Menstrual Extraction Might be Ready for its Closeup

 

As I personally digest the possible consequences of this election, I expect to be writing more sporadically through the end of the year. This will surely involve several repeats of previous posts, starting with this one.

I wrote this piece in July of 2022 — just as the shock of the Dobbs decision was setting in — and I think I unintentionally creeped some people out. It was, by a wide margin, my least-read post, even as it offered a highly practical workaround for women wanting to end a pregnancy.

Now, with the abortion landscape likely to deteriorate — and with the availability of abortion pills under threat from several directions — I am quite sure this workaround is worth another look. 

There is no reason why a safe, dirt-cheap, non-medical procedure that’s in widespread practice worldwide shouldn’t be part of the abortion discussion.

So here, with light edits, is my case for menstrual extraction.

 

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 gently 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 — also called “menstrual regulation” — is 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 menstrual 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 a woman could indeed be taught to do it herself.

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.

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. It’s considered “managing one’s period.”

Which is one reason why the term “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 is mostly used for: first-trimester 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.

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 anti-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 Bangladeshi 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 prime time.

It wouldn’t be anyone’s first choice for an abortion. It needs to be done 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-states, 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 completely legal.

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. Lest you think I'm crazy, please read this dry two-paragraph abstract from a 1980 paper in the NIH National Library of Medicine, seven years after Roe v Wade.

The Del-Em device first came to my attention through an illuminating article  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.