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The Philadelphia Story (Another Experiment on Women)
by Philadelphia Women’s Health Collective & friends
On the weekend of May 13, 1972, twenty women travelled by bus from Chicago to Philadelphia, to recieve abortions in an out-patient clinic. The women were scheduled to get abortions at Chicago clinics which had just been shut down by the Chicago police. The Philadelphia Women’s Health Collective became involved when the Women’s Center was contacted to arrange emergency overnight housing.
The weekend proved to have physically dangerous consequences for the women from Chicago. It was an exhausting and frightening experience for those of us in the Health Group. It raised serious questions about the safety of the abortion technique used and the people who engineered the weekend (most particularly Harvey Karman). But, beyond this, it forced us to confront issues such as our lack of control over experimentation on women, lack of access to reliable information on abortion, and our vulnerability to exploitation by both the “hip” and straight medical establishments as a result. We have written this report in order to share the information we gathered during and since this weekend and our analysis of some of the issues involved.
A History of the Weekend and the “Super-Coil” Technique
The arrangements for this weekend were made by Merle Goldberg, a woman from NYC who had been involved in the abortion movement for several years. Harvey Karman, who claims to be a PhD psychologist and inventor of the flexible cannula,1 was flown in from Los Angeles to teach a technique of performing abortions in the second trimester of pregnancy to two doctors at the clinic in Philadelphia, Baron Gosnell and Benjamin Graber. Neither of the doctors had ever used the technique before and it is unclear whether either had even performed second trimester abortions. The cast of characters this weekend also included a crew from Channel 13, the NET station in NYC, who were supposedly to make a film about the experiences of the women as they went through their abortions.
The Health Group was contacted to arrange housing for the women (at that time up to 40 were expected) less than a day before they were to arrive in Philadelphia. None of us had ever heard of the “super-coil” technique. We attempted to get reliable information on its safety as a procedure and came up with completely contradictory results. Altough we were being asked to participate in the activities of the weekend, none of the questions we raised to any of the people involved in arranging the weekend were satisfactorily answered. We eventually decided to locate one place to house all the women because we were told that the abortions would be performed with or without our cooperation or opposition. We felt that the women would be medically safer in one location than scattered in private homes around the city without immediate access to medical attention.
The twenty women, not the expected forty, did not arrive until late in the evening and the procedures were begun immediately. One woman was not pregnant. Four women were in the first trimester; they received vacuum aspirator abortions, using the “Karman cannula.” These women experienced no complications. The remaining fifteen women were in the second trimester of pregnancy and received “super-coil” abortions.
The “super-coil” abortion involves insertion of a number of plastic coils into the uterus, packing the vagina, waiting for a period of 16 to 24 hours, and removing the coils, after which a spontaneous abortion supposedly occurs. The uterus is then evacuated by vacuum aspiration using a Karman cannula.
The “super-coil” is said to be less traumatic than the saline method. Its proponents, Harvey Karman and Merle Goldberg, claim that it has a low or almost non-existent morbidity rate, is simple, quick and relatively painless. Karman is quoted in an early summer issue of the -L.A. Free Press (obviously after the Philadelphia experience) as saying, “We have never had to put anyone in the hospital, there have never been any complications, and the procedures are all painless”.
Of the fifteen women aborted by the “super-coil” in May, nine had complications; making the morbidity rate 6_% — higher than that of any other second trimester abortion method which is currently used. These complications included one perforation of the uterus, which eventually led to a hysterectomy performed at Presbyterian Hospital in Philadelphia; two women with retained tissue, necessitating repeated uterine aspirations; one women with peritonitis (a serious inflammation of the wall of the abdomen) requiring exploratory surgery (a “laparotomy”); seven women with fevers of 100.4 or greater2; and a number of women discovered to be anemic after the procedure. These statistics hardly seem to support Karman’s claims.
A number of women who were being aborted found the procedure to be very painful. Evacuation of the uterus did not occur spontaneously, and often the fetal material had to be pulled out with ring forceps. The simplicity and quickness of this method is clearly very questionable. And regardless of quickness or simplicity, the high morbidity rate seems to indicate that this method—the super coil—is decidedly inferior to any other presently used method of second trimester abortion.
The complications which resulted from the technique were not the only indication of the questionable nature of the activities which occurred that weekend. Although blood was drawn when women arrived, the lab work (to detect anemia and blood type, including Rh factor) was not done until after the women left Philadelphia. Also those of us who participated in the weekend were not given accurate information concerning the NET film. The Philadelphia women’s objections to the filming were completely ignored. Despite the claim by Karman and Goldberg that the purpose of the film was to demonstrate the plight of women attempting to obtain abortions, its major focus was on Karman and his techniques. None of the complications resulting from the procedures were even mentioned. The source of the arrangements for the filming has still not been explained.
During the weekend the women in the Health Group felt an almost overwhelming sense of powerlessness to effectively intervene or change anything that was happening. We feel that we learned at first hand the acute need for a network of information on abortion procedures and those who perform them. Only such a network accessable to women all over the country can alert women to the possibilities of exploitation and medical mis-practice in the abortion business. The women from Chicago were mostly young, poor, and black (many of them on welfare) and we feel that the exploitation and medical experimentation to which they were subjected was linked to this fact. Women must gain the power to control and, if necessary, to prevent such “experiments.” We can do this only if we are well-organized and informed.
Harvey Karman and His Friends: Who Are They?
Harvey Karman and Merle Goldberg are well known to a large number of women involved in abortion throughout the country (and probably the world.) Karman was sent to Bangla Desh by Malcolm Potts of International Planned Parenthood, to perform super-coil abortions on many of the women who were raped by the Pakistani soldiers. This expedition has helped to develop his image as a culture hero even in a women’s magazine such as Ms. We will probably never know the morbidity/mortality rates for our third world sisters in Bangla Desh.
Several years ago, Karman and Goldberg were connected to Women’s Medical Center in New York City. According to women we spoke to who worked in the clinic, both Karman and Goldberg were involved in what were considered, at the least, questionable medical practices. According to our sources there was little record-keeping and little or no follow-up for the women who received abortions. Karman also seemed to believe that women experience no real pain during abortions and rarely if ever gave women any type of anaesthesia.
According to three women who worked in the clinic, the Board of Directors of Women’s Medical Center eventually closed the clinic at least in part because of what they learned of Karman’s and Goldberg’s activities. It has since been reorganized and re-opened with Karman and Goldberg completely out of the picture.
Karman left New York after his association with the clinic ended and has since been active on the West Coast. Various women’s groups in California (particularly Self-Help Clinic One of the Feminist Women’s Health Center in Los Angeles) have had experience with Karman. Their experience indicates that Karman is more concerned with undermining women’s control of their health care and propagating his own technology and reputation than with meeting the health needs of women. In the October/ November issue of The Monthly Extract, the newsleter published in conjunction with the Los Angeles Self-Help Clinic, Karman was denounced: “When a man seeks publicity at the expense of women; when a man experiments with techniques on hopeless victims in Bangla Desh. on very young women from the Black community; when a man runs a paid ad denigrating the efforts of dedicated feminists, THAT MAN IS NOT A FEMINIST.”
Recent Abortion Experimentation
On the West Coast, Karman has recently been performing an experimental early abortion procedure called endometrial aspiration (it is also known as menstrual extraction, although this term applies to a procedure which is not being developed primarily as an abortion technique). Endometrial aspiration is being actively pushed on the East Coast by Merle Goldberg for the National Women’s Health Coalition. The National Women’s Health Coalition in conjunction with the Population Council is conducting a study of endometrial aspiration. The procedure involves the insertion of a 4 mm. cannula through the cervix into the uterus. With the application of suction, the lining of the uterus (the endometrium) is extracted.
The procedure can be performed on a women whose period is up to 10-14 days late. Because of the small size of the cannula necessary at such an early date, dilation is not required and anaesthesia does not always have to be used. Presently, this abortion procedure is being performed on many women who do not have a means of positively confirming pregnancy.
The need for new abortion and contraceptive techniques is urgent. But because reproduction control has always been directed at women, women have been the experimental animals used to test out new techniques. Abuse has been rampant. The best known example is the pill, but any new method of birth control or abortion technology is susceptible to the same chain of events, unless women intervene. When experimentation is done—on women—we must attempt to understand and control it.
To begin to achieve an understanding of the experimentation into endometrial aspiration, two sets of questions must be asked, one political and one medical. Politically:
- Do researchers have accountability? This means that the researchers must be in regular contact with a consistent group of women, including feminists with health skills, who review their progress and can control decisions about their experimentation.
- Financial arrangements—who is pocketing profits? Are massive amounts of money accumulating in the hands of researchers, backers, or marketers, or are funds being channeled back into the women’s health movement for further research, clinics, education, etc.?
- Are women given complete information about the experimental nature of the method, including all possible risks? If they are depending upon the technique as an abortion procedure, are they given complete information concerning the confirmation of pregnancy?
- Is there dependable record keeping and follow up? Side effects, rate of failure, long-term effects both positive and negative?
- What is the rate of retained tissue? Of infection?
- What is the effect on the body of repeated endometrial aspirations?
- How many women using endometrial aspiration are pregnant? How many late in menstruation? For how many is a late or missed period a sign warning of potential medical problems and not pregnancy?
Menstrual extraction is a woman-developed technique; it was invented by women in the L.A. Self-Help Clinic who have been using it on themselves for over a year and a half. It was conceived of and is being used as a means of giving women control of various aspects of their reproductive system. It is of concern to women not only as an abortion technique. However, as an early abortion procedure, known as endometrial aspiration, it is rapidly becoming a male-controlled research experiment. It is being seized by people who have no commitment to the women’s movement or to women in general, but who are committed only to increasing their own power, reputations, and bank accounts. These people must be stopped and the technology returned to women’s control.
What is to be Done?
Recent developments with endometrial aspiration and the Philadelphia women’s experience with the super-coil abortions make it clear that for women to begin to assert control over experimentation being done on women, two immediate steps must be taken:
- We must continue to develop a network of information accessable to women all over the country. We must investigate and share our information concerning abortion and birth control techniques. This network is crucial not only to our ability to react responsibly and quickly in crisis situations such as Karman’s experiment in Philadelphia, but also to our development of long term strategies for gaining control over medical practices in our local situations.
- We must develop informed sets of medical standards to guide us in evaluating experimentation performed on women. We must be able to determine when and how women are being exploited as experimental guinea pigs by both the ‘hip’ and the ‘straight’ medical professions.
One of Karman’s most successful methods for manipulating radical women and others involved in health has been to employ our own rhetoric about the rigidity and professionalism of the medical establishment. Karman is not a medical doctor. This, in itself, is not something to hold against him. Trained, competent para-medics can play a crucial role in our struggle to demystify and change the medical system in this country. However, we leave ourselves wide open to becoming a part of what exploits women (i.e., second-rate medical care in this case) if we just dismiss medical standards and practices because they are a part of organized medicine as it exists now. Para-medics like Harvey Karman may be able to confuse and rip us off more easily than doctors. Not everyone who works outside of the medical system is working for our best interests. We must have our own standards which we have developed out of our own research and experience, which we have discussed and criticized, on which we can rely. In the name of feminism we should not be risking women’s lives!
No matter where or what we are doing in terms of abortion and women’s health we have got to have the control; the only way we can get it is to take it. This report was written in an effort to share some of our conclusions and information as a step towards educating ourselves to sieze that control.
- A cannula is a small piece of tubing inserted into the cervix through which a fetus is sucked by a vacuum aspirator. It used to be that cannulas were inflexible because vacuum aspirator abortions used to entail dilation of the cervix; now it is common that the cervix is not dilated and flexible cannulas are used.
- See “Joint Program for the Study of Abortion: Early Medical Complications of Legal Abortion.” Christopher Tietze, M.D. and Sarah Lewit. Population Council, Vol. 3, No.6, June 1972.