Menstrual extraction

Menstrual extraction
Background
Abortion type	Surgical
First use	1971
Gestation	First trimester
Usage
	Developed and used in a feminist, non-medicalized context.
	Infobox references

Last updated October 11, 2024

Menstrual extraction (ME) is a type of manual vacuum aspiration technique developed by feminist activists Lorraine Rothman and Carol Downer to pass the entire menses at once. The non-medicalized technique has been used in small feminist self-help groups since 1971 and has a social role of allowing access to early abortion without needing medical assistance or legal approval.^[1]^[2]^[3]^: 406 ME usage declined after 1973, when Roe v. Wade legalized abortion in the United States. There has been renewed interest in the technique, in the 1990s and more recently in the 2010s, due to increased restrictions on abortion. In some countries where abortion is illegal, such as Bangladesh, the terms "menstrual regulation" or "menstrual extraction" are used as euphemisms for early pregnancy terminations.

Development within a feminist context

In 1971, Lorraine Rothman and Carol Downer, members of a feminist reproductive health self-help group, modified equipment found in an underground abortion clinic that was developed for a new non-traumatic, manually-operated-suction abortion technique.^[4] They took the thin, flexible plastic Karman cannula (about the size of a soda straw), and the syringe (50 or 60ml), and added a one-way bypass valve, to fix two main problems.^[2] The contraption could prevent air from being pumped into the uterus, and also suctioned uterine contents directly into the syringe, thus limiting the amount that could be removed. They added two lengths of clear plastic tubing, one from the cannula to the collection jar and another to go from the collection jar to the syringe. With this new setup, the contents of the uterus went directly into the jar, allowing for the extraction of more material, and the two-way bypass valve diverted any air that may have been inadvertently pushed back toward the body to exit harmlessly into the air; this would prevent air from entering the uterus.^[2] Rothman and Downer dubbed the new invention the "Del Em". By making it possible for more than one person to operate the device, the skill level required of the operators was greatly reduced. One person could concentrate on guiding the sterile cannula through the vaginal cavity into the cervical os while another could pump the syringe to develop the vacuum. The Del Em made the procedure more comfortable, with personal control of the suction.^[5]

Downer considers the teaching and usage of self-help groups to be a key radical feminist action to ensure women's reproductive sovereignty.^[6]

Legality

ME was developed and used before the Roe v. Wade Supreme Court decision legalized abortion in 1973. In order to avoid legal issues, Downer and Rothman downplayed the device's potential use as an abortion method. They called the new technique "menstrual extraction" or "ME" to highlight its harmless use in suctioning out menstrual blood and tissue. To further emphasize the innocuousness of ME, "the procedure was only performed when a woman's period was due, and they wouldn't take a pregnancy test beforehand. That way, everyone had plausible deniability."^[4]

Since 1971, groups performing menstrual extractions have had an excellent safety record, obviating any opportunity for legal action culminating in the prosecution of any individual. However, the possibility of legal troubles continues to exist, and because of that many of these self-help groups have sought legal advice and researched the laws in the states in which they perform ME. Additionally, many of these self-help groups do not publicize themselves or offer menstrual extraction to those outside of their tight-knit groups, in order to protect themselves and their techniques from legal investigations.^[7]

There is one instance in which Carol Downer had legal entanglements. It is well known as the "Yogurt Defense" case, in which Downer was arrested while at her self-help group and charged with practicing medicine without a license because she inserted yogurt into the vagina of Z. Budapest, another member of the group, as treatment for a yeast condition.^[8] Downer went to trial and was acquitted, as the jury did not see inserting yogurt as practicing medicine.^[2]^[9]^: 57

Usage

Pre-Roe v. Wade

ME made its debut at the National Organization for Women conference in Santa Monica, California, in August 1971. To Rothman and Downer's dismay, the organizers of the conference were "so appalled that they refused to give the women exhibit space."^[10] Instead, Downer and Rothman hung flyers around the conference, announcing a demonstration in their hotel room. The attendees were given a plastic speculum to begin their education. From the extensive mailing list collected during these demonstrations, Downer and Rothman began a national tour, going all over the country (to 23 cities on a Greyhound bus) teaching the new technique.^[7]^[11]^[12] According to the National Women's Health Network, "the early self-helpers advocated that women join self-help groups and practice extracting each others' menses around the time of their expected periods."^[13] The Roe v. Wade Supreme Court decision made abortion legal in 1973. After that, menstrual extraction was practiced much less, though it did not disappear.

After legalization of abortion

It did begin to regain its popularity in the late 1980s and early 1990s, when the U.S. Supreme Court ruled on Webster v. Reproductive Health Services , which limited access to abortion by state of residence and type of medical insurance.^[2] Self-helpers even reprised the 1971 tour, traveling around the U.S. sharing self-examination and menstrual extraction techniques; however it never reached the heights of the early 1970s.^[13]

Menstrual extraction has regained popularity once again in the 2010s, in addition to other self-induced abortion methods.^[14]^[15] These self-helpers are following the 1970s methods of teaching by meeting in other women's homes, performing cervix examinations on each other, and learning menstrual extraction directly from other women. One new underground network, made up of women knowledgeable about ME and other self-induced abortion methods, has performed over 2,000 abortions between 2015 and 2018.^[15] The women involved in this network range from those in medical professions, such as nurses or midwives, to others like herbalists or those just interested in learning the procedure. Many of the participants in these networks, and women who seek self-induced abortions overall, are low-income earners, cannot travel to obtain an abortion, or dislike clinical settings.^[14]^[16]

Similar techniques

Although menstrual extraction is technically similar to manual vacuum aspiration (MVA) and menstrual regulation (MR), it is a unique form because it is not medicalized. It originated in the feminist self-help movement and it is performed by small groups of women where the person getting a ME has complete control over the procedure. Menstrual extraction "minimiz[es]... power differentials between providers and receivers... [which] stands in direct contrast to [MVA and MR]."^[2]

Around the same time that menstrual extraction was first used in the United States, a method utilizing nearly identical technology was beginning to be used internationally. This method, another type of manual vacuum aspiration, is most often called menstrual regulation. As with ME, menstrual regulation, when desired as a method of controlling fertility, is performed very early in the menstrual cycle, earlier than a pregnancy test can be performed. One main difference between these two methods is the equipment used. The Del Em was a do-it-yourself assembly consisting of three parts: a cannula with a one-way valve, a collection jar and a syringe, all connected with plastic tubing. Meanwhile, menstrual regulation is performed with a commercially produced kit consisting of two parts: a cannula with a one-way valve and a directly connected syringe. With this kit, the contents of the uterus are sucked directly into the syringe. ME is performed by a group, while menstrual regulation is performed by an individual practitioner.^[2]^[9]^: 169

According to the National Abortion Federation (NAF), "in the developing world, menstrual regulation is still a crucial strategy to circumvent anti-abortion laws." Although abortion is illegal in Bangladesh, the government has long supported a network of menstrual regulation clinics.^[17]^[18] It is estimated that 468,000 menstrual regulations are performed each year in Bangladesh.^[19] NAF also reports, "some other countries allow menstrual regulation because it presumably takes place without a technical verification of pregnancy".^[20] Said countries are claimed to include Korea, Singapore, Hong Kong, Thailand, and Vietnam.^[21] In Cuba, where abortion is legal, menstrual regulation is widely practiced—menstrual extraction is offered to everyone whose period is two weeks late, without a pregnancy test.^[22]

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons women give for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

Dilationand curettage (D&C) refers to the dilation of the cervix and surgical removal of sections and or layers of the lining of the uterus and or contents of the uterus such as an unwanted fetus, remains of a non viable fetus, retained placenta after birth or abortion as well as any abnormal tissue which may be in the uterus causing abnormal cycles by scraping and scooping (curettage). It is a gynecologic procedure used for treatment and removal as well as diagnostic and therapeutic purposes, and is the most commonly used method for first trimester abortion or miscarriage.

Intact dilation and extraction is a surgical procedure that terminates and removes an intact fetus from the uterus. The procedure is used both after miscarriages and for abortions in the second and third trimesters of pregnancy. When used to perform an abortion, an intact D&E can occur after feticide or on a live fetus.

<span class="mw-page-title-main">Asherman's syndrome</span> Medical condition

Asherman's syndrome (AS) is an acquired uterine condition that occurs when scar tissue (adhesions) forms inside the uterus and/or the cervix. It is characterized by variable scarring inside the uterine cavity, where in many cases the front and back walls of the uterus stick to one another. AS can be the cause of menstrual disturbances, infertility, and placental abnormalities. Although the first case of intrauterine adhesion was published in 1894 by Heinrich Fritsch, it was only after 54 years that a full description of Asherman syndrome was carried out by Joseph Asherman. A number of other terms have been used to describe the condition and related conditions including: uterine/cervical atresia, traumatic uterine atrophy, sclerotic endometrium, and endometrial sclerosis.

Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion or retained fetal and placental tissue, or to obtain a sample of uterine lining. It is generally safe, and serious complications rarely occur.

Dilation and evacuation (D&E) or dilatation and evacuation is the dilation of the cervix and surgical evacuation of the uterus after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to remove all pregnancy tissue.

<span class="mw-page-title-main">Self-induced abortion</span> Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

<span class="mw-page-title-main">Unsafe abortion</span> Termination of a pregnancy by using unsafe methods

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention. About 25 million unsafe abortions occur a year, of which most occur in the developing world.

<span class="mw-page-title-main">Carol Downer</span> American feminist lawyer and non-fiction author

Carol Downer is an American feminist lawyer and non-fiction author who focused her career on abortion rights and women's health around the world. She was involved in the creation of the self-help movement and the first self-help clinic in LA, which later became a model and inspiration for dozens of self-help clinics across the United States.

<span class="mw-page-title-main">History of abortion</span>

The practice of induced abortion—the deliberate termination of a pregnancy—has been known since ancient times. Various methods have been used to perform or attempt abortion, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. The term abortion, or more precisely spontaneous abortion, is sometimes used to refer to a naturally occurring condition that ends a pregnancy, that is, to what is popularly called a miscarriage. But in what follows the term abortion will always refer to an induced abortion.

The Karman cannula is a soft, flexible cannula used in medical procedures that was popularized by Harvey Karman in the early 1970s. The flexibility of the Karman cannula was claimed to reduce the risk of perforating the uterus during vacuum aspiration. Both Karman's procedure, menstrual extraction, and his cannula were embraced by activists Carol Downer and Lorraine Rothman, who modified the technique in 1971 and promoted it. The "self-help" abortion movement envisioned by Downer and Rothman never entered the mainstream in the U.S. before or after Roe v. Wade. Physicians sometimes use a Karman cannula in early induced surgical abortion, in treatment of incomplete abortion, and in endometrial biopsy. In 2010, a Sri Lankan physician named Geeth Silva was the first physician to use the Karman cannula in the removal of impacted faeces from a patient; this was done in Columbo at the Sri Jayawardenepura General Hospital. Physicians and other health care providers sometimes use a Karman cannula in "menstrual regulation" vacuum aspiration procedures in developing countries where abortion is illegal.

<span class="mw-page-title-main">Lorraine Rothman</span> American activist

Evelyn Lorraine Rothman was an American activist. She was a founding member of the feminist self-help clinic movement. In 1971, she invented the Del-Em menstrual extraction kit to make abortions available to women before Roe v. Wade. She was an advocate of self-induced abortions.

<span class="mw-page-title-main">Jane Elizabeth Hodgson</span> Physician, obstetrician, gynecologist

Jane Elizabeth Hodgson was an American obstetrician and gynecologist. Hodgson received a bachelor's degree from Carleton College and her M.D. from the University of Minnesota. She trained at the Jersey City Medical Center and at the Mayo Clinic.

<span class="mw-page-title-main">Harvey Karman</span> American psychologist

Harvey Leroy Karman was an American psychologist and the inventor of the Karman cannula, a flexible suction cannula used for early-term abortions.

The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis.

Abortion-rights movements, also self-styled as pro-choice movements, are movements that advocate for legal access to induced abortion services, including elective abortion. They seek to represent and support women who wish to terminate their pregnancy without fear of legal or social backlash. These movements are in direct opposition to anti-abortion movements.

Abortion is illegal in Bangladesh under most situations, but menstrual regulation is often used as a substitute. Bangladesh is still governed by the penal code from 1860, where induced abortion is illegal unless the woman is in danger.

Abortion in Kazakhstan is legal as an elective procedure up to 12 weeks, and special circumstances afterwards. The relevant legislation is based on the laws inherited from the country's Soviet past, when abortion was legally permitted as a contraceptive.

The women's health movementin the United States refers to the aspect of the American feminist movement that works to improve all aspects of women's health and healthcare. It began during the second wave of feminism as a sub-movement of the women's liberation movement. WHM activism involves increasing women's knowledge and control of their own bodies on a variety of subjects, such as fertility control and home remedies, as well as challenging traditional doctor-patient relationships, the medicalization of childbirth, misogyny in the health care system, and ensuring drug safety.

Nepal legalised abortion in March 2002, under the 11th Amendment to the Civil Code. The legal services were successfully implemented on December 25, 2003. The high maternal mortality rates in Nepal led to the government legalising it. More than 500,000 women sought abortion between 2004 and 2014. In 2014, 323,100 women in Nepal had the abortion; among this, only 42% of abortions were legal and 19% were treated for abortion complications. Similar study had found the rate of unintended pregnancy as 50%.

References

↑ Natural Liberty: Discovering Self-Induced Abortion Methods. Las Vegas, Nevada: Sage Femme!. 2008. pp. 30, 63–77. ISBN 978-0-9645920-0-1. Archived from the original on 2013-10-23.
1 2 3 4 5 6 7 Copelton, Denise A. "Menstrual Extraction, Abortion, and the Politics of Feminist Self-help". Advances in Gender Research. 8: 129–164. doi:10.1016/S1529-2126(04)08005-1.
↑ Boston Women's Health Book Collective (1992). The New Our Bodies, Ourselves. New York: Simon and Schuster Inc. ISBN 978-0-671-79176-6.
1 2 Greenspon, Christopher (2017-04-14). "The secret home abortion movement that started in LA two years before Roe v. Wade". Off-Ramp. Southern California Public Radio. Retrieved 2018-07-23.
↑ Chalker, Rebecca (Spring 1993). "The Whats, Hows, and Why of Menstrual Extraction". On The Issues. Retrieved 5 January 2018.
↑ "Reproductive Sovereignty or Bust! By Carol Downer". www.countercurrents.org. Retrieved 2024-10-10.
1 2 Chalker, Rebecca; Downer, Carol (1992). A Woman's Book of Choices, Abortion, Menstrual Extraction, RU-486. New York: Four Walls Eight Windows. ISBN 978-0-941423-86-1.
↑ Downer, Carol (May 21, 2015). "DIY Abortions Can Have Legal Complications". Women's eNews. Retrieved 2018-07-23.
1 2 Ruzek, Sheryl Burt (1979). The Women's Health Movement: Feminist Alternatives to Medical Control. New York: Praeger Publishers. ISBN 978-0-03-041436-7.
↑ Woo, Elaine (October 3, 2007). "Lorraine Rothman, 75; feminist clinic's co-founder helped demystify gynecology". Obituaries. Los Angeles Times.
↑ Davis, Flora (1991). Moving the Mountain: The Women's Movement in America since 1960. New York: Simon Schuster. p. 233. ISBN 978-0-671-79292-3.
↑ Morgen, Sandra (2002). Into Our Hands The Women's Health Movement in the United States, 1969-1990. New Brunswick, New Jersey: Rutgers University Press. p. 8. ISBN 978-0-8135-3071-0.
1 2 Pearson, Cindy (March–April 1996). "Self Help Clinic Celebrates 25 Years". Network News. National Women's Health Network. Retrieved 5 January 2018.
1 2 Liss-Schultz, Nina (March–April 2018). "Inside the Top-Secret Abortion Underground". Mother Jones . Retrieved 2018-10-18.
1 2 Presser, Lizzie (2018-03-28). ""Whatever's your darkest question, you can ask me." A secret network of women is working outside the law and the medical establishment to provide safe, cheap home abortions". The California Sunday Magazine. Retrieved 2018-10-18.
↑ Ojanen-Goldsmith, A; Prager, S (October 2016). "Beyond the clinic: preferences, motivations, and experiences with alternative abortion care in North America". Contraception. 94 (4): 398–399. doi:10.1016/j.contraception.2016.07.062. ISSN 0010-7824.
↑ Bergum, SE (1993). "Saving lives with menstrual regulation". Plan Parent Chall, International Planned Parenthood Newsletter (1): 30–1. PMID 12345324.
↑ Amin, R; Kamal, GM; Mariam, AG (27 October 1988). "Menstrual regulation in Bangladesh: an evaluation of training and service programs". International Journal of Gynecology & Obstetrics. 27 (2): 265–71. doi:10.1016/0020-7292(88)90018-5. PMID 2903095. S2CID 8028636.
↑ Henshaw, Stanley K; Singh, Susheela; Haas, Taylor (19 January 1999). "Incidence of Abortion Worldwide". International Family Planning Perspectives and Digest. 25 (Suppl). International Perspectives on Sexual and Reproductive Health: S30-8. doi:10.2307/2991869. ISSN 1944-0405. JSTOR 2991869. PMID 14627053 . Retrieved 5 January 2018.
↑ C Joffe (1999). "Abortion in Historical Perspective". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG (eds.). A Clinician's Guide to Medical and Surgical Abortion. Philadelphia: Churchill Livingstone. Archived from the original (Reprint by National Abortion Federation) on 2006-09-22.
↑ "Abortion for All: How the International Planned Parenthood Federation promotes abortion around the world - IPPF's Illegal Activities". lifeissues.net. 2000.
↑ Veeken, Hans (7 October 1995). "Cuba: plenty of care, few condoms, no corruption". BMJ. 311 (7010): 935–7. doi:10.1136/bmj.311.7010.935. PMC 2550926 . PMID 7580557 . Retrieved 5 January 2018.