Académique Documents
Professionnel Documents
Culture Documents
hoose
A Women’s Guide to
Reproductive Freedom
1
I may be arrested, I may be tried and thrown into jail, but I never will be silent;
I never will acquiesce or submit to authority, nor will I make peace with a system
which degrades woman to a mere incubator and which fattens on her innocent
victims. I now and here declare war upon this system and shall not rest until the path
has been cleared for a free motherhood and a healthy, joyous, and happy childhood.
— Em m a Goldm an
A Question of Access
E berhardt Press is pleased
to print the second edition of
Free to Choose. We received mostly
of women. This includes the family,
church, capitalism and the state, to
name a few. The knowledge we share
positive feedback on the first edition and the ways we use it can be seen as
and a few thoughtful critiques that tools for unravelling this web of op-
are deeply appreciated. pression.
Part of our intention in putting this I emphasis the necessity for access
pamphlet together is to aid the dis- to abortion and not for legality. The
cussion around the issue of abortion reason for this distinction is a mat-
access in a anti-state context. It bears ter of control. The state may grant
repeating that we should never allow or withdraw a woman’s “right” to
laws or governments to dictate the have a legal abortion. The state
profoundly personal and life altering may shut down clinics and imprison
decisions we make around abortion, abortion providers. Criminalization
birth control or bringing a child into has always made getting safe abor-
the world. tions more difficult. However, no
It is also our intention to better state has ever stopped women from
equip ourselves and our comrades having abortions.
with the knowledge and tools for It is up to women to make sure we
making safe and empowered choices never go back to the bad old days of
in our bedrooms and in the world back alley abortions. We should not
we live in. I firmly believe that it is allow ourselves, our sisters, moth-
ultimately a woman’s decision to ers or friends to end up uneducated,
do what she will with her body. It is ill-equipped or desperate. We are re-
important to keep in mind that deci- sponsible for our bodies, our choices
sions are made within the context of and our lives.
the world a woman lives in, her com- I have also included stories where-
munity, family and lovers. in women teach themselves safe and
There is a complex web of social re- effective ways to end a pregnancy.
lationships that create the oppression When we examine our history, we
2 Introduction
find examples of women’s groups,
who, like Jane and other anonymous
groups, were unwilling to wait for
abortion to be a legally granted
“right.” “Let’s just stop the frustra-
tion and humiliation of trying to
persuade the powers that be to le-
galize abortion. Let’s just take back
the technology, the tools, the skills,
and whatever else we need...” stated
a woman who helped form one such
group in the 1970s. It truly is humili-
ating to ask the state for control over
one’s own body. We need not lobby,
we need not beg, nor demand our
“rights” to be granted to us.
From traditional herbs to end or
prevent pregnancy to underground
abortion services, women have al-
ways defended and exercised our
ability to choose. The knowledge
exists for women to exercise their
reproductive freedoms in safe and
empowering ways. The time has
come to take it back.
This brief introduction is meant to
be educational. I hope that it can be a
o
starting point for further exploration
and discussion. I encourage people to
review the recommended books at
the end of this pamphlet. Let’s sup-
port one another, learn from our
mistakes and remember our history. To know our history
love and solidarity,
Esther Eberhardt is to begin to see how to
take up struggle again.
Note: The following may be triggering if
you have experienced sexual abuse or have
had a difficult abortion experience. ]
Introduction 3
Let’s not go back
B ecause of significant advances
in abortion technology and the
widespread availability of legal abor-
she did have a positive pregnancy
test. There was one other finding:
a small puncture point with a little
tion, many people have forgotten bit of bleeding at the entrance of her
what life was like when abortion was uterus.... I suspected that either she
illegal. Dr. Jerry Hulka, Professor of had tried to abort herself, or some-
Obstetrics and Gynecology at the one else had done it to her. When I
University of North Carolina School checked on her a little later, I had to
of Medicine, describes what he saw press the point of asking her what
on an ongoing basis as an intern, a had happened because she had vis-
resident, and then as an attending ibly weakened.
physician, in hospitals in Pittsburgh “I had to do it,” she said. “I went
from 1957 to 1967. “In one hospital, to this lady who put a coat hanger
we had a special ward that was al- up in me. She told me not to panic,
ways filled with women who had but if there was some real prob-
infections and perforations from il- lem, don’t say anything but go to
legal abortions,” he says. Dr. Hulka the emergency room. I figured that
often assisted Dr. Sam Barr, a senior blood coming out whenever I went
physician on the staff, with these to the bathroom was a problem and
cases. Dr. Barr ultimately wrote a I got real scared.”
book about the need for abortion With luck, I thought, the worst
reform, in which he recalled one un- diagnosis would be that this wom-
forgettable case: an’s bladder had been perforated.
That would not be pleasant, but
I’ll never forget one patient ; she hopefully there wasn’t any major
was 32 years old and the mother systemic problem. I started massive
of two children. She was admitted antibiotic treatment immediately,
through the emergency room [and] beginning with several transfusions
wouldn’t say anything except that to replace the blood she had lost...
she thought she ought to get help [but] three hours later I learned I
as soon as possible... Her symptoms was wrong.... First, the laboratory
were relatively mild. Her pelvis was reported that preliminary studies
moderately tender and her uterus indicated an infection with gas gan-
was only slightly enlarged, but grene. Then, the nurse on the floor
o
Booth, one of the scary. From the be-
founders of the Chi- ginning, we tried
cago women’s libera- to make the experi-
tion movement, and ence different. We
some of her friends, Menstrual extraction is explained what it
ran an ad hoc abor-
tion referral service a practice maintained by a was going to be like,
how it was going to
out of Heather’s dor-
mitory room at the
small cadre of women who feel, what the basic
m.o. was.” Leslie re-
University of Chica- believe in the importance members receiving
go. One day, Heather
of self-empowerment. counseling calls at
]
called some women her home. “When
together, talked about you said, ‘This is
the politics of abortion, Jane from Women’s
trained them to coun- Liberation,’ you could
sel, handed over her contact sheets, hear an audible sigh of relief.”
and left. “I was ready to move on,” The first thing that needed im-
she says. provement was the price: The abor-
“That was the real beginning of tions were expensive — from $600
Jane,” says a woman we’ll call Leslie, to $1,000 — and that was out of the
a long-time member of the group. reach of many poor women. So the
Right away, the women in the group group decided to attempt to gain
14 Menstrual Extraction
In 1970, Carol Downer, a house-
The Development of wife and mother of six young chil-
Menstrual Extraction dren, was working on the abortion
committee of the Los Angeles chap-
MENSTRUAL EXTRACTION (ME) ter of the National Organization for
was developed as a technique to Women (NOW). “One woman in
help women maintain control over the group was working in an illegal
their menstrual cycles, and hence, abortion clinic in Santa Monica,”
over their reproductive lives. On or Carol recalls. “She had figured out
about the day that a woman expects that abortion wasn’t as difficult as it
her menstrual period, the contents was made out to be, and suggested
of the uterus are gently suctioned that we do abortions ourselves.”
out, lightening and greatly shorten- One day Carol went to the clinic
ing the expected period. If an egg with that woman and the woman’s
has been fertilized within the pre- daughter, who was going to have
ceding weeks, it will be suctioned an IUD inserted. Suddenly Carol
out as well. Dealing as it does with found herself in the procedure
normal bodily functions, ME is not room, where the younger woman
a medical treatment — but a home was already on the examination
health-care technique, similar in table with a speculum in place. “I
many ways to self-catheterization, got a glimpse of her cervix and was
at-home bladder instillations, and completely bowled over,” Carol re-
other health-maintenance routines. members. “It was such a shock to
The tabloids and the electronic see how simple and accessible our
media have labeled menstrual ex- anatomy is. At that moment, ev-
traction “self-abortion” or “do-it- erything clicked for me. I had read
yourself abortion,” but these terms The Abortion Handbook, and realized
are misleading. First of all, due to that if women just had some basic
the location of the uterus, it is virtu- information about their bodies,
ally impossible for a woman to do they could take care of themselves
ME on herself. To do the procedure and wouldn’t have to depend on
safely and correctly, a woman needs back alley abortionists. “
the help of one or more women who Carol and a small group of activ-
are trained and experienced in ME. ists organized an event billed as a
In this sense, it is no more appropri- “Self-Help Clinic” at Everywoman’s
ate to label ME “self-abortion” than Bookstore in Venice Beach on April 7,
it is to call home birth “self-birth.” 1971. “To us, ‘self-help’ meant taking
Lorraine Rothman, one of the devel- control of our bodies and our health
opers of ME. explains that the name care,” she says.
menstrual extraction was chosen Lorraine Rothman, a public school
“because it is a very literal descrip- teacher in Orange County, just
tion of the process.” south of Los Angeles, and herself
Menstrual Extraction 15
the mother of four, recalls the first cessible a woman’s cervix (the neck
Self-Help Clinic meeting vividly. “I of the uterus that protrudes into the
had read an article in Everywoman’s vagina) was. “After that, the discus-
Newspaper that made it sound like sion took a different turn,” Lorraine
women in L.A. were doing abor- remembers. “We talked about tak-
tions. I thought, ‘Of course. What ing charge of our own health care.”
did women do before they had doc- One woman had brought a can-
tors? It can’t be that hard. Let’s just nula and a large plastic syringe
stop the frustration and humiliation (minus the needle) from Karman’s
of trying to persuade the powers abortion clinic and showed it to the
that be to legalize abortion. Let’s group. Lorraine immediately felt
just take back the technology, the that the device had two obvious
tools, the skills, and whatever else weaknesses. “For one thing, there
we need.’” was no mechanism to prevent air
In the weeks before the first Self- from being accidentally pumped
Help Clinic, Carol and a few other back into the uterus — which was
women from the group had visited one of the big scary things about
an underground abortion clinic run illegal abortion,” she says. “For an-
by Harvey Karman in Santa Monica. other, the uterine contents passed
Karman, who the group later found directly through the cannula into
out was not a medical doctor, was the syringe. If the syringe got full,
one of the most active proponents the cannula would have to be re-
of a new, non-traumatic suction moved, so that the syringe could be
abortion technique that made use emptied. This was clumsy to han-
of a flexible plastic cannula (a thin dle and caused additional discom-
tube about the size of a soda straw fort for the woman. I thought there
that can be inserted into the uterus) must be a better way.”
and a hand-held syringe used to cre- Lorraine took the apparatus
ate suction and to collect the uterine home and spent the next week
contents. Proponents of this tech- haunting hardware stores, grocery
nique generally eschewed the use stores, chemistry labs and aquari-
of a curette, a razor-sharp, spoon- um shops. She brought her version
like instrument used for D&Cs. At of the device to the next Self-Help
the first Self-Help Clinic meeting, Clinic meeting. This modified de-
about 30 women sat in a circle on vice consisted of a cannula and a
the floor. When Carol’s turn came large (50 or 60cc) syringe for pump-
to speak, she said she had some- ing suction, but Lorraine’s version
thing special she wanted to share had two tubes, one leading from
with the group. She climbed up on the cannula into a collection jar,
a desk, inserted a plastic speculum and the other leading from the sy-
into her vagina, and demonstrated ringe into the jar. When pumped,
to the amazed onlookers how ac- the syringe created a vacuum inside
16 Menstrual Extraction
the jar, and the contents of the uter- had heard about Dr. Franz Koomey,
us were sucked into the jar, instead the doctor in Washington state who
of into the syringe. An automatic had led the fight to legalize abortion
two-way bypass valve, which Lor- there and who used paramedics in
raine located in a scientific mail or- his clinics. “I mentioned Koomey to
der catalog, prevents air from being Lorraine one evening, and she just
pumped back into the uterus.3 She said, ‘Let’s go!’” Without so much as
dubbed the device “Del-Em.” doing the laundry, the two took off
“We were on that device like ducks the next morning in the Rothman
on a June bug,” Carol remembers. family station wagon for the Pacific
“Word about this new technique got Northwest. “I just told my husband
around very quickly. We were learn- that 1 would need the car for a cou-
ing to estimate the size of a pregnant ple of weeks. I was afraid if I asked
and non-pregnant uterus, and got a he might say no.” Lorraine remem-
lot of practice. But for women who bers with a laugh.
were in fact pregnant, we were get- Carol and Lorraine worked in
ting too many incomplete abortions Koomey’s clinic for several days
and we wanted to know more.” Carol observing abortions. “Dr. Koomey
IPAS kit
DEL-EM
The DEL-EM and a kit used for menstrual regulation in developing countries, made
by the International Projects Assistance Service (IPAS). The major difference is
that the DEL-EM collects the uterine contents in a jar, while it goes directly into the
syringe in the IPAS kit. Both kits have a two-way bypass valve to prevent air from
entering the uterus. For information, write to IPAS at 300 Market St., Suite 200,
Chapel Hill, NC, 27516 or call 800-334-8446.
Menstrual Extraction 17
had a well deserved reputation as ME marathon with plastic specu-
an activist, but we were shocked lums in little brown bags, and the
that he still used curettes and large, Self-Help group acquired a national
stiff cannulas which required that mailing list. From the list, Carol
the cervix be dilated a lot before and Lorraine put together a na-
they could be inserted.” Carol says. tional tour. Traveling by bus and
“Women were given no anesthet- selling speculums transported in
ic, and, consequently, had a lot of boxes marked “toys,” they hit 23 cit-
pain.” (Unanesthetized procedures ies in six weeks, spreading the word
were a prominent hallmark of ille- about self-examination, menstrual
gal abortions, because women were extraction and self-empowerment.
usually required to leave the prem- Lolly Hirsch, a housewife and
ises quickly, and to do so, they had mother of five from Stamford, Con-
to be mobile.) necticut, was one of the women who
One day, Koomey invited Carol attended a menstrual extraction
and Lorraine to do procedures un- demonstration at the Santa Monica
der his supervision. They found the NOW conference. Lolly and her
D&C procedure without anesthetic daughter Jeanne immediately saw
excessively brutal. “At the end of the implications of menstrual ex-
the day, we had a lot of experience, traction. “The self-empowerment
but we were more convinced than aspects were just so phenomenal,”
ever that the suction procedure was Jeanne observes. “My mother and I,
the way to go.” Lorraine says. and later, my sisters, were definitely
Menstrual extraction made its committed.” In the next 10 years,
public debut at the National Orga- Lolly and Jeanne started a number
nization for Women conference in of self-help groups in the Stamford
Santa Monica in August, 1971. The area, got on the college lecture cir-
conference organizers thought that cuit, and began publishing a news-
the concept was too shocking and letter, wryly entitled The Monthly
refused to grant the group exhibit Extract: An Irregular Periodical.
space. Undeterred, the West Coast “Ultimately, several women we
Sisters, as they were now known, met on the tour migrated to Los
put up leaflets announcing demon- Angeles, and joined the struggle,”
strations of the procedure in their Carol Downer recalls. “They all
hotel room. shared our vision of wanting to
“Women f locked in,” Lorraine change women’s lives, and they had
reports. “The first day we packed the will and the wits to do it.” The
in twenty or more at a time for group, which had lost some origi-
demonstrations. The next day they nal members and gained some new
were lined up in the hallway. We ones, founded the Women’s Abor-
did demonstrations all day until we tion Referral Service with the high-
were exhausted.” Women left the ly appropriate acronym of WARS.
18 Menstrual Extraction
They made an arrangement with still learned the technique and a
a doctor who worked at a hospi- small number of them, perhaps
tal where a staff psychiatrist rub- as many as a thousand at any one
berstamped “applications” WARS time, maintained their skills, “just
brought in and the abortions were in case.”
done quite openly. After Roe v. Wade legalized abor-
Then, suddenly, on January 22, tion, providers sprung up nation-
1973, after more than two years wide, and by the mid-1970s, about
of internal rancor, indecision, and 75% of U.S. counties had an identi-
equivocation, the United States Su- fiable abortion provider. Because of
preme Court announced its deci- the widespread availability of abor-
sion in the case of Roe v. Wade. tion, doctors assumed that there
“That abruptly changed every- was no longer any need for women
thing,” Carol says. “We borrowed to be concerned about taking care
some money, hired a doctor, and of themselves, and were sometimes
opened a clinic.” In March of critical of the continuing interest
1973, WARS became the Women’s in menstrual extraction, especially
Choice Clinic of the Los Angeles since there were no studies on its
Feminist Women’s Health Center. safety and effectiveness.
In July, Lorraine opened a sister To counter this criticism, Carol
clinic in Santa Ana, near her home and Lorraine contacted various re-
in Orange County. Other Feminist search organizations in search of
Women’s Health Centers opened in funding for a study. The one ex-
the next two or three years in Chi- pression of interest came from Dr.
co and San Diego, California, Port- Christopher Tietze, the preeminent
land, Oregon, Tallahassee, Florida, expert on abortion and contracep-
and Atlanta, and later, Yakima, tion at the Population Council, a so-
Washington, ultimately forming cial policy organization funded by
the Federation of Feminist Wom- the Rockefeller family. “Dr. Tietze
en’s Health Centers. was quite intrigued by ME and our
For the time being, which right experience with it, and encouraged
then seemed like forever, Carol, us to submit a proposal,” Carol re-
Lorraine, and their cohorts focused calls. “We did submit one, but the
their attention on managing legal Foundation declined to fund it on
abortion clinics and working on a the grounds that it did not fund
broad range of reproductive health ‘direct services.’” Menstrual extrac-
concerns — safe second trimester tion became a practice maintained
abortions, woman-centered child- by a small cadre of women who
birth, the cervical cap, and many worked tirelessly for legal abortion,
others — at the local, state, and na- but who continued to believe in
tional levels. Menstrual extraction the enduring importance of self-
went on the back burner. Women empowerment.
20 Menstrual Extraction
They found that they could shorten when I had ovulated. Because of the
and significantly diminish a normal variability of my cycle, I spent a lot
heavy period, which could be a boon of time in suspense, wondering if
to female athletes, travelers, camp- my period was ever going to come.
ers, revolutionaries — any woman After I began doing menstrual ex-
to whom a long or heavy period traction, if my period didn’t come
might pose a substantial inconve- by day 35, I would called my self-
nience. They also found that when help group and have an extraction.
employed on a regular basis, men- Once it turned out that I was preg-
strual extraction could be used as nant, but the extraction still felt so
birth control, similar to an IUD, to normal — as normal as getting my
prevent the implantation of a fertil- period when I wanted it.
ized egg about two weeks after fer-
tilization. In short, they found that M enstrual extraction clearly has
being able to safely extract the con- a variety of uses, and consequently,
tents of the uterus provided a mea- has significant implications for wom-
sure of reproductive control that few en’s health. The next section reveals
women had even dreamed of. how this simple technique has been
Val, a massage therapist, com- adapted on a global scale to save the
bined menstrual extraction with fer- lives of many women.
tility awareness for several years.
Fertility awareness employs the Menstrual Regulation
observation of cervical secretions, In the Developing World
basal body temperature, and a host
of bodily signs to pinpoint ovula- At the same time that menstrual
tion. Knowing the precise time of extraction was developing in Cali-
ovulation can be useful in avoid- fornia, international family plan-
ing pregnancy, by abstaining from ning activists began using a nearly
intercourse until about 24 hours identical method of fertility control
after ovulation. Fertility awareness in developing countries. The tech-
can also be useful in enhancing nique has had a variety of names:
the chances of getting pregnant, “minisuction,” “menstrual induc-
by identifying the fertile time and tion,” and “menstrual aspiration.”
coordinating it with intercourse or However, the term most widely
donor insemination. My periods used today is menstrual regulation
were always somewhat irregular, (MR). Like menstrual extraction,
coming anywhere from 27 to 35 the procedure is often done with-
days. Fertility awareness gave me out a laboratory test to confirm
much more information about and pregnancy. MR can also be used for
control over my cycle than I ever teaching women about their anato-
dreamed possible, but there were my and fertility, diagnosing uterine
still times when I just couldn’t tell cancer, menstrual disorders, and
o
kit used in menstrual regulation fear they may be pregnant often seek
is com merc ia l ly to induce miscar-
produced and mar- riages with sticks,
keted4. With this wires or other in-
kit, the uterine con-
tents are suctioned When used properly, struments, by drink-
ing toxic substances,
directly through
the cannula into a these techniques are or by douching with
harmful concoctions.
safer than childbirth.
]
syringe, while with In Nicaragua, for ex-
t he D e l-Em , t he ample, women com-
contents are suc- monly use wire from
tioned through the telephone cables to
cannula and a plas- induce miscarriages.
tic tube about two feet long into a Others resort to poorly trained abor-
collection jar. tionists who often use stiff, unster-
Early on, it became clear to medical ile instruments. As a result, at least
professionals and family planning ex- 200,000 women die each year,5 and
perts that paramedics and lay people many more are left infertile or with
with even minimal education could lifelong health problems. In addition,
learn to use hand-generated suction hundreds of thousands of children
devices safely and effectively. Today, are left motherless or with a mother
training in most countries typically who may be too ill or disabled to pro-
lasts from one to three weeks, occa- vide for them adequately.
sionally longer, and is done on both Many doctors who do menstrual
a formal basis, including classroom regulation may use anesthesia, but in
lectures, demonstrations, and super- some clinics, the only anesthesia that
vised practice; and on an informal is used is the comforting hand and
basis, often consisting of demonstra- soothing voice of a counselor. Zarina,
tions only. Trainees may observe a counselor at a women’s clinic in
from 10 to 20 procedures before be- Bangladesh, reports that most of the
ginning hands on training, and then women who seek MR have already
do up to 20 procedures under supervi- endured childbirth; most say the dis-
sion before doing them on their own. comfort from the procedure is quite
22 Menstrual Extraction
tolerable, even without anesthesia. In care techniques are profoundly
practice, menstrual regulation is per- relevant. Women may consciously
formed up to eight to 10 weeks from choose to use menstrual extraction
the last period, but in many countries, or to take herbs for fertility control
the procedure is also done up to 12 for a variety of reasons. When used
weeks from the last menstrual peri- properly, these techniques are far
od. There are no reliable statistics on safer than childbirth, and can put an
the rate of incomplete procedures in end to the makeshift methods that
Bangladesh or other countries where desperate women have often used to
MR is in use, but the rate of incom- prevent unwanted pregnancies.
pletes appears to be low, according
to Zarina because “most women in
these countries usually don’t come in Notes
until they are eight to ten weeks from (1) Today, this problem would probably be
their last period, when it is easier to recognized as disseminated intravascular co-
determine, by examining the tissue, agulation (DIC), in which the blood loses its
whether or not an implantation has ability to clot. For more information on this
been missed.” Menstrual regulation is rare but serious complication read A Book of
practiced throughout Latin America, Women’s Choices pages 233-234.
Asia, in many African countries, and (2) If air is accidentally pumped into the uter-
on a limited basis in the Middle East. us, it will probably pass through the egg tubes
In every setting in which this tech- into the abdominal cavity, causing gas-like
discomfort or pain. If any air accidentally
nique has become accessible, the
enters the blood stream this can result in a
complication rate for self-induced fatal air embolism.
and poorly done abortions has been
(3) L.C. Phelan and P.T. Maginnis, The
dramatically reduced. In Indonesia, Abortion Handbook (North Hollywood,
for example, one study found that CA; Contact Books, 1969).
the rate of septic abortion was 80% (4) This device is manufactured by Internation-
higher in areas in which menstrual al Projects Assistance Service (IPAS), P.O. Box
regulation (in this case, suction cu- 100, Carrboro, NC 27510, (800) 334-8446
rettage) was not available, but that (5) R. Barnett, as told to D. Baker, They
where MR was available, wards for- Weep on my Doorstep, Beaverton, OR;
merly reserved for cases of septic Halo Publishers, 1969 p. 74
abortion were no longer necessary.6 (6) F.A. Moeloek, et al., “The Relation Be-
Clearly, if menstrual regulation were tween Menstrual Regulation service and the
employed more widely, the health Incidence of Septic Abortions in Indonesia,”
of many women — and the lives of p.2 Available from the International Wom-
many others — would be saved. en’s Health Coalition, 24 East 21st Street
New York, NY 10010.
I n a n e r a t h at i s h o s t i l e t o
reproductive freedom, menstrual
extraction and other home health-