Planned Parenthood Black Community recently posted on
Twitter: “If you are a black woman in America, it’s statistically safer to have
an abortion than to carry a pregnancy to term or give birth #scarystats.“
According to commonly cited stats, all pregnant women are
statistically safer having an abortion than giving birth, though the degree of safety falls on a sliding scale. The rate of maternal death in the United States is lowest for white women and highest for black women,
with pregnant women of other races or ethnicities landing somewhere in the middle.
I want to address this question: is it statistically
safer for a pregnant woman in the United States to have an abortion than to carry a baby to term or
give birth?
It’s not statistically safer for the unborn baby, of course,
who always dies in an abortion. One cannot address the broader moral issue of abortion without addressing the status of the unborn. But, for the sake of
this post, I am only going to look at the initial claim involving the mothers.
My interest in this is not to make an anti-abortion argument, though I am happy to do that and have done so elsewhere. My interest is in the facts swirling around a claim that has life-changing implications for pregnant women.
My interest in this is not to make an anti-abortion argument, though I am happy to do that and have done so elsewhere. My interest is in the facts swirling around a claim that has life-changing implications for pregnant women.
* * * * *
When I began researching, I noticed immediately that studies often did not distinguish between a death that was the result of a complication during pregnancy vs. a death that was the result of complication specifically during delivery. Granted, women who give birth are pregnant for longer (most abortions occur in the first trimester) and so have more time in which to develop complications. However, a direct comparison between 'death during delivery' and 'death during abortion' would seem to provide a necessary and more accurate distinction. It strikes me
that there should be at least three clearly distinct categories:
- maternal deaths during pregnancy
- maternal deaths from delivery
- maternal deaths from abortion
The second dilemma was that some states keep statistics in
such a way that if a women dies for any reason whatsoever while pregnant (or within a year
after pregnancy), it falls under the broad category of maternal deaths. However,
women often die within this time frame for reasons not related to their
pregnancy in any way. When considering maternal deaths in Illinois between 2002 and 2011, for example, "more than one-third were the result of car accidents, homicide,
substance abuse and suicide; 13 percent, in fact, were homicides.” It hardly
seems fair to have those deaths count as a ‘maternal death’ when considering the risk of pregnancy or birth. We need to make
the language of our categories more specific:
- maternal deaths related to pregnancy
- maternal deaths related to delivery
- maternal deaths related to abortion.
The third confusing element was that not all 'births' are created equal. Natural delivery has better
statistical safety than C-sections do. Necessary
C-sections and inductions have better statistical safety than unnecessary C-sections and inductions, which happen more often than
you may think (see my notes at the end). So for the sake of clarity, we now need more categories:
- maternal deaths related to pregnancy
- maternal deaths related to natural delivery
- maternal deaths related to necessary C-sections
- maternal deaths related to necessary inductions
- maternal deaths related to unnecessary C-section
- maternal deaths related to unnecessary inductions
- maternal deaths related to abortion (perhaps there should a division here between medical and surgical abortions?)
The fourth hurdle was that the statistics tracking maternal
death are generally limited to within the scope of a year from pregnancy and
birth/abortion. However, the ripple effect of either choice lasts much, much longer than
that. What is the 5-year impact on women? The 10-year impact? Are there relevant stats
showing the long-term impact of the choice to go through the birthing process
vs. abortion? As a matter of fact, there are. Here's one:
“In a 1997 government funded study in Finland, women who abort are approximately four times more likely to die in the following year than women who carry their pregnancies to term. In addition, women who carry to term are only half as likely to die as women who were not pregnant. Women who had abortions were 3.4 times more likely to commit suicide compared to women who had not been pregnant in the previous year and 6 times more likely to commit suicide than women who delivered. The Finland researchers found that compared to women who carried to term, women who aborted in the year prior to their deaths were 60 percent more likely to die of natural causes, seven times more likely to die of suicide, four times more likely to die of injuries related to accidents, and 14 times more likely to die from homicide. Researchers believe the higher rate of deaths related to accidents and homicide may be linked to higher rates of suicidal or risk-taking behavior….
- maternal deaths related to complications during pregnancy
- maternal deaths related to natural delivery (1 year, 5 year, 10 year, 20 year, life)
- maternal deaths related to necessary C-sections (1 year, 5 year, 10 year, 20 year, life)
- maternal deaths related to necessary inductions (1 year, 5 year, 10 year, 20 year, life)
- maternal deaths related to unnecessary C-section (1 year, 5 year, 10, year, 20 year, life)
- maternal deaths related to unnecessary inductions (1 year, 5 year, 10 year, 20 year, life)
- maternal deaths related to abortion (1 year, 5 year, 10, year, 20 year, life)
To make it more complicated, there is a huge range
of mitigating circumstances when it comes to increased or decreased risk during pregnancy and delivery (age; previous abortions; number of children; quality of pre-natal and post-natal care; drug use; weight; comorbidities, which account for almost 50% of life-threatening complications for pregnant women; diabetes and cardiovascular disease). In addition, pregnancy can have significant long-term health benefits for the mother that don't show up in the statistics, such as longer life (!) and a reduced risk of breast and gynecological cancers. Breastfeeding apparently builds a resistance against cardiovascular disease and cancer.
In other words, someone who says, 'Women who are pregnant and give birth are at X amount of risk!' is making a remarkably sweeping claim that paints a false picture of the actual risk many, if not most, pregnant women actually face. Someone who says, "Look how safe abortion is!" can only say that by refusing to take in to account the long-term negative impact of abortion.
* * * * * *
Is it statistically safer for a pregnant woman in the United States to have an abortion than to carry a baby to term or give birth?
Once again, this is not about my opposition to abortion; this is about discovering, as I researched a topic I formerly knew nothing about, that the mainstream narrative appears to be misleading at best and false at worst. Just how misleading is not entirely clear to me, because it's hard to put real numbers to the categories I noted above, and it's even harder to find statistics that deal with all the mitigating circumstances I mentioned.
As for the racial disparities mentioned by Planned Parenthood, they seem to be far more closely correlated with circumstances than with race.
Once again, this is not about my opposition to abortion; this is about discovering, as I researched a topic I formerly knew nothing about, that the mainstream narrative appears to be misleading at best and false at worst. Just how misleading is not entirely clear to me, because it's hard to put real numbers to the categories I noted above, and it's even harder to find statistics that deal with all the mitigating circumstances I mentioned.
As for the racial disparities mentioned by Planned Parenthood, they seem to be far more closely correlated with circumstances than with race.
“'Though black women in the U.S. are not more likely than white women to have underlying pregnancy complications, such as preeclampsia, they are two to three times more likely to die of those complications.' Why? The general consensus seems to be lack of proper health care.”
Pregnant black women are not fated to die at a greater
rate than other mothers because they are black. There are solutions that are tragically often not present or readily available to them. The best thing Planned Parenthood can do - if they really care about women’s health - is to offer black women better health care, not abortion. Lest you think this kind of a solution is too simplistic or is simply wishful thinking, here’s a
fascinating real-world scenario: North Carolina has managed to erase the white/black maternal mortality rate gap by addressing overall issues of poverty and health. That in itself should tell you there is a lot more going on here than simply genetic predisposition.
If we are truly for the flourishing of women and children,
we should be doing at least four key things that stood out during my research:
- Addressing how to more adequately provide health care for everyone. The CDC claims that 60% of maternal deaths are preventable.
- Building communities committed to the flourishing of women physically, economically, mentally, emotionally and spiritually, especially when they are pregnant.
- Doing everything we can to bring about economic justice in communities that lack education, resources, and opportunity, three things which are significant factors in maternal health.
- Instilling moral/ethical training that guides people more effectively in making wise lifestyle choices, which can have a significant impact on long-term health physical, emotional, spiritual, economic and relational health.
The moral status of abortion does not change based on whether or not this kind of stabilizing structure is present, but for those of us who are committed to defending the life of the unborn, we must not forget to be committed to also doing all we can to build a culture that supports life not just in theory but in action; not just at birth, but before and after; not just by focusing on the child, but by focusing on mothers as well.
LIST OF RESOURCES/QUOTES
“But when U.S. women
die during or soon after pregnancy, it often has nothing to do with obstetric
complications, Chescheir pointed out. Violence and drug abuse are major causes. A second
study in the same issue of the journal looked at maternal deaths in Illinois
between 2002 and 2011. More than one-third were the result of car accidents,
homicide, substance abuse and suicide; 13 percent, in fact, were homicides.” https://www.cbsnews.com/news/death-rate-is-up-during-pregnancy-childbirth-in-u-s/
“Unnecessary and
emergency cesareans are the largest risk factors for complications for weeks,
months, and even years after a woman gives birth.” http://www.health4mom.org/the-truth-about-death-in-childbirth
“Statistics for 40
states and the District of Columbia, gleaned from death certificates, indicate
that whereas the reported maternal mortality rate from 1999 to 2002 was 9.8 per
100,000 live births, it jumped to 20.8 per 100,000 live births for the period
2010 to 2013. But the numbers in the latter period may have been
affected by a small change in the forms that are filed when a person
dies. Until relatively recently most states relied on a death certificate form
that was created in 1989. A newer version of the form, released in 2003, added
a dedicated question asking whether the person who died was currently or
recently pregnant—effectively creating a flag for capturing maternal mortality.
Specifically, this recently introduced question asks if the woman was pregnant
within the past year, at the time of death or within 42 days of death.” https://www.scientificamerican.com/article/has-maternal-mortality-really-doubled-in-the-u-s/
As Maron points out,
several factors may explain the high maternity death rate in the United States:
- Poorer pre-natal health. An increasing
number of pregnant women have existing chronic health conditions, such as
diabetes and high blood pressure, which significantly raise the risk of
complications during pregnancy.
- Inadequate post-natal care. Women
weakened by childbirth complications have an increased risk of dying up to
a year after the end of the pregnancy, yet many do not receive quality
follow-up medical care.
- Racial inequalities in health care.
Although black women in the U.S. are not more likely than white women to have
underlying pregnancy complications, such as preeclampsia, they are two to three times more
likely to die of those complications.
“None of these authors
are able to explain the racial differences in maternal mortality rates.
However, “quality of prenatal delivery and postpartum care, as well as
interaction between health-seeking behaviors and satisfaction with care may
explain part of this difference” (American
Medical Association, 1999, p. 1221). The Center
for Disease Control (1999), though, points to the fact that 50% of
pregnancies are unplanned. These pregnancies are associated with increased
mortality for the mother and infant. “Lifestyle factors (e.g., smoking,
drinking alcohol, unsafe sex practices, and poor nutrition) and inadequate
intake of foods containing folic acid pose serious health hazards to the mother
and fetus and are more common among women with unintended pregnancies” (Center
for Disease Control, 1999, p. 849). In addition, the CDC estimates that
half of the women that experience an unintended pregnancy do not seek prenatal
care during the first trimester. To discover interventions that may diminish
maternal mortality, 25 states have reestablished maternal mortality review
committees to examine factors that may contribute to maternal deaths (American
Medical Society, 1999). To understand the disparity in maternal mortality rates
among black and white women, much more public health surveillance and
prevention research is needed.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595019/
“Caughey, M.D., chair
of the Department of Obstetrics and Gynecology at Oregon Health & Science
University School of Medicine in Portland and a lead author of the 2014
ACOG/SMFM recommendations. “In fact, if anything, we started to see an increase
in maternal mortality.” Harvard’s Shah points out that C-sections are major
surgery, with all of the risks of any hospital procedure. “Unnecessary
C-sections may be responsible for up to 20,000 major surgical complications a
year, including everything from sepsis [a
life-threatening complication of certain infections] to hemorrhage to organ
injury,” he says. The challenge is identifying the ones that aren’t necessary
and implementing measures to stop them from occurring. Life-threatening
complications are very rare whether babies are born vaginally or by C-section.
But women with low-risk pregnancies undergoing their first C-section were three
times more likely to die or suffer serious complications—such as blood clots,
heart attack, and major infections—compared with women delivering vaginally,
according to a 14-year analysis of more than 2 million women in Canada
published in 2007 and cited by the ACOG guidelines.” https://www.consumerreports.org/c-section/your-biggest-c-section-risk-may-be-your-hospital/
“70 per cent of
maternal deaths were attributable to six factors: medical comorbidities,
pregnancy problems, hypertensive disorders of pregnancy, inadequate use of
antenatal care, substance misuse and Indian ethnicity. Medical comorbidities
accounted for 49 per cent of the deaths analyzed by the study. Conditions such
as asthma, autoimmune diseases, inflammatory/atopic disorders, mental health
problems, essential hypertension, haematological disorders, musculoskeletal
disorders and infections were highlighted as being particularly dangerous to
mothers giving birth.” http://www.independentnurse.co.uk/news/comorbidities-biggest-risk-when-giving-birth/72388
“It was quoted
recently in the literature that 'The risk of death associated with childbirth
is approximately 14 times higher than with abortion' (Raymond and Grimes 2012).
This statement is unsupported by the literature and there is no credible
scientific basis to support it.
A number of factors
enter into the relative risks of dying from abortion compared to childbirth, in
addition to the methodological issues identified above. These include patient
age, operator skill and experience, race, gestational age, type of procedure
employed, pre-existing physical and mental health, etc. In a growing body of
literature, childbirth is protective against death from non-obstetric causes,
including breast cancer and suicide in both the immediate and long term
(Gissler et al. 1996, 2005; Marzuk et al. 1997; Thorp et al. 2003; Carroll
2007). In a large, health record-linked U.S. study spanning 8 years, women who
aborted compared to those who delivered, were 62 percent more likely to die
from any cause. Suicide carried a 154 percent increased risk (Reardon et al.
2002). In Finland, using a comprehensive health data linkage system, Gissler et
al. (1997) examined death rates up to 1 year after abortion and found a 4 times
higher risk among women who aborted versus those who carried to term. Similar
adverse findings were reported in subsequent studies: mortality was lower after
a birth (28.2/100,000) than after an induced abortion (83.1/100,000)—a 3 times
higher mortality risk for abortion compared to childbirth (Gissler et al.
2004b); abortion was associated with a 6 times higher risk for suicide compared
to birth (Gissler et al. 2005). Without such record-linkage, 73 percent of all
pregnancy-associated deaths would have been missed if they were based only upon
death certificates. The percentage of deaths due to abortion would have been
even higher (Gissler et al. 2004a). In the U.K., Morgan et al. (1997) reported
a similar increased risk of suicide for women electing abortion versus
delivery: 8.1 suicide attempts per thousand among those who had abortions
compared to only 1.9 suicide attempts per thousand among those who had given
birth. Both Hoyer and Lund (1993) and Appleby (1991) found childbirth overall
to be risk protective against suicide.
“The mortality studies
in Finland found a three-fold increased risk of suicide in the first year
following an abortion compared to the general population and a six-fold higher
risk compared to women who gave birth. The highest suicide rate was within two
months of the abortion. In the California studies, women with a history of
abortion had higher rates of psychiatric treatment over a four-year study
period and were 187 percent more likely to die of heart diseases, which can
also be affected by stress. “Numerous studies have linked abortion to higher
rates of substance abuse, self-destructive behavior, psychiatric
hospitalization, sleep disorders, eating disorders and a general increase in
treatments sought for medical care,” said Reardon. “More research is needed to
explore how these or other pathways may help to explain the higher mortality
rates observed in record linkage studies.” http://aaplog.org/abortion-and-subsequent-maternal-death-rates-first-new-study-from-denmark/
“Compared to women who
carried their first pregnancy to term, after adjusting for age and birth year,
the cumulative risk of death for women who had a 1st trimester
abortion was significantly higher in all periods examined from 180 days (84%)
through 10 years (39%). The risk of death was likewise significantly higher for
women who had abortions after 12 weeks from one year (331%) through 10 years
(141%) when compared to women who delivered a first pregnancy. Finally, for
women who miscarried, the risk was significantly higher for cumulative deaths
through 4 years (75%) and at 10 years (48%).” http://www.wecareexperts.org/content/new-study-reproductive-history-and-mortality-rates-using-national-data-denmark-just-publishe
“Mortality risks associated
with induced abortion and spontaneous abortion are more pronounced when more
than one is experienced. Dr. Reardon’s summary Multiple Abortions Increase Risk
of Maternal Death Springfield, IL (September 7, 2012) — A single induced
abortion increases the risk of maternal death by 45 percent compared to women
with no history of abortion, according to a new study of all women of
reproductive age in Denmark over a 25 year period. In addition, each additional
abortion is associated with an even higher death rate. Women who had two
abortions were 114 percent more likely to die during the period examined, and
women had three or more abortions had a 192 percent increased risk of death.
Elevated rates of death were also observed among women who experienced miscarriages,
ectopic pregnancies or other natural losses. Women with a history of successful
deliveries were the least likely to die during the 25 years examined. Women who
had never been pregnant had the highest mortality rate. Among women with a
history of multiple pregnancies, women with a history of both abortions and
natural losses, but no live births, had the highest mortality rate.” http://aaplog.org/abortion-and-subsequent-maternal-death-rates-second-of-2-new-studies-from-denmark/
“A 1997 government
funded study in Finland, women who abort are approximately four times more
likely to die in the following year than women who carry their pregnancies to
term. In addition, women who carry to term are only half as likely to die as
women who were not pregnant. Women who
had abortions were 3.4 times more likely to commit suicide compared to women
who had not been pregnant in the previous year and 6 times more likely to
commit suicide than women who delivered .The Finland researchers found
that compared to women who carried to term, women who aborted in the year prior
to their deaths were 60 percent more likely to die of natural causes, seven times
more likely to die of suicide, four times more likely to die of injuries
related to accidents, and 14 times more likely to die from homicide. Researchers
believe the higher rate of deaths related to accidents and homicide may be
linked to higher rates of suicidal or risk-taking behavior….
Two studies of the
entire population of women in Denmark published in 2012 have shown similar
results. The first found that the risk of death following
abortion remains higher in each of the first ten years following the abortion.
The second found that the risk of death
increases with each abortion, 45% after one abortion, 114% after two abortions,
and 192 percent after three or more abortions.
"Doctors at Tel Aviv University found that women who have had just one abortion – even in the early stages of a first-trimester pregnancy – have significantly higher rates of C-sections (25 percent to 18 percent), slightly higher rates of labor complications resulting in induced labor (seven percent to five percent), and higher rates of a retained placenta (when the "afterbirth" fails to deliver) ( seven percent to five percent). The study, published in the Journal of Maternal Fetal and Neonatal Medicine, also found that women who had a previous abortion more commonly needed fertility treatments and were more likely to develop diabetes during pregnancy.
Dr. Liran Hiersch led the five-year study at Rabin Medical Center in Israel. The team of researchers compared the pregnancy outcomes of women who had a previous abortion or miscarriage against those women who were in their first pregnancies. Researchers did not distinguish between early chemical abortion and surgical abortion and, unfortunately, did not even distinguish between women who had an abortion and women who had a miscarriage. https://www.lifesitenews.com/news/study-one-abortion-increases-risks-in-future-pregnancies
Nevertheless, the study proves that intentionally inducing abortion can and does cause future pregnancy complications."
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