I truly believe in the saying 'Trust Women' — An interview with Susan Yanow
Tuesday, May 01, 2012
Susan Yanow has decades of experience improving access to women's health care.©Cortesía de Susan Yanow
Through decades of experience improving access to women’s health care, Susan Yanow has cultivated a deep and nuanced understanding of how best to help women worldwide have safe abortions. One of her key interests in the last decade has been the potential of medical abortion—both within and outside of health-care systems. Yanow is a reproductive health consultant who works with three US-based and three international organizations to train clinicians on medical abortion provision and to help women access the information and services they need. Internationally, Yanow consults for Women on Web, Women on Waves and the International Consortium on Medical Abortion. In the United States, she works with the Reproductive Health Access Project, Advancing New Standards in Reproductive Health at the University of California – San Francisco, and Ibis Reproductive Health.
In this interview with Medical Abortion Matters, Yanow shares her thoughts on current best practices—and the future potential of medical abortion to help more women outside the health-care system.
What information do you think women need to know to understand what medical abortion is and how to use the pills successfully outside the health-care system?
I think the answer to that question is very much framed by what country the woman is in. For example, for women in Ireland and Northern Ireland, anti-abortion efforts there have put out a lot of myths about the danger of using medications to end a pregnancy. So in that context, a lot of the work is what I call “myth busting,” as opposed to places in Asia and Africa, for example, where there’s a lack of knowledge about the medicine’s potential. In Africa, the medicines may be available at a pharmacy down the street, but women have no idea they can be used safely to end an unwanted pregnancy. And if they have heard rumors about the pills, they have no idea how to use them. So again, I think the country of the woman is part of what defines what information she actually needs.
What do you think women should be told about accessing urgent medical care if they have a problem?
I think Women on Web actually does an excellent job of identifying the symptoms that need urgent care, and Women on Web works very hard to say to women: “Don’t take these medicines unless you can get to a doctor within an hour or two.” But the reality is, lots of women don’t live within two hours of a medical facility, and they need to end an unwanted pregnancy. I truly believe in the saying “trust women.” If they’re given full information about the risks, it is their right to decide whether it is more risky to have this pregnancy and carry to term or to end it.
I think we as advocates—and certainly clinicians—sometimes are so concerned about a bad outcome that we don’t look at the whole context of the woman’s life and we don’t honor her ability, given full information, to make her own decision about what risk makes the most sense for her. It’s very hard to quickly give a woman the space to really think through her situation, yet that’s what is most important because we can never fully know another person’s situation.
After a woman has taken the medication, are there methods that are easy but reliable to help a woman gauge whether she is no longer pregnant?
The short answer is to ask a woman if she feels like she’s no longer pregnant—if her symptoms of pregnancy have subsided—because you can’t take a pregnancy test right away and many women cannot go for an ultrasound. But we forget that not every woman knows what the symptoms of pregnancy are. Some women really need help itemizing: frequent urination, nausea, breast tenderness. Did you have any of those? Do you now? And of course, helping women understand that symptoms don’t go away within 10 minutes after the bleeding stops. What we’re learning is there are no short-cuts. A woman needs a complete answer.
With Women on Web, we’ve actually done a lot of work recently to change some of our language so that when women say “is the abortion complete?” we don’t just say yes. We say abortion is a process; you may have one to three weeks of light bleeding; the uterus is going to slowly empty itself; this is completely normal.
Are there any other effective practices you have observed to help women who use medical abortion outside the health-care system?
What’s interesting to me is that we haven’t thought about how to help women who are in countries where abortion is legal but not accessible, which includes some women in the United States, for example, and undocumented immigrants in Western Europe who can’t access the health-care systems of the countries they’re in. We haven’t done a good job of thinking about how to help those women, and I think it’s an increasingly important issue—what information would those women need to have in order to access medical abortion and stay out of the criminal justice system?
Communities—the people, groups, systems and environment surrounding the woman—obviously play a role in restricting or facilitating access to safe abortion. How have you seen this demonstrated in your work?
I think more and more organizations are focusing on how stigma is a huge barrier to the individual woman because it cuts her off from the community that might be supportive to her because the assumption is that she has done something wrong and that she will be shamed and will not be supported. We’ve all had the experience in the United States, for example, of being in a situation where we’re a little nervous saying that we’re in support of women making decisions about their bodies and abortion because we think the whole room is anti-choice, only to find that when we speak up other people speak up too. But I think stigma has been internalized by us as advocates and by clinicians, as well as by women, and that is a huge barrier to building the connections that would support providers and women and mobilize neighbors.
I was struck by the media reports of a woman in Idaho, in the United States, who was being prosecuted for self-inducing and how nobody in her community would talk to her. All I could think was there had to be other women in that community who have had abortions. Why are we as a movement not going out there and helping her find those supportive networks and helping to build them?
With Women on Web, our very first training was in Tanzania and we started building support with community activists by asking how many people had had somebody close to them either injured or die in an unsafe abortion. Almost everyone in the room raised their hand. That alone built community so that when we got to people’s feelings about abortion, there was more room for those who were less comfortable about it to talk without anybody feeling threatened, and I think that is the kind of community building we need to do more of. We as a movement have not taken on the community building needed to overcome the stigma and move ourselves and the women we want to help forward.
Do you have any additional thoughts on innovative strategies that might increase women’s access to information and medical abortion drugs?
With Women on Web, we’re trying to think about the reality that in a lot of developing countries, mobile phones are far more prevalent than computers and text messaging is not expensive. How can we use that to push out information in a more creative way?
Are there any exciting new strategies that don’t involve electronic technology?
Word-of-mouth is word-of-mouth whether it happens through Facebook, or me talking to you on the telephone, or me meeting you under the tree in the yard at the marketplace. In some ways, the basic woman-to-woman connection is still the most effective; it’s just that we now have ways to connect women that are not face-to-face.
I also think we’re all learning to use language better—how not to talk about complete abortion, for example, or not to talk about symptoms of pregnancy without explaining what those symptoms are. Those aren’t innovations, but we’re learning in the person-to-person context how to be clearer and more precise. So much information sharing happens between women who are not clinicians or professionals, and we are getting better at how to talk about the process in a way that more matches what the woman’s experience and concerns are. So I think the innovation may be the understanding that you don’t have to be a clinician to be an expert in medical abortion.