Top 25 events might have included these items

To the Editors of Contraceptive Technology Update:

I have been a subscriber to Contraceptive Technology Update for many years and rarely take issue with the content. I must, however, register my total surprise and dismay at your "25 Events to Know in Reproductive Health" that appeared in the January 2005 issue. Two of the most glaring that were omitted, from a national and international health perspective, are:

1. Introduction and development of suction curettage in the 1950s coupled with the development manual vacuum aspiration using the Karmen cannula (soft tip). These were epic events that changed the lives of millions of women forever. They made induced abortion safer and remain the foundation for abortion services in the United States and throughout the world. In support of this, please see the following quote taken from a recent presentation by Malcolm Potts, published by the British Pregnancy Advisory Service: Abortion Law Reforms: Pioneers of Change.

Professor Potts, MB, Bchir, PhD, is a former member and executive committee member of the Abortion Law Reform Association and a professor of Population and Family Planning at the University of California, Berkeley, and is the former president of Family Health International.

"Shortly after the [abortion] law was reformed [in England], I met an American called Harvey Karmen [PhD], who had gone one step further than the Eastern Europeans in simplifying early abortion techniques (sharp curettage). He had devised a plastic 50 ml syringe with a flexible plastic cannula that made it possible to do abortions with a piece of equipment costing only a few pounds. Harvey and I published the first description in The Lancet in 1972, and since that time the technology has gone round the world. "

2. Introduction of the Yoon falope ring for laparoscopic tubal ligation in the late 1960s by, I believe, Drs. In Bae Yoon and Theodore King in an article published in AJOB/GYN or Obstetrics and Gynecology.

I trust you will not think my response "overly picky." The battle for reproductive health rights and services has been a long and difficult one. Tragically, in all too many instances, the medical community, especially eminent obstetricians and gynecologists, has obstructed progress. Karmen, went to jail because of his beliefs and experience, which subsequently were confirmed one-thousandfold. He clearly deserves a prominent place in the history of reproductive health.

The work of Yoon should not be overlooked either. Voluntary sterilization remains the contraceptive method with the greatest impact on population stabilization nationally and globally. The development of the Yoon falope ring revolutionized ambulatory voluntary sterilization-made it safer, easier to do, dramatically shorter recovery period and reversible. It still remains a major factor in the continuing efforts to limit population growth.

Noel McIntosh, MD, ScD, Senior Associate, Population and Family Health Services, Bloomberg School of Public Health, Johns Hopkins University in Baltimore, and Adjunct Professor of International Health at Tulane University School of Public Health, New Orleans

Dear Dr. McIntosh:

Thank you for your very insightful letter. You might be interested to know that suction curettage, a far safer approach to therapeutic abortions than sharp curettage, was described in the 1920s at Johns Hopkins. Papal pronouncements in 1930 and 1931 terminated terminations in your fair city immediately. The turn of suction abortions and the role of the Karmen cannula in therapeutic abortions and menstrual regulation procedures worldwide has led to safer, more widely available abortions in most countries worldwide.

You are right! This was an omission from our list. We stand corrected. Dr. Potts and his wife, Martha Campbell, PhD, have pointed out to me that abortion is readily available in all 60 nations that have achieved a stable population. . . . all, that is, except Ireland, where women can and do obtain abortions readily in England or on ships that set anchor off the coast of Ireland!

As you know, tubal sterilization is the most commonly used method of birth control throughout the world (as well as in the United States). The role of the falope ring has been immense, so you are right again!

We thank you and ask any other readers who would like to send us their comments, to do so.

Robert Hatcher, MD, MPH, CTU Editorial Advisory Board Chairman