Possible Adverse Effects

Abortion: A Help or Hindrance to Public Health? (Congressional Testimony, 1974)

ED. This testimony is posted for two main reasons:

— to show how much information was available in 1974 regarding abortion complications to women, such as sterility and prematurity of subsequent pregnancies.

— to serve as an important archival piece.]

by Andre E. Hellegers, M.D.

Dr. Andre E. Hellegers is a Professor of Obstetrics and Gynecology at Georgetown University Hospital, Director of the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics, and past President of the Society of Gynecologic Investigation and of the Perinatal Research Society.

On April 25, 1974, the Senate Judiciary Subcommittee on Constitutional Amendments held a day of hearings on proposed constitutional amendments to protect the unborn child, with special emphasis on the public health aspects of the practice of abortion. At that time, Dr. Hellegers presented the following testimony on his own behalf.

The abortion issue has been discussed at all sorts of levels.

The issues of population expansion, of women's liberation, of adoption, of maternal health and infant mortality, of religion, of public health and morbidity, have all been brought into it and all sorts of statistics have been bandied about.

Of course, these are all issues of interest to various groups, but fundamentally there would be no national debate of the present magnitude, if it weren't for one issue.

The issue is whether, in abortion, human life is killed. That is the one key issue.

Now, I believe it is necessary to state that issue more clearly. Usually the question is put in the form of "When does human life begin?" That may be putting the question in a form which confuses things rather than clarifying them.

I do not believe there is any question when biological human life begins. It is at conception, by which I mean when a sperm fertilizes an ovum. To say that it begins at any other time is Biological Nonsense.

Sperm alone do not lead to the birth of babies, nor do ova alone. It is when the two are fused that the process of human development starts and it ends at death. I will only add that with in vitro fertilization (IVF) the truth of this statement is even clearer than it ever was before.

But I suspect that this undoubted fact is not what the abortion debate is about. That the fetus is alive and not dead is undoubted. If the fetus were dead, and abortion would not need to be performed and there would be no child to raise.

That the fetus is biologically human is also clear. It simply puts it in a category of life that is different than the cat, the rat, or the elephant. So the human fetus represents undoubted human life and genetically it is different than any other animal life.

But I think what those who do not oppose abortion mean to actually convey is that this life is not sufficiently valuable to be protected. It has no value, no dignity, no soul, no personhood, no claim to be protected under the Constitution.

That is not a biological question. That is a value issue. The issue is hidden under such language as “meaningful” life or “potential” for life, or “quality” of life. What is at stake goes far beyond the issue of abortion.

The question is this: are there to be live (not dead) humans (not rats, cats, etc.) who are to be considered devoid of “value”, “dignity”, “soul”, “meaningfulness”, “protection under the Constitution”, or whatever phrase or word by which one wants to describe the inclusionary or exclusionary process?

This is fundamentally why I am opposed to abortion. It is because it attaches no value to live biological human entities. I am not among those who believe that all human life must be kept alive by machines at all costs, but I am opposed to a philosophy that proceeds to actively kill existing human life for utilitarian purposes. This cheapens all covenants existing among men.

Furthermore, I am puzzled by the selectivity with which some would apply abortion. If the fetus does not constitute truly human life, I do not see why so many would deny abortion on demand. It is sometimes said we do so because after the 13th week, or at some other arbitrary time, it become dangerous. But we do not prevent women from becoming trapeze artists for financial reasons, we don’t prevent men from becoming football players or boxers for financial reasons. I frankly don’t see why we should prevent women from incurring mortality or morbidity risks in abortion if they thought it was financially advantageous to them. But the problem is, of course, the fetal killing.

I also don’t understand why genetic counselors would approve of abortion of fetuses if they are abnormal, but 96% would not if the fetus is of the “wrong” sex. If a fetus of the wrong sex does not represent human life, why shouldn’t one abort it?

I don’t understand those who say they don’t like abortion and would only use it as a last resort. If abortion does not kill human life, why should it be a last resort and not a first resort? Some might feel better with one abortion per year than a pill per day.

So, I see this constant ambivalence about abortion, but I understand the ambivalence, because I think the vast majority of people now know how babies are produced and they can’t quite avoid the issue of the fetus all of the time.

So, the fundamental question is whether we shall assign no value to certain categories of human existence.

Inevitably, physicians are also asked to address themselves to other health issues

in abortion, although compared to the massive loss of life, I personally think they are peripheral, although obviously important in their own right.

The first claim made is usually that [legal] abortion reduces maternal deaths. Perhaps it does, but one should look at figures carefully, for they are usually presented in terms of percentages. The absolute numbers are much more revealing. Table I gives the deaths from abortions and the total number of maternal deaths from 1942 through 1972. The figures for 1973 are not yet available.

You will see that in 1942 there were 1,231 deaths from abortions. By 1968, this had come down to 133. Fairly consistently since 1961, the number of deaths decreased by 20 to 30 per year. Since then, the decrease has pretty much stopped. The percentage of all maternal deaths which are due to abortions was 16.9% in 1942 and 17.8% in 1972.

I have also appended, for his own information, the figures through 1967 for every senator’s state on this subcommittee [these tables are not reproduced here]. Again, you will see you cannot hope to go much further in the control of death from abortion. Moreover, these abortion deaths include all spontaneous [miscarriage] and truly therapeutic abortions.

What these figures clearly show is that the percentage of maternal deaths which are due to abortions have remained constant since 1942, and the number of both has steadily decreased. This has happened in every country in the world regardless of its abortion laws.

Since 1962, the time of the proposed A.L.I. law, the average decrease in abortion deaths per year was 22.  The greatest decrease has been between 1965 and 1966 when the decrease was 46. Between 1968 and 1969, abortion death decreased by 1; between 1969 and 1970, by 4. In other words, the decrease in abortion deaths has slowed down markedly in recent years… The fact of the matter is that abortion deaths were quite rare before the law was changed, and as a condition become rare, it becomes difficult to reduce the numbers even further.

TABLE I

The United States
TOTAL ABORTION DEATHS  OTHER MATERNAL DEATHS   TOTAL MATERNAL DEATHS
Year  White Non-White Total   White Non-White    Total    White  Non-White  Total

1942  917    314    1,231  4,598  1,438   6,036   5,515   1,752   7,267
1943  853    312    1,165  4,610  1,422   6,032   5,463   1,734   7,197
1944  695    201       986  3,953  1,421   5,473   4,468   1,622   6,369
1945  602    286       888  3,520  1,260   4,780   4,122   1,546   5,668
1946  535    225       760  3,272  1,121   4,493   3,807   1,346   5,253
1947  385    200       585  3,170  1,223   4,393   3,555   1,423   4,978
1948  321    175       496  2,432  1,194   3,626   2,753   1,369   4,122
1949  236    158       394  1,863     959   2,822   2,099   1,117  3,216
1950  193    123       316  1,680     964   2,644   1,873   1,087  2,960
1951  170    133       303  1,608     901   2,509   1,778   1,034  2,812
1952  196    124       320  1,428     862   2,290   1,624      986  2,610
1953  162    132       294  1,317     774   2,091   1,479      906  2,385
1954  156    131       287  1,124     694   1,818   1,280      825  2,105
1955  150    116       266     984     651   1,635   1,134     767   1,901
1956  138      83       221    880     601    1,481  1,081      684  1,702
1957  126    134       260     871     615   1,486     997      749  1,746
1958  136    123       259     802     520   1,322     938      643  1,581
1959  138    146       284     789     515   1,304     927      661  1,588
1960                       289                      1,290                       1,579
1961                       324        

              1,249                      1,573 
1962                       305                      1,160                       1,465
1963                       272                      1,466                       1,738
1964  117    130       247      634    462   1,096     751      592  1,343
1965  106    129       235      550    404      954     656      533  1,189
1966    96     93       189      509     351     860     605      444  1,049
1967    76     84       160      495     332     827     571      416    987 
1968                       133                         726                         859
1969                       132                         669                         801
1970                       128                         675                         803
1971                       120                         610                         730
1972                       140                         640                         780
1973                                  NOT   YET  AVAILABLE (in 1974)
[National Center for Health Statistics]

The other claim which is made glibly is that abortion decreases infant mortality. That, of course, is absurd. No infant’s life can be saved by aborting another fetus. Obviously, if one does one million abortions, none of these fetuses will ever become infant deaths, since they’ll never live to be infants. And, of course, like the maternal mortality figures, the infant mortality figures have also been coming down for years.

To the extent that, by abortion or contraception or by anything else women do not have 7th or 8th children, who have a greater chance of dying than 2nd or 3rd children, this also will improve mortality figures.

But what I think needs to be clear is that no abortion saves an infant’s life. It simply prevents fetuses from becoming infants and even having a chance to die as infants. It is somewhat like saying that Vietnam deaths were good because they prevented a lot of cancer which might have occurred at a later age in all the people who were killed.

If, then, the fetus is not a member of the human race, it is clear that the whole abortion debate would change.

If the fetus does represent human life, then it is hard to see how one can justify killing 1,000,000 lives or more for the questionable saving of a few pregnant women.

But I think the analysis should not cease there. Legalized abortion is said to have decreased morbidity from illegal abortions…However, it also causes morbidity. The troubling fact is that about half of all abortions in the United States are done in the unmarried, who are at greatest risk of such morbidity.

Swedish and Norwegian figures cite an incidence of sterility following abortion of about 4%. We have no U.S. figures. If we are to do one million abortions per year, and 500,000 of them are to be on the unmarried, it would leave 20,000 women per year sterile, and this would happen every year.

This strikes me as a serious figure. The problem is, of course, that in the abortion debate, one only hears about its immediate hospital effects, whereas the subsequent sterility does not occur in the hospital. I doubt many women are given this information in abortion counseling.

To my mind, an equally serious problem is the increasing evidence that aborting a pregnancy yields a considerable increase in the birth of prematures in subsequent pregna

ncies.

Prematurity has long been known to be associated with an increased incidence in cerebral palsy, mental retardation and lesser forms of damage to the central nervous system, such as learning disabilities. The more serious the prematurity, the more serious the consequences.

I am glad to know that federal funds are now being spent to study this matter [Reminder: this testimony was given in 1974.]

Again, the data imply that first pregnancies aborted yield the greatest damage, and the later in pregnancy the abortion is done, the worse the consequences.

It is difficult to assess the precise damage which may be incurred in human or financial terms.

In women who have the abortion in the first twelve weeks (the most favorable group) the data are still highly disturbing. In a studied group of 143 such women, 30 percent subsequently delivered prematurely, compared to 11.2 percent in 143 women who had not had a previous induced abortion.

Even more seriously, 8.5% of the aborted women delivered prior to 32 weeks, compared to 2.1 percent of women in the non-aborted group. It is in this gestational age group that the severe mental damage occurs. Between 32 and 35 weeks, the previously aborted group produced 5% of its children and the non-aborted group 1.4% of its children. It is in this group that the lesser cerebral damage occurs. If, conservatively estimated, only 10% of these infants developed central nervous system damage, we would still be faced with a problem of major proportions.

Let us assume 1,000,000 legal abortions per year for the United States as a desirable public health aim. Assume that one-fourth would be done in first pregnancies, a conservative figure. That would be 250,000. If 8.5% were to deliver before 32 weeks, again a conservative figure, that yields 20,000 such deliveries. If 10% of these were to acquire cerebral palsy or mental retardation that would be 2,000 per year, again a conservative figure.

Again I know of no abortion counseling service which informs its clients of these odds while seeking their full, free and informed consent for these procedures. Indeed, I also know of none which, in addition, informs them that abortion may kill live human beings, and even the Supreme Court does not deny that possibility since it prescinded from making a judgment on the matter.

The Committee can receive testimony from others about such matters as uterine perforations, blood loss, guilt feelings, ectopic pregnancies, infection – in brief, such things as modern medicine can largely solve through surgery, transfusions, tranquilizers, antibiotics, etc.

My own major concerns are threefold: the relatively small numbers of maternal lives allegedly saved – if any – and at the expense of the hundreds of thousands of fetal lives destroyed; the subsequent sterility; and the emerging problem of prematurity and mental damage in subsequent children.

But of all of these, obviously the key one is the massive destruction of fetal life and the profoundly disturbing issue of denying a share in our humanness and its dignity, value and protection to an entire class of human, living, biological entities, to put it as coldly as I can

Surely, the issue is whether under the Constitution we want to introduce the notion that biological and socio-economic problems should be resolved by procedures which kill, or even may kill, human life.

As an immigrant to this country, I would hope the United States, of all countries, could do better than that.

What seriously bothers me about the Supreme Court decision is that it did not have the courage to decide when life starts – which we all know biologically. It was faced with the problem of when life starts as a value. I am deeply disturbed that it took the decision that when you don’t know whether in performing an abortion you will kill a human life you may proceed, instead of saying you must desist [Do No Harm].

That decision marks a watershed which I believe neither medicine, nor law, nor government should accept.

Again, as an immigrant, I have always had the notion, but perhaps it is an illusion, that in the United States, of all countries, men and women might be considered equally worthy of protection under the Constitution, regardless of their age, race, color, creed or size.

Obviously, such a notion presents enormous emotional, economic, logistic, legal and medical problems. But I also, intuitively, hold to the notion that the American Experiment in Human Living should be inclusionary and not exclusionary, and that the issue at stake in the proposed constitutional amendment is whether the fetus, as a first prototype of “meaningless” life, shall be excluded or included.

Dr. Andre E. Hellegers is a Professor of Obstetrics and Gynecology at Georgetown University Hospital, Director of the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics, and past President of the Society of Gynecologic Investigation and of the Perinatal Research Society. On April 25, 1974, the Senate Judiciary Subcommittee on Constitutional Amendments held a day of hearings on proposed constitutional amendments to protect the unborn child, with special emphasis on the public health aspects of the practice of abortion. At that time, Dr. Hellegers presented the following testimony on his own behalf.

[ED. This testimony is posted for two main reasons:

— to show how much information was available in 1974 regarding abortion complications to women, such as sterility and prematurity of subsequent pregnancies.

— to serve as an important archival piece.]

Another Chart of Related Data: 

Table 2

Maternal Abortion Deaths
1940-1985

Estimated Number of Deaths Due To:    
                                                                                          Total Number
         Abortions Induced   Illegal     Spontaneous  Induced Abortion
Year for Legal Reasons  Abortions    Abortions     Maternal Deaths

1940            94                1,313           272                   1,407
1941            78                1,080           224                   1,158
1942            70                   962           199                   1,032 
1943            65                   910           189                     975
1944            55                   770           160                     825
1945            50                   694           144                     744
1946            43                   593           123                     636
1947            33                   457             95                    490
1948            28                   388             80                    416
1949            26                   298             70                    324
1950            17                   246             53                    263
1951            31                   226             46                    257
1952            21                   249             50                    270
1953            14                   230             50                    244
1954            21                   223             43                    244
1955            13                   211             42                    224
1956            11                   174             36                    185
1957            10                   209             41                    219
1958             1  &

nbsp;                 215             43                    216
1959             5                    235             44                    240
1960            10                   241             38                    251
1961             4                    271             49                    275
1962             5                    253             47                    258
1963             5                    234             41                    239
1964             5                    207             35                    212
1965             4                    197             34                    201
1966             1                    159             29                    160
1967             4                    135             21                    139
1968             2                    109             22                    111
1969             1                    115             16                    116
1970            10                   109               9                    119
1971            15                     75              9                      90
1972            24                     41             25                      65
1973            25                     22             10                      47
1974            26                      7              21                     33
1975            29                      5              14                     34
1976            11                      3              13                     14
1977            17                      4              16                     21
1978             9             

          8               9                     17
1979            18                      0               9                     18         

1980             9                       2               6                     11
1981             7                       1               3                      8
1982            11                       1              6                     12
1983            10                       1              7                     11
1984            11                       1              6                     12
1985             6                       2              6                       8

Sources: Data for 1940-1971 are from the National Center for Health Statistics (NCHS); data for 1972-1985 (the last year for which data are available) are from the Centers for Disease Control and Prevention (CDC). Through 1971, the "Illegal Abortion Deaths" column is the sum of deaths reported as due to "Abortions Induced for Other Reasons" and "Other and Unspecified Abortions" by NCHS. (NCHS reports abortion-related deaths as due to these two causes as well as to "Abortions Induced for Legal Reasons" or "Spontaneous Abortions.") From 1972 onward, the "Illegal Abortion Deaths" column aggregates those reported by CDC under that heading as well as those reported as "Other" and "Unknown".

[Life Without Roe, Horatio R. Storer Foundation, p.11]

[ED. This testimony is posted for two main reasons:

— to show how much information was available in 1974 regarding abortion complications to women, such as sterility and prematurity of subsequent pregnancies.

— to serve as an important archival piece.]