Correcting Untruths about Abortion and Contraception at U.Va.

It has come to the University's attention that there are individuals in our community who while they lack any scientific training or clinical experience have taken it upon themselves to disseminate inaccurate information about specific University health care procedures and policies.
 
In addition, they have unjustly attacked the credibility of a number of University staff members who have dedicated their lives to the health and well-being of our patients and our students. These assertions that U.Va. leaders have engaged in any unethical practices are unsupported and simply untrue.
 
The University physicians and nurses who have come under attack are individuals who have committed decades to providing the best possible care to our patients at the University, whose work has been recognized as extraordinarily competent and compassionate by individuals directly observing it and benefiting from it, and who continue to be regarded as role models in these qualities for the next generation of young physicians and nurses in training. They live by the highest professional and ethical standards.
 
In an effort to set the record straight, the University developed this Q&A to provide truthful information for reasonable individuals who might want to ask legitimate questions about the services provided by University-associated clinicians to their patients.

Q. Are abortions performed at the Medical Center?

A. Yes. Abortions are performed at the Medical Center in accordance with the legal framework established in Roe v. Wade and pertinent sections of the Code of Virginia. The Medical Center receives neither federal nor state funds for performing abortions. Most other academic medical centers in the U.S. similarly provide this service for their patients.

Q. What are the reasons for abortions that are performed at the Medical Center?

A. Abortions are performed because of fetal anomalies, rape or incest, endangerment of the life of the woman, or other compelling personal factors.

Q. How far along in her pregnancy can a woman obtain an abortion at UVa Medical Center?

A. Elective abortions are performed up to 14 weeks gestational age (12 weeks after conception).

Abortions for genetically or developmentally abnormal pregnancies are generally performed up to 22 weeks gestational age (20 weeks after conception).

Q. Are women contemplating abortion at the Medical Center provided with accurate information about the alternatives as well as the short and long-term risks of abortion?

A. Yes. Women receive non-directive all-options counseling at least 24 hours prior to the procedure. This includes the nature, benefits and risks of, and alternatives to the abortion procedure. The benefits and risks addressed include both physical and mental health issues. The women are offered printed materials from the Department of Health about services available for pregnant women, about fetal development, and about abortion.1,2,3

Q. Are women contemplating abortion at the Medical Center provided with accurate information about services related to continuing the pregnancy?

A. Yes. They are informed about the availability of prenatal, neonatal, and postnatal care, as well as about social service support systems and adoption options.

Can staff and trainees decline to provide abortion-related services without penalty?

A. Yes. However, all staff and trainees are expected to participate in the emergency care of a patient who is seeking or who has had abortion-related services.4

Q. Are abortions performed at the Student Health Center or the Teen Health Center?

A. No. Abortions are not performed at Student Health or at the Teen Health Center.

Q. Do the Student Health Center and the Teen Health Center offer advice to women related to unplanned pregnancies?

A. Yes. Student Health and Teen Health Center clinicians provide non-directive, all-options counseling to patients who have unplanned pregnancies. Student Health and the Teen Health Center clinicians do not force information or recommendations of any kind for particular options onto any patient. This approach is consistent with national guidelines for women's health care. The Teen Health Center provides prenatal care for women who continue their pregnancies and has a Social Worker on staff who assists with adoption services.

Q. How many UVa students have unplanned pregnancies?

A. The number of unplanned pregnancies among UVa student patients has declined dramatically over the last several decades. In the early 1980's, around 220 student patients per year presented with unplanned pregnancies, and 95 % elected to undergo abortions. During each of the past five years, the number of student patients presenting with unplanned pregnancies has been between 10 and 15. Approximately half the women chose to carry the pregnancy to term, and the other half chose abortions. There are many contributors to the dramatic reduction of unplanned pregnancies and abortions.

Q. Does having an abortion increase a woman's risk of breast cancer?

A. No. There is no increase in breast cancer risk associated with abortion at any age.5, 6

Q. Does having an abortion increase a woman's risk of a subsequent preterm birth?

A. Perhaps. Although scientific evidence is not yet compelling, surgical abortion may increase a woman's chance of having a subsequent preterm birth.7 The risk of preterm birth increases with the number of surgical abortions that a woman undergoes. Patients seeking abortions at the Medical Center are informed about this possible risk. (Most preterm births occur in women with either no risk factors or with other known risk factors, not prior abortion.8)

Q. Do Medical Center and Student Health Center clinicians adequately inform patients of the risks of contraception?

A. Yes, Medical Center (including the Teen Health Center) and Student Health Center clinicians apprise patients of the significant risks that are uncommonly associated with contraception. Patients are also provided with information about the risks of pregnancy. The provision of contraceptive counseling and prescriptions does not require written informed consent.

The Student Health Gynecology Clinic provides students with comprehensive information sheets with details about hormonal contraception and emergency contraception, including information on safety, associated risks, possible side effects, and warning signs of problems.

Q. Do the Medical Center and the Student Health Center offer emergency contraception to patients? How does it work?

A. Emergency contraception is available at pharmacies over-the-counter to women age 17 and older. Charlottesville's pharmacies are similar to those in all other Virginia cities in this regard. Emergency contraception is available by prescription to women under age 17 from clinicians at the Medical Center and at Student Health. Recent scientific research has shown that emergency contraception works by disrupting ovulation.9 It is unlikely to act by interfering with implantation although the possibility has not yet been completed excluded. Mifepristone (RU486) and misoprostol are not FDA-approved methods of emergency contraception and are not prescribed or provided by either the Teen Health Center or Student Health.

Q. Does Student Health employ students to distribute emergency contraception on Grounds?

A. No. The allegation that Student Health has ever employed students to carry the "morning-after pill" around Grounds and distribute it during weekends is absolutely untrue.

Q. Does emergency contraception increase a woman's risk of serious health problems or death?

A. No. There have been no deaths or serious complications causally linked to emergency contraception10. Pregnancy itself is associated with risks to a woman's health and life.

Q. Does emergency contraception increase a woman's risk for having an ectopic pregnancy?

A. No. Emergency contraception reduces the risk of ectopic pregnancy because it prevents pregnancy overall.10

References

1. Virginia Department of Health. A Virginia Guide to Services for the Pregnant Woman.
2. Virginia Department of Health. Fetal Development – Understanding the Stages.
3. Virginia Department of Health. Abortion – Making an Informed Decision.
4. The Limits of Conscientious Refusal in Reproductive Medicine ACOG Committee Opinion no. 385. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110:1203-81.
5. Induced Abortion and Breast Cancer Risk. ACOG Committee Opinion No. 434. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;113:1417–8.
6. Beral V, Bull D, Dell R, Peto R, Reeves G. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries. Collaborative Group on Hormonal Factors in Breast Cancer. Lancet 2004;363: 1007–16.
7. Shah, P., Zao, J. and on behalf of Knowledge Synthesis Group of Determinants of preterm/LBW births. Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta-analyses. BJOG: An International Journal of Obstetrics & Gynaecology 2009; 116: 1425–1442.
8. Richard E. Behrman, Adrienne Stith Butler, Editors, Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences, and Prevention. The National Academies Press. 2007.
9. Leung et al. Mechanisms of action of hormonal emergency contraceptives. Pharmacotherapy 2010;3092:158-168.
10. Emergency Contraception. Practice Bulletin No. 112. American College of Obstetricians and Gynecologists. Obstet Gynecol 2010;115:1100–9.