Menstrual Extraction and the DIY Abortion

I am quite sure most Americans have never heard of menstrual extraction — I certainly hadn’t — but I’m thinking that could change, and soon.

As the name implies, this is a technique for extracting, via suction, a woman’s entire menstrual flow, all at once. It takes about half an hour.

If her period is too heavy or too crampy, if it threatens to mess with her vacation, or if she just doesn’t want to deal with it this month, menstrual extraction is an option.

She can use one of several suction devices, including a homemade one called a “Del-Em” machine — forty dollars’ worth of lab tubing, a syringe, and a mason jar — with which she can safely extract the contents of her uterus.

And if that uterus happens to contain an unwanted early-stage fetus, that too will be extracted. Who’s to know?

Though it’s been under the radar for a long time, menstrual extraction — often called “menstrual regulation” — is a real thing. It’s practiced all over the world.

The Del-Em itself was developed in 1971 by radical feminists, at a time when feminist activism was a formidable social and political force. They were looking for a way to end a pregnancy, without the participation of either the medical profession or the male of the species. The method had to be cheap, easy, and above all, safe. The Del-Em hit three-for-three.

Using the same basic physics as a turkey baster, a Del-Em extraction is not considered a medical procedure. I hasten to add that proper instruction is essential. It’s best administered by a nurse, midwife, or knowledgeable friend, but you could indeed be taught to do it yourself.

I won’t go into the details, but you can see for yourself here, or here, or look up “menstrual extraction” on Wikipedia.

Anyway, the word got around. Quietly. Abortion was illegal then, and there was real risk in stepping around the law. Useful knowledge was spread carefully among the many women’s self-help groups, some of them clandestine, that proliferated in those early days of reproductive consciousness. Under such conditions, where women were discreetly teaching the Del-Em technique to other women, nobody wanted a high profile.

Even so, the device had a promising future, and it surely would have seen widespread use, had Roe v. Wade not rendered it irrelevant in 1973.

Which is probably why we’ve never heard of it. And why its relevance has now returned, with a vengeance.

To be sure, the potential benefits of using menstrual extraction to foreshorten one’s period might be worth exploring. While I’ve never personally menstruated, I’ve known many people who do, and I can easily imagine several of them tempted by the prospect of getting the whole thing out of the way on their lunch hour.

In Cuba, where abortion is fully legal, menstrual extraction is offered free to any woman whose period is two weeks late. No questions asked, no pregnancy test required.

But please, if you’re reading this while female, feel free to weigh in. I don’t mean to be glib about any of this, nor do I propose to speak for the Estrogen-American community.

But regardless of its use in managing one’s period, “menstrual extraction” is surely one of the great euphemisms of all time. The term itself is a masterpiece of verbal misdirection. It provides near-perfect cover for what the technique really is: a “DIY abortion.”

The brilliance of the euphemism is that it allows one to claim — even, perhaps, under oath — that one has been engaged, not in an abortion, but in getting one’s menstrual cycle back on track. Which happens to be true.

As an evidentiary matter, the two processes are identical. In both, the evidence is promptly disposed of, and the woman moves on with her life.

As you might expect, similar methods have long been in use in places where abortion is illegal. But, curiously, the governments in some of these places tend to tolerate, and even encourage “menstrual regulation.” Some even offer it as a public service.

In Bangladesh, for instance, the government sees it as a sensible loophole in the country’s entrenched abortion laws. Embracing the euphemism, they’ve institutionalized the notion that unless a woman has been “verified” as pregnant, she’s free to “regulate” her menstrual cycle as she sees fit. In other words, if the pregnancy isn’t confirmed, presumably by a doctor, it doesn’t exist. Ergo, there’s nothing to abort.

While this logic has some gaping holes, it must nonetheless enjoy at least a modicum of official standing, because the government actually supports menstrual regulation clinics throughout the country.

As bureaucratic workarounds go, this is a remarkably effective one. Nearly half a million “regulations” (wink, wink) are performed in Bangladesh each year. As far as the authorities are concerned, that’s half a million women who skipped their period. What’s wrong with that?

Similar tolerance can apparently be found in Korea, Singapore, Hong Kong, Thailand, and Vietnam.

So, given the current climate in this country, menstrual extraction just might be ready for its closeup.

It wouldn’t be anyone’s first choice for an abortion, at least until more is known. It needs to be done early in the first trimester, which limits its use. It’s safe, but largely unsupervised, so proper instruction is a must. But mostly, it will never be preferred to medication abortions, which will be the overwhelming favorite as long as the pills are available.

But in red-state cities, where pill delivery is likely to be iffy, it’s hard not to see it catching on. The technique can easily be taught and passed along — woman to woman, group to group — as highly motivated women start organizing to find viable ways around medieval laws.

The demand will be there. Many such women won’t be able to obtain, or afford, a medication abortion. Many won’t be able to travel for a surgical one. Under such conditions, a device like the Del-Em just might find its market. And its covert practitioners.

Del-Em checks a lot of boxes. It can be used in the home. It leaves no trace of a pregnancy. It has a legal and legitimate use for anyone who menstruates. And, as in Bangladesh, one could even make the case — as lawyers surely will — that it’s not illegal.

Of course, it’s disgraceful that we even need to think like this. It’s disgraceful that we’re being dragged, kicking and screaming, into this new age of workarounds. Of which the Del-Em will be just one of many.

But that’s where we’ve landed. That’s the wilderness SCOTUS has so cavalierly dropped us into — an abominable new reality, in which we’ll measure our victories in small increments.

So let’s celebrate those small increments when they do occur. Let’s pretend the Del-Em is a good thing, even if it’s just a necessary thing.

P.S. The Del-Em device first came to my attention through an illuminating article last May in The Atlantic, in which Jessica Bruder provides a sort of overview of abortion workarounds, and of the women’s groups who were then preparing for the end of Roe.

For more about the underground abortion movement of the sixties and seventies, see The Janes, an excellent documentary on HBO. While it doesn’t cover the Del-Em story, it does provide a poignant look at how women back then learned to assert rights they didn’t yet have.