Possible Adverse Effects

Fact Or Fraud: Is Abortion Safer Than Childbirth?

People, historically, are known to accept as factual that which is not.

If they hear something repeated often enough, and forcefully enough, many people tend to accept it at face value.

In fact, that was a frequent comment of Hitler.

Consequently, propaganda, prejudices, and old wives’ tales have far more impact than they should. Thus, medical wisdom should lead us to discover how & where so-called “facts” developed, before we accept them as truth.

In the summer of 1971, the American College of Obstetrics and Gynecology (ACOG) filed a brief before the U.S. Supreme Court asserting that “the medical procedure of induced abortion is potentially 23.3 times as safe as the process of going through ordinary childbirth.” 1

 

A couple of years later, in considering its Roe v. Wade decision, the Court “took as ‘established medical fact’ the contention that in the first 3 months of pregnancy ‘mortality in abortion is less than mortality in normal childbirth’.”2 Realizing that ‘safety’ in childbirth can be evaluated in terms of morbidity (complications) and/or mortality (death), we will direct our attention to evaluating ‘safety’ in terms of maternal mortality (maternal death) in this article.

 

The claim of the relative safety of abortion over pregnancy and childbirth has become one of the rallying cries for pro-abortion forces and is still supported by organizations such as the American Medical Association. In the April 5, 1989 edition of the Atlanta Journal and Constitution, the AMA continued to state, “The medical risks to a woman of childbirth are greater than the risks of abortion.” But how much truth is there to this claim?

 

To separate fact from fraud, one must first find out how comparisons are made between maternal mortality rates for childbirth and for abortion.

 

In 1983, the Maternal Mortality Collaborative, a special interest group of ACOG, began monitoring maternal deaths from 19 reporting areas between 1980-1985. It defines such mortality as: “the death of any woman that was caused or contributed by pregnancy, occurring during pregnancy or within one year of the termination of the pregnancy.”3

 

These deaths are sub-categorized as directly resulting from complications of childbirth, indirectly resulting from pre-existing health problems, and resulting from “non-maternal” causes which were accidental or incidental to the pregnancy.

 

Another major source of mortality figures for various studies is the National Center for Health Statistics. They define maternal mortality to include deaths up to 42 days after the termination of pregnancy. All state health departments forward information from death certificates to this national source where figures are analyzed, coded and computerized.

 

State regulations regarding the death certificates themselves vary. For example, according to the Georgia Vital Records Department, the funeral home receiving the body is responsible for the completion of such forms. A doctor (either M.D. or D.O.) or coroner fills out the medical portion, which includes three lines for direct or contributing causes of death. Unfortunately, these forms are often left incomplete.

 

It is clear that there is no consistent standard or definition by which these statistics are gathered and reported. Therefore, even at the basic level of these mortality statistics, there are inherent differences and potential problems.

 

Abortion-related mortality is defined as those deaths resulting directly or indirectly from abortion complications whether they be physical or emotional.

 

 

Statistics Flawed

When comparing overall maternal mortality rates with abortion-related death rates, researchers generally calculate the number of maternal deaths per 100,000 live births, versus abortion-related deaths per 100,000 abortions performed.4 This method of comparison has several inherent flaws:

**Though abortion deaths are measured per case, overall maternal mortality is measured per live births:

 

Abortion dea

ths                                   Maternal deaths

# of abortions                                     # of live births

 

The equation on the left only includes abortion deaths per number of abortion procedures.

 

 

The equation on the right includes all maternal deaths (including stillbirths, miscarriages, abortions, and ectopic pregnancies) in the numerator.

 

The denominator eliminates these “cases of pregnancy” since they do not result in a live birth, thus, “inflating” the number of maternal deaths. (Statistically, there would be about 120,000 “cases of pregnancy” for every 100,000 live births, resulting in a much lower mortality ratio.)

           

** Maternal death rates actually include all abortion-related deaths – the very data to which they are compared.

           

** Maternal mortality figures also include deaths from ectopic pregnancies. However, in 1979, ectopic pregnancy deaths were excluded from the abortion mortality ratio even though between 1972-1981, 21 deaths resulted from ectopic pregnancies that occurred soon after an attempted legal abortion.5

           

** Deaths from causes completely unrelated to the pregnancy, such as auto accidents, physical abuse, homicide, etc. are usually included in maternal mortality figures.

           

** Studies compare the isolated procedure of abortion with maternal deaths which include deaths over the entire 9 months of pregnancy and several months to a year post-partum. No attempt is made to compare “apples with apples”, i.e. deaths occurring from abortions performed within the first 20 weeks of pregnancy, compared to maternal deaths occurring during this same period.6

 

In addition to these flaws, figures and statistics quoted are frequently a decade our of date. Medical advances in obstetrics and gynecology have greatly reduced the “risks” of pregnancy in the last couple of decades.

 

Professor Kenneth Ryan [Chairman, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School] has suggested “that ours is the safest of all times for a woman to have a baby”, and attributes this to “the vanishingly low level of maternal mortality and the remarkable achievements of neonatal medicine”.7

 

Those pointing to the danger of childbirth need to look at the current statistics.

 

 

Current Maternal Deaths

Even with all the flaws mentioned above, the mortality rate from one study during 1980-85 was only 10 maternal deaths per 100,000 live births which is a significant reduction from 50/100,000 live births in the 1950s. 8

 

The Maternal Mortality Collaborative findings, published in July, 1988, record that of the 712 maternal deaths documented from 1980 to 1985, 111 deaths were due to causes in no way related to the pregnancy (accidents, homicides, unrelated diseases, etc.).

 

From 1980-85, the main causes for these deaths were embolism (which can also easily occur in an abortion) and non-obstetric injuries. Further down the list of causes come hypertensive diseases of pregnancy, ectopic pregnancy (which an abortion cannot prevent), obstetric hemorrhage, cerebrovascular accidents, and anesthesia complications.9 

 

Similarly, a study conducted in Massachusetts from 1980-85 found that the leading causes of maternal death in that state were trauma (suicides, homi

cides, and auto accidents) and pulmonary embolism.10

This MA study also contended that one-third to one-half of the deaths were preventable.

 

Many experts believe that prenatal care, simple precautions and abstention from alcohol and drugs during pregnancy could lower maternal mortality drastically.

 

Another major culprit in existing deaths appears to be the alarming rise in Caesarean-section deliveries. In 1985, this procedure accounted for about 22.7% of deliveries. The relative risk of maternal death is 10 times higher in a C-section than in vaginal delivery.11

 

The challenge is to be able to identify the one woman in a thousand who need help, without intervening inappropriately in too many cases in which the woman would otherwise do fine,” asserts Professor Ryan. 12 

 

A final interesting factor in current studies indicates that mortality rates increase with age; they are significantly higher for women 30 years and older, and are lowest among women under 20 years of age.13  Current trends indicate that women are delaying childbirth to make way for careers and other interests.

    

Despite these two trends which would indicate an increase in maternal mortality, the mortality rate is actually decreasing.

  

But what of the dangers of abortion? Recent reports also have shed new light on abortion-related deaths.

 

Abortion Safer?

To a large extent the premise on which the pro-abortion faction operates is the belief that legal abortion makes life better and safer for women. They contend that legal abortion saves lives of women that would die from illegal, unsafe abortions. They claim that 5,000-10,000 women died of illegal abortions each year prior to Roe v. Wade, and yet there is absolutely no factual data to support this claim.14 

 

In 1972, only 39 deaths related to criminal abortion were recorded.

 

Regardless of the truth or fallacy of these numbers, one fact is clear: women are still dying from abortions.

 

 

RELATIVE RISK IN FIRST 20 WEEKS
OF NATURAL PREGNANCY VERSUS INDUCED ABORTION:
COMPARATIVE DATA FOR 1972-1977 INCLUSIVE

——————————————————————-

Entity                Death-to-Case Rate(1)                    Relative Risk(2)
——————————————————————–

Spontaneous Abortion (NCHS)    1.0                                1.0

Spontaneous Abortion (CDC)      2.2                                2.2

Induced Abortion ≤ 20 Weeks     2.4 (3)                           2.4
Ectopic Pregnancy                202.3                             202.3 
——————————————————————–

1. Expressed as the number of maternal deaths per 100,000 cases in each category or classification.
2. Based on the index rate of 1.0 for the death rate associated with adjusted maternal causes.
3. Based on 12 maternal deaths in 58,642 abortions performed during the second 20 wee

ks of pregnancy, reported for the years 1972-1977 by the Abortion Surveillance Branch of the Center for Disease Control, Atlanta.

 

 

RELATIVE RISK IN SECOND 20 WEEKS AND BEYOND
OF NATURAL PREGNANCY VERSUS INDUCED ABORTION:
COMPARATIVE DATA FOR 1972-1977 INCLUSIVE

——————————————————————–
       Entity                  Death-to-Case Rate(1)          Relative Risk(2)
——————————————————————–

Adjusted Maternal Causes         11.5                                  1.0   

Induced Abortion ≥ 21 Weeks    20.5 (3)                           1.8
———————————————————————————————–

1. Expressed as the number of maternal deaths per 100,000 cases in each category or classification.
2. Based on the index rate of 1.0 for the death rate associated with adjusted maternal causes.
3. Based on 12 maternal deaths in 58,642 abortions performed during the second 20 weeks of pregnancy, reported for the years 1972-1977 by the Abortion Surveillance Branch of the Center for Disease Control, Atlanta.

 

 

The National Department for Health Statistics lists abortion as the direct or contributing cause for 13 deaths in 1986, it most recently tabulated year.

 

However, there is no way of insuring that deaths caused by abortion are actually listed that way on death certificates.

 

It is believed that deaths from abortions are greatly under-reported.

 

The leading causes of death in abortion-related maternal mortality include infection, hemorrhage, general anesthesia complications and pulmonary or amniotic fluid embolism.

 

The type of procedure used is one factor associated with abortion deaths. A study on abortion mortality from 1972-1981 listed a death-to-case ratio of 4.9 per 100,000 abortions for dilatation and evacuation, 9.6/100,000 for installation methods, and over 60/100,000 for hysterectomy and hysterotomy.15

 

An increasingly high proportion of these deaths were due to general anesthesia complications. Only 7.7% of abortion-related deaths were due to anesthesia from 1972-75; the percentage had inflated to 29.4% from 1980-85. 16

 

Certain general anesthesia methods are more dangerous for some pregnant women. Pregnancy can increase sensitivity to the respiratory depressant effects of some narcotics, tranquilizers and inhalation drugs. 17

 

The increasing gestational age of the fetus directly relates to abortion deaths. For each additional two weeks gestation at which an abortion is performed, the risk of uterine perforation is 1.4 times higher. 18   Uterine tears occur in 2 of every 1000 abortion procedures, effecting 2,500 women each year. The risk of dying for these women increases one hundred-fold. 19

    

Long term physical and psychological problems from abortion are ignored in current statistical information. Post Abortion Syndrome, now recognized by the psychiatric profession as a mental disorder, may account for later deaths. Years after their abortions, countless women suffer from the depression and self-abuse of this condition. “No less than 90 percent of aborted women experience moderate to severe emotional and psychiatric stress following an abortion. In addition, aborted women face a suicide risk nine times greater than that of non-aborted women.” 20  Yet deaths from suicide and self-destruction are seldom related on the death certificates to abortions.

  

Physical complications from an abortion can also manifest themselves in later pregnancies. Uterine scarring or weakness from earlier abortion can result in premature delivery, stillbirth, hemorrhage, and other problems which can cause maternal deaths.

 

Ectopic pregnancies increased more than 4-fold from 1970 until 1975, for no discernible reason. 21  But it is possible that this, too, is abortion related. If scar tissue from an abortion prevents an egg from leaving the Fallopian Tube, it may very well result in the ectopic pregnancy.

 

In the Maternal Mortality Collaborative study mentioned previously, of the women who died, 3.3% had abortions, 10.6% had ectopic pregnancies, 10.1% had stillbirths and 19.3% had premature live births. 22  It would be interesting to know which of the women with the last 3 situations had experienced earlier abortions. These deaths, 43.3% of those reported, may actually have been abortion-related [because all these conditions are exacerbated by abortion].

 

In the book, New Perspective on Human Abortion, Thomas Hilgers, M.D. and Dennis O’Hare performed a study comparing maternal mortality rates  for abortion and natural pregnancy. They considered the errors made in previous studies and adjusted their comparison to give a more accurate view. They found pregnancy to be slightly safer than abortion during the first 20 weeks of gestation, and nearly twice as safe in the second 20 weeks (see charts, p.6). 23

    

In conclusion, the pro-abortion stand that abortion is safer than childbirth has not withstood the scrutiny of detailed evaluation. Because of flaws, inconsistencies and misinformation in reporting maternal deaths, an accurate picture of the relative safety of abortion vs. childbirth cannot be determined.

 

However, it is apparent that pregnancy and childbirth have become safer each year. Furthermore, one could argue that safety is not even a factor; women abort for reasons of convenience, not for reasons of safety.

 

REFERENCES

1. Thomas W. Hilgers, M.D. and Dennis O’Hare, “Abortion Related Maternal Mortality: An In-Depth Analysis,” New Perspectives on Human Abortion, Frederick, MD: Univ Publications of America Inc, 1981, p.69.

2. Ibid, p.69.

3. R, Rochar, L. Koonin, H Arrash, and J. Jewett, “Maternal Mortality in the United States: Report from the Maternal Mortality Collaborative”, Obstetrics & Gynecology, 72:1, July 1988, p. 92

4. Hilgers, op.cit., p.69.

5. CDC Abortion Surveillance, November 1985, p.9.

6. Ibid, p.69-91.

7. Kenneth J. Ryan, “Giving Birth in America, 1988”, Family Planning Perspectives, 20:6, Dec, 1988, p.298.

8. Rochat et al, op,cit., p.91.

9. B. Sachs, D. Brown, S. Driscoll, E. Schulman, D. Acker, B.Ransil and J. Jewett, “Hemorrhage, Infection, Toxemia, and Cardiac Disease, 1954-85: Causes for Their Declining Role in Maternal Mortality”, American Journal of Public Health, 78:6, June 1988, p. 671.

10. Ibid.

11. Rochat et al, op.cit., p.95

12. Ryan, op.cit., p.300.

13. A.Kaunitz, J. Hughes, D. Grimes, J. Smith, R. Rochat, and M. Kaffrissen, “Causes of Maternal Mortality in the United States,” Obstetrics and Gynecology, 65:5, May 1985, p. 607.

14. Hilgers, op.cit., p.80.

15. D. Grimes and K. Schulz, “Morbidity and Mortality from Second Trimester Abortions,” Journal of Reproductive Medicine, 30:7, July 1985, p. 505.

16. H. Atrash, T. Cheek, and C. Hogue, “Legal Abortion Mortality and General Anesthesia,”  American Journal of Obstetrics and Gynecology, 158:2, Feb. 1988, p.421.

17. H. Atrash, H. Mackay, M. Binkin,  and C. Hogue, “Legal Abortion Mortality  in the United States: 1972-1982,” American Journal of Obstetrics and Gynecology, 156:3, March 1987, p. 609.

18. Digest: “Abortion Fatalities could be Prevented by Earlier Diagnosis of Hemorrhage,” Family Planning Perspectives, 16:6, Nov/Dec 1984, p.284.

19. “Dilating Sponges Can Help Curb Perforation Risk With Abortions,” OB GYN News, Rockville MD, 15March1988.

20. David Reardon. Aborted Women, Silent No More, Loyola University Press, 1987, xxiv.

21. H. Lawson, H. atrash, A. saftlas, A. Franks, E. Finch, and J. Hughes, “Ectopic Pregnancy Surveillance, United States, 1970-1985,” CDC Morbidity and  Mortality Weekly Report, 37:SS-5, Dec. 1988, p. 10.

22. L. Koonin, H. Atrash, R. Rochat, and J. Smith, “Maternal Mortality Surveillance, United States, 1980-1985,” CDC Morbidity and Mortality Weekly Report, 37:SS-5, Dec. 1988, P.22

23. Hilgers, op.cit., p. 88-89.

[excerpted from Life Support, Summer 1989, GNLI]