The claim that abortion is safer than childbirth has been used as a legal precedent in the judicial overturn of laws restricting abortion. However, a literature review shows that morbidity-mortality data for abortion and child birth are not always comparable. Abortion and childbirth are dissimilar in intent, stage of pregnancy, method and manner. Factors that may skew the comparison of childbirth versus abortion risks include: Intervals that differ for reporting deaths, abortions that can be reported as live births, premature closing of records, abortions that are unreported, abortions performed on women not pregnant, complications not reported by patient, absence of follow-up, abortion estimates that always exceed Public Health Service figures, borderline cases reported inconsistently, and many others.
Reported risks of induced abortion are numerous; the reports vary widely in the rates reported. Among the risks are: Increased susceptibility of breast cancer (24 times as likely if first pregnancy ends in abortion); predisposition to ectopic pregnancy (one study suggested that 45 percent of all ectopic pregnancies follow induced abortion); uterine infection (up to 17.5 percent of all cases after abortion); uterine hemorrhage (up to 4.9 percent); loss or deformity of subsequent infants; and many others. This literature review provides reason to doubt that abortion is safer than childbirth.
Introduction
"Abortion is safer than childbirth" -this claim has been used often to justify legalization of abortion. In fact this assurance loomed large in the reasoning of the pro-abortion Supreme Court decisions1 which claimed that 19th century state anti-abortion laws were enacted primarily to protect women from the high mortality of induced abortion in the 19th century; but now first trimester abortions are as safe or safer than child birth.2
More recently, the June 15, 1983, Akron and Planned Parenthood (of Kansas City) pro-abortion Supreme Court decisions cited Cates and Grimes on the safety of second-trimester abortion.3
But even if abortion were allegedly proven safer than childbirth for the expectant mother, that would not justify it; abortion is never safe for the unborn child!
False Comparison
Attempting to compare mortality and morbidity rates for women who abort with those who give birth hardly constitutes a foolproof procedure be cause:
"One of the most frequent warnings which is given regarding the comparison of vital statistics data is that interpretation of differences must not be made when the data are not comparable'... The warning that the data compared especially must be comparable really means that they must be essentially identical in regard to all other factors except the one or ones in terms of which the interpretation is to be made... The failure to take account of differences other than those considered in the interpretation has also been termed the fallacy of concealed classification,"... If we classify males according to occupation, we might find that the death rate of bank presidents is higher than that of news boys; but this would not be because of different ages...An equally serious fallacy arises from failure to consider the period of exposure to risk or the use of an incorrect figure to represent the group exposed to risk."4
Intrinsic Factors Differ
The preceding warnings are violated by comparing abortion with childbirth. Abortion is dissimilar from childbirth in respect to (a)intent (abortion intends to destroy the offspring; childbirth aims to deliver the live offspring; (b)duration (most abortions occur before 12 weeks gestation-childbirth usually occurs around 40 weeks gestation); (c)method (abortion is a surgical procedure-childbirth usually is not); and (d)manner (abortion is artificially induced-childbirth is not).
Even more problems hinder accurate reporting of abortion risks:
Hesitancy To Admit Risks
An editorial in the Medical Journal of Australia stated:
"Traditionally, the medical profession has been unwilling to present concrete facts to the public concerning the possible dangers associated with various procedures, especially surgical procedures. Perhaps it is now time for doctors to be more open and honest and to encourage better education of the community. The general public should be allowed to know that mid-trimester abortions are not simple, safe procedures and that they may carry a significant risk, not only of morbidity, but of death."5
Willard Cates, M.D., former head of the Centers for Disease Control of the U.S. Public Health Service, has been quoted in additional acknowledgment that underrating is substantial in the event of what abortionists consider a complication to abortion--a live birth. The Philadelphia Inquirer reports:
"(Live births) are little known because organized medicine, from fear of public clamor and legal action, treats them more as an embarrassment to be hushed up than a problem to be solved. It's like turning yourself in to the IRS for an audit." Cates said. "What is there to gain? The tendency is not to report because there are only negative incentives."6
Lack of Uniform Definitions
The U.S. Public Health Service, through the CDC, has stated:
"An abortion death is defined as one that occurs from complications of an abortion in which the illness leading to the death began within 42 days of the abortion."7
Yet, the National Center for Health Statistics notes the following variations in state death certificate reports: Alabama, Iowa and New York City ask whether there was a pregnancy within the past six months; Illinois, Nebraska and Virginia, within the past three months; North Dakota, within the past 18 months; and Missouri and New Jersey, within the past 90 days. Only New York City asks questions concerning delivery and live versus still birth.8
Statistics gathered from pregnancy and childbirth beyond the 42-day limit the CDC used for abortion will bias the results in favor of abortion safety.
Assignment Of Risks
The U.S. Public Health Service (PHS) Handbook on the Reporting of Induced Termination of pregnancy states:
"Although unlikely, the induced abortion procedure may result in a live birth. Should this occur, the report of induced termination of pregnancy is not (emphasis in original) to be filed. Rather a certificate of live birth is to be prepared for the infant."9
Thus, an operation which began as abortion is statistically recorded as a live birth, and the associated morbidity and mortality will also presumably be attributed to the live birth!
Additionally, the PHS instructions for filling out the U.S. Standard Report of Induced Termination of Pregnancy instructs the recorder of abortion complications: If no complications have occurred at the time the report is completed. check 'none'...This item will provide data regarding the risk of induced termination" (emphasis in original).10
Thus, if the abortion report is completed at the time of the abortion, risks may be understated because:
"As a rule - little blood is lost during the vacuum aspiration procedure itself, and the bleeding due to retained tissue usually does not occur for several days after the procedure ."11
Intent To Avoid Knowledge Of Abortion And Abortion Complications
Menstrual regulation, menstrual extraction, endometrial aspiration and surgical aspiration of the uterus are terms which "allow" abortion without prior pregnancy tests. According to abortionist Warren Hern, the term menstrual regulation originated as a euphemism for early abortion prior to legalization of abortion and was perceived by its originators as a useful deception {and is still useful.). . . in a politically repressive setting."12
Is the performance of menstrual regulation a way of avoiding requirements for reporting morbidity and mortality from early abortion?
Non-Abortions Reported as Abortions
False pregnancy tests occur:
"In a large series of abortions performed during 1970-1971, about 0.3 per cent of all women diagnosed as being pregnant in the first trimester of gestation proved to be not pregnant."l3
Complication-free abortions, performed on women who are not even pregnant are currently recorded for statistical purposes as "safe abortions"-statistics gained at the expense of unnecessary surgery.
There is also the circumstance of abortionist physicians who certify a woman's pregnancy without a thorough physical examination.
In September 1972, Jeanie Barba and Nancy Smith, staff writers for the Santa Monica California, Evening Outlook, authored six articles published Sept. 25-30. 1972) detailing certain aspects of the abortion industry under the California Therapeutic Abortion Act of 1976.
They wrote:
"On three separate occasions, within the last two months, a woman investigator hired by the Evening Outlook went through referral and testing procedures and was certified as being pregnant-but she wasn't: "The procedure at most hospitals involved in the abortion business apparently is to take the woman's word that she is pregnant and...to go ahead with an operation without a thorough physical examination.
"The Evening Outlook investigator's experience bears out this conclusion:"
"While she was given a blood test and pregnancy test at one hospital, the examining doctor did not wait for results of the tests before certifying her as pregnant. No pregnancy test or blood test was given at the other hospital or at the medical office."14
Reluctance To Report Abortion Complications
Women experiencing guilt or shame following abortion may be reluctant to report delayed complications or to permit follow-up surveys at examinations.
In a prospective survey of first trimester abortion complications. Hodgson noted that 28 of 200 women who might have had complications gave fictitious names." 17 Tietze has also reported an abortion-related death where the woman had used a fictitious name.15
Abortion Estimates Inflated
Statistical estimates are extrapolated from abortions actually reported and then used as the baseline for computing mortality and morbidity. These estimates may be higher than the total number of abortions actually performed. Any such overestimates would bias the statistics in favor of abortion safety. The research affiliate of Planned Parenthood. The Alan Guttmacher Institute estimates: "each year generates a total number of legal abortions approximately 10 to 20 percent higher than that reported by CDC."16
Do doctors. clinics and hospitals keep two abortion tallies, for total count as well as for morbidity and mortality!?
Additionally, while New York City reported resident and non-resident abortions from July 1, 1970, to June 30, 1972, to total 334,865, Jean Pakter, M.D., stated:
"After correcting for under-reporting (approximately 16.7 percent), it is conservatively estimated that 402,000 abortions were actually performed in the two-year period."17
A wide discrepancy in the total number of abortions would necessarily mean a wide shift in the rate of abortion complications, in favor of abortion safety.
For example, if CDC death estimates are compared to the Guttmacher Institutes estimates of total abortions. the risk ratio will be lower than if CDC figures arc used throughout. Which comparison is correct?
Abortion Death Excluded from Statistics
In reporting on New York abortion figures, an abortion-related death was at first included, then later excluded from abortion mortality figures by the same authors.
Three days after undergoing a suction curettage abortion, a woman committed suicide, not knowing she was never pregnant. Christopher Tietze, M.D., and Alan Guttmacher, M.D., included this as an abortion-related death in a letter in the British medical journal, the Lancet, Jan. 13, 1973. However, Tietze, Pakter and Berger, writing a special communication article in the July 30, 1973, Journal of the American Medical Association (JAMA), noted this same death but did not compute it in the abortion mortality table. A June 1973 article by Jean Pakter and others in the American Journal of Public Health also did not list the suicide-abortion death. Lastly, an article by Tietze , Pakter, Berger and Katz in the March 1974 issue of Obstetrics and Gynecology did tabulate the death.
If this same death was reported so differently, could it be that other abortion-related deaths are being excluded too?
Maternal Mortality Statistics Inflated
A July 9, 1982 article by Cates and others in JAMA stated, "In Georgia in 1973-76. record linkage of deaths and births found 50 percent more child birth-related deaths 6 (i.e., 50 percent more deaths than had previously been linked to childbirth.)
The supporting footnote to the Cates article refers to an earlier article by Rubin McCarthy, Shelton et al. which noted that the vital records unit of the Georgia Department of Human Resources classified maternal deaths as those deaths resulting from complications of pregnancy, the childbirth, or the puerperium." 18
The authors preferred to use the more comprehensive World Health Organization maternal death definition: "The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy from any cause related to or aggravated by the pregnancy or its management, but not accidental or incidental causes."
The authors also included deaths up to 189 days after delivery which they believed were related to the childbirth. This expanded definition, including the increase beyond the 42-day period, may have accounted for the 50 percent increase in maternal mortality statistics.
Other Tactics
Extensive review of the medical literature shows that some abortion proponents, when confronted with medical articles on abortion deaths or complications, will:
* Ignore the articles;
* Claim that the scientific protocol is suspect:
* Claim that the conclusions are premature or not substantiated elsewhere;
* Claim there is no universal agreement in scientific circles;
* Claim that data from foreign sources does not apply to American women;
* Claim that one abortion procedure cannot be compared to another;
* Dismiss damaging articles from some foreign countries because of illegality of abortions there, even though performed by physicians:
* Reclassify abortion-related deaths to other causes or factors; and
* Blame complications on smoking, drinking or other such factors.
Possible Adverse Health Consequences Of Legally Induced Abortion
Breast Cancer
In a study of 163 women under 32 in the Los Angeles area who developed breast cancer, matched by 163 controls, it was concluded that women who had a first-trimester abortion (induced or spontaneous) before a first full-term pregnancy experienced breast cancer at a rate of 2.4 times that of non-aborting women. 19
The U.S. Public Health Service s CDC reports 8,595,920 abortions between 1972 and 1980. 20 Utilizing the CDC data on the number of women not having their first full-term pregnancy prior to undergoing elective abortion, upwards of 4,545,000 American women may! be a increased risk of breast cancer because of abortion.
Ectopic Pregnancy
Ectopic pregnancy occurs when the fertilized ovum implants outside the womb, such as in the abdominal cavity, ovary or fallopian tube. Ectopic pregnancies can be life threatening.
In a study which matched control and case subjects for age, parity (number of offspring) and socioeconomic status, it was concluded that induced abortion created a predisposition to ectopic pregnancy in subsequent pregnancies. This study of Greek women revealed 45 percent of all ectopic pregnancies followed induced abortion. 21
There is the additional consideration of how deaths are reported which result from an abortion and subsequent rupture of a pregnancy misdiagnosed as uterine, but which in fact was ectopic.
The CDC has noted, "between 1972 and 1977... six women died from ectopic pregnancies after undergoing a legally-induced abortion procedure. Because deaths from ectopic pregnancies are not considered abortion-related... they have not been tabulated."22
By 1978 the CDC had identified 10 deaths caused by ruptured ectopic pregnancy in women aged 18 to 31 after undergoing legal abortion. Yet none of these deaths were classified as being caused by abortion, even though they were discovered by CDC's abortion surveillance program.23
Double Abortion
Abortion proponents claim that suction curettage or vacuum aspiration is the "safest" abortion procedure. Yet, some women undergo two suction procedures to abort the same pregnancy. Thus, risk of abortion death and complications is doubled for such women. If reported twice, complication-free double abortions pad the "safety" figures.
The following re-evacuation rates have been noted for vacuum abortions.
No. of Abortions Re-evacuations Percent Author
16,410 83 .5 Wulff (24)
1,123 16 1.42 Moberg (25)
420 14 3.33 Nemec (26)
Uterine Infection
Proponents of abortion may try to minimize the risk of dilation and curettage or vacuum aspiration abortions. The comparison below demonstrates the range in the reported incidence of pelvic infection:
No. of Abortions Percentage of Uterine Infections Author
16,410 .1 Wulff (24)
2,972 2.0 Edelman (27)
1,123 7.2 Moberg (25)
812 17.5 Stallworthy (28)
Moberg's infection rate is 72 times that reported by Wulff and both are reporting in respected peer-review journals. Stallworth's reported rate is 175 times the pelvic infection rate reported by Wulff. Which, if any, do we believe?
Uterine Perforation
Perforation of the uterus is not always evident during uterine aspiration abortion. Treatment and management of perforation can involve observation alone. laparotomy (surgical incision through the abdominal wall), and hysterectomy (surgical removal of the uterus).
Again, the reported rates vary so widely that one wonders what to believe. However, Frederick J. Taussig, M.D., in his classic work; on abortion, said:
"Perforation is one of those misadventures that probably occur very much more frequently than the printed records would indicate. Most of the cases are never reported because after all, it is usually the operator's fault, and not a pleasant thing to write about. You can hardly find a busy gynecologist who will not, when questioned, tell you of at least one such disagreeable experience."29
No. of Abortions Percent of Perforations Author and Date
10,890 .02 Bozorgi 1977
1,668 .35 Conger 1972
431 1.13 Brenner 1971
812 1.72 Stallworthy 1971
Uterine Hemorrhage
The amount of blood loss (as reported to public health authorities) varies from 50 milliliters to 500 milliliters.33 Apparently, the Joint Program for the Study of Abortion at the CDC has not established a standard constituting hemorrhage.34 With this fact in mind. note the following reported variations. Again, what are we to believe?
No. of Abortions Percent of Hemorrhage Min. blood
Loss Stand. Author
20,248 .05 ? Hodgson (35)
2,972 1.3 100 ml Edelman (27)
3,482 4.9 50 ml Stewart (36)
Infertility
Determining the rate of secondary infertility due to induced abortion is complicated by the fact that many women may be deliberately avoiding sub sequent pregnancy. However, evidence in several studies shows a connection between induced abortion and subsequent infertility: In Poland, Midar found 6.9 percent infertility in women who had had induced abortions; 37 Segleneitse reported up to 16 percent in Latvia; and Trichopoulos reported 45 percent in Greece.39
In the Greek study, each of the 83 women who underwent an illegal dilatation and curettage abortion were matched by two control subjects. The relative risk of secondary infertility among women with at least one induced abortion and no spontaneous abortion was 3.4 times greater than it was among women with no induced or spontaneous abortions.
Spontaneous Abortion, Fetal Loss, Prematurity and Child Health
A 1976 study of 211 women who had undergone illegally induced abortion showed 43.2 percent were pregnant within one year of the abortion, with fetal loss among the 211 patients at 17 percent compared with 7.5 percent for women pregnant after spontaneous abortion. Of the 211 who had induced abortions. 4.3 percent of their subsequent pregnancies ended with spontaneous abortion in the first trimester, 8.5 percent in the second trimester, and 13.7 percent in live premature delivery. 40
A Latvian study of legal abortion within the Soviet territory noted, regarding subsequent pregnancies:
"First, every sixth to seventh pregnancy ends in spontaneous abortion. Second, a connection has been established between injury during the abortion to the spot where the fetal egg is attached and deformation of the child in a subsequent pregnancy.
". . . In a women's hospital in East Germany 250 women who had had abortions were studied and the same number who had never had an abortion. In the first group 56 deformed children had been born; in the second, 15. In the first group there were 1.8 percent more instances when the fetus was in a transverse position, twice as much weakness in the birth process, and- what was most disagreeable-between 055 percent to 1.71 percent more stillbirths. . . In a word the destroyed child takes revenge on the next, desired child.
"A study was conducted by A. Shustskeya in Byelorussia over a period of 13 years; it covered 7,550 women who had aborted their first pregnancies. Every fifth now suffers from acute or chronic inflammation of the sexual organs. Eight percent (604 women) are barren. Though they had undergone treatment over a period of ten years, they still cannot conceive.
"More data is provided by T. Fedorova: After the first abortion, 36 percent of the women are chronically unwell. P. Kas'ko and G. Kniga call the first abortion a hormonal shock to the woman's organism, which has not yet reached its full maturity...They studied the delayed (from half a year to two years consequence of this operation and found a hormonal insufficiency in almost half of those examined ."38
In an American study, women who had legal abortions were compared with women who had term deliveries. The case-control study by Levin, Ryan and others was published in 1980 with support from a grant from the National Foundation--March of Dimes.
The authors concluded that women who had two or more prior induced abortions had a two- to three-fold increase in spontaneous first-trimester abortion (i.e., miscarriage of a wanted pregnancy) between 14 to 19 and 20 to 27 weeks gestation. Smoking status, prior spontaneous loss, method of prior abortion, or amount of cervical dilation did not explain the results. 34
Placenta Previa
If there is a significant degree of placenta previa (i.e., the placenta or afterbirth lies in the lower part of the uterus and blocks passage of the baby in vaginal deliver), Caesarean section is indicated, resulting in higher mortality and morbidity for both mother and child than vaginal delivery.
A retrospective study has Barret and others at Vanderbilt University concluded that, when compared to a control group, there was a seven- to 15-fold increase in the occurrence of placenta previa in women who had first trimester abortions. The physiological changes in the woman from first-trimester abortions (suction or sharp curettage) apparently are permanent. The authors said it is possible that endometrial scarring from sharp or suction curettage may predispose an abnormal site for placental implantation. 41
Conclusion
Indeed, we may never be able to determine the exact complication and death rates from abortion, lacking precise data as a result, in part, of insufficient follow-up of abortions.
In addition, complications and deaths attributed to subsequent pregnancies may, in reality, have been caused by prior abortion. Statistically, however, such morbidity and mortality is being attributed to pregnancy and childbirth, not to the prior abortion!
This analysis should, in the very least, cast doubt on the claim, "abortion is safer than childbirth." (For the unborn baby, of course, abortion is never safe: It is meant to be lethal.)
Since the statistical methodology is questionable (as I believe is evident from this analysis), the conclusion, "Abortion is safer than child birth," may prove untrue for the mother as well.
An additional point to note is that while abortion proponents claim abortion is safe for women, their analysis of potential harm is limited to certain physical aspects of female anatomy. No mention is made of the psychological social and moral devastation that can accrue to the whole woman from abortion.
