The Basics of Reproductive Health

Pregnancy

Pregnancy begins when a fertilized egg completes implantation into the lining of the uterus. In most cases, for pregnancy to occur, an egg is released from the ovaries through ovulation and travels to the fallopian tube. If sperm are present in the fallopian tubes and fertilize the egg, the fertilized egg will travel down to the uterus to implant into the uterine lining.

During in vitro fertilization, or IVF, which is a type of fertility treatment, eggs are collected from the ovaries and fertilized by sperm in a lab. Then, one or more fertilized eggs are placed in the uterus by a healthcare provider with the goal that one or more will implant and the pregnancy will begin.

Contraception

Contraception is any method, medicine, or device used to prevent pregnancy. Contraceptive methods generally work by preventing sperm from reaching an egg or preventing ovaries from releasing eggs. Some methods, like the hormonal IUD, make implantation of the egg in the uterus unlikely.[1] Most methods fall within one of four categories, ordered here from most to least effective at preventing pregnancy:

• Female and male sterilization: Tubal ligation, vasectomy

• Long-acting reversible contraception (LARC): Intrauterine devices (IUDs), hormonal implants

• Short-acting hormonal methods: Oral contraceptive pills, hormone patch, vaginal ring, hormonal injection

• Barrier methods: Condoms, diaphragms, sponges, cervical caps

Not everyone has the same access to contraception. In Montana, 55,610 women live in a contraceptive desert, where they lack reasonable access to the full range of contraceptive methods. Approximately 15,250 Montana women live in a county without a single health center providing the full range of contraceptive methods.[2]

Abortion

An abortion is a common health intervention that ends a pregnancy. There are two extremely safe and effective methods of abortion care - procedural and medication.

A procedural abortion takes place at a health center, where a qualified healthcare provider uses gentle suction and/or scraping to remove the embryo or fetus. These procedures include aspiration, dilation and evacuation (D&E), and dilation and curettage (D&C).

For a medication abortion (aka using “abortion pills”) a qualified healthcare provider gives you two types of pills to take, mifepristone and misoprostol. Individuals have the choice to either go to a healthcare center to receive the medication (and take the mifepristone in the clinic) or to receive the pills through the mail and take them in the setting of their choosing.

Abortion is safe. A procedural abortion is one of the safest medical procedures available, with a lower complication rate than a colonoscopy or getting your wisdom teeth removed. The pills used in medication abortion are safer than medicines like Tylenol, penicillin, and Viagra.[3] And, abortion is much safer than childbirth. Research has estimated that the mortality risk of staying pregnant is 35-39 times greater than the mortality risk of having an abortion.[4]

Miscarriage (or early pregnancy loss)

A miscarriage is the spontaneous loss of a pregnancy before 24 weeks gestation. Miscarriages are extremely common, with approximately 25% of those who have a uterus experiencing a miscarriage in their lifetime.[5] An estimated 10-20% of known pregnancies end in miscarriage, and many miscarriages happen before individuals even know they’re pregnant.[6] Most miscarriages happen in the first trimester, and this is often referred to as “early pregnancy loss.”

Miscarriage care is similar to abortion care. The three main treatments of miscarriage care are:

• Expectant Management: Giving the body time to pass the tissue on its own, without any intervention. If the body doesn’t pass all of the tissue, another treatment is recommended.

• Medication: This is faster and more predictable than expectant management, as medication helps the body remove any leftover tissue. The medicines mifepristone and/or misoprostol are commonly used for medication management of miscarriage. (These are also the pills used in medication abortion.)

• Dilation & Curettage (D&C): This surgical procedure is the most predictable treatment and involves dilating the cervix and removing tissue from the uterus. D&C is also a type of procedural abortion.[7]

Miscarriages can have complications that require immediate medical attention, including heavy bleeding (called hemorrhage) and uterine infection caused by tissue remaining in the uterus after a miscarriage.[6]

In states with abortion bans, pregnant individuals are being denied miscarriage care which is leading to their deaths. Healthcare providers are fearful of breaking the law and waiting until the pregnant patient is extremely ill before they provide care - and for some patients, it is too late.[8]

All Montanans should have access to the information, products, and services they need to make the choices that are best for them. Regardless of age, location, or economic status, Montanans need essential reproductive healthcare including contraception, abortion, and miscarriage treatment.

CITATIONS

[1] Birth control methods | Office on Women’s Health. (n.d.). OASH | Office on Women’s Health. https://www.womenshealth.gov/a-ztopics/birth-control-methods [2] PowerToDecide.org Bedsider.org. (2023). Contraceptive access in Montana. https://powertodecide.org/sites/default/ files/2023-07/State%20Factsheet_Montana.pdf [3] What facts about abortion do I need to know? (n.d.). Planned Parenthood. https://www.plannedparenthood.org/learn/abortion/ considering-abortion/what-facts-about-abortion-do-i-need-know [4] Stevenson, A. J., Raymond, E., & Grossman, D. (2023). COMPARING MORTALITY RISK OF INDUCED ABORTION WITH MORTALITY RISK OF STAYING PREGNANT. Contraception, 127, 110150. [5] Ghosh, J., Papadopoulou, A., Devall, A. J., Jeffery, H. C., Beeson, L. E., Do, V., ... & Gallos, I. D. (2021). Methods for managing miscarriage: a network meta-analysis. Cochrane Database of Systematic Reviews, (6). [6] Miscarriage - Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancyloss-miscarriage/symptoms-causes/syc-20354298 [7] What happens after a miscarriage? An Ob-Gyn discusses the options. (n.d.). ACOG. https://www.acog.org/womens-health/ experts-and-stories/the-latest/what-happens-after-amiscarriage-an-ob-gyn-discusses-the-options [8] Life of the mother. (2024, September 26). ProPublica. https:// www.propublica.org/series/life-of-the-mother