On The Medical Role of Abortion

This post was tough to write, and I fully expect I got some things wrong. Let me know if you spot an error or a place where I’ve made a mistake.

One of the benefits of Wardley Mapping is that making a map invites you to take vague and general concepts and make them more meaningful and specific. Instead of repeating a buzzword or two that “sums up” the situation in an inappropriately simplistic way, we get to break the situation down into a specific, working model that describes what it’s made of and how we think it works. That model then becomes something we can test against our own experiences, the experiences of others, and future experiences that have yet to occur.

Mapping is thinking. It is also sharing, challenging, and refining. But we only get the breakthroughs that Wardley Mapping promises when we work with specifics, not generalities.

That’s why this post is not about abortion. It is about abortion with respect to medical care.

Why are we wading into these waters? Why risk getting political? Well, because it’s a situation that matters. And what good is something like Wardley Mapping if it isn’t used in situations that matter?

Sure, Wardley Mapping can also help you decide what widget to build or how to squeeze a few extra bucks out of a weak market situation. That’s its most facile use. But I believe Wardley Mapping is good in a crisis. And while there is no shortage of crises to pick from where I live, in the United States, this one in particular has been on my mind, weighing heavily every day.

I started mapping it out, and you may call me uneducated and ignorant, but I learned some things that shocked me. And if I didn’t know these things, I have to wonder how many of you are about to have a similar experience.

I started my map of abortion the way I start many maps… with a user. I chose to start with Pregnant Person.

And as with many maps I make, I knew that in order to understand the situation, I would need to understand the value chains the user is part of. Again, I’m scoping it to medical care for this first map.

I used a common formula for making an initial value chain: “[User] depends on [Need], which depends on [Capability].”

Filling it in, it looks like: “Pregnant Person depends on _____, which depends on Abortion.”

A visualization of the value chain described above, with a fill-in-the-blank. “Pregnant Person depends on _____, which depends on Abortion.”

Or, said another way, “Abortion enables _____ for a Pregnant Person.”

Mapping moment: How many different kinds of medical care can you identify to fill in the blank?

Knowing what goes in the blank is a quick test of how well you understand the situation.

Suffice it to say that I did not understand the situation very well. No surprise there, since I don’t understand most things well. But I always make up for it by learning quickly through reading and consulting experts. This situation was no exception.

Here’s what I found after reading the work of various medical experts:

  • Abortion enables life-saving care after a miscarriage with complications for a Pregnant Person.
  • Abortion enables life-saving care after an ectopic pregnancy for a Pregnant Person.
  • Abortion enables life-saving care in other situations incompatible or risky with pregnancy (such as cancer treatment, pulmonary hypertension, or uterine infection) for a Pregnant Person.
  • Abortion also enables a choice for a Pregnant Person — between continuing or ending a pregnancy when the fetus is…
    • already dead,
    • won’t survive to term,
    • or will die shortly after birth.

A visualization of the value chain described above, with a fill-in-the-blank. “Pregnant Person depends on _____, which depends on Abortion.”

This list is obviously incomplete, even within the scope of medical care (for instance, some abortion drugs like Methotrexate are used to treat autoimmune disorders, arthritis, and cancer). And there are many other scopes to understand, but I wanted to focus on abortion with respect to medical care for pregnant people in this post because even my feeblest attempt to map it out significantly changed my understanding of the situation.

For instance, I had no idea that miscarriages were so common, nor that abortion had such a prominent medical role as life-saving treatment. I had no idea that tables like the following existed, articulating exactly which abortion methods are used in which miscarriage scenarios.

Expectant Management:Wait for nonviable pregnancy tissue to pass on its own from the uterus. Safe up to ~8 weeks GA. For individuals who want to non-invasively manage their miscarriage at home and are medically stable, without contraindications. About 80% of miscarriages will complete on their own in 8 weeks. Medical Management (for miscarriage): Facilitate passage of nonviable pregnancy tissue from the uterus, typically with misoprostol +/- mifepristone. In early pregnancy, allows shorter time course than expectant management in patients without complications. Treatment with misoprostol results in complete passage of the non-viable pregnancy within 2 days in most cases. Uterine aspiration/ Suction curettage: Dilation of cervix and aspiration of nonviable pregnancy tissue from uterus. Can be used up to 14-16 weeks gestation. For individuals who are medically unstable, or have incomplete miscarriage after expectant or medical management or desire prompt resolution of miscarriage. Typically an office procedure. Dilation and evacuation (D&E): Dilation of cervix and evacuation of stillborn with suction and/or forceps, typically used from 14 weeks up until 28 weeks GA. Ensures prompt passage of stillborn, does not require laboring, will typically be performed in an operating room with sedation. Labor induction (for stillbirth): Induce onset of labor, typically with misoprostol +/- mifepristone. Patient will vaginally deliver stillborn. For individuals with a stillbirth, who prefer to deliver stillborn (opportunity to view or hold). Performed in a hospital.
Weigel, Sobel, Salganicoff, Understanding Pregnancy Loss in the Context of Abortion Restrictions and Fetal Harm Laws, (KFF, December 2019) https://www.kff.org/womens-health-policy/issue-brief/understanding-pregnancy-loss-in-the-context-of-abortion-restrictions-and-fetal-harm-laws/ (accessed July 23rd, 2022).

Mapping provoked me to ask questions and do research to fill in the blanks, and it forced me to understand the specifics of the situation.

And now, when I see proposed legislation about abortion, I cannot see it the same way. I was already worried, but now I am also worried through this lens of medical care, and I see the obvious consequences that are before us.

For instance, Senate Bill 106, a proposed Pennsylvania state constitutional amendment, which passed both the PA Senate and House within 48 hours of introduction, reads as follows:


It is only the first step on one path to criminalizing abortion in Pennsylvania. The measure needs to pass again in the next session of the PA legislature, and then voters will approve or deny the amendment in a public referendum. That paves the way for criminalization, and it is shocking to me that such a proposal does not recognize the obvious consequences of its breadth, even only considering abortion through the lens of medical care, as we are doing here.

In this proposed vision of the future, how many pregnant people will die?

Furthermore, there’s the issue of proactive compliance to proposed abortion restrictions. Legal ambiguity slows down medical decision-making. When a pregnant person’s life is in danger, will doctors wait for approval from lawyers before providing life-saving care? Will they delay care until the patient is on an obvious path to death?

These questions have an answer, and that answer is “yes.” We can see it happening right now in Texas and Missouri.

When I teach Wardley Mapping, I always tell students to look out for the absence of meaningful specificity. If someone uses a buzzword or other overly broad term in their reasoning and rhetoric, ask for specifics.

“Which kind of _____?”

“_____ with respect to what?”

As we see with abortion, if meaningful specificity in what is being proposed is not readily available, then it’s cause for serious concern.

Vague, overly broad abortion proposals are now producing consequences not only in medical care, but in many other arenas as well — domestic violence, sexual violence, or economic violence, to name a few. And of course these consequences will only be amplified by gender and racial prejudice.

I fear the consequences of our default path.

If you are scared or angry, do not wait for the situation to unfold. We are not going to be able to wait this out or luck our way through it. Pick an aspect that you feel is important to understand and map it to see how it works and what the options really are. Then start finding friends who are doing the work in those places.

As you saw in this post, your first map doesn’t even have to be impressive. In fact, I didn’t even make a full map, just a small value chain following a fill-in-the-blank formula. But it doesn’t matter that it’s small or simple, since it helped me understand the situation better. And your maps will help you in that way as well.

I’m using maps to more effectively speak with my political representatives and to help stir up trouble in cooperation with experts who have been doing this work for years. I promise you can do the same, and I emphatically encourage you to do so. Reach out if you have questions or need help.

In the meantime, Simon Wardley has shared his own brief analysis of abortion in a thread here.

Simon Wardley. Restricting abortion requires ... * shifting agency to a foetus to use a women's body without her consent. * a definition of life that includes non viable organisms. * the restriction of autonomy for women which has its origins in slavery and property. This was a thirty minute unfinished exercise mapping the beliefs. There is no way that modern society should be entertaining these ideas of limiting abortion. Restricted autonomy is a belief that should have been deprecated along with slavery (still unfortunately with us).
Simon Wardley’s tweet. Accessed July 23rd, 2022.

A special thanks to everyone who reviewed this post and offered feedback.

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