A woman came to me with a sad and perplexing story shortly after I began practicing obstetrics and gynecology. She was in her late 30s and had two or three children. She told me that she had been raped at work in a janitorial closet, after all the other staff members had left. She did not report the assault – in the mid-1970s, there was no provision for the care of sexual assault survivors in our town.
This woman went to her family doctor, she told me, because her period was late. He told her that she shouldn’t worry – that she was still recovering from the trauma of what had happened to her. A month later, she still hadn’t started her period, and she returned to that doctor and requested a pregnancy test. He told her not to worry and didn’t order the test. The third time, he complied with her request, and the test was positive. If I were her, I would be terrified of her co-worker and outraged at the doctor.
There are three lessons here: Even good doctors are fallible. Pregnancy is common after rape, even though there is a false belief that it is rare. Do-it-yourself pregnancy tests are advisable.
When I was in medical school, the only pregnancy test involved injecting an animal with a sample of the woman’s urine – and waiting a couple of days for the result.
Tests had improved a few years later when I was in general practice. We had kits the nurse would use. As I remember, it took half an hour for the test to develop, so we’d often call the patient when the result was available. Unfortunately, a positive result appeared different across test brands. When we switched brands, we misinterpreted a few tests and made some embarrassing calls. “I’m sorry to say that what I told you yesterday was wrong. Your test result is negative, not positive.”
Now you can get tests at the store that are inexpensive, sensitive and quite accurate. We can thank Margaret Crane, a product designer at Organon, who designed the first at-home test. It became available in Canada in 1971, but not in the USA until 1977.
What caused the delay in its availability in this country? The (male) executives of her company didn’t trust women to do their own tests. There might also have been some pressure from the medical community not to give up the income from pregnancy testing. This innovation required a woman with imagination, artistic ability and faith in womankind to make the first model of a home pregnancy test.
Another heroine of reproductive health just died. Sharon Camp earned a doctorate in foreign relations, then spent years in Washington, D.C., as a lobbyist. She learned that Emergency Contraceptive Pills were available in Europe, but not in the U.S. This seemed wrong to her, and she lobbied drug manufacturers to sell ECPs, but without success. Although she had no background in the pharmaceutical business, she started her own company to market Plan B, the first ECP in the U.S.
At first, the FDA required a prescription for Plan B. I told the local pharmacies that I was available to call in that prescription, and did so many times for women whom I had never met. Later, Camp lobbied the FDA successfully to make ECPs available without a prescription to women over a certain age, and eventually to women without any age limit.
Neither Crane nor Camp had medical training. However, both recognized the need and found a way to help women obtain the care they wanted. They found ways to lower barriers to reproductive health care.
Richard Grossman, M.D., is a retired obstetrics-gynecology physician who lives in the Bayfield area. Read his blog at population-matters.org.
