Is the Federal Government Politicizing Research Involving Fetal Tissue?
Landmark Report Concludes Abortion in U.S. is Safe
Advanced Prenatal Testing Means More Gut-Wrenching Decisions Over Abortion
Mail-Order Home Medical Abortions Found as Safe as Those Done in Clinic
Abortion-By-Mail Study Outrages Opponents
Telemedicine Abortions Under Attack as a New Option for Women
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FM","link":"/"}},"futureofyou_444641":{"type":"posts","id":"futureofyou_444641","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444641","score":null,"sort":[1538075041000]},"guestAuthors":[],"slug":"governments-decision-to-review-research-of-fetal-tissue-blasted-as-political-move","title":"Is the Federal Government Politicizing Research Involving Fetal Tissue?","publishDate":1538075041,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>\u003cstrong>Updated at 3:45 pm ET\u003c/strong>\u003c/p>\n\u003cp>The Department of Health and Human Services says it is reviewing all medical research involving human fetal tissue.\u003c/p>\n\u003cp>HHS \u003ca href=\"https://www.hhs.gov/about/news/2018/09/24/statement-from-the-department-of-health-and-human-services.html\" target=\"_blank\" rel=\"noopener\">said this week\u003c/a> that it will conduct an audit of \"all acquisitions involving human fetal tissue\" as well as \"all research involving fetal tissue to ensure consistency with statutes and regulations governing such research and to ensure the adequacy of procedures and oversight of this research in light of the serious regulatory, moral, and ethical considerations involved.\"[contextly_sidebar id=\"SsrZIxp3cgGelsMqmovjR5mXFrobSZOz\"]\u003c/p>\n\u003cp>In addition, HHS announced that it has canceled \u003ca href=\"https://www.fpds.gov/ezsearch/search.do?q=advanced+bioscience+resources+VENDOR_DUNS_NUMBER%3A%22786845982%22&s=FPDSNG.COM&templateName=1.4.4&indexName=awardfull&sortBy=SIGNED_DATE&desc=Y\" target=\"_blank\" rel=\"noopener\">a $15,000 contract\u003c/a> for a California-based company called Advanced Bioscience Resources to provide the Food and Drug Administration with human fetal tissue to develop testing protocols. The contract was terminated, HHS said, because the department \"was not sufficiently assured that the contract included the appropriate protections applicable to fetal tissue research or met all other procurement requirements.\"\u003c/p>\n\u003cp>Scientists use fetal tissue in medical research because it grows quickly and is highly versatile and long-lasting.\u003c/p>\n\u003cp>\"It allows us to answer specific questions that can't be answered by adult tissue, which is far more specialized,\"\u003c/p>\n\u003cp>NIH Associate Director for Science Policy Carrie Wolinetz \u003ca href=\"https://www.npr.org/sections/health-shots/2015/09/29/444214443/research-on-fetal-tissue-draws-renewed-political-scientific-scrutiny\" target=\"_blank\" rel=\"noopener\">told NPR's Rob Stein\u003c/a> in 2015. \"Fetal tissue can contain information — about structural features, or the architecture of organs — that cells in a dish alone can't provide. And this is sometimes very important to our understanding of disease.\"\u003c/p>\n\u003cp>Fetal tissue used in scientific research often comes from aborted fetuses. In an email to NPR, \u003ca href=\"https://law.wisc.edu/profiles/racharo\" target=\"_blank\" rel=\"noopener\">Alta Charo\u003c/a>, a professor of law and bioethics at the University of Wisconsin, explains why that is.[contextly_sidebar id=\"G1kyrCYVpzDmWCInUE7H0cF8gc9zn4Ce\"]\u003c/p>\n\u003cp>\"Miscarriages are not often an available source, as they do not take place in a controlled environment and may be due to genetic or other anomalies that would render the cadaveric tissues useless,\" she says. \"Therefore, the tissue usually comes from a fetus that has been aborted.\"\u003c/p>\n\u003cp>Despite the small size of the canceled FDA contract, some observers said the larger political symbolism is evident.\u003c/p>\n\u003cp>\"My instinct is that this is driven by politics, and is part of the overall effort to stigmatize and eventually criminalize abortion, as well as part of a larger campaign to roll-back the clock on sexual and reproductive rights,\" Charo says.\u003c/p>\n\u003cp>However, \u003ca href=\"https://lozierinstitute.org/team-member/david-prentice/\" target=\"_blank\" rel=\"noopener\">David Prentice\u003c/a>, vice president and research director for the Charlotte Lozier Institute, a conservative think tank opposed to abortion, says the HHS announcement doesn't go far enough.\u003c/p>\n\u003cp>\"Canceling a small FDA contract ... seems designed to mollify some Members of Congress and groups who were outraged by the continuing funding of fetal tissue research with taxpayer dollars,\" Prentice writes in an email to NPR. \"But what's needed is wholesale reform across the breadth of HHS. Use of fetal tissue is antiquated research, and [HHS Secretary Alex] Azar should redirect those funds to modern science and better alternatives, including adult stem cells.\"\u003c/p>\n\u003cp>\u003cem>Science\u003c/em> notes that on earlier this month, 45 groups opposed to abortion \u003ca href=\"https://www.sba-list.org/wp-content/uploads/2018/09/Group-Letter-to-Azar-FDA-and-fetal-tissue-FINAL-with-Signatures.pdf\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Azar calling the FDA contract for fetal tissue \"shocking\" and \"unacceptable.\" A few days later, 85 members of Congress \u003ca href=\"https://chrissmith.house.gov/uploadedfiles/2018-09-17_-chs-hartzler-walker_letter_on_fda_fetal_tissue_contract.pdf\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to the FDA's commissioner, urging the agency to cancel the contract.\u003c/p>\n\u003cp>The National Institutes of Health, which also falls under HHS, spent $98 million last fiscal year on research that involved human fetal tissue. The NIH said it \"concurs that it is important that research involving human fetal tissue should be consistent with the statutes and regulation governing such research and that it is important to have adequate procedures for oversight.\"[contextly_sidebar id=\"xJs8IF14XoPynhHrniTrS5E5qgAhyVmm\"]\u003c/p>\n\u003cp>Use of fetal tissue in research has been controversial for some time, \u003cem>Science\u003c/em> magazine reported on Tuesday:\u003c/p>\n\u003cblockquote>\u003cp>\"In 2016, \u003ca href=\"https://energycommerce.house.gov/news/press-release/house-creates-select-panel-investigate-handling-infant-lives/\" target=\"_blank\" rel=\"noopener\">Republican members of the House of Representatives\u003c/a>, led by Representative Marsha Blackburn (TN), \u003ca href=\"https://www.sciencemag.org/news/2017/01/fact-checking-congress-s-fetal-tissue-report\">produced a report\u003c/a> that urged the federal government to transition to obtaining fetal tissue from miscarriages and stillbirths. But opponents of fetal tissue research have failed repeatedly to pass legislation that would end funding for research using tissue from electively aborted fetuses — most recently earlier this month, when language prohibiting such funding was stripped from a 2019 HHS spending bill.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003ca href=\"https://trentcenter.duke.edu/node/221\" target=\"_blank\" rel=\"noopener\">Ross McKinney\u003c/a>, chief scientific officer at the Association of American Medical Colleges, says fetal tissue was key in the development of major medical advances such as vaccines for polio, rubella, measles, chickenpox, adenovirus and rabies, as well as treatments for diseases such as rheumatoid arthritis, cystic fibrosis and hemophilia.\u003c/p>\n\u003cp>\"The unique characteristics of this tissue are essential to the study of fetal diseases, like those caused by Zika virus, and hold promise for advancing biomedical research in other areas as well, bringing hope to patients struggling with diseases such as Alzheimer's, Parkinson's, and multiple sclerosis,\" he writes in an email to NPR.\u003c/p>\n\u003cp>\"Fetal tissue continues to be an important resource for biomedical research, and the Association of American Medical Colleges fully supports its availability as one of the scientific methods that could save and improve lives.\"[contextly_sidebar id=\"GY9wMG5EY8EjMrFWoS2AArgcQmiE5UTu\"]\u003c/p>\n\u003cp>During \u003ca href=\"https://www.npr.org/2016/01/28/464594826/in-wake-of-videos-planned-parenthood-investigations-find-no-fetal-tissue-sales\" target=\"_blank\" rel=\"noopener\">a 2015 brouhaha\u003c/a>, the Obama-era HHS \u003ca href=\"https://www.plannedparenthood.org/files/3514/4709/3497/HHS_Letter_2015_08_14_-_FT_Research.pdf\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to two Republican senators calling the use of fetal tissue in medical research \"an instrumental component of our attempts to understand, treat, and cure a number of conditions and diseases that affect millions of Americans,\" noting that scientists in the U.S. have been working with fetal tissue \u003ca href=\"https://fas.org/sgp/crs/misc/R44129.pdf\" target=\"_blank\" rel=\"noopener\">since the 1930s\u003c/a>.\u003c/p>\n\u003cp>\u003cem>NPR science correspondent Rob Stein contributed to this report.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Health+And+Human+Services+Says+It%27s+Reviewing+Use+Of+Fetal+Tissue+For+Research&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"The audit has been called a political gesture to placate anti-abortion groups that oppose use of the tissue. Fetal tissue has played a part in developing vaccines and medical treatments.","status":"publish","parent":0,"modified":1538075106,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":917},"headData":{"title":"Is the Federal Government Politicizing Research Involving Fetal Tissue? | KQED","description":"The audit has been called a political gesture to placate anti-abortion groups that oppose use of the tissue. Fetal tissue has played a part in developing vaccines and medical treatments.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Is the Federal Government Politicizing Research Involving Fetal Tissue?","datePublished":"2018-09-27T19:04:01.000Z","dateModified":"2018-09-27T19:05:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444641 https://ww2.kqed.org/futureofyou/?p=444641","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/27/governments-decision-to-review-research-of-fetal-tissue-blasted-as-political-move/","disqusTitle":"Is the Federal Government Politicizing Research Involving Fetal Tissue?","source":"Health","nprImageCredit":"Chip Somodevilla","nprByline":"Laurel Wamsley, NPR","nprImageAgency":"Getty Images","nprStoryId":"651838889","nprApiLink":"http://api.npr.org/query?id=651838889&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/2018/09/26/651838889/health-and-human-services-says-its-reviewing-use-of-fetal-tissue-for-research?ft=nprml&f=651838889","nprRetrievedStory":"1","nprPubDate":"Wed, 26 Sep 2018 16:17:00 -0400","nprStoryDate":"Wed, 26 Sep 2018 15:12:00 -0400","nprLastModifiedDate":"Wed, 26 Sep 2018 16:18:07 -0400","path":"/futureofyou/444641/governments-decision-to-review-research-of-fetal-tissue-blasted-as-political-move","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Updated at 3:45 pm ET\u003c/strong>\u003c/p>\n\u003cp>The Department of Health and Human Services says it is reviewing all medical research involving human fetal tissue.\u003c/p>\n\u003cp>HHS \u003ca href=\"https://www.hhs.gov/about/news/2018/09/24/statement-from-the-department-of-health-and-human-services.html\" target=\"_blank\" rel=\"noopener\">said this week\u003c/a> that it will conduct an audit of \"all acquisitions involving human fetal tissue\" as well as \"all research involving fetal tissue to ensure consistency with statutes and regulations governing such research and to ensure the adequacy of procedures and oversight of this research in light of the serious regulatory, moral, and ethical considerations involved.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In addition, HHS announced that it has canceled \u003ca href=\"https://www.fpds.gov/ezsearch/search.do?q=advanced+bioscience+resources+VENDOR_DUNS_NUMBER%3A%22786845982%22&s=FPDSNG.COM&templateName=1.4.4&indexName=awardfull&sortBy=SIGNED_DATE&desc=Y\" target=\"_blank\" rel=\"noopener\">a $15,000 contract\u003c/a> for a California-based company called Advanced Bioscience Resources to provide the Food and Drug Administration with human fetal tissue to develop testing protocols. The contract was terminated, HHS said, because the department \"was not sufficiently assured that the contract included the appropriate protections applicable to fetal tissue research or met all other procurement requirements.\"\u003c/p>\n\u003cp>Scientists use fetal tissue in medical research because it grows quickly and is highly versatile and long-lasting.\u003c/p>\n\u003cp>\"It allows us to answer specific questions that can't be answered by adult tissue, which is far more specialized,\"\u003c/p>\n\u003cp>NIH Associate Director for Science Policy Carrie Wolinetz \u003ca href=\"https://www.npr.org/sections/health-shots/2015/09/29/444214443/research-on-fetal-tissue-draws-renewed-political-scientific-scrutiny\" target=\"_blank\" rel=\"noopener\">told NPR's Rob Stein\u003c/a> in 2015. \"Fetal tissue can contain information — about structural features, or the architecture of organs — that cells in a dish alone can't provide. And this is sometimes very important to our understanding of disease.\"\u003c/p>\n\u003cp>Fetal tissue used in scientific research often comes from aborted fetuses. In an email to NPR, \u003ca href=\"https://law.wisc.edu/profiles/racharo\" target=\"_blank\" rel=\"noopener\">Alta Charo\u003c/a>, a professor of law and bioethics at the University of Wisconsin, explains why that is.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"Miscarriages are not often an available source, as they do not take place in a controlled environment and may be due to genetic or other anomalies that would render the cadaveric tissues useless,\" she says. \"Therefore, the tissue usually comes from a fetus that has been aborted.\"\u003c/p>\n\u003cp>Despite the small size of the canceled FDA contract, some observers said the larger political symbolism is evident.\u003c/p>\n\u003cp>\"My instinct is that this is driven by politics, and is part of the overall effort to stigmatize and eventually criminalize abortion, as well as part of a larger campaign to roll-back the clock on sexual and reproductive rights,\" Charo says.\u003c/p>\n\u003cp>However, \u003ca href=\"https://lozierinstitute.org/team-member/david-prentice/\" target=\"_blank\" rel=\"noopener\">David Prentice\u003c/a>, vice president and research director for the Charlotte Lozier Institute, a conservative think tank opposed to abortion, says the HHS announcement doesn't go far enough.\u003c/p>\n\u003cp>\"Canceling a small FDA contract ... seems designed to mollify some Members of Congress and groups who were outraged by the continuing funding of fetal tissue research with taxpayer dollars,\" Prentice writes in an email to NPR. \"But what's needed is wholesale reform across the breadth of HHS. Use of fetal tissue is antiquated research, and [HHS Secretary Alex] Azar should redirect those funds to modern science and better alternatives, including adult stem cells.\"\u003c/p>\n\u003cp>\u003cem>Science\u003c/em> notes that on earlier this month, 45 groups opposed to abortion \u003ca href=\"https://www.sba-list.org/wp-content/uploads/2018/09/Group-Letter-to-Azar-FDA-and-fetal-tissue-FINAL-with-Signatures.pdf\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Azar calling the FDA contract for fetal tissue \"shocking\" and \"unacceptable.\" A few days later, 85 members of Congress \u003ca href=\"https://chrissmith.house.gov/uploadedfiles/2018-09-17_-chs-hartzler-walker_letter_on_fda_fetal_tissue_contract.pdf\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to the FDA's commissioner, urging the agency to cancel the contract.\u003c/p>\n\u003cp>The National Institutes of Health, which also falls under HHS, spent $98 million last fiscal year on research that involved human fetal tissue. The NIH said it \"concurs that it is important that research involving human fetal tissue should be consistent with the statutes and regulation governing such research and that it is important to have adequate procedures for oversight.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Use of fetal tissue in research has been controversial for some time, \u003cem>Science\u003c/em> magazine reported on Tuesday:\u003c/p>\n\u003cblockquote>\u003cp>\"In 2016, \u003ca href=\"https://energycommerce.house.gov/news/press-release/house-creates-select-panel-investigate-handling-infant-lives/\" target=\"_blank\" rel=\"noopener\">Republican members of the House of Representatives\u003c/a>, led by Representative Marsha Blackburn (TN), \u003ca href=\"https://www.sciencemag.org/news/2017/01/fact-checking-congress-s-fetal-tissue-report\">produced a report\u003c/a> that urged the federal government to transition to obtaining fetal tissue from miscarriages and stillbirths. But opponents of fetal tissue research have failed repeatedly to pass legislation that would end funding for research using tissue from electively aborted fetuses — most recently earlier this month, when language prohibiting such funding was stripped from a 2019 HHS spending bill.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003ca href=\"https://trentcenter.duke.edu/node/221\" target=\"_blank\" rel=\"noopener\">Ross McKinney\u003c/a>, chief scientific officer at the Association of American Medical Colleges, says fetal tissue was key in the development of major medical advances such as vaccines for polio, rubella, measles, chickenpox, adenovirus and rabies, as well as treatments for diseases such as rheumatoid arthritis, cystic fibrosis and hemophilia.\u003c/p>\n\u003cp>\"The unique characteristics of this tissue are essential to the study of fetal diseases, like those caused by Zika virus, and hold promise for advancing biomedical research in other areas as well, bringing hope to patients struggling with diseases such as Alzheimer's, Parkinson's, and multiple sclerosis,\" he writes in an email to NPR.\u003c/p>\n\u003cp>\"Fetal tissue continues to be an important resource for biomedical research, and the Association of American Medical Colleges fully supports its availability as one of the scientific methods that could save and improve lives.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>During \u003ca href=\"https://www.npr.org/2016/01/28/464594826/in-wake-of-videos-planned-parenthood-investigations-find-no-fetal-tissue-sales\" target=\"_blank\" rel=\"noopener\">a 2015 brouhaha\u003c/a>, the Obama-era HHS \u003ca href=\"https://www.plannedparenthood.org/files/3514/4709/3497/HHS_Letter_2015_08_14_-_FT_Research.pdf\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to two Republican senators calling the use of fetal tissue in medical research \"an instrumental component of our attempts to understand, treat, and cure a number of conditions and diseases that affect millions of Americans,\" noting that scientists in the U.S. have been working with fetal tissue \u003ca href=\"https://fas.org/sgp/crs/misc/R44129.pdf\" target=\"_blank\" rel=\"noopener\">since the 1930s\u003c/a>.\u003c/p>\n\u003cp>\u003cem>NPR science correspondent Rob Stein contributed to this report.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Health+And+Human+Services+Says+It%27s+Reviewing+Use+Of+Fetal+Tissue+For+Research&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444641/governments-decision-to-review-research-of-fetal-tissue-blasted-as-political-move","authors":["byline_futureofyou_444641"],"categories":["futureofyou_1","futureofyou_73","futureofyou_1064"],"tags":["futureofyou_342","futureofyou_1176","futureofyou_1615","futureofyou_294"],"collections":["futureofyou_1094"],"featImg":"futureofyou_444642","label":"source_futureofyou_444641"},"futureofyou_440262":{"type":"posts","id":"futureofyou_440262","meta":{"index":"posts_1591205157","site":"futureofyou","id":"440262","score":null,"sort":[1521248326000]},"guestAuthors":[],"slug":"landmark-report-concludes-abortion-in-u-s-is-safe","title":"Landmark Report Concludes Abortion in U.S. is Safe","publishDate":1521248326,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.[contextly_sidebar id=\"jMTkDIjBqWWCgCakps1aEu2Qa7NrZakX\"]\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.[contextly_sidebar id=\"zTJU1sTa18fez3ecDq44jqN6KfYhyHGL\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The report says many state laws on abortions don't have a medical purpose and can make outcomes worse.","status":"publish","parent":0,"modified":1521248645,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":785},"headData":{"title":"Landmark Report Concludes Abortion in U.S. is Safe | KQED","description":"The report says many state laws on abortions don't have a medical purpose and can make outcomes worse.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Landmark Report Concludes Abortion in U.S. is Safe","datePublished":"2018-03-17T00:58:46.000Z","dateModified":"2018-03-17T01:04:05.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"440262 https://ww2.kqed.org/futureofyou/?p=440262","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/03/16/landmark-report-concludes-abortion-in-u-s-is-safe/","disqusTitle":"Landmark Report Concludes Abortion in U.S. is Safe","source":"Health","nprImageCredit":"Bryce Duffy","nprByline":"Alison Kodjak\u003cbr />NPR Shots","nprImageAgency":"Getty Images","nprStoryId":"593447727","nprApiLink":"http://api.npr.org/query?id=593447727&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/03/16/593447727/landmark-report-concludes-abortion-is-safe?ft=nprml&f=593447727","nprRetrievedStory":"1","nprPubDate":"Fri, 16 Mar 2018 19:20:00 -0400","nprStoryDate":"Fri, 16 Mar 2018 11:00:00 -0400","nprLastModifiedDate":"Fri, 16 Mar 2018 17:28:28 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/03/20180316_atc_landmark_report_concludes_abortion_in_us_is_safe_.mp3?orgId=1&topicId=1128&d=227&p=2&story=593447727&ft=nprml&f=593447727","nprAudioM3u":"http://api.npr.org/m3u/1594364521-59ee98.m3u?orgId=1&topicId=1128&d=227&p=2&story=593447727&ft=nprml&f=593447727","path":"/futureofyou/440262/landmark-report-concludes-abortion-in-u-s-is-safe","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/03/20180316_atc_landmark_report_concludes_abortion_in_us_is_safe_.mp3?orgId=1&topicId=1128&d=227&p=2&story=593447727&ft=nprml&f=593447727","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440262/landmark-report-concludes-abortion-in-u-s-is-safe","authors":["byline_futureofyou_440262"],"categories":["futureofyou_1060","futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_342","futureofyou_61","futureofyou_215"],"collections":["futureofyou_1093"],"featImg":"futureofyou_440264","label":"source_futureofyou_440262"},"futureofyou_435960":{"type":"posts","id":"futureofyou_435960","meta":{"index":"posts_1591205157","site":"futureofyou","id":"435960","score":null,"sort":[1509995619000]},"guestAuthors":[],"slug":"advanced-prenatal-testing-will-mean-more-gut-wrenching-decisions-about-abortion","title":"Advanced Prenatal Testing Means More Gut-Wrenching Decisions Over Abortion","publishDate":1509995619,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>\u003cem>Excerpts from \"The Other Scarlet 'A': Abortion's Relationship to Genetic Testing\" from THE GENE MACHINE by Bonnie Rochman. Copyright © 2017 by Bonnie Rochman. Used by permission of \u003ca href=\"https://us.macmillan.com/fsg\" target=\"_blank\" rel=\"noopener\">Farrar, Straus and Giroux\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>When the second purple line appeared on the white plastic wand on a March morning in 2002, I knew next to nothing about pregnancy and even less about raising a child. It was years before I’d go on to cover parenting and pediatrics, and write about sequencing children’s genomes. Yet from the first days of that pregnancy, I was already enmeshed in the most cutting-edge technologies of the time, thanks to my friend Tali, whose son was due a week after mine.\u003c/p>\n\u003caside class=\"pullquote alignright\">How people feel about disability and how that impacts their decisions around abortion are the real topics in any discussion about advanced prenatal testing.\u003c/aside>\n\u003cp>Tali had recently moved to my home state of North Carolina from Israel, where nuchal translucency testing was standard. I had no idea what it was, but I figured it was important, judging by her level of outrage that this test to gauge Down syndrome risk — combination of an ultrasound to measure the collection of fluid under the skin on the back of a fetus’s neck, and a blood draw — wasn’t commonly available in the United States. Within days, she told me that she’d found a doctor who was getting certified to perform the testing. He needed subjects. Tali and I volunteered.\u003c/p>\n\u003cp>I had signed up blithely, without seriously considering what I’d do if the test result came back positive. I expected good news — and, fortunately, I got it. Now, more than a decade later, nuchal translucency is old hat. Other, more sophisticated tests have begun to usurp what was lauded as the latest in prenatal technology in the early aughts.\u003c/p>\n\u003cp>Nuchal translucency offered both Tali and me reassurance. But the various permutations of prenatal screening and testing do not always provide comfort. I am witness to that in the heart of midtown Manhattan, not far from Radio City Music Hall, in a clinic where a woman and her husband have just made a life-altering decision. The woman is 40 years old, with high cheekbones and skin the color of toasted almonds. She is 12-and-a-half weeks pregnant with one baby, but minutes earlier, before she sat down with me in an empty exam room, she was pregnant with two.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"i4qdnvXQQLlENO4hP9XlMVjlFUStRjgc\"]Her journey to motherhood had not been easy. The twins had been conceived via in vitro fertilization after the woman and her partner had spent more than a year trying to get pregnant the old-fashioned way. A week before, she had had a microarray analysis that peered deeply into the genetic makeup of her twins.\u003c/p>\n\u003cp>Microarray analyzes fetal cells for countless less apparent disorders that occur when a tiny snippet of DNA has been added somewhere it’s not supposed to be or deleted entirely, revealing genetic hiccups that previously could not be detected prenatally. Some of these changes are meaningless; others may be associated with autism or rare disorders such as DiGeorge syndrome, which is characterized by heart problems and a roughly 25 percent risk of developing schizophrenia.\u003c/p>\n\u003cp>As the woman explained, “We made use of technology throughout this process, so it would be a shame not to take advantage of this [test]. I wanted to make sure that, given my age, there was nothing wrong.”\u003c/p>\n\u003cp>She knew that the microarray would reveal all sorts of genetic blips, DNA duplications and deletions too tiny to be seen under a microscope, some of which are associated with worrisome conditions and others of which aren’t understood. The test would also detect major chromosomal problems, of which Down syndrome is the most common.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Just because a patient can know something, must she? What is one of the most joyous times of life has turned into something ominous and fraught, loaded with the potential to go wrong.'\u003c/aside>\n\u003cp>Even at age 40, just 1 of 100 pregnancies results in Down syndrome. And yet the couple beat those odds: one of the twins was confirmed to have the extra 21st chromosome that causes the condition.\u003c/p>\n\u003cp>“You don’t think it’s going to happen to you and then here it is. I still can’t get over the fact. Today we reduced the baby with Down syndrome,” the woman tells me, using a common euphemism for terminating one or more fetuses in cases where a woman is carrying more than she intends to deliver. Many doctors call this “fetal reduction.” She reflects on her decision, made possible by these new tests, as she lowers herself onto an exam table to rest. “I look at this as a sign from God. My mother believes in karma. I think this baby was only meant to be for twelve weeks and his suffering was shortened,” she says. She raises herself up on her elbows and looks at her husband. “Then I feel like, ‘Oh my god, I just killed a baby.’ ”\u003c/p>\n\u003cp>Considering that women have been getting pregnant for a very long time, prenatal diagnosis — the ability to peer inside the womb and emerge with a snapshot of fetal health — is a fairly recent development, a convergence of medical technologies such as amniocentesis and ultrasound with emerging insights about genes and chromosomes. But it’s the legalization of abortion in 1973 that really served as a catalyst for change. After all, without the ability to choose whether or not to continue a pregnancy, knowledge gleaned from prenatal diagnosis would have remained largely theoretical. With the decriminalization of abortion, what to do became a choice.\u003c/p>\n\u003cp>While there are women who’d never opt for an abortion, it’s disingenuous to ignore the fact that terminating a pregnancy is one possible outcome of earlier, more sophisticated genetic tests. The issue of how people feel about disability and, in turn, how that impacts their decisions regarding abortion is an essential aspect of any discussion about advances in prenatal testing.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I don't understand why even women in their twenties aren't undergoing this testing. Knowledge is power.'\u003c/aside>\n\u003cp>Yet abortion remains the elephant in the room when it comes to prenatal testing. When I discuss my work with colleagues and friends interested in the subject, some say, “ You’re not going to mention abortion, are you? My gut tells me that I think you’re walking into a minefield if that becomes a major part of the book.” Others say, “Abortion should definitely be a chapter. How could it not be?”\u003c/p>\n\u003cp>Much of the prenatal testing conversation centers on Down syndrome because the condition is so well- known, unlike others that affect far fewer people. One of every 792 babies born in the United States has Down syndrome. Compared to many other chromosomal conditions, however, Down syndrome is considered a relatively mild genetic complex. Chromosome 21 is the smallest chromosome, so the extra genetic material that accompanies a third copy is not as massive or overwhelming as it would be had it occurred on another, larger chromosome. The genetic disorder that results from a triplication of any chromosome is called a trisomy. A trisomy 22 baby, for example, probably would not make it to birth.\u003c/p>\n\u003cp>Starting in the 1970s, various epidemiologists began making the case that standardizing testing for Down syndrome was a public health priority. Since then, screening for Down syndrome has become broadly accepted by the medical community and, in turn, by many pregnant women and their partners. In 2007, the American College of Obstetrics and Gynecology expanded its prenatal screening recommendations to offer all women, regardless of age, the option of screening and diagnosis for genetic conditions, including Down syndrome.\u003c/p>\n\u003cp>One of the consequences is clear. In 2015, Brian Skotko, who co-directs the Down Syndrome Program at Massachusetts General Hospital, published a comprehensive look at Down syndrome live-birth rates in the United States. Between 2006 and 2010, he and his colleagues calculated that 30 percent fewer babies with Down syndrome were born than were expected, due to elective terminations.\u003c/p>\n\u003cp>Decisions about whether to have a baby with Down syndrome tend to vary geographically and by level of education. In the 2015 study, abortions for reasons of Down syndrome were highest in the Northeast and Hawaii and lowest in the South. Asians were the most likely to terminate due to Down syndrome, while Hispanics and American Indians were the least likely.\u003c/p>\n\u003cfigure id=\"attachment_370960\" class=\"wp-caption aligncenter\" style=\"max-width: 507px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Down-syndrome.jpg\">\u003cimg class=\"size-full wp-image-370960\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Down-syndrome.jpg\" alt=\"\" width=\"507\" height=\"337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome.jpg 507w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome-375x249.jpg 375w\" sizes=\"(max-width: 507px) 100vw, 507px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A baby girl with Down Syndrome and her mother. \u003ccite>( JGI/Tom Grill/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>The Rise of Noninvasive Prenatal Screening \u003c/strong>\u003c/p>\n\u003cp>Various forms of prenatal testing have been around for decades, but when noninvasive prenatal screening (NIPS) debuted in 2011, its greater accuracy combined with its ease of use contributed to its rapid uptake. In a few short years, NIPS, also called cell-free DNA screening, has become pervasive in the prenatal-testing market. Rather than face off with a long needle or catheter guided through the cervix or abdomen late in the first trimester, or a long needle in the abdomen in the second trimester, a quick venipuncture can collect enough blood midway through the first trimester to gauge whether the fetus’s chromosomes are intact, with high accuracy and no in utero assault. Within a few weeks of a woman learning she’s pregnant, her blood contains fragments of fetal DNA (NIPS actually detects DNA from the placenta, considered a proxy for fetal DNA, that is free-floating in the mom’s bloodstream). The amount of cell- free DNA from the fetus and mother can then be analyzed to predict Down syndrome (and an increasing number of other chromosomal conditions) with up to 99 percent accuracy — though the concept of accuracy itself is nuanced and complex and fluctuates depending on the age of the mother. NIPS, being a blood test, also sidesteps the very small but still scary risk of miscarriage that accompanies CVS (short for \u003ca href=\"https://www.mayoclinic.org/tests-procedures/chorionic-villus-sampling/basics/definition/prc-20013566\" target=\"_blank\" rel=\"noopener\">chorionic villus sampling\u003c/a>) or amnio.\u003c/p>\n\u003caside class=\"pullquote alignright\">The doctor said: 'I get people coming in here who ... want to know this is 100 percent fine. I can't give you 100 percent. I can give you 80 percent. And I said, \"I'm going to take those odds.\"\u003c/aside>\n\u003cp>Initially reserved for women over 35, NIPS has now spread to younger women as well, and has spawned a $500 million industry expected to balloon to $2 billion by 2020. But who gets the testing ranges widely, depending upon who goes to the doctor in the first place. Lower-income women, due to lack of access, don’t seek out prenatal care nearly as regularly as more well-to-do mothers. If they do, they’re often too far along in their pregnancies to get screened. Due to geographic discrepancies in Medicaid coverage, NIPS or other tests may not be covered. ...\u003c/p>\n\u003cp>Despite its high degree of accuracy, NIPS is not perfect. Nor does it equate with a diagnosis. NIPS is a screening test; it can be complicated by a lower-than-expected fraction of fetal DNA and even by an underlying maternal cancer diagnosis. Only CVS or amnio can offer confirmation. But the message is not always getting across to women — or their doctors. Cases have been reported of women coming close to terminating pregnancies they believed were affected based on NIPS results — only to learn that they were not. Experts blame the companies that market the tests for robust advertising that they say misleads patients — and some physicians — into believing that the results are equivalent to a diagnosis. To address misunderstanding, the American Congress of Obstetricians and Gynecologists issued a statement in 2015 stressing that any positive results need to be confirmed via other tests such as amniocentesis. In other words, ACOG emphasizes, a decision to have an abortion should not be based solely on the results of NIPS.\u003c/p>\n\u003cp>Yet there has been little public conversation about widespread prenatal screening and the “consequences of the transformation of every fetus — and not only the precious fetus produced thanks to complex technological interventions — into an ‘at risk’ entity, extensively tested, measured and evaluated by health professionals,” wrote the science historian Ilana Löwy in a paper about prenatal diagnosis.\u003c/p>\n\u003cp>In an op-ed in The New York Times, “\u003ca href=\"https://opinionator.blogs.nytimes.com/2014/06/04/the-t-m-i-pregnancy/?_r=0\" target=\"_blank\" rel=\"noopener\">The T.M.I. Pregnancy,\u003c/a>” Patricia Volk lamented that all the testing surrounding her daughter-in-law’s supposedly “normal” pregnancy had left them both feeling “guardedly happy.” She recounted a series of scary ultrasound findings that turned out to be nothing, and mused: “Prenatal science has helped a lot [of] people and people-to-be. But just because a patient can know something, must she? Odds are in this baby’s favor, yet every sonogram adds something scary to the pot. What is one of the most joyous times of life has turned into something ominous and fraught, loaded with the potential to go wrong.”\u003c/p>\n\u003cp>Yet one person’s anxiety is another’s sigh of relief. The debate over what testing and how much hinges on so many factors. In fact, two letters to the editor in response to “The T.M.I. Pregnancy” highlight why this push-and-pull is one of the great medical and social conundrums of our time. In one, Alastair Pullen describes his experience declining all testing during his wife’s first pregnancy “for all of the reasons this article mentions.” Halfway through the pregnancy, he and his wife agreed to an ultrasound and discovered their daughter had a fatal condition and would not survive long after birth. “Faced with a horrible decision,” Pullen writes, “we decided to induce preterm labor. Becket was stillborn. The only thing worse would have been if we had had no knowledge of her condition.” Pullen had first decided not to test but ended up grateful he changed his mind. He and his wife welcomed testing in later pregnancies; they now have three healthy children, and, he says, “the barrage of testing affirmed our excitement.”\u003c/p>\n\u003cp>Ingrid Chafee, on the other hand, gave birth when no tests were available. She was shocked when she delivered her firstborn in 1965, only to learn he had hydrocephalus and spina bifida. Surgery repaired much of the damage, but her son — who now holds a doctorate from Oxford — still has physical problems. She concludes: “He has said many times that he is glad that there were no ultrasound tests available at the time of his birth. If there had been, he wouldn’t be here. To know or not to know? It’s up to each to decide.”\u003c/p>\n\u003cp>\u003cstrong>Who Is a Gift and Who a Burden?\u003c/strong>\u003c/p>\n\u003cp>The ethics of abortion are set to become much more complicated as more women have access to powerful genetic tests such as microarray, for these tests can identify genetic flaws that are not readily understood.\u003c/p>\n\u003cp>Microarray had confirmed that the almond skinned woman who had the fetal reduction was carrying one twin with Down syndrome. But in the case of more ambiguous genetic errors in a boy named Ryan Docherty, confirmation was the easy part. It was the interpretation — figuring out the significance of the problems that microarray had detected in utero — that proved difficult.\u003c/p>\n\u003cp>When she was pregnant, Ryan’s mom, Jen Sipress, had a microarray test. You’ll recall that chromosomal microarray analysis can detect deletions and duplications of genetic material — errors that are far smaller than an entire extra chromosome. But just because they’re smaller doesn’t mean they can’t wreak havoc. Some are associated with genetic disorders; many more aren’t associated with anything because they’re so newly discovered or because they don’t appear to be detrimental according to the limited amount of research that exists. Sipress, 42, is a New York City narcotics prosecutor; she thrives on evidence. When her test results came back, the evidence was disconcerting: Ryan, still in utero, had not one but two findings — “variants of uncertain significance” — inherited from his mother and his father. Docherty had passed down a duplication involving six genes, while Sipress had contributed a deletion on chromosome 15 involving four genes. In general, deletions are considered more worrisome than duplications; our bodies can often deal with some extra genetic material, but it’s not as easy to compensate for DNA gone AWOL. To make matters worse, one of the four missing genes had been associated in the medical literature with intellectual and developmental delay. Here’s where things got really confusing: Sipress was missing that same gene and she didn’t appear to be affected at all. She worked hard as the family’s primary income earner, putting drug dealers behind bars. She hadn’t even known she was missing any genes until the microarray results came back. But genes—or their absence — can affect people differently; it’s a phenomenon called “variable expressivity.”\u003c/p>\n\u003cp>Before the amniocentesis to collect fetal cells for the microarray analysis, Sipress and Docherty had decided that were they to learn that their unborn child wouldn’t be able to live independently as an adult, they would end the pregnancy. When they got the results, they leaned toward abortion. After talking to their doctor, Ron Wapner, author of a \u003cem>New England Journal of Medicine\u003c/em> study about microarray’s effectiveness, they changed their minds. As Sipress recalls, Wapner said, “‘I get people coming in here who . . . want to know this is 100 percent fine.’ And he said, ‘I can’t give you 100 percent. I can give you 80 percent.’ And I said, ‘I’m going to take those odds.’ ”\u003c/p>\n\u003cp>Emotionally, it was a terrible time for Sipress and Docherty. Ryan was their first child, and he had been conceived after two rounds of IVF. But Sipress doesn’t regret finding out. “I don’t understand why even women in their 20s aren’t undergoing this testing,” she says. “Knowledge is power. Doesn’t everyone realize that?”\u003c/p>\n\u003cp>It’s certainly made for some awkward conversations with her husband’s family in Scotland, who know about the missing genes. “They ask if there is something wrong with the kid, and I say, ‘Technically, yes, but he’s not exhibiting any symptoms,’ ” says Sipress. To that end, Docherty, who stays home with Ryan, is a vigilant observer. “Are we still worried?” says Docherty. “Absolutely.” It’s easy to attribute every behavioral challenge — Ryan’s not a good sleeper, but neither are lots of babies — to the missing genes. Anticipating this, Wapner has cautioned them against engaging in this sort of genetic determinism. “He said, ‘Go about your business. If you feel something is really wrong, then you act.’ To be honest,” says Docherty, “Ryan doesn’t have a problem, as far as I can see.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>To what end are we willing to go to detect disability? Once we find it, is there a dividing line between “good,” or tolerable, disabilities and “bad,” or intolerable, limitations? How do we decide which ones may warrant abortion and which are acceptable? What feels overwhelming to one person— the birth of a child with a genetic disorder— may feel like God’s gift to another. Who are we to judge what — who, more accurately—is a gift and who is a burden?\u003c/p>\n\n","blocks":[],"excerpt":"Advanced prenatal genetic testing transforms every fetus into an 'at risk' entity. And we should be talking about that, says author Bonnie Rochman in 'The Gene Machine.'","status":"publish","parent":0,"modified":1514584359,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":3388},"headData":{"title":"Advanced Prenatal Testing Means More Gut-Wrenching Decisions Over Abortion | KQED","description":"Advanced prenatal genetic testing transforms every fetus into an 'at risk' entity. And we should be talking about that, says author Bonnie Rochman in 'The Gene Machine.'","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Advanced Prenatal Testing Means More Gut-Wrenching Decisions Over Abortion","datePublished":"2017-11-06T19:13:39.000Z","dateModified":"2017-12-29T21:52:39.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"435960 https://ww2.kqed.org/futureofyou/?p=435960","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/11/06/advanced-prenatal-testing-will-mean-more-gut-wrenching-decisions-about-abortion/","disqusTitle":"Advanced Prenatal Testing Means More Gut-Wrenching Decisions Over Abortion","nprByline":"Bonnie Rochman","path":"/futureofyou/435960/advanced-prenatal-testing-will-mean-more-gut-wrenching-decisions-about-abortion","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Excerpts from \"The Other Scarlet 'A': Abortion's Relationship to Genetic Testing\" from THE GENE MACHINE by Bonnie Rochman. Copyright © 2017 by Bonnie Rochman. Used by permission of \u003ca href=\"https://us.macmillan.com/fsg\" target=\"_blank\" rel=\"noopener\">Farrar, Straus and Giroux\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>When the second purple line appeared on the white plastic wand on a March morning in 2002, I knew next to nothing about pregnancy and even less about raising a child. It was years before I’d go on to cover parenting and pediatrics, and write about sequencing children’s genomes. Yet from the first days of that pregnancy, I was already enmeshed in the most cutting-edge technologies of the time, thanks to my friend Tali, whose son was due a week after mine.\u003c/p>\n\u003caside class=\"pullquote alignright\">How people feel about disability and how that impacts their decisions around abortion are the real topics in any discussion about advanced prenatal testing.\u003c/aside>\n\u003cp>Tali had recently moved to my home state of North Carolina from Israel, where nuchal translucency testing was standard. I had no idea what it was, but I figured it was important, judging by her level of outrage that this test to gauge Down syndrome risk — combination of an ultrasound to measure the collection of fluid under the skin on the back of a fetus’s neck, and a blood draw — wasn’t commonly available in the United States. Within days, she told me that she’d found a doctor who was getting certified to perform the testing. He needed subjects. Tali and I volunteered.\u003c/p>\n\u003cp>I had signed up blithely, without seriously considering what I’d do if the test result came back positive. I expected good news — and, fortunately, I got it. Now, more than a decade later, nuchal translucency is old hat. Other, more sophisticated tests have begun to usurp what was lauded as the latest in prenatal technology in the early aughts.\u003c/p>\n\u003cp>Nuchal translucency offered both Tali and me reassurance. But the various permutations of prenatal screening and testing do not always provide comfort. I am witness to that in the heart of midtown Manhattan, not far from Radio City Music Hall, in a clinic where a woman and her husband have just made a life-altering decision. The woman is 40 years old, with high cheekbones and skin the color of toasted almonds. She is 12-and-a-half weeks pregnant with one baby, but minutes earlier, before she sat down with me in an empty exam room, she was pregnant with two.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Her journey to motherhood had not been easy. The twins had been conceived via in vitro fertilization after the woman and her partner had spent more than a year trying to get pregnant the old-fashioned way. A week before, she had had a microarray analysis that peered deeply into the genetic makeup of her twins.\u003c/p>\n\u003cp>Microarray analyzes fetal cells for countless less apparent disorders that occur when a tiny snippet of DNA has been added somewhere it’s not supposed to be or deleted entirely, revealing genetic hiccups that previously could not be detected prenatally. Some of these changes are meaningless; others may be associated with autism or rare disorders such as DiGeorge syndrome, which is characterized by heart problems and a roughly 25 percent risk of developing schizophrenia.\u003c/p>\n\u003cp>As the woman explained, “We made use of technology throughout this process, so it would be a shame not to take advantage of this [test]. I wanted to make sure that, given my age, there was nothing wrong.”\u003c/p>\n\u003cp>She knew that the microarray would reveal all sorts of genetic blips, DNA duplications and deletions too tiny to be seen under a microscope, some of which are associated with worrisome conditions and others of which aren’t understood. The test would also detect major chromosomal problems, of which Down syndrome is the most common.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Just because a patient can know something, must she? What is one of the most joyous times of life has turned into something ominous and fraught, loaded with the potential to go wrong.'\u003c/aside>\n\u003cp>Even at age 40, just 1 of 100 pregnancies results in Down syndrome. And yet the couple beat those odds: one of the twins was confirmed to have the extra 21st chromosome that causes the condition.\u003c/p>\n\u003cp>“You don’t think it’s going to happen to you and then here it is. I still can’t get over the fact. Today we reduced the baby with Down syndrome,” the woman tells me, using a common euphemism for terminating one or more fetuses in cases where a woman is carrying more than she intends to deliver. Many doctors call this “fetal reduction.” She reflects on her decision, made possible by these new tests, as she lowers herself onto an exam table to rest. “I look at this as a sign from God. My mother believes in karma. I think this baby was only meant to be for twelve weeks and his suffering was shortened,” she says. She raises herself up on her elbows and looks at her husband. “Then I feel like, ‘Oh my god, I just killed a baby.’ ”\u003c/p>\n\u003cp>Considering that women have been getting pregnant for a very long time, prenatal diagnosis — the ability to peer inside the womb and emerge with a snapshot of fetal health — is a fairly recent development, a convergence of medical technologies such as amniocentesis and ultrasound with emerging insights about genes and chromosomes. But it’s the legalization of abortion in 1973 that really served as a catalyst for change. After all, without the ability to choose whether or not to continue a pregnancy, knowledge gleaned from prenatal diagnosis would have remained largely theoretical. With the decriminalization of abortion, what to do became a choice.\u003c/p>\n\u003cp>While there are women who’d never opt for an abortion, it’s disingenuous to ignore the fact that terminating a pregnancy is one possible outcome of earlier, more sophisticated genetic tests. The issue of how people feel about disability and, in turn, how that impacts their decisions regarding abortion is an essential aspect of any discussion about advances in prenatal testing.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I don't understand why even women in their twenties aren't undergoing this testing. Knowledge is power.'\u003c/aside>\n\u003cp>Yet abortion remains the elephant in the room when it comes to prenatal testing. When I discuss my work with colleagues and friends interested in the subject, some say, “ You’re not going to mention abortion, are you? My gut tells me that I think you’re walking into a minefield if that becomes a major part of the book.” Others say, “Abortion should definitely be a chapter. How could it not be?”\u003c/p>\n\u003cp>Much of the prenatal testing conversation centers on Down syndrome because the condition is so well- known, unlike others that affect far fewer people. One of every 792 babies born in the United States has Down syndrome. Compared to many other chromosomal conditions, however, Down syndrome is considered a relatively mild genetic complex. Chromosome 21 is the smallest chromosome, so the extra genetic material that accompanies a third copy is not as massive or overwhelming as it would be had it occurred on another, larger chromosome. The genetic disorder that results from a triplication of any chromosome is called a trisomy. A trisomy 22 baby, for example, probably would not make it to birth.\u003c/p>\n\u003cp>Starting in the 1970s, various epidemiologists began making the case that standardizing testing for Down syndrome was a public health priority. Since then, screening for Down syndrome has become broadly accepted by the medical community and, in turn, by many pregnant women and their partners. In 2007, the American College of Obstetrics and Gynecology expanded its prenatal screening recommendations to offer all women, regardless of age, the option of screening and diagnosis for genetic conditions, including Down syndrome.\u003c/p>\n\u003cp>One of the consequences is clear. In 2015, Brian Skotko, who co-directs the Down Syndrome Program at Massachusetts General Hospital, published a comprehensive look at Down syndrome live-birth rates in the United States. Between 2006 and 2010, he and his colleagues calculated that 30 percent fewer babies with Down syndrome were born than were expected, due to elective terminations.\u003c/p>\n\u003cp>Decisions about whether to have a baby with Down syndrome tend to vary geographically and by level of education. In the 2015 study, abortions for reasons of Down syndrome were highest in the Northeast and Hawaii and lowest in the South. Asians were the most likely to terminate due to Down syndrome, while Hispanics and American Indians were the least likely.\u003c/p>\n\u003cfigure id=\"attachment_370960\" class=\"wp-caption aligncenter\" style=\"max-width: 507px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Down-syndrome.jpg\">\u003cimg class=\"size-full wp-image-370960\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Down-syndrome.jpg\" alt=\"\" width=\"507\" height=\"337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome.jpg 507w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Down-syndrome-375x249.jpg 375w\" sizes=\"(max-width: 507px) 100vw, 507px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A baby girl with Down Syndrome and her mother. \u003ccite>( JGI/Tom Grill/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>The Rise of Noninvasive Prenatal Screening \u003c/strong>\u003c/p>\n\u003cp>Various forms of prenatal testing have been around for decades, but when noninvasive prenatal screening (NIPS) debuted in 2011, its greater accuracy combined with its ease of use contributed to its rapid uptake. In a few short years, NIPS, also called cell-free DNA screening, has become pervasive in the prenatal-testing market. Rather than face off with a long needle or catheter guided through the cervix or abdomen late in the first trimester, or a long needle in the abdomen in the second trimester, a quick venipuncture can collect enough blood midway through the first trimester to gauge whether the fetus’s chromosomes are intact, with high accuracy and no in utero assault. Within a few weeks of a woman learning she’s pregnant, her blood contains fragments of fetal DNA (NIPS actually detects DNA from the placenta, considered a proxy for fetal DNA, that is free-floating in the mom’s bloodstream). The amount of cell- free DNA from the fetus and mother can then be analyzed to predict Down syndrome (and an increasing number of other chromosomal conditions) with up to 99 percent accuracy — though the concept of accuracy itself is nuanced and complex and fluctuates depending on the age of the mother. NIPS, being a blood test, also sidesteps the very small but still scary risk of miscarriage that accompanies CVS (short for \u003ca href=\"https://www.mayoclinic.org/tests-procedures/chorionic-villus-sampling/basics/definition/prc-20013566\" target=\"_blank\" rel=\"noopener\">chorionic villus sampling\u003c/a>) or amnio.\u003c/p>\n\u003caside class=\"pullquote alignright\">The doctor said: 'I get people coming in here who ... want to know this is 100 percent fine. I can't give you 100 percent. I can give you 80 percent. And I said, \"I'm going to take those odds.\"\u003c/aside>\n\u003cp>Initially reserved for women over 35, NIPS has now spread to younger women as well, and has spawned a $500 million industry expected to balloon to $2 billion by 2020. But who gets the testing ranges widely, depending upon who goes to the doctor in the first place. Lower-income women, due to lack of access, don’t seek out prenatal care nearly as regularly as more well-to-do mothers. If they do, they’re often too far along in their pregnancies to get screened. Due to geographic discrepancies in Medicaid coverage, NIPS or other tests may not be covered. ...\u003c/p>\n\u003cp>Despite its high degree of accuracy, NIPS is not perfect. Nor does it equate with a diagnosis. NIPS is a screening test; it can be complicated by a lower-than-expected fraction of fetal DNA and even by an underlying maternal cancer diagnosis. Only CVS or amnio can offer confirmation. But the message is not always getting across to women — or their doctors. Cases have been reported of women coming close to terminating pregnancies they believed were affected based on NIPS results — only to learn that they were not. Experts blame the companies that market the tests for robust advertising that they say misleads patients — and some physicians — into believing that the results are equivalent to a diagnosis. To address misunderstanding, the American Congress of Obstetricians and Gynecologists issued a statement in 2015 stressing that any positive results need to be confirmed via other tests such as amniocentesis. In other words, ACOG emphasizes, a decision to have an abortion should not be based solely on the results of NIPS.\u003c/p>\n\u003cp>Yet there has been little public conversation about widespread prenatal screening and the “consequences of the transformation of every fetus — and not only the precious fetus produced thanks to complex technological interventions — into an ‘at risk’ entity, extensively tested, measured and evaluated by health professionals,” wrote the science historian Ilana Löwy in a paper about prenatal diagnosis.\u003c/p>\n\u003cp>In an op-ed in The New York Times, “\u003ca href=\"https://opinionator.blogs.nytimes.com/2014/06/04/the-t-m-i-pregnancy/?_r=0\" target=\"_blank\" rel=\"noopener\">The T.M.I. Pregnancy,\u003c/a>” Patricia Volk lamented that all the testing surrounding her daughter-in-law’s supposedly “normal” pregnancy had left them both feeling “guardedly happy.” She recounted a series of scary ultrasound findings that turned out to be nothing, and mused: “Prenatal science has helped a lot [of] people and people-to-be. But just because a patient can know something, must she? Odds are in this baby’s favor, yet every sonogram adds something scary to the pot. What is one of the most joyous times of life has turned into something ominous and fraught, loaded with the potential to go wrong.”\u003c/p>\n\u003cp>Yet one person’s anxiety is another’s sigh of relief. The debate over what testing and how much hinges on so many factors. In fact, two letters to the editor in response to “The T.M.I. Pregnancy” highlight why this push-and-pull is one of the great medical and social conundrums of our time. In one, Alastair Pullen describes his experience declining all testing during his wife’s first pregnancy “for all of the reasons this article mentions.” Halfway through the pregnancy, he and his wife agreed to an ultrasound and discovered their daughter had a fatal condition and would not survive long after birth. “Faced with a horrible decision,” Pullen writes, “we decided to induce preterm labor. Becket was stillborn. The only thing worse would have been if we had had no knowledge of her condition.” Pullen had first decided not to test but ended up grateful he changed his mind. He and his wife welcomed testing in later pregnancies; they now have three healthy children, and, he says, “the barrage of testing affirmed our excitement.”\u003c/p>\n\u003cp>Ingrid Chafee, on the other hand, gave birth when no tests were available. She was shocked when she delivered her firstborn in 1965, only to learn he had hydrocephalus and spina bifida. Surgery repaired much of the damage, but her son — who now holds a doctorate from Oxford — still has physical problems. She concludes: “He has said many times that he is glad that there were no ultrasound tests available at the time of his birth. If there had been, he wouldn’t be here. To know or not to know? It’s up to each to decide.”\u003c/p>\n\u003cp>\u003cstrong>Who Is a Gift and Who a Burden?\u003c/strong>\u003c/p>\n\u003cp>The ethics of abortion are set to become much more complicated as more women have access to powerful genetic tests such as microarray, for these tests can identify genetic flaws that are not readily understood.\u003c/p>\n\u003cp>Microarray had confirmed that the almond skinned woman who had the fetal reduction was carrying one twin with Down syndrome. But in the case of more ambiguous genetic errors in a boy named Ryan Docherty, confirmation was the easy part. It was the interpretation — figuring out the significance of the problems that microarray had detected in utero — that proved difficult.\u003c/p>\n\u003cp>When she was pregnant, Ryan’s mom, Jen Sipress, had a microarray test. You’ll recall that chromosomal microarray analysis can detect deletions and duplications of genetic material — errors that are far smaller than an entire extra chromosome. But just because they’re smaller doesn’t mean they can’t wreak havoc. Some are associated with genetic disorders; many more aren’t associated with anything because they’re so newly discovered or because they don’t appear to be detrimental according to the limited amount of research that exists. Sipress, 42, is a New York City narcotics prosecutor; she thrives on evidence. When her test results came back, the evidence was disconcerting: Ryan, still in utero, had not one but two findings — “variants of uncertain significance” — inherited from his mother and his father. Docherty had passed down a duplication involving six genes, while Sipress had contributed a deletion on chromosome 15 involving four genes. In general, deletions are considered more worrisome than duplications; our bodies can often deal with some extra genetic material, but it’s not as easy to compensate for DNA gone AWOL. To make matters worse, one of the four missing genes had been associated in the medical literature with intellectual and developmental delay. Here’s where things got really confusing: Sipress was missing that same gene and she didn’t appear to be affected at all. She worked hard as the family’s primary income earner, putting drug dealers behind bars. She hadn’t even known she was missing any genes until the microarray results came back. But genes—or their absence — can affect people differently; it’s a phenomenon called “variable expressivity.”\u003c/p>\n\u003cp>Before the amniocentesis to collect fetal cells for the microarray analysis, Sipress and Docherty had decided that were they to learn that their unborn child wouldn’t be able to live independently as an adult, they would end the pregnancy. When they got the results, they leaned toward abortion. After talking to their doctor, Ron Wapner, author of a \u003cem>New England Journal of Medicine\u003c/em> study about microarray’s effectiveness, they changed their minds. As Sipress recalls, Wapner said, “‘I get people coming in here who . . . want to know this is 100 percent fine.’ And he said, ‘I can’t give you 100 percent. I can give you 80 percent.’ And I said, ‘I’m going to take those odds.’ ”\u003c/p>\n\u003cp>Emotionally, it was a terrible time for Sipress and Docherty. Ryan was their first child, and he had been conceived after two rounds of IVF. But Sipress doesn’t regret finding out. “I don’t understand why even women in their 20s aren’t undergoing this testing,” she says. “Knowledge is power. Doesn’t everyone realize that?”\u003c/p>\n\u003cp>It’s certainly made for some awkward conversations with her husband’s family in Scotland, who know about the missing genes. “They ask if there is something wrong with the kid, and I say, ‘Technically, yes, but he’s not exhibiting any symptoms,’ ” says Sipress. To that end, Docherty, who stays home with Ryan, is a vigilant observer. “Are we still worried?” says Docherty. “Absolutely.” It’s easy to attribute every behavioral challenge — Ryan’s not a good sleeper, but neither are lots of babies — to the missing genes. Anticipating this, Wapner has cautioned them against engaging in this sort of genetic determinism. “He said, ‘Go about your business. If you feel something is really wrong, then you act.’ To be honest,” says Docherty, “Ryan doesn’t have a problem, as far as I can see.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>To what end are we willing to go to detect disability? Once we find it, is there a dividing line between “good,” or tolerable, disabilities and “bad,” or intolerable, limitations? How do we decide which ones may warrant abortion and which are acceptable? What feels overwhelming to one person— the birth of a child with a genetic disorder— may feel like God’s gift to another. Who are we to judge what — who, more accurately—is a gift and who is a burden?\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/435960/advanced-prenatal-testing-will-mean-more-gut-wrenching-decisions-about-abortion","authors":["byline_futureofyou_435960"],"categories":["futureofyou_452","futureofyou_1","futureofyou_1064"],"tags":["futureofyou_342","futureofyou_1439","futureofyou_587","futureofyou_1275","futureofyou_1015","futureofyou_120","futureofyou_80","futureofyou_1386","futureofyou_1388","futureofyou_520","futureofyou_1389"],"featImg":"futureofyou_436849","label":"futureofyou"},"futureofyou_395754":{"type":"posts","id":"futureofyou_395754","meta":{"index":"posts_1591205157","site":"futureofyou","id":"395754","score":null,"sort":[1495737041000]},"guestAuthors":[],"slug":"mail-order-home-medical-abortions-found-as-safe-as-those-done-in-clinic","title":"Mail-Order Home Medical Abortions Found as Safe as Those Done in Clinic","publishDate":1495737041,"format":"aside","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Medical abortions done at home with online help and pills sent in the mail appear to be just as safe as those done at a clinic, according to a new study.\u003c/p>\n\u003cp>The research tracked the outcomes of 1,000 women in Ireland and Northern Ireland, who used a website run by a group called Women on Web to get abortion pills. The Netherlands-based nonprofit provides advice and pills to women seeking an early abortion in more than 140 countries where access to abortion is restricted. Ireland and Northern Ireland have some of the world's strictest laws, often only granting approval when a woman's life is at risk.\u003c/p>\n\u003cp>To use the service, women complete an online form, which is reviewed by a doctor. They are sent two drugs in the mail — mifepristone and misoprostol — and given instructions on how to take the pills, which have been used since 1988 to induce early abortions. They are later asked to fill out an evaluation form.\u003c/p>\n\u003cp>About 95 percent of the women in the study reported successfully ending their pregnancy; nearly all were less than nine weeks pregnant at the time of the online consultation. The researchers said less than 10 percent reported symptoms of a potentially serious complication like very heavy bleeding, fever or persistent pain, comparable to the rates for women who seek medical abortions at clinics where abortion is legal. Seven women needed a blood transfusion and 26 received antibiotics. No deaths were reported.\u003c/p>\n\u003cp>Follow-up information was missing for about one-third of the 1,636 women who were sent pills over three years, so some complications may have been missed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study was published online last week in the British journal, The BMJ. Women on Web provided the data and the patient feedback for the study; two of the authors are affiliated with the group. In the past decade, the group has helped about 50,000 women have a medical abortion at home.\u003c/p>\n\u003cp>\"We now have evidence that self-sourced medical abortion that's entirely outside the formal health care system can be safe and effective,\" said Dr. Abigail Aiken, an assistant professor at the University of Texas at Austin who led the study. \"Women are very capable of managing their own abortions and they're able to determine themselves when they need to seek medical attention.\"\u003cbr>\nOther experts agreed the study shows how women might be able to safely sidestep restrictive abortion laws.\u003c/p>\n\u003cp>\"This undermines the efficacy of these laws and leaves them unenforceable,\" said Bernard Dickens, a professor emeritus of health law and policy at the University of Toronto, who co-wrote an accompanying commentary. He cited a number of legal loopholes that would make it difficult to prosecute people helping women have an abortion at home.\u003c/p>\n\u003cp>Aiken said the website does not operate in the U.S. but that a telemedicine study of the abortion pill is underway.\u003c/p>\n\u003cp>Linda Kavanath, a spokeswoman for the Abortion Rights Campaign in Ireland, said women should be reassured about the safety of doing a medical abortion on their own, adding that the threat of a 14-year jail sentence in Ireland has had a chilling effect.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"These services will exist until the legislation is changed to grant women access to abortion,\" she said. \"Women will always find a way to have abortions and we're just fortunate that these safe methods now exist.\"\u003c/p>\n\n","blocks":[],"excerpt":"About 95 percent reported successfully ending their pregnancy. The researchers said less than 10 percent reported symptoms of a potentially serious complication.","status":"publish","parent":0,"modified":1495737041,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":570},"headData":{"title":"Mail-Order Home Medical Abortions Found as Safe as Those Done in Clinic | KQED","description":"About 95 percent reported successfully ending their pregnancy. The researchers said less than 10 percent reported symptoms of a potentially serious complication.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Mail-Order Home Medical Abortions Found as Safe as Those Done in Clinic","datePublished":"2017-05-25T18:30:41.000Z","dateModified":"2017-05-25T18:30:41.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"395754 https://ww2.kqed.org/futureofyou/?p=395754","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/05/25/mail-order-home-medical-abortions-found-as-safe-as-those-done-in-clinic/","disqusTitle":"Mail-Order Home Medical Abortions Found as Safe as Those Done in Clinic","nprByline":"Maria Cheng\u003cbr />Associated Press","path":"/futureofyou/395754/mail-order-home-medical-abortions-found-as-safe-as-those-done-in-clinic","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medical abortions done at home with online help and pills sent in the mail appear to be just as safe as those done at a clinic, according to a new study.\u003c/p>\n\u003cp>The research tracked the outcomes of 1,000 women in Ireland and Northern Ireland, who used a website run by a group called Women on Web to get abortion pills. The Netherlands-based nonprofit provides advice and pills to women seeking an early abortion in more than 140 countries where access to abortion is restricted. Ireland and Northern Ireland have some of the world's strictest laws, often only granting approval when a woman's life is at risk.\u003c/p>\n\u003cp>To use the service, women complete an online form, which is reviewed by a doctor. They are sent two drugs in the mail — mifepristone and misoprostol — and given instructions on how to take the pills, which have been used since 1988 to induce early abortions. They are later asked to fill out an evaluation form.\u003c/p>\n\u003cp>About 95 percent of the women in the study reported successfully ending their pregnancy; nearly all were less than nine weeks pregnant at the time of the online consultation. The researchers said less than 10 percent reported symptoms of a potentially serious complication like very heavy bleeding, fever or persistent pain, comparable to the rates for women who seek medical abortions at clinics where abortion is legal. Seven women needed a blood transfusion and 26 received antibiotics. No deaths were reported.\u003c/p>\n\u003cp>Follow-up information was missing for about one-third of the 1,636 women who were sent pills over three years, so some complications may have been missed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study was published online last week in the British journal, The BMJ. Women on Web provided the data and the patient feedback for the study; two of the authors are affiliated with the group. In the past decade, the group has helped about 50,000 women have a medical abortion at home.\u003c/p>\n\u003cp>\"We now have evidence that self-sourced medical abortion that's entirely outside the formal health care system can be safe and effective,\" said Dr. Abigail Aiken, an assistant professor at the University of Texas at Austin who led the study. \"Women are very capable of managing their own abortions and they're able to determine themselves when they need to seek medical attention.\"\u003cbr>\nOther experts agreed the study shows how women might be able to safely sidestep restrictive abortion laws.\u003c/p>\n\u003cp>\"This undermines the efficacy of these laws and leaves them unenforceable,\" said Bernard Dickens, a professor emeritus of health law and policy at the University of Toronto, who co-wrote an accompanying commentary. He cited a number of legal loopholes that would make it difficult to prosecute people helping women have an abortion at home.\u003c/p>\n\u003cp>Aiken said the website does not operate in the U.S. but that a telemedicine study of the abortion pill is underway.\u003c/p>\n\u003cp>Linda Kavanath, a spokeswoman for the Abortion Rights Campaign in Ireland, said women should be reassured about the safety of doing a medical abortion on their own, adding that the threat of a 14-year jail sentence in Ireland has had a chilling effect.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"These services will exist until the legislation is changed to grant women access to abortion,\" she said. \"Women will always find a way to have abortions and we're just fortunate that these safe methods now exist.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/395754/mail-order-home-medical-abortions-found-as-safe-as-those-done-in-clinic","authors":["byline_futureofyou_395754"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1"],"tags":["futureofyou_342","futureofyou_1280","futureofyou_1127","futureofyou_1126","futureofyou_1281"],"featImg":"futureofyou_397500","label":"futureofyou"},"futureofyou_283173":{"type":"posts","id":"futureofyou_283173","meta":{"index":"posts_1591205157","site":"futureofyou","id":"283173","score":null,"sort":[1479337968000]},"guestAuthors":[],"slug":"abortion-by-mail-study-outrages-opponents","title":"Abortion-By-Mail Study Outrages Opponents","publishDate":1479337968,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me.'\u003c/aside>\n\u003cp>“I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.\u003c/p>\n\u003cp>Marie is part of a small but closely watched research effort to determine whether medical abortions — those induced by medicine instead of surgery — can be done safely through an online consultation with a doctor and drugs mailed to a woman’s home.\u003c/p>\n\u003cp>At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women. Opponents of abortion find the concept dangerous and deeply disturbing.\u003c/p>\n\u003cp>The idea builds on a trend that is helping women obtain birth control more easily. A growing number of smartphone apps and websites now make it possible to get prescription contraceptives without visiting a doctor’s office first. The pills Marie and the other women received through the study are not allowed for sale in pharmacies and are usually available only at hospitals and abortion clinics.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Australia and the Canadian province of British Columbia allow women to get abortion pills by mail after consulting with a physician or other health care provider via phone or the internet. Several international organizations offer mail service in countries where abortion is otherwise unavailable or severely restricted. The oldest group, Women on Web, based in the Netherlands, has provided abortion medications to about 50,000 women in 130 countries since 2006. The service is not available in the United States, and the Food and Drug Administration warns against buying the drugs over the internet.\u003c/p>\n\u003cp>Having the pills delivered to her home in Hawaii meant that Marie could avoid the cost and time of traveling by plane to the nearest abortion clinic, over 100 miles away in Honolulu or Maui. Once she received them, she set the package aside for a week in her bedroom, waiting until she could schedule time off from her job at McDonald’s.\u003c/p>\n\u003cp>\u003cstrong>Over in Three Hours\u003c/strong>\u003c/p>\n\u003cp>The first pill, as expected, had little effect. The next morning, with her mother at her home to watch her toddler, she took the second. Almost immediately, the bleeding and cramping began. Within three hours, her eight-week pregnancy was over. She described the pain as a five on a 10-point scale. That night she cooked dinner for her family, and the next day she went back to work.\u003c/p>\n\u003cp>The study Marie participated in is being conducted in four states — Hawaii, New York, Oregon and Washington. It is being funded and organized by Gynuity Health Projects, a nonprofit research group focused on reproductive health services that seeks to improve women’s access to medical abortions. The FDA has allowed the experiment. Women learn about it when contacting the abortion clinics in the study and other health providers who are aware of the trial and the website telabortion.org.\u003c/p>\n\u003cp>Danco Laboratories, the company that makes the pills, has no plans to seek wider distribution of the medication either through mail-order pharmacies or physical pharmacies, a spokeswoman said. It would have to seek the FDA’s permission to do so; the agency can also ask companies to change how their drugs are distributed.\u003c/p>\n\u003cp>“Abortion is a politically charged issue in this country, and there is an extra degree of caution,” said the spokeswoman, Abby Long, explaining that research would be needed to support changing the drug’s distribution.\u003c/p>\n\u003cp>Of the first 12 women who participated in the study, all in Hawaii, 11 reported they had no complications and one did not take the pills, researchers said. Ten who completed surveys afterward said they were satisfied with the service and would recommend it to a friend, according to the researchers.\u003c/p>\n\u003cp>“It’s absolutely an important step forward to expanding access to abortion that is safe and effective and creating options for women,” said Susan Wood, director of the Jacobs Institute of Women’s Health at George Washington University, in Washington, D.C. She was not involved in the study.\u003c/p>\n\u003cp>\u003cstrong>Outraged\u003c/strong>\u003c/p>\n\u003cp>Anti-abortion groups are outraged by the experiment.\u003c/p>\n\u003cp>“We have grave concerns about handing out dangerous, life-ending drugs without medical supervision because women face great risks for chemical abortions,” said Kristi Hamrick, spokeswoman for Americans United for Life.\u003c/p>\n\u003cp>Carol Tobias, president of the National Right to Life Committee, also raised safety concerns.\u003c/p>\n\u003cp>“If pills are sent through the mail, who are they supposed to call if they have a problem?” she said.\u003c/p>\n\u003cp>“There are serious downsides from the pills,” she said, adding, “and just talking to someone over a computer and sending pills in the mail, to me, that is just reckless.”\u003c/p>\n\u003cp>The process does not allow women to avoid the doctor’s office entirely. Using a video hookup on a home computer, a woman first consults with a doctor (or other clinician such as a nurse practitioner) at one of three participating abortion clinics who evaluates her medical history and explains how to take abortion pills and what to expect afterward. She must then get medical tests including ultrasound and bloodwork.\u003c/p>\n\u003cp>If the tests show she is eligible for the study, the clinic sends her a package with pills and instructions via overnight mail. After taking them, she has some additional tests, such as an ultrasound to verify that the abortion is complete and also a phone consultation to review the results.\u003c/p>\n\u003cp>\u003cstrong>Declining Access\u003c/strong>\u003c/p>\n\u003cp>Access to abortion has been declining steadily in the United States as dozens of clinics have been forced to close under new state restrictions. In Texas, the number of clinics fell to 18 in 2015 from 41 in 2012. Five states have just one clinic that offers abortions.\u003c/p>\n\u003cp>Medical abortions require women to take two drugs that together induce a miscarriage. The first, mifepristone (marketed as Mifeprex), is typically taken in a doctor’s office or clinic while the second, misoprostol, is given to the woman to take at home the next day.\u003c/p>\n\u003cp>In the United States, the FDA has approved medical abortion pills for use only in the first 10 weeks of pregnancy, while surgical abortions can be done later than that.\u003c/p>\n\u003cp>Medical abortions make up a quarter of all abortions in the country. About 2.8 million women in the United States have used mifepristone to terminate a pregnancy since the drug’s approval in 2000, according to Danco Laboratories, its manufacturer.\u003c/p>\n\u003cp>The American abortion study using overnight mail comes nearly a decade after Iowa became the first state to offer medical abortion counseling via telemedicine from a physician. But in Iowa and the three states that followed — Alaska, Maine and Minnesota — women must still go to a clinic that stocks mifepristone to receive the pills.\u003c/p>\n\u003cp>If the study shows the telemedicine and mail approach works, that could encourage the FDA to stop restrictions on mifepristone, Gynuity’s principal investigator, Dr. Elizabeth Raymond, said.\u003c/p>\n\u003cp>“All kinds of dangerous drugs are prescribed and available at pharmacies, including drugs for heart disease and Viagra,” she said. “There is no justification for why this safe drug should not be in pharmacies now.”\u003c/p>\n\u003cp>But even if the FDA were to lift its restriction on where abortion pills are dispensed, 19 states ban the use of telemedicine for abortion and require a physician to be physically present when consulting a woman, according to the Guttmacher Institute, a reproductive rights research group.\u003c/p>\n\u003cp>“While this has the potential for being the future of abortion delivery for a good segment of the population, that vision might not be fulfilled due to the politics around the issue and restrictions in many states,” said Jessica Arons, president and chief executive of the Reproductive Health Technologies Project in Washington, an advocacy group.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"A small but closely watched study is underway to determine whether abortions induced by medicine instead of surgery can be done safely with just an online consultation and drugs mailed to the home.","status":"publish","parent":0,"modified":1479432360,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1440},"headData":{"title":"Abortion-By-Mail Study Outrages Opponents | KQED","description":"A small but closely watched study is underway to determine whether abortions induced by medicine instead of surgery can be done safely with just an online consultation and drugs mailed to the home.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Abortion-By-Mail Study Outrages Opponents","datePublished":"2016-11-16T23:12:48.000Z","dateModified":"2016-11-18T01:26:00.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"283173 http://ww2.kqed.org/futureofyou/?p=283173","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/11/16/abortion-by-mail-study-outrages-opponents/","disqusTitle":"Abortion-By-Mail Study Outrages Opponents","source":"Future of You","nprByline":"Phil Galewitz\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/futureofyou/283173/abortion-by-mail-study-outrages-opponents","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me.'\u003c/aside>\n\u003cp>“I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.\u003c/p>\n\u003cp>Marie is part of a small but closely watched research effort to determine whether medical abortions — those induced by medicine instead of surgery — can be done safely through an online consultation with a doctor and drugs mailed to a woman’s home.\u003c/p>\n\u003cp>At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women. Opponents of abortion find the concept dangerous and deeply disturbing.\u003c/p>\n\u003cp>The idea builds on a trend that is helping women obtain birth control more easily. A growing number of smartphone apps and websites now make it possible to get prescription contraceptives without visiting a doctor’s office first. The pills Marie and the other women received through the study are not allowed for sale in pharmacies and are usually available only at hospitals and abortion clinics.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Australia and the Canadian province of British Columbia allow women to get abortion pills by mail after consulting with a physician or other health care provider via phone or the internet. Several international organizations offer mail service in countries where abortion is otherwise unavailable or severely restricted. The oldest group, Women on Web, based in the Netherlands, has provided abortion medications to about 50,000 women in 130 countries since 2006. The service is not available in the United States, and the Food and Drug Administration warns against buying the drugs over the internet.\u003c/p>\n\u003cp>Having the pills delivered to her home in Hawaii meant that Marie could avoid the cost and time of traveling by plane to the nearest abortion clinic, over 100 miles away in Honolulu or Maui. Once she received them, she set the package aside for a week in her bedroom, waiting until she could schedule time off from her job at McDonald’s.\u003c/p>\n\u003cp>\u003cstrong>Over in Three Hours\u003c/strong>\u003c/p>\n\u003cp>The first pill, as expected, had little effect. The next morning, with her mother at her home to watch her toddler, she took the second. Almost immediately, the bleeding and cramping began. Within three hours, her eight-week pregnancy was over. She described the pain as a five on a 10-point scale. That night she cooked dinner for her family, and the next day she went back to work.\u003c/p>\n\u003cp>The study Marie participated in is being conducted in four states — Hawaii, New York, Oregon and Washington. It is being funded and organized by Gynuity Health Projects, a nonprofit research group focused on reproductive health services that seeks to improve women’s access to medical abortions. The FDA has allowed the experiment. Women learn about it when contacting the abortion clinics in the study and other health providers who are aware of the trial and the website telabortion.org.\u003c/p>\n\u003cp>Danco Laboratories, the company that makes the pills, has no plans to seek wider distribution of the medication either through mail-order pharmacies or physical pharmacies, a spokeswoman said. It would have to seek the FDA’s permission to do so; the agency can also ask companies to change how their drugs are distributed.\u003c/p>\n\u003cp>“Abortion is a politically charged issue in this country, and there is an extra degree of caution,” said the spokeswoman, Abby Long, explaining that research would be needed to support changing the drug’s distribution.\u003c/p>\n\u003cp>Of the first 12 women who participated in the study, all in Hawaii, 11 reported they had no complications and one did not take the pills, researchers said. Ten who completed surveys afterward said they were satisfied with the service and would recommend it to a friend, according to the researchers.\u003c/p>\n\u003cp>“It’s absolutely an important step forward to expanding access to abortion that is safe and effective and creating options for women,” said Susan Wood, director of the Jacobs Institute of Women’s Health at George Washington University, in Washington, D.C. She was not involved in the study.\u003c/p>\n\u003cp>\u003cstrong>Outraged\u003c/strong>\u003c/p>\n\u003cp>Anti-abortion groups are outraged by the experiment.\u003c/p>\n\u003cp>“We have grave concerns about handing out dangerous, life-ending drugs without medical supervision because women face great risks for chemical abortions,” said Kristi Hamrick, spokeswoman for Americans United for Life.\u003c/p>\n\u003cp>Carol Tobias, president of the National Right to Life Committee, also raised safety concerns.\u003c/p>\n\u003cp>“If pills are sent through the mail, who are they supposed to call if they have a problem?” she said.\u003c/p>\n\u003cp>“There are serious downsides from the pills,” she said, adding, “and just talking to someone over a computer and sending pills in the mail, to me, that is just reckless.”\u003c/p>\n\u003cp>The process does not allow women to avoid the doctor’s office entirely. Using a video hookup on a home computer, a woman first consults with a doctor (or other clinician such as a nurse practitioner) at one of three participating abortion clinics who evaluates her medical history and explains how to take abortion pills and what to expect afterward. She must then get medical tests including ultrasound and bloodwork.\u003c/p>\n\u003cp>If the tests show she is eligible for the study, the clinic sends her a package with pills and instructions via overnight mail. After taking them, she has some additional tests, such as an ultrasound to verify that the abortion is complete and also a phone consultation to review the results.\u003c/p>\n\u003cp>\u003cstrong>Declining Access\u003c/strong>\u003c/p>\n\u003cp>Access to abortion has been declining steadily in the United States as dozens of clinics have been forced to close under new state restrictions. In Texas, the number of clinics fell to 18 in 2015 from 41 in 2012. Five states have just one clinic that offers abortions.\u003c/p>\n\u003cp>Medical abortions require women to take two drugs that together induce a miscarriage. The first, mifepristone (marketed as Mifeprex), is typically taken in a doctor’s office or clinic while the second, misoprostol, is given to the woman to take at home the next day.\u003c/p>\n\u003cp>In the United States, the FDA has approved medical abortion pills for use only in the first 10 weeks of pregnancy, while surgical abortions can be done later than that.\u003c/p>\n\u003cp>Medical abortions make up a quarter of all abortions in the country. About 2.8 million women in the United States have used mifepristone to terminate a pregnancy since the drug’s approval in 2000, according to Danco Laboratories, its manufacturer.\u003c/p>\n\u003cp>The American abortion study using overnight mail comes nearly a decade after Iowa became the first state to offer medical abortion counseling via telemedicine from a physician. But in Iowa and the three states that followed — Alaska, Maine and Minnesota — women must still go to a clinic that stocks mifepristone to receive the pills.\u003c/p>\n\u003cp>If the study shows the telemedicine and mail approach works, that could encourage the FDA to stop restrictions on mifepristone, Gynuity’s principal investigator, Dr. Elizabeth Raymond, said.\u003c/p>\n\u003cp>“All kinds of dangerous drugs are prescribed and available at pharmacies, including drugs for heart disease and Viagra,” she said. “There is no justification for why this safe drug should not be in pharmacies now.”\u003c/p>\n\u003cp>But even if the FDA were to lift its restriction on where abortion pills are dispensed, 19 states ban the use of telemedicine for abortion and require a physician to be physically present when consulting a woman, according to the Guttmacher Institute, a reproductive rights research group.\u003c/p>\n\u003cp>“While this has the potential for being the future of abortion delivery for a good segment of the population, that vision might not be fulfilled due to the politics around the issue and restrictions in many states,” said Jessica Arons, president and chief executive of the Reproductive Health Technologies Project in Washington, an advocacy group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/283173/abortion-by-mail-study-outrages-opponents","authors":["byline_futureofyou_283173"],"categories":["futureofyou_1060","futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_342","futureofyou_1127","futureofyou_1126"],"featImg":"futureofyou_283176","label":"source_futureofyou_283173"},"futureofyou_3240":{"type":"posts","id":"futureofyou_3240","meta":{"index":"posts_1591205157","site":"futureofyou","id":"3240","score":null,"sort":[1432143022000]},"guestAuthors":[],"slug":"telemedicine-abortions-under-attack-as-a-new-option-for-women","title":"Telemedicine Abortions Under Attack as a New Option for Women","publishDate":1432143022,"format":"standard","headTitle":"Contributor | KQED Future of You | KQED Science","labelTerm":{"term":172,"site":"futureofyou"},"content":"\u003cp>The House of Representatives’ approval last week of a bill to ban abortions after 20 weeks brings into sharp focus the issue of early access to abortion. Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine.\u003c/p>\n\u003cp>Iowa and Minnesota are the only states that offer so-called “telemed” abortions. Women who choose this option confer with a doctor through an Internet video connection and can then be prescribed two drugs, mifepristone and misoprostol, which when taken in sequence induce an abortion. Women who opt for a medication abortion can be no more than nine weeks into their pregnancy.\u003c/p>\n\u003cp>Supporters of telemed abortions say it increases the odds that a woman will be able to get an abortion earlier in her pregnancy, when the procedure is safer and cheaper, and in areas where providers are stretched thin. In 2011, \u003ca href=\"http://www.guttmacher.org/pubs/journals/psrh.46e0414.pdf\">89 percent of counties nationwide had no clinics that provided abortion services\u003c/a>, according to the Guttmacher Institute, and more than a third of women of childbearing age lived in those counties.\u003c/p>\n\u003cp>Opponents say that “webcam” abortions are unsafe and suggest that clinics are using them as moneymakers to boost the number of abortions they can provide.\u003c/p>\n\u003cp>“We believe it’s too dangerous for women,” says Cheryl Sullenger, a senior policy adviser at Operation Rescue, a group that opposes abortion. “There’s no physical exam ahead of time, and there are a lot of cues a doctor gets from a medical exam.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Planned Parenthood of the Heartland provides surgical and medication abortion at two of its 13 sites in Iowa and telemed medication abortions at six sites. The organization began offering telemed services in 2008.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful.\"\u003cbr>\n\u003ccite>Greg Hoversten, an Iowa City physician\u003c/cite>\u003c/aside>\n\u003cp>If a woman opts for a medication abortion through that group, she’ll go to the clinic and meet with a member of the staff who will explain the procedure and answer questions, get her informed consent, check her blood type and take a brief medical history. She’ll have an ultrasound to ensure she’s not more than nine weeks pregnant.\u003c/p>\n\u003cp>Then the staff member will connect her via videoconference with the doctor, who will review the ultrasound and any other relevant medical information, and talk with the patient to ensure she’s comfortable with her decision.\u003c/p>\n\u003cp>At that point, the doctor will use a computer to unlock a drawer in the clinic that contains the pills. While the doctor and staff member observe, the patient will take the first pill, then bring the second pill home to take 24 to 48 hours later. A follow-up visit is scheduled two weeks later to make sure the abortion was successful.\u003c/p>\n\u003cp>\u003cb>A Safer Option for Women? \u003c/b>\u003c/p>\n\u003cp>Penny Dickey, chief clinical officer at Planned Parenthood of the Heartland, says patients get exactly the same care in person or in the telemedicine appointments.\u003c/p>\n\u003cp>The overall rate of abortion has \u003ca href=\"http://www.guttmacher.org/media/nr/2014/02/03/\">decreased in Iowa, as it has nationally since 1981\u003c/a>. Medication abortions, whether provided telemedically or face to face, accounted for nearly a quarter of abortions in 2011, up from 17 percent in 2008.\u003c/p>\n\u003cp>Meanwhile, a study comparing the two-year periods before and after telemed abortions were introduced found that the proportion of medication abortions increased from 46 percent to 54 percent at the Iowa Planned Parenthood clinics. The study published in the American Journal of Public Health in 2012 also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518368/\">found that women were 46 percent more likely to have an abortion during their first trimester\u003c/a> after telemed abortions were introduced.\u003c/p>\n\u003cp>“From a public health perspective, even though there was a relatively small decline in second trimester abortions, it’s significant,” says Daniel Grossman, lead author of the study and vice president for research at Ibis Reproductive Health, an organization focused on women’s reproductive health. “Second trimester abortions have higher complications and are more expensive for women.”\u003c/p>\n\u003cp>Cost is an issue, since only about 12 percent of abortions are paid for by private insurance, \u003ca href=\"http://www.guttmacher.org/media/inthenews/2011/01/19/index.html\">a study\u003c/a> by the Guttmacher Institute found.\u003c/p>\n\u003cp>The median cost of a first-trimester abortion, whether surgical or medication, \u003ca href=\"http://www.guttmacher.org/pubs/journals/j.whi.2014.05.002.pdf\">was approximately $500 in 2012\u003c/a>, compared with a median cost of $1,350 for a surgical abortion at 20 weeks, according to Guttmacher.\u003c/p>\n\u003cp>The Iowa telemed operation may be on borrowed time, however. In 2013, the state Board of Medicine adopted a new rule that requires a physician to be physically present for a medication abortion. Planned Parenthood of the Heartland sued, and the group is awaiting a decision by the state’s Supreme Court, expected “anytime,” according to Mike Falkstrom, the group’s general counsel.\u003c/p>\n\u003cp>After an emotionally charged hearing, the board chairman said his group acted because of concerns that women’s health was not being protected in the telemed abortions. Greg Hoversten, an Iowa City physician, said at the hearing that complications could be serious, \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/08/30/iowa-board-bans-telemedicine-abortions/2750185/\">according to quotes in the Des Moines Register\u003c/a>.\u003c/p>\n\u003cp>“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful,” he said when explaining why he thought a physician should be close by.\u003c/p>\n\u003cp>The Iowa rule is similar to actions in 16\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_MA.pdf\"> other states that require physicians to be in the room to provide medication abortions\u003c/a>.\u003c/p>\n\u003cp>Supporters of telemed abortions argue that the procedure is safe and having a doctor physically present is unnecessary.\u003c/p>\n\u003cp>In a 2011 study published in Obstetrics & Gynecology, Grossman compared the results for patients who received medication abortions telemedically in Iowa versus those who were in the room with the doctor. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21775845\">The results were almost identical\u003c/a>: 99 percent of telemedicine patients had a successful abortion compared with 97 percent of those who were face-to-face with the doctor.\u003c/p>\n\u003cp>“Adverse events are no higher with telemedicine,” says Grossman. “We have looked at this and we have some data that shows it’s just as safe as medication abortions provided in person.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story originally ran on \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine.","status":"publish","parent":0,"modified":1434048237,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":1075},"headData":{"title":"Telemedicine Abortions Under Attack as a New Option for Women | KQED","description":"Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Telemedicine Abortions Under Attack as a New Option for Women","datePublished":"2015-05-20T17:30:22.000Z","dateModified":"2015-06-11T18:43:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"3240 http://ww2.kqed.org/futureofyou/?p=3240","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/05/20/telemedicine-abortions-under-attack-as-a-new-option-for-women/","disqusTitle":"Telemedicine Abortions Under Attack as a New Option for Women","nprByline":"Michelle Andrews, Kaiser Health News","path":"/futureofyou/3240/telemedicine-abortions-under-attack-as-a-new-option-for-women","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The House of Representatives’ approval last week of a bill to ban abortions after 20 weeks brings into sharp focus the issue of early access to abortion. Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine.\u003c/p>\n\u003cp>Iowa and Minnesota are the only states that offer so-called “telemed” abortions. Women who choose this option confer with a doctor through an Internet video connection and can then be prescribed two drugs, mifepristone and misoprostol, which when taken in sequence induce an abortion. Women who opt for a medication abortion can be no more than nine weeks into their pregnancy.\u003c/p>\n\u003cp>Supporters of telemed abortions say it increases the odds that a woman will be able to get an abortion earlier in her pregnancy, when the procedure is safer and cheaper, and in areas where providers are stretched thin. In 2011, \u003ca href=\"http://www.guttmacher.org/pubs/journals/psrh.46e0414.pdf\">89 percent of counties nationwide had no clinics that provided abortion services\u003c/a>, according to the Guttmacher Institute, and more than a third of women of childbearing age lived in those counties.\u003c/p>\n\u003cp>Opponents say that “webcam” abortions are unsafe and suggest that clinics are using them as moneymakers to boost the number of abortions they can provide.\u003c/p>\n\u003cp>“We believe it’s too dangerous for women,” says Cheryl Sullenger, a senior policy adviser at Operation Rescue, a group that opposes abortion. “There’s no physical exam ahead of time, and there are a lot of cues a doctor gets from a medical exam.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Planned Parenthood of the Heartland provides surgical and medication abortion at two of its 13 sites in Iowa and telemed medication abortions at six sites. The organization began offering telemed services in 2008.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful.\"\u003cbr>\n\u003ccite>Greg Hoversten, an Iowa City physician\u003c/cite>\u003c/aside>\n\u003cp>If a woman opts for a medication abortion through that group, she’ll go to the clinic and meet with a member of the staff who will explain the procedure and answer questions, get her informed consent, check her blood type and take a brief medical history. She’ll have an ultrasound to ensure she’s not more than nine weeks pregnant.\u003c/p>\n\u003cp>Then the staff member will connect her via videoconference with the doctor, who will review the ultrasound and any other relevant medical information, and talk with the patient to ensure she’s comfortable with her decision.\u003c/p>\n\u003cp>At that point, the doctor will use a computer to unlock a drawer in the clinic that contains the pills. While the doctor and staff member observe, the patient will take the first pill, then bring the second pill home to take 24 to 48 hours later. A follow-up visit is scheduled two weeks later to make sure the abortion was successful.\u003c/p>\n\u003cp>\u003cb>A Safer Option for Women? \u003c/b>\u003c/p>\n\u003cp>Penny Dickey, chief clinical officer at Planned Parenthood of the Heartland, says patients get exactly the same care in person or in the telemedicine appointments.\u003c/p>\n\u003cp>The overall rate of abortion has \u003ca href=\"http://www.guttmacher.org/media/nr/2014/02/03/\">decreased in Iowa, as it has nationally since 1981\u003c/a>. Medication abortions, whether provided telemedically or face to face, accounted for nearly a quarter of abortions in 2011, up from 17 percent in 2008.\u003c/p>\n\u003cp>Meanwhile, a study comparing the two-year periods before and after telemed abortions were introduced found that the proportion of medication abortions increased from 46 percent to 54 percent at the Iowa Planned Parenthood clinics. The study published in the American Journal of Public Health in 2012 also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518368/\">found that women were 46 percent more likely to have an abortion during their first trimester\u003c/a> after telemed abortions were introduced.\u003c/p>\n\u003cp>“From a public health perspective, even though there was a relatively small decline in second trimester abortions, it’s significant,” says Daniel Grossman, lead author of the study and vice president for research at Ibis Reproductive Health, an organization focused on women’s reproductive health. “Second trimester abortions have higher complications and are more expensive for women.”\u003c/p>\n\u003cp>Cost is an issue, since only about 12 percent of abortions are paid for by private insurance, \u003ca href=\"http://www.guttmacher.org/media/inthenews/2011/01/19/index.html\">a study\u003c/a> by the Guttmacher Institute found.\u003c/p>\n\u003cp>The median cost of a first-trimester abortion, whether surgical or medication, \u003ca href=\"http://www.guttmacher.org/pubs/journals/j.whi.2014.05.002.pdf\">was approximately $500 in 2012\u003c/a>, compared with a median cost of $1,350 for a surgical abortion at 20 weeks, according to Guttmacher.\u003c/p>\n\u003cp>The Iowa telemed operation may be on borrowed time, however. In 2013, the state Board of Medicine adopted a new rule that requires a physician to be physically present for a medication abortion. Planned Parenthood of the Heartland sued, and the group is awaiting a decision by the state’s Supreme Court, expected “anytime,” according to Mike Falkstrom, the group’s general counsel.\u003c/p>\n\u003cp>After an emotionally charged hearing, the board chairman said his group acted because of concerns that women’s health was not being protected in the telemed abortions. Greg Hoversten, an Iowa City physician, said at the hearing that complications could be serious, \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/08/30/iowa-board-bans-telemedicine-abortions/2750185/\">according to quotes in the Des Moines Register\u003c/a>.\u003c/p>\n\u003cp>“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful,” he said when explaining why he thought a physician should be close by.\u003c/p>\n\u003cp>The Iowa rule is similar to actions in 16\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_MA.pdf\"> other states that require physicians to be in the room to provide medication abortions\u003c/a>.\u003c/p>\n\u003cp>Supporters of telemed abortions argue that the procedure is safe and having a doctor physically present is unnecessary.\u003c/p>\n\u003cp>In a 2011 study published in Obstetrics & Gynecology, Grossman compared the results for patients who received medication abortions telemedically in Iowa versus those who were in the room with the doctor. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21775845\">The results were almost identical\u003c/a>: 99 percent of telemedicine patients had a successful abortion compared with 97 percent of those who were face-to-face with the doctor.\u003c/p>\n\u003cp>“Adverse events are no higher with telemedicine,” says Grossman. “We have looked at this and we have some data that shows it’s just as safe as medication abortions provided in person.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story originally ran on \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/3240/telemedicine-abortions-under-attack-as-a-new-option-for-women","authors":["byline_futureofyou_3240"],"series":["futureofyou_172"],"categories":["futureofyou_1"],"tags":["futureofyou_342","futureofyou_346","futureofyou_348","futureofyou_138","futureofyou_270","futureofyou_80","futureofyou_347","futureofyou_349","futureofyou_345","futureofyou_344","futureofyou_343"],"featImg":"futureofyou_3241","label":"futureofyou_172"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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