Positives in miscarriage, abortion, and the continuity of reproductive experiences

[Trigger warning for abuse/abusive relationships and miscarriage experiences.]

I got out of an abusive relationship just in time to realize I was pregnant. Like over a month pregnant, with a fetus of a man who had slammed me against walls, told me I wouldn’t achieve my dreams, and belittled me until I was a shadow of who I’d been when I moved in with him.

I hated him for so many reasons, but the pregnancy was number 1. We slept together after I moved out; he finished and drove me to the airport. I cried the entire cross country plane ride.

I found out I was pregnant about five weeks later when I returned to our shared city. From the moment the Doctor told me I couldn’t stop throwing up–not from morning sickness, but from hate. I could not believe he would be my first pregnancy after he’d already taken so many firsts from me. I rocked myself in my apartment. I didn’t sleep until I was so exhausted from crying that I couldn’t move. I couldn’t think. The world made no sense.

And then, a little more than two weeks later, I miscarried. I miscarried alone, laying on the stupid floor of my stupid studio.

I drank too much that summer to forget the images of my empty uterus, and the ultrasound tech saying my body had done a “very good job” expelling the fetus. I took pills to black out my impregnator’s face. I numbed myself with anything I could find in order to ignore what I knew he would have said if I told him: You are not even good enough to carry a baby.

The abusive relationship and miscarriage ruined me. I spent time with people who actively did not like me. I dropped out of school. I lost 30 pounds. I moved home. Looking in the mirror was impossible. I couldn’t stand myself; I believed so deeply in his degraded image of me.

Fast forward through rehab and therapy, and I was unintentionally pregnant again. I scheduled my abortion the day after I peed on a stick. I did not doubt myself or even think twice. My second pregnancy did not ruin me, but instead was a stark reminder of how far I’d come in loving myself. Choosing abortion meant I believed in my future as a Doctor. Choosing abortion meant I’d uninvested in my abuser’s degraded image of myself, which placed my highest achievements at being a wife and mother.

I do not for one minute “like” that either of the fetuses came into my life, but I am thankful for both the pregnancy experiences none the less. I am thankful for the miscarriage because I believe that out of a place of self hate, I would have chosen to keep the fetus. And I believe being a single mother of an abuser’s child would not have been conducive to my personal or professional success. I am also thankful for the miscarriage–in which I had no choice–because it was in part what allowed me to feel empowered by the ability to choose my abortion.

My experiences illustrates the perils of abusive relationships on reproductive health, and the heart break of a miscarriage. But they also illuminate the positives sometimes found in miscarriages, and the can-be positive impact of the continuity of reproductive events. I am stronger on the other end of these experiences, and though I would not wish abuse, miscarriage, or unwanted pregnancy on any one, I am so proud to be the person I am today, in part, because of them.

I think we sometime separate reproductive experiences into bad or good. But these experiences, for me, were a healthy mix of both. In accepting that reality, I am better able to accept myself, and the extreme complexity of reproductive health.

Ohio: Home of the Poisonous Nut

By: Catrina Otonoga

Ohio has been fighting a quiet battle for our lives. Across the state, clinics struggle to find partnerships with private hospitals in order to remain open, the Board of Health is in disarray after the resignation of the Director amid rumors he was not closing clinics quickly enough, and Ohio Right to Life is in the ears and offices of our highest state officials.

It’s not an uncommon refrain these days in America. Michigan is fighting back against a ban on including abortion in insurance policies. And, who hasn’t heard about Texas – with Wonder Woman Wendy at the helm of, perhaps, the greatest reproductive rights uprising in United States history?

But, in the Buckeye state we are under attack, and we haven’t had much of a rallying cry.

Here in Ohio, the heart of it all, we have another heartbeat bill on the table. A bill that contains no exceptions for rape or incest, and would make performing an abortion after a heartbeat is detected a felony. That’s as early as six weeks into a pregnancy.

Clinics are closing across the state. Women in the Toledo area are traveling to Michigan because their rights are being chipped away in their own backyard. Abortion is legal in Ohio, but restrictions are becoming so onerous that clinics can no longer operate, and women cannot access services without crossing the state or state lines.

And, at the helm of it all is Governor John Kasich. Behind the seemingly moderate exterior that got him elected, is a politician who has enacted some of the harshest abortion restrictions in the United States. Do a search for “Kasich, Abortion” and the articles that pop up are from the last time Ohio wasn’t under a blanket of snow – last summer, when he signed the budget into law, and with it, a host of laws that have led to massive consequences for women’s health in Ohio. Aside from a few quotes put out by advocates for abortion rights in the state, Kasich has remained clean of a lot of the backlash.

The upcoming Gubernatorial race in Ohio promises to focus on abortion issues, but many political experts agree that people who make abortion a priority during an election have already sorted themselves onto the Democratic side.

Like Virginia in their Gubernatorial, it’s time for Ohio to rally, to take ourselves off the defensive, and to stop letting extremists run our state and control our bodies under the guise of moderate politics.

To take action and check out these great organizations in Ohio: OhioNow, NARAL Pro-Choice Ohio , Women Have Options

Amazing & inspiring art courtesy of the Repeal Hyde Art Project

The River Runs Yellow: The Elk River Spill The Intersection of Environmental and Reproductive Justice

Water from the faucets is flowing a deep and toxic shade of yellow. Parents cannot bathe their babies in a warm tub without burning their skin with chemicals, pour a glass of water in the middle of the night without stomach pains following, or cook a basic meal with water from the tap. A drive to the closest store for bottled water can take an hour or more down winding roads that are difficult to navigate in the snow. The water is poisoned with two chemicals whose long and short term effects and side effects are unknown, and it is seeping into the ground, affecting backyard gardens and farms, wells, septic tanks, and running water.

This is not happening across the ocean, in some land far away – although it may feel like it. It is happening 359 miles from Washington, DC, 228 miles from Pittsburgh and 162 miles from Columbus. It is happening in homes, hospitals, restaurants, and schools. It is happening in Charleston, West Virginia and in and along the Ohio River, where early this month MCMH and PPH were spilled into the Elk River by Freedom Industries. There are parts of Appalachia where the sticky sweet smell of licorice permeates the air — you can almost feel the chemicals land on your skin. Perhaps the most shocking part about the spill is that someone noticed. This beautiful land and the generations of families who live there are fighting on many fronts. But, maybe the greatest threat to justice in Appalachia is environmental. Coal has left an indelible mark on the land and has deeply effected the choices people can and do make when choosing whether to parent and how to raise their children.

While the state is working to increase regulations on the two women’s health clinics in the state, state agencies responsible for the investigation and cleanup of the spill had their budget cut 7.5% for the second consecutive year the day before the spill. Women, their families, and their supporters are marching throughout West Virginia for the ability to access abortion and holistic reproductive care, meanwhile they are drinking water that may be eliminating their ability to make choices about their bodies in the first place. Crude MCHM, the chemical foam used to wash coal and the first of the chemicals to be leaked into the water supply for over 300,000 residents has barely been tested or studied. Does it cause reproductive failure? Cancer? Miscarriage? Fetal Anomalies? Death? No one is sure. And it may be years before we ever know…. If ever.

In a few weeks I will be walking down frozen dirt roads, taking Instagram pictures of icicles on soft pine trees with my dog following close behind on a road in Appalachia, not far from this spill. When we get back to the house we will unbundle, I will get us each some water, and I will take a bath. I have no idea what this water will do to me, if it has been touched by this spill or some other, if it will effect me or my someday children. And, I will be outraged that Governor Earl Ray Tomblin thinks that protecting citizens means letting them wonder whether their water is safe.

Environmental justice is not an issue for environmental and green advocates alone. The ability for parents to raise their children in environments free from unregulated poison – to be able to send their children to school where they can wash their hands safely, to come home and eat a meal, and wash up before bed without fear is essential. Environmental justice is reproductive justice.

Egg Donation: A Lesson in Patience

A friend of mine, and fellow blogger here, gave me some words of wisdom a short while back regarding this whole egg donation business. She said “The coordinators are always enthusiastic about placing people. I was more realistic about how long I thought my placement would take, since I’m very short. Honestly, the process took about 6 months before a match was confirmed.”

A lesson in realism and patience. It’s been 3 months since I started working with Columbia, and 2 months since I had my physical. I’ve been matched with potential recipients twice. So far, no takers. It’s tough to sit and wait. And it is worse when they call you and tell you that in 2 weeks, you may be starting the process. Then 2 weeks go by with no news, and it’s a huge let down.

Part of what sucks is how excited my coordinator was. She told me flat out that there would be “no issues with placing me really quickly.” What she didn’t specify is what she meant by “really quickly.” My old coordinator suggested that “quickly” could be a matter of weeks. I was already skeptical heading into Columbia, but still. It’s frustrating, because you can’t talk to the recipients and tell them how awesome you really are. And it’s humbling, because these families are choosing someone else, and you will never know why.

I’m lucky to live in a huge city where there are lots of places for me to try to get matched. And I plan on applying to NYU next. The more locations that I can use, the better my chances are. But at this point, I’m getting a little downtrodden about the whole thing. It’s not like I dwell on it everyday or anything, but once a week or so, someone who knows that I’m trying to do this asks about my matches. It sucks to tell them that I wasn’t chosen.

So, for those of you out there who are thinking about becoming egg donors, consider the waiting game. And for those of you somewhere along in the process, good luck! I hope that you are matched soon.

How to find a job in reproductive health

I have been lucky enough to have never had a real job. Yes I spent many a summer among six year olds, but I have never worked for a for-profit company, never stood behind a counter, never taken someone’s order.   Over the past five years I have been even luckier to almost exclusively work for organizations dedicated to reproductive health and rights.  Now after landing my first job out of grad school, the first gig I plan to stay in for more than two years, it seemed about time to put all the knowledge I have garnered to work for someone else.

1. Don’t be afraid of networking.  Just because you’re a self-righteous crusader doesn’t mean a job will magically fall into your lap.  Lots of people do lots of incredible things.  It’s who you know AND what you know.  Possibly in that order, but you need both.

2. Know what you’re talking about.  And I don’t mean be able to recite Gonorrhea symptoms or what TRAP stands for.  I mean stay on top of the organizations and issues you love EVERY DAY.  Get on Twitter and Facebook and RHReality Check and set-up a Google Reader to guide you through the rest of that internet thing.  Perhaps most importantly read feminist theory, old and new.  It’ll inspire you.  Don’t forget books.

3. Find a mentor, or two.  Sometimes it takes someone else believing you for you to believe in yourself.  Sometimes you just need to talk to someone older and wiser who understands how badly you want to change the world.  And when you find a mentor, don’t let them go.

4. Keep your activist friends and make new ones.  Not everyone you love is going to care about vaginas the way you do, but there will be days when you’ll want to pick-up the phone and cry over a Governor’s veto override or celebrate the IOM. It’s essential to have people on speed dial for these pivotal moments.

5. Grapple with and respect the complexities of reproductive health, justice, and rights.  Analyze yourself and where you fit into these intersections.  Where you are an ally, an activist, and perhaps most importantly inapplicable?

6. Obtain marketable skills.  Bleeding heart activist does not go on a resume but is still a requirement for the job.  Find hard skills like communications, development, clinical, legal, and research that excite you and pursue them.  Volunteering is a great way to do this, and can often lead to a job.  Remember, there needs to be a reason to hire you.

7. Judge what you’re up against.  Sex is, well, sexy.  Lots of people leave undergrad thinking they are the first to bring condoms or Take Back the Night to their campus.  You’re not.

8. Be nice.  If I could give anyone one piece of advice it would be this.  This planet is small, your city/town is smaller, our universe, minuscule.  People will remember you and they will show-up when you least expect them, so be nice.

9. Fear not grunt work.   If you do a good job with copying they will give you fun stuff to do, I promise.  It just might take a year or three… but we all must suffer through maintaining calendars and wrangling space phones, no matter how smart or passionate or deserving you are.  At least one day you might take pity on an intern and order a shredding truck instead of making her/him do it by hand.

10. Remember the economy sucks and do not give-up!  I too worked outside of reproductive health but I came back to it within two years and you can too!  Do not forget that there are relevant skills that you can gather outside the field to help you land that perfect position.

IUD insertion immediately after abortion: Time to break down the barriers

Although women get abortions for many reasons, the majority of women choosing abortion do so because they got pregnant when they didn’t want to be. It stands to reason that at the time of the abortion is a perfect time to help women start using highly effective contraceptives. One of the most effective methods, the IUD, is an ideal choice for women without plans to become pregnant in the short-term because once inserted it is effective for 7-12 years (depending on which IUD is chosen) and requires no ongoing maintenance, unlike other methods which require visits to clinics and remembering to take a pill daily, change a patch or ring, or get a shot every 3 months. All of this ongoing maintenance requires time and money.

So the IUD offers women a simple, long-term, easily reversible contraception that is as effective as tubal ligation (having one’s tubes “tied”). It is also the most cost-effective method available (when used long-term; the costs over the first few years are higher than other methods). So what’s the hold-up? Why do only 5.5% of Americans use IUDs?

Women do not get the most effective contraceptive care for the same reasons that many Americans don’t get the most effective health care in general. We have a system built on a fee-for-service model that relies on short-term membership in private insurance plans, which disincentivizes investment in preventive, cost-effective care that has up-front costs. We have a system that bills per service rather than for caring for a patient. We have a system in which pharmaceutical and device companies raise their prices significantly with impunity. (We also have a culture that systematically misinforms teens and adults alike about sex and contraception, but you can read about that here, here, and here).

Many women with private insurance find that their insurance does not cover one of the most effective, and the most cost-effective, methods available. The IUD itself can cost over $800, with the insertion fee from the physician easily bringing the cost to $1200 or more. Because many young people will change from insurer to insurer as they change jobs, the companies generally do not want to invest that kind of money into pregnancy prevention for their members. What makes sense for the individual, or even our society as a whole, often does not make sense for a profit-driven insurance company.

Billing is another barrier. Unfortunately, all clinics providing reproductive health care must pay attention to their bottom line. They can’t provide the vital services they offer if they don’t stay afloat. So unnecessary requirements, such as lack of reimbursement from insurance companies for IUD insertion done on the same day as an abortion, substantially hamper access for women. The result has often been that women have to wait until their follow-up appointment to get their IUD inserted, meaning they have to go through another procedure (when the IUD could easily have been inserted in less than 1 minute if done immediately after the abortion) and also have to make it to a follow-up appointment, which means more time off from work, more money for child care and transportation, and often more money for the visit to the clinic.

Barriers within the medical system also get in the way; some physicians believe that inserting an IUD immediately after abortion is more likely to cause complications and more likely to self-expulse (or fall out).

Because of these barriers, many women who want to use an IUD for contraception after an abortion are leaving without one. Although they are given follow-up appointments and theoretically should as a result have good access to IUDs, the fact is that many women are slipping through the cracks.

Fortunately, a new study shows that IUD insertion immediately after an abortion is safe and effective, and most importantly prevents repeat unintended pregnancy. 575 women who wanted an IUD after their abortion were randomly assigned to two groups: one group that had the IUD inserted immediately while the other was given a follow-up appointment for the IUD two to six weeks after the abortion. Not surprisingly based on prior studies, the group that had the IUD inserted immediately after the abortion had a slightly higher expulsion rate (5% vs. 2.7%) than the delayed insertion group. Though this might sound like an argument against immediate insertion of IUDs after abortion, what’s actually important is how the individual woman is affected. Despite this higher expulsion rate, NONE of the women in the immediate insertion group were pregnant within six months, as opposed to FIVE in the delayed insertion group. All of those pregnancies occurred among the 29% of women who never managed to get their IUD after their abortion.

Bottom line: immediate IUD insertion after abortion is safe, effective, saves money, and most importantly, prevents unintended pregnancy! I hope that policy-makers and doctors will take note of this study and take action to break down the medical, policy, insurance, and financial barriers that keep women from getting the best care possible.