The Association of Reproductive Health Professionals (ARHP) celebrates the lives and achievements of two remarkable women: Drs. Elizabeth Connell and Louise Tyrer, with their compelling stories from the 40s, 50s, and 60s, as physicians protecting women's lives before Roe v. Wade. Both women saw firsthand the devastation and loss of life before abortion was legal in the United States. Today, both express fear and rage about the current state of reproductive rights and family planning in this country and what the future may hold.
Dr. Elizabeth Connell
A Pioneer Still Fighting for Women's Reproductive Rights
Mincing no words about the worsening state of reproductive rights for women, cause she has championed for more than 50 years
Every morning at dawn at her home in Atlanta, 79-year-old Dr. Elizabeth Connell plunges into her pool for her one-hour morning swim. The exercise is disciplined enjoyment for the woman many in the reproductive rights movement consider an icon. It is also symbolic, for just as she smoothly slices through water, Connell cuts through the spin of numerous Food and Drug Administration (FDA) and other committee meetings to get to the core question: How can we help women get and maintain their reproductive rights?
I remember Betty Connell sitting as the FDA chair, always being the iconoclast and saying in the middle of some stodgy hearing where data were being presented and regulations were being read out, But what is it about that particular product that really makes people excited? How is it going to help women? says Ward Cates, MD, president of Family Health International in North Carolina, who considers Connell among the world's greatest mentors.
She's always the best source for the latest, funniest joke, not always jokes you could repeat in public. She headed up, for the FDA, the Vaginal Contraceptive Advisory Panel, a group with extensive experience in clinical obstetrics and gynecology and they became known as Connell's Vaginal Commandos, says Gordon Perkin, MD, senior fellow at the Bill and Melinda Gates Foundation Global Health Program. Perkin has known Connell since the early 1960s, when he was associate medical director with Dr. Alan Guttmacher at Planned Parenthood Federation of America (PPFA).
Betty doesn't mince words, and I love that, says Wayne Shields, president and CEO of the Association of Reproductive Health Professionals (ARHP), which Connell helped found four decades ago with fellow reproductive rights pioneer and long-time friend, Dr. Louise Tyrer, and others. I've seen her chair FDA committees and controversial hearings, and she has a strong hold on everything that's going on in that room. She understands the issues, and she knows the context. She's an absolutely dynamic individual.
Today Connell is blunt about the worsening state of reproductive rights for women, a cause she has championed for more than 50 years, in a wide variety of situations.
It's hard to conceptualize what it was like before Roe v. Wade unless you were actually there, Connell says, barely containing her anger. In the large hospitals, ward after ward was filled with women suffering and dying from botched abortions. In some hospitals, it was the job of the first-year resident to sleep all day, because he would be up all night scraping out the remains of illegal abortions, giving blood to the women who were bleeding, trying desperately to keep them out of shock and treating their infections. This was the norm until we got Roe v. Wade and the New York law that preceded it. I'm very much afraid that the way things are going now, we could go right back to that again.
The current erosion of women's reproductive rights is insidious, says Connell, who makes that statement from an informed professional perspective. In 1970 she became the first woman to chair a female-majority FDA committee and, three years later, was the first woman member of the State Department's Research Advisory Committee. Since 1970, Connell has chaired, been a member of, or served as a consultant for many federal committees dealing with women's reproductive health.
It's a tragedy now, seeing what's going on in many of those committees, Connell says. They have become very politically motivated and are not functioning properly. In fact, they are actually counter-effective. When we were doing our early work at the FDA looking at prescription and over-the-counter (OTC) products, drugs, and devices, we were scientists evaluating scientific data. But what's happened over the last few years is that appointments to the committees are not always based on the fact that you know what you're talking about and have done work in the field. A number of these people are appointed to further the goals of certain people in Washington who don't want family planning and don't want abortion. These committees are now stacked let's call it what it is with people who are doing the bidding of individuals on a political basis with total disregard for the science. For example, look at the morning after pill emergency contraception, recommended for OTC status by the FDA advisory committee which is now being tied up politically with absolutely no medical justification whatsoever. Here is a real chance to reduce the number of unintended pregnancies and abortions, yet its approval is being blocked.
Connell became a pioneer in the reproductive rights movement because her gender, experience, and sensitivities compelled her to do so.
Connell was born in Springfield, Massachusetts, in 1925 to parents who each had a doctorate degree in psychology and taught at Smith College (her mother received a Phi Beta Kappa award and graduated from Vasser College with a degree in mathematics). Connell knew early on that I had to do something. Because she liked working with people, she volunteered as an occupational therapist assistant at the University of Pennsylvania in the summer of 1944, after her first year of college at Penn State University. Immodestly, I looked around and thought, I'm as smart as those doctors. Why do I want to spend my life teaching their patients how to weave baskets? So she transferred to Penn and then was accepted into the university's medical school, from which she graduated in 1951.
To tell the truth, I always wanted to be a general surgeon, but there were hardly any women in medicine at that time, and I was already sort of odd. And since women particularly didn't go into surgical specialties in those days, I gave up the idea of general surgery and went into obstetrics and gynecology, she says.
Connell married a classmate, and the couple moved to the 'huge metropolis' of Blue Hill, Maine, population about 900, where they worked in a 26-bed hospital and she slogged through snow and mud to make house calls. That was when she first became acutely aware of what life was like for most women.
You can't take care of women without having the problems of individual women brought to your doorstep every day, she says. In a hospital setting, people come and go, but when you live in a small town, you see lives quite differently. I quickly realized how difficult it was for women to control their fertility, and the price they were forced to pay.
In Blue Hill, Connell had the second and third of her six children. Since she had very rapid deliveries, she kept supplies in her car in case she had to give birth while on a house call (a circumstance that, fortunately, never arose). Although she thoroughly enjoyed being a family doctor, when a more modern medical center opened nearby, Connell grew restless for more training. She and her family returned to Philadelphia, where she did a residency in gynecology.
What I remember so clearly every day and every night was the constant stream of women coming in for help with their botched abortions. Over time, we saw the patterns, she says. You got to know pretty quickly who had done the abortion. We knew who was out there, including one man who did nice clean abortions putting a little red rubber catheter into the uterus to start the abortion. We also knew the absolute butchers. The women ran the gamut of circumstances, but they kept coming into the Philadelphia hospitals, and we had to deal with them. It made me sick at heart but also very angry.
In 1960 Connell moved to New York for an obstetrics residency at Mount Sinai Hospital with Dr. Alan Guttmacher, who later became the first full-time president of PPFA. There was no shortage of horror stories there, either. One woman made a particular impression.
She was not able to get a sterilization procedure done by anyone, Connell remembers. She never wanted to have children, and she'd had several abortions. There wasn't a doctor in New York City she could find who would do a tubal ligation, which is what she wanted, because she was young and had no children. She happened to be a lab technician, so she took cultures home, looked in a mirror and found her cervix and squirted these cultures of live organisms up through her cervix trying to block off her uterus and tubes with scar tissue. This just goes to show how desperate women were during those times. They resorted to very desperate means to control their fertility. She nearly died. She finally pulled through but not without some very hair-raising moments.
After her residency at Mount Sinai, Connell received an American Cancer Fellowship, during which she gained experience performing radical cancer surgery. Recognizing a major unmet need, after two years in group practice, Connell decided to open family planning clinics in Spanish Harlem. The priests in the area said, Don't go. But as soon as I opened the doors, the women crowded in. They were so happy and so relieved, and the lives of many of them were totally changed.
That simple desire to help these women changed Connell's life and career. Because she received no money from the federal, state, or city governments, she had to get grants. She also studied the various forms of contraception that were being developed. That led to writing papers, going on the lecture circuit, and becoming an expert who was regularly appointed to committees.
Suddenly I had a career in women's reproductive health, she says, creating and working in programs all over the world. She moved to the Rockefeller Foundation in 1973, giving out grants for five years. She continued her activities in the field of contraception, including a 10-year effort to get the three-month injectable product Depo Provera approved. The history of the reproductive rights movement and contraception is detailed in her book, The Contraception Sourcebook, published by McGraw-Hill in 2001.
Connell and her first husband divorced, and five years later, she married Howard Tatum, MD, inventor of the Tatum T prototype for intrauterine devices (IUDs) that are still in use today. He also determined the reasons for the disastrous problems with the Dalkon Shield, which still have a heavy impact on the use of IUDs in the United States today.
Connell frequently comments, One thing I find utterly incredible is that the same people who are trying to take away a woman's right to abortion and sterilization are also trying to remove those methods we have, or will have in the future, to prevent abortions. It just blows my mind, she exclaims. They are working hard to prevent us from getting good contraceptive care to women. They call the IUD and the birth control pills abortifacients, which is madness. They aren't. These are methods that block ovulation. How can you have an abortion if you haven't ovulated in the first place? They call emergency contraception the abortion pill, which is also wrong. Emergency contraception prevents pregnancy and would not work if a woman is already pregnant. This is all just scientifically unsound, but it shows the extent to which people are willing to lie about how these methods work. This whole scene makes no sense and is very destructive to the health care of women.
Connell is also concerned that the specialty of reproductive health care for women, once a good career choice for medical students, has been gradually losing ground as a result of frivolous lawsuits and the rising cost of malpractice insurance. Additionally, the majority of doctors who performed abortions in the past have stopped after having been targeted, threatened with violence, and even killed by anti-abortion protesters. Connell asks her friend, Dr. Louise Tyrer, When we first started in medical school, did you ever dream that doctors would be putting on bullet-proof vests to practice medicine? It's pretty bad.
Connell is clear about what terrifies her: The flight of trained doctors; the lack of new recruits; the problems with lawsuits and insurance; the continued cutting of funds for family planning clinics in the United States and internationally that practice or mention birth control methods beyond abstinence-only messages; the censorship of sex education and the gag rule on abortions and referrals; the political appointees to federal committees; the pressure placed on scientists and researchers, including some at federal agencies; and the political power of extremists who want to outlaw all abortions.
There are many medical, social, and political issues that we urgently need to deal with. That's why it's critical for people to understand what's currently going on and that if we lose the progress we've made, we'll be back to where we were before Roe v. Wade, and the reproductive rights of women will once again be severely challenged, Connell warns.
Dr. Louise Tyrer
A Passionate Pioneer for Reproductive Rights
Helping to make family planning a movement
Dr. Louise Tyrer, 84, enters a room with an air about her, like the elegant and confident women Katharine Hepburn so often portrayed. Yet linger with her for a moment and a hint of sassiness surfaces in her incisive conversation. In another era, some might have called Tyrer a 'dame' with a brain. To those in the reproductive health field, Tyrer is known as a true pioneer of the pro-choice, pro-family planning movement.
Scientists and health care professionals regard Tyrer as a living legend in the international community of family planners and reproductive rights advocates.
"She has helped to make family planning a movement, says Linda Dominguez, Lead Clinician, Southwest Women's Health New Mexico. She addresses the whole woman and the part family planning plays in women's lives.
Tyrer was a founding member of the Association of Reproductive Health Professionals (ARHP) in 1963. According to Wayne Shields, ARHP's president and CEO, She was an amazing obstetrician/gynecologist (ob/gyn) provider prior to Roe v. Wade, when abortion was illegal. She was one of the first voices for the pro-choice movement.
Bearing the demands of that history, Tyrer is alarmed as she watches the Bush administration and conservative lawmakers take a wrecking ball to the strong health care edifice that she, colleague Dr. Elizabeth Connell, and so many others worked so hard to erect over the past 50 years.
What will happen to women especially poor women under the congressional edict that allows hospitals, individual doctors, health management organizations, and insurance companies to refuse to provide abortion services and even referrals as a matter of conscience? worries Tyrer.
It's very frightening and shocking to think that we could go back to those days of botched abortions and women dying from abortion hemorrhage and infection. I believe those days could return, says Tyrer. We can't just sit by idly and say, We won those battles a long time ago, we don't have to think or worry about that. We do. We have to do something about it, much more than we did the first time around. Those who are opposed to abortion rights and various methods of contraception have cleverly reframed the issues so that many of people don't realize what rights they would really lose.
Reproductive rights is not simply a lifelong profession for Louise Tyrer, it is a deeply personal mission.
Tyrer was born in 1921 in Shanghai, China, to Seventh Day Adventist missionaries. Her father was a surgeon in Central China who managed a church hospital, and her mother served as a teacher and nurse.
It was a lovely life, says Tyrer, with servants, a goat-herder, a pet chicken, and a small missionary schoolhouse and high school in Shanghai. The family fled in 1937 when the Japanese invaded the country, signaling the start of World War II in the East.
At 16, Tyrer attended religious college in southern California. Laughed at in science class for wearing long curls and a long dress, she demanded that her mother allow her an extreme makeover so she could be stylish and fit in. In this, as in more consequential matters, she had her family's support. She also recalls one of her female classmates slitting her throat because she was pregnant with no options for termination, which greatly affected Tyrer.
People would ask me, What do you want to do when you grow up, little girl? Well I'm going to be doctor and going to get married and have six children, I'd answer and I was serious, Tyrer says. They would laugh at me. And my mother said, Don't worry about it. You can do and be anything you want to if you set your mind to it.
Tyrer was determined to become a doctor, because I saw the suffering the Chinese women went through. They could not be examined by a male doctor, so they would point to a model of a female body to indicate where they felt pain. Often women came to the hospital too late and died.
Tyrer was also deeply affected by seeing throngs of malnourished children. I always knew I was going to do obstetrics and gynecology. I thought I would go back to China as a missionary. I was going to do something to change the world so there weren't starving children, she says.
As if being a woman in medical school in the 1940s was not challenging enough, Tyrer married and had a baby while still in school. She and her husband graduated in 1944 with a one year old son in their arms.
World War II was raging as she was doing her internship and residency in obstetrics and gynecology at Los Angeles General Hospital, which set aside two wards for 30-40 women suffering from abortion complications. Divorced from her husband and with a son to support, Tyrer focused on making a living. It was not easy.
These women came in dying from botched abortions and infections. It was just such a waste of human life, says Tyrer.
The first deaths sear the soul, says Tyrer, and they remain fresh memories for her, as do images of women lined up on gurneys outside the operating room 18 hours a day, waiting for doctors to take them in and scrape out the remnants of what was causing the hemorrhaging and infection.
One woman came in already in shock, she was hemorrhaging so much. The first thing we did was to give her blood to rebuild her strength so she could go through the surgical procedure to remove leftover tissue from the partial abortion. Despite getting a transfusion, she continued to bleed, says Tyrer, who then discovered that the abortionist had torn the cervix and the uterine artery. Tyrer had to cut through the abdomen and tie off the uterine artery to stop the bleeding.
The woman survived the botched abortion, but two days later she came down with gangrene, obviously through the use of unclean instruments during the abortion. We couldn't give her penicillin, because it had all gone to war. We gave her a sulfa drug, but it didn't work. We put her in the private room reserved for women who were dying. An autopsy revealed she had gangrene extensively throughout her body.
Tyrer tells another story that underscores the importance of women having the right to reproductive options. A gypsy woman, pregnant for the 13th time, had been in labor for three days. Tyrer discovered that the fetus was already dead and lying cross-wise in the woman's worn-out uterus. At 3 am, Tyrer telephoned her female supervisor at home most of the male doctors had gone to war who advised Tyrer to give the woman ether until she stopped breathing to relax the uterus, so that Tyrer could manually turn and extract the fetus. However, the turn ruptured the uterus and the uterine artery, and the woman started hemorrhaging. In a second call, the doctor suggested a hysterectomy to control the bleeding, but it was too late, and the woman died.
I was so distraught; I couldn't come to work for three days. I was ready to quit the practice, she says. It took quite a bit for me to come back. But then each person had a tale to tell of something similar. We did the best we could. Every day there were women dying, and the load of carrying that around was a shock to my system. But I stayed because they needed us. Women doctors were running the medical system in the United States and there weren't very many of us in those days. I eventually got to a place where I understood you couldn't save everybody's life.
In 1948 Tyrer went into private practice and began teaching in hospitals and university medical centers in California and later in Nevada. The horror stories continued, such as the 15-year-old girl from a nearby Indian reservation brought in by some boys who tried to perform an abortion on her.
She was almost dead from hemorrhaging, Tyrer says. They got drunk and used a kitchen knife to cut her vagina open and reach up inside her and cut her cervix. She was four months pregnant. I didn't know if I could save her or not. Tyrer removed the products of conception and sewed her up, following a hysterectomy. The girl was saved but permanently scarred.
In 1971 Tyrer was recruited to be director of family planning at the American College of Obstetricians and Gynecologists (ACOG) in Chicago, based on a recommendation from her friend and colleague, Dr. Elizabeth Connell. Tyrer was the first woman physician hired by the College.
Tyrer ran two family planning programs funded by the Federal Office of Economic Opportunity, the predecessor of the Community Services Administration, which was later folded into the Department of Health and Human Services. One program was to develop post-delivery educational materials for underprivileged women in county hospitals on how they could control their fertility. She also tracked the program's effectiveness.
It was very rewarding, says Tyrer. I felt like I was a missionary.
After five years the grant ran out, and in 1975 Tyrer was recruited by Planned Parenthood Federation of America (PPFA) to become vice president of medical affairs. She stayed for 15 years.
The major contribution I made at that time was the development of national medical standards and guidelines for use in prescribing the various methods of contraception at Planned Parenthood clinics around the world, explains Tyrer. She created two medical review committees: one committee of medical experts that reviewed standards and guidelines, and a smaller committee that reviewed litigation from malpractice lawsuits resulting from reported claims about complications involving contraceptive use. Meanwhile, Tyrer also worked to make abortion legal.
All those deaths made me very strongly pro-choice, so I was willing to spend my time, energy, and money to try to change the law so that women didn't have to die from having botched abortions in this country, she says.
Tyrer also used Planned Parenthood's federal funding to help establish and monitor family planning clinics, train staff, and monitor success in more than 20 developing countries. I didn't imagine I could ever do that much, she says.
At age 70, Tyrer retired from Planned Parenthood but not from the causes she has championed for decades. Since July 1991 she has been a family planning consultant to many groups, including Abortion Rights Mobilization in New York and the U.S. State Department; medical director for Planned Parenthood in Northern Nevada; and ARHP's medical director. She has also been a behind-the-scenes rabble-rouser for the legalization of medication abortion, also known as mifepristone or RU-486. In 1992 she received international media attention by serving as advising physician for a woman who had obtained RU-486 in England, meeting her at the arrival gate at John F. Kennedy Airport.
Tyrer is an intense, healthy, and active senior citizen and she doesn't mind telling anyone. A couple of years back, her holiday card featured a bikini-clad Tyrer on the beach of some far-off island. She dates a gentleman whom she met while skiing in the Italian Alps.
Dr. Louise Tyrer is an inspiration to a whole generation of women personally and in their careers, says Vanessa Cullins, MD, PPFA's vice-president for medical affairs. She has been a role model in continuing to be a healthy sexual being throughout life, to carry out loving, long-lasting relationships.
She's an icon, says Susan Wysocki, WHNP-BC, FAANP, president and CEO of the National Association of Nurse Practitioners in Women's Health. I want my obituary to read that I was struck by lightning while skiing in the Swiss Alps [like Louise] at the age of 105, still active and vibrant and thinking about what is next. That's how I see Louise.
Dr. Louise Tyrer leans forward, her voice intense with the strength of her feelings as she muses on the current erosion of reproductive rights.
We can't go back; we cannot go back, she implores. We've seen what happens to women when they don't have the option to control their own fertility. We've seen them die. We can't let that happen. We might end up with a constitutional amendment banning all forms of abortion. That could happen if the people of this country don't stand up to be counted and say that we will not permit rights for reproductive care of any kind to be taken away.
Written by Karen Ocamb
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