital – it cannot be a public hospital. So if there are no non-public hospitals within 30 miles of an abortion clinic, then the clinic must shut down.

Why? It’s cheaper for the “state” to pay for an abortion or the “complications of abortion” (*lightning and thunder*) than it is to pay for disability costs or indeed “child benefits for poor families”.

Nope, it’s sneaking Christianity via the backdoor and crippling the supply of a medical procedure. In the rough parlance it is called a “Coathanger decision”.

Doctors must inform patients seeking abortions exactly how much money the clinic made from abortions within the past year, and how much money the clinic stands to lose if the patient chooses not to get an abortion.

This is to shock people into going “YOU MAKE MONEY OFF SOMETHING PEOPLE NEED! YOU HEARTLESS MONSTERS”. This is a groundwork law to make doctors out to look like the benefit of the suffering of others.

No abortion doctor I am aware of has done abortions without suggesting to the mother to utilise proper contraception. In “business parlance” it’s “shooting yourself in the foot”.

Medicine is the only job that seeks to put itself out of a job. A lot of what doctors do is to reduce incidences of disease. If we thought like the way this rule implies we think then I would be telling you to eat naught but Big Macs and that Seatbelts are for Squares and Clean Drinking Water Reduces Your Immunity To Bacteria and you should totally eat uncooked chicken

We make money on Abortions. If we didn’t then you wouldn’t have any professional abortionists, you would have amateur ones. And there is nothing more terrifying in this conversation than the term Amateur Gynaecologist.

There is a conflict of interest in purchasing a cup of coffee but we don’t have to dance through fucking accounts of Starbucks everytime I want a latte. And neither do I need the shoe size of the man who picked my coffee because the next one is everyone’s favourite way of making abortions that much more horrible for those involved.

Before this bill, patients seeking abortions in Ohio were already required to view an ultrasound of the foetus. Now, the doctor must describe the foetus visually and explain the current development of its features. Victims of sexual assault are not exempt, and the patients must pay extra for the ultrasound.

This is just “taunting” women who want abortions by making an already emotional procedure (for some) more stressful.

In the case of first trimester pregnancies this is a pointless bit of rigmarole designed to make the procedure of the majority of abortion seem more complicated than it actually is. While I am not “taken” on the notion of trans-vaginal ultrasound being invasive, I am however coming from a ethos where patients care more about the disease than any discomfort in the treatment, so it isn’t as much of a problem in my experience, but if women in the USA find it invasive then it probably is invasive to them.

What it is though is unnecessary. You may as well demand women do the Macarena before they are allowed to have an abortion.

Extends the waiting period for abortion to 48 hours, and eliminates the option for women to bypass it because of a medical emergency or as a victim of rape.

This just makes it harder to get an abortion. Reduced clinics plus this mean that most people will have to waste up to a week travelling to a place where they can get an abortion. And again it makes it harder for rape victims to get help and delays in medical emergencies can kill. This is just a dangerously stupid law. It inordinately punishes the poor (days off work?), rural people and generally is meant to traumatise women into “Just Accept It”. Which as we know doesn’t work.

Before, a doctor could get a medical waiver to bypass these restrictions if the pregnancy was causing health problems. But now, doctors will only be able to get those waivers if the potential health risks are so great that the pregnant person could die. 

There are two indicators for bad outcomes in any disease. Mortality and Morbidity. A disease may not be very good at killing people, it may be excellent at harming them in other permanent ways. Rubella is a great example. Harmless to the mother, great at harming foetuses.

Punishes doctors who don’t comply with the new restrictions with a felony charge and up to a $1 million dollar fine.

This causes doctors to leave the practice. While it harms careers, medicine is a more recession proof economy than most. In light of “laws like this one” most doctors stop doing the procedure.

Doctors have stated that they oppose this and other bills like this because it compromises patient care. It is a bill designed to provide an inferior, unscientific, unprofessional and traumatic service to women at a time when they require compassion. It is a bill designed to increase the cost of abortion, decrease the availability and reduce the quality of care.

It is a bill designed to force the moral choices of Christian Fundamentalists onto others under the guise of “Won’t Someone Think of the Children” and with a healthy dose of “Speaking as a Mother”. Any non-evidence based approach to Medicine can only be called one thing. Quackery.

Miri’s got what you need to go let the Governor of Ohio know what you think of this “plan”.

And to the pro-lifers? IF you don’t like abortion then don’t have one. Don’t force your choices onto other women.


  1. CaitieCat says

    A small note only, that some of my trans brothers and siblings with non-binary gender also have uteri, and also sometimes become pregnant.

    That teeny quibble aside, thanks for putting some medical information into the topic, and some light on an important issue, the chipping-away at bodily autonomy at the hands of religious authoritarians.

  2. Pierce R. Butler says

    The “logic” of the abortion->breast cancer claim involves breast tissues beginning to make the changes needed for lactation during early pregnancy, and having that process go awry when the pregnancy ceases early.

    Last I heard, nearly all gynecologists and oncologists alike dispute this reasoning. One reputable (& pro-choice) researcher thinks there may be something to it, but freely admits the effect is so small it can’t be teased out from the statistics. (Apparently breast cancer does occur at slightly higher than average rates among women who never experience pregnancy, so the maturation/lactation sequence may have something to do with such tumors.)

    Otherwise, the claims of a->bc derive mostly from statistics showing that breast cancer patients report having had abortions at higher rates than non-bc women, which ignores that the stigma generated by anti-choicers means that cancer-free women disclose their prior abortions at lower rates than those with positive diagnoses.

  3. slc1 says

    Even worse is the attempt by the fuckken born agains to claim that life begins at conception. This is utter balderdash because more then 1/2 of all fertilized eggs fail to implant and are expelled, making, under this preposterous definition, god the worlds champion abortionist.

  4. angharad says

    Thanks Avicenna. This is pretty thorough.

    I wonder if those who try to push ultrasound viewing before abortions have ever seen a seven or eight week embryo by ultrasound. I have, and the description would have gone something like ‘see this little blob here, that kind of looks like a frog…’ Frankly I think those who would ban late term abortions should be forced to see pictures of some of the congenital problems that can affect developing foetuses, like that one where the foetus’ intestines grow along the umbilical cord instead of inside the abdomen…

    Also, I in no way support ‘hippie’ notions of ‘communing’ with your child from conception, but depending on how your body reacts to pregnancy you can begin to experience symptoms from pretty early on. Often these are indistinguishable from PMS however, and usually noticed after diagnosis (eg ‘So that’s why my breasts have been really sore lately’).

    And finally, the C part of a D&C may not hurt, but the D part can be kind of unpleasant…

  5. ema says

    I’m curious, trigger warning for what?

    Roughly 90% of abortion in the UK occurs within the first trimester […] the US rate of first term abortion is far lower than other nations.

    US rate is 91.7%*, with 74.2% of [all] abortions … performed by curettage at ≤13 weeks’ gestation, 16.5% … performed by early medical abortion (a nonsurgical abortion at ≤8 weeks’ gestation), and 8.1% … performed by curettage at >13 weeks’ gestation.

    IDX or Intacct Dilation and Extraction. Or to the American Infidels who read my blog? Partial Birth Abortion.

    Perhaps a bit confusing for lay readers when you use medical terms and political propaganda without making it clear? Intact D&E is a medical procedure that has nothing to do with “Partial Birth” abortion, a political term with no basis in reality.

    The foetus is effectively destroyed in utero and removed in one piece. The difference between this and D&E is that the foetus has to be dismembered in order to be removed…. It is banned in the USA.

    Intact and dismemberment D&Es are just D&E variants, with the same D protocol.

    The morons we elected to office banned intact D&Es and mandated D&Es with dismemberment only.

    While I am not “taken” on the notion of trans-vaginal ultrasound being invasive, I am however coming from a ethos where patients care more about the disease than any discomfort in the treatment, so it isn’t as much of a problem in my experience, but if women in the USA find it invasive then it probably is invasive to them.

    What it is though is unnecessary.

    You are not “taken” on the notion that unnecessarily shoving instruments up patients’ orifices without their consent is invasive?


  6. Maureen Brian says

    Thanks, Avicenna, that’s a good explanation of all you really need to know to discuss this coherently.

    Pierce R Butler @ 3,

    Have you considered that women may be reporting abortions more frequently during the process of diagnosing breast cancer because they are asked it more frequently then? I mean, my orthopaedic surgeon never asked me this when he reconstructed my leg – he didn’t need to know!

    But if there are confused doctors or confused hospital administrators out there who think there may, just may, be a correlation then they’ll be looking for the evidence. That in itself would skew the results.

  7. says

    @Maureen (5)

    I believe the study was a retrospective one so there was no influence. It was literally looking at patient records where x and y were both present vs. x and no y.

  8. says

    @EMA You make it sound like abortion doctors are sneaking into patients rooms to do vaginal probes while they sleep…

    It’s not the case. You still get consent. You say “Before we begin we have to do x procedure to achieve this”, so “before we help you we have to do an ultrasound to adhere to the rules of the state”.

    It’s unnecessary.

  9. says


    Yes, but what if she says “no, I don’t want the probe?”

    “Sorry, you can’t get an abortion.” – that will be the response.

    It’s bullshit, that’s what it is. If she wants an abortion, she needs to have a probe shoved into her vagina – whether or not she actually wants it. It’s a “but thou must” kind of choice for her.

  10. says

    Do people actually want medical tests done to them? In my experience no one wants to be in hospital but they HAVE to. There are events forcing their hands to undergo a series of difficult and often invasive procedures if they want proper care.

    Many of these procedures exist for the purpose of diagnosis but many physicians use them to avoid liability.

    It’s a medical procedure. If it needs doing it needs doing. Portraying it in emotive language so far doesn’t help because it’s a normal medical procedure and we are just as guilty of emotionalising it as “partial birth” abortion is in the hands of the pro-lifers.

    It’s a pointless high resolution scan normally used to visualise the reproductive organ such as ovary and produce a better resolution of the foetus during a period where the foetus doesn’t look particularly human. It’s a waste of resources, a pointless charge and a pointless procedure to delay the procedure on the medical side. On the patient side? It’s an extra waste of time and stressful as it’s an attempt at humanising something that isn’t a fully formed human yet.

    It could be worse, it could be an MRI that they mandate. That will really increase the price of abortions to damaging levels.

    It’s more that someone has to sit there and tell you what your foetus looks like than the procedure itself. Most people who work at these clinics are immensely sympathetic and will make the experience as pain free as possible and as quick as possible.

    It’s bullshit but the major bullshit that it is is the increase of stress and the increase of costs rather than a massive amount of patients saying “Nope! I don’t want any ultrasounds!”

  11. CaitieCat says

    Avi, you’re getting perilously close to mansplaining here. If wmoen tell you that it’s invasive to have to undergo a transvag probe that they don’t want, why are you spending so much energy telling us they don’t really view it as invasive after all, and/or telling them they shouldn’t? Cause that’s where it sounds like you’re going.

    Fact is, it’s a politically-mandated invasive and totally unnecessary medical procedure.

    Would you be happy if you had to have surgery on your knees, and they told you you couldn’t have it unless they did a colonoscopy first? Probably not. You’d be unhappy about the wasteful and stupid and invasive procedure, no?

    Your article is great, but you’re verging on telling women what their experience is, in the face of their telling you different. Perhaps it’s time to recognize that, though you know the medical stuff really well, of course, you may not have a very solid idea of the invasive stupidity of these laws like the people who would be violated by them do?

  12. says

    You are right. What I was trying to do was point out that you shouldn’t demonise the procedure which a fair few pro-choicers do. The Trans-vaginal US is highly effective and useful.

    There is plenty of quackery with regards to the dangers of ultrasound… A few pro-choicers and lifers like pointing that out.

  13. CaitieCat says

    Thanks for hearing me so well. :)

    I agree – the procedure itself isn’t the problem, and can sometimes be medically necessary and/or desired by the patient. It’s the politico-religious mandate to force women to do it whether it’s medically necessary or not, and whether they consent or not, that’s the issue..

    This stupid law also forces doctors to lie to their patients. it’s fucking evil. :/

  14. says

    The places I have seen that do it “blame the law” as in “I know this is unnecessary, but the law state that we have to do this. It will only take a few moments.”

    It’s work to rule stuff.

  15. garnetstar says

    How is a medical emergency supposed to wait 48 hours or until approval of a waiver? I knew a woman who had a rupture of an artery in her fifth month. She was rushed to the hospital, but still nearly bled to death before they could get her into surgery, abort the fetus, and repair the artery.

    Her husband and little daughter wouldn’t have been very pleased to have to wait and so have lost her. She wouldn’t have liked it either, but since she’s a woman, that wouldn’t matter.

  16. psocoptera says

    One of the objections is that the religious right are using the transvaginal ultrasound, not as a medical tool, but a punishment to deter women from seeking an abortion. While they may be thinking of it as a financial burden, there are also “rape as a punishment” overtones about forcing the use of this particular tool that are incredibly creepy. It is one thing for the doctor to say that it needs to be done so they can see what they are doing. It is another thing for the state to say that you need to get it done, because you are a bad person for wanting to end your pregnancy and they want you to reconsider. None of the justifications for requiring have been medical – they want you to hear the heartbeat, ect. Also, in my experience, it not always painless.

    Also, I thought they did have an exception to the wait period for medical emergencies on this one. Otherwise, it is just murder. A provision like that would have killed my mother when I was little.

  17. Pteryxx says

    The places I have seen that do it “blame the law” as in “I know this is unnecessary, but the law state that we have to do this. It will only take a few moments.”

    Avicenna… of course it’s the law’s fault, of course it’s unnecessary, but it’s still potentially traumatic. To use your example, being forced to have an extra MRI and look (again) at a detailed picture of your brain tumor or shattered bone, while a doctor describes it in detail to you, before you’re allowed to get it treated, is not going to be a mere nuisance or formality to a lot of patients. “Here’s where the bullet went in…” Does that clarify the matter?

    Please read one patient’s first-hand experience here:

  18. jenBPhillips says

    What I was trying to do was point out that you shouldn’t demonise the procedure which a fair few pro-choicers do. The Trans-vaginal US is highly effective and useful.

    I don’t think anyone is disputing the utility and potential benefit of the procedure WHEN WARRANTED. I’ve had several TV US’s due to either (wanted, carried to term) pregnancy or (unwanted, gotta check and see if there’s torsion) ovarian cysts. In these situations, I had no objections whatsoever to having a rigid wand inserted into my vagina, because it was clearly an appropriate medical procedure. However, I really cannot imagine the horror of having this done to me by coercion for no other reason than to make me acknowledge the existence of a beating embryonic heart and other evidence of a pregnancy that I wish to terminate.

    You picture a practitioner saying “I know this is unnecessary, but the law states that we have to do this”. I have a hard time picturing a practitioner being able to go through with something so invasive, mandated purely by conservative politics, at all. Is there another circumstance in medicine that is comparable at all? I don’t think so. Thus, I think you are underestimating the physical and emotional impact of what is essentially state-sanctioned sodomy.

    Other than that, though, I’m a big fan of yours. :) Keep up the great writing.

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