Physical Effects
Physical effects of induced abortion
Each year Irish women are referred to England for abortions. Most of these women have been advised by medical practitioners or health professionals. Are they being made aware of the risks involved?
Physical Complications occur because:
1. The neck of the womb is tightly closed and must be opened by artificial dilation.
2. An instrument called a sound, like a steel rod which indicates the direction of the canal and the size of the uterus, is the first instrument introduced into the neck of the womb in the process of dilatation. If this sound is pushed too far or too forcibly the uterus may be perforated. However, use of the sound may avoid perforation by abortion instruments "which would produce greater injury" (Stubblefield 1986)
3. Infection in the Vagina (the birth canal) can be carried upwards into the uterus and spread into the fallopian tubes, causing pelvic inflammatory disease (P.I.D. / salpingitis). The operator may lack experience and fail to estimate the gestational age, or to recognise developmental abnormalities in the uterus (Hern, 1984).
During the Operation
1. "uterine perforation, laceration of the cervix, haemorrhage and anaesthesia-related accidents" (Castadot 1986)
2. Pelvic infections, bleeding requiring transfusion and unintended surgery (laparotomy, hysterotomy, hysterectomy) these represent 88% of all major early complications (Tietze 1983)
3. Shock, haemorrhage, failure of the uterus to contract, immediate re-evacuation being necessary (Stubblefield 1986)
4. Anaesthetic accidents; collapse (Baird 1984, Cates 1987); Epileptic fit (Sederberg-Olsen 1983, Brash 1976);. Death (Kafrissen 1986, Mulder 1985, Cates 1981)
5. Incomplete abortion - to check this "a gauze bag is commonly used to collect tissue within the suction bottle" (Hern 1984)
Abortion Complications
Cervical and Ovarian Cancer
A number of studies done in the past 20 years indicate the existence of an increased risk of cervical and ovarian cancer where there has been a history of induced abortion. A higher incidence of rectal cancer may also be related to induced abortion, but further research is needed to explain this connection.(8-16)
A study published in the Medical Journal of Australia found that the incidence of cervical cancer increased amongst women with a history of previous induced abortion. (8) The researchers considered other possible causes but confirmed an association between a greater cancer risk and women who had undergone two or more abortions.
In 1993, La Vecchia and colleagues (9) established a cervical cancer risk following one induced abortion and reported that "...cervical cancer was directly associated with induced abortions." A second study by Schwartz and colleagues10 found a significant relationship between leiomyosarcoma (a cancerous tumour in the smooth muscle of the uterus) and a history of induced abortion.
Studies published in the British Journal of Cancer (11) and the Journal of the National Cancer Institute (12), found that women with one abortion face a relative risk of 2.3 of developing cervical cancer, compared to non-abortive women. Women with two or more abortions face a greatly increased relative risk of 4.92.
Mc Pherson wrote in the American Journal of Epidemiology (13) that for ovarian cancer, "a history of having had an induced abortion was a factor that remained statistically significant."
In 1992 Negri (14) et al conducted an Italian case-control study on the incidence of ovarian cancer among women who suffered incomplete pregnancies. They found that there was a positive relationship between ovarian cancer and abortion and that this risk rose with each abortion a woman underwent. Levin et al (14) a discovered similar results.
Many studies on abortion and subsequent cancers of the reproductive system, point to a theory that, carrying a pregnancy to term actually reduces a woman's risk of developing breast and other cancers. This idea is confirmed by Albrektsen's study,(15) published in May 1995 in the International Journal of Cancer, which determined that childbirth actually gives protection against cancers of the reproductive system. This protection occurs because of "a mechanical shed of malignant or pre-malignant cells at each delivery." This protection is not found in pregnancies ended by induced abortion.
Kvale and Heuch16 carried out a Norwegian study of 63,090 women and found 581 cases of colon cancer and 250 cases of rectal cancer. The authors report that "having had many abortions was associated with a high risk of colorectal cancer." The relative risk of both colon and rectal cancer ranged from 1.16 to 1.72. In other words the risk was up to 72% higher for women who had had abortions than for women who had carried their pregnancies to term.
Uterine Perforations
Many publications list uterine perforation as a recognised complication of abortion. (17) The most common abortion techniques (Dilation & Curettage, Suction & Curettage) all carry a risk factor for uterine perforation. Researchers working in the field of post-abortion medical problems, as detailed below, agree that cervical or uterine damage continues to be a major ongoing complication that can even affect subsequent pregnancies.
A report conducted by Kaali and colleagues,(18) published in the American Journal of Obstetrics and Gynaecology found that "most traumatic uterine perforations are unreported or even unsuspected." Records from the 1970's showed that tears to the wall of the uterus occurred up to 6.4 times per 1000 abortions.
However, they conclude that such injuries are only detected during later gynaecological surgeries. Consequently, they now report the "true incidence of uterine perforations was...19.8 for every 1000 procedures."
M White et al (18) a also conducted a case-controlled study of uterine perforations and abortion. They record a perforation rate of 30.4 per 1000 procedures.
In reality, it is impossible to know the true rate of uterine perforation following induced abortion. However, there is reason to believe that post-abortion uterine damage frequently goes unreported or even unnoticed. A report published by Leibner entitled Delayed presentation of uterine perforation (19) confirms this; "Although uterine perforation with intra-abdominal injury is a well described complication of vacuum aspiration [suction] termination of pregnancy, most post-abortion perforations go undetected."
A significant consequence of perforation is that future pregnancies are affected. Uterine perforations produce scar tissue that can affect the implantation of a later embryo, making further childbearing more difficult. (20)
Nemec et al (21) reported that 6% of women who became pregnant after hysterotomy abortions (a similar procedure to a caesarean delivery) suffered rupture of their uterus. Substantial risk of rupture was found in 26% of these cases. More dangerously, uterine rupture is also one of the feared, and sometimes fatal, complications of prostagland in abortion.
Cervical Lacerations
Many studies have been completed which examine the relationship between cervical dilation and subsequent cervical damage, including laceration to the cervix. Cervical dilation is frequently used to facilitate abortion.
Molin et al (22) discuss the problem of reduced cervical resistance following first-trimester abortion. Cervical resistance is a stiffness in the neck of the uterus which makes it difficult to expand.
The study suggests that reduced cervical resistance has been associated with a reduction in the ability to continue subsequent pregnancies. Dilation up to 9 millimetres at the time of an abortion can lead to a fall in cervical resistance of 12.5% in patients, while dilation up to 11 millimetres can lead to a fall in cervical resistance of 66 to 67%.
F J Zlatnik (23) and colleagues concluded in their report that injury to the cervix could be a possible cause of later miscarriages. The study examined radiological inspections of the upper cervical canal in women with a history of premature deliveries. Zlatnik thus confirmed that induced abortion can cause the cervical muscles to be weakened and can therefore result in repeated pregnancy loss.
K Schulz (24) and colleagues wrote in The Lancet journal, that cervical injury is one of the most frequent complications of suction curettage abortion. They report a rate of cervical injury of up to 1.6 per 100 abortions. The authors also argue that fractures of the cervix may occur during forceful dilation of the cervix which can lead to cervical incompetence.
Placenta Praevia
In a normal pregnancy, the placenta is attached to the supero-anterior (upper) wall of the uterus. In placenta praevia it implants in the inferior part of the uterus. Being near or over the cervix causes a blockage and leads to major complications for the mother.
Placenta praevia usually presents in the second and third trimester of pregnancy and can cause mortality to both unborn child and mother. It is one of the leading causes of excessive vaginal bleeding during pregnancy and usually necessitates a caesarean section.
A review of 12 studies by researchers at the Robert Wood Johnson Medical School found that there was a strong association between a previous induced abortion and a higher risk of placenta praevia among U.S. women. (25)
A study by Barrett et al (26) at Vanderbilt University U.S.A found that a significant number of women whose pregnancies were complicated by placenta praevia had a history of induced abortion. Furthermore they found that women with a previous history of induced abortion were 7 to 15 times more likely to develop placenta praevia in a later pregnancy.
F Hutchinson (27) from the Cancer Research Centre in Seattle, evaluated the probability of placenta praevia being associated with a history of induced abortion by various methods. The study was conducted over two years and like the previous studies, concluded that the risk of placenta praevia is significantly increased by curettage abortions.
Pelvic Inflammatory Disease
Pelvic Inflammatory Disease (PID) is a common condition in which infection in the lower female reproductive tract spreads to the upper tract. PID is a common cause of morbidity among women of reproductive age. Serious consequences of the disease include increased risk of infertility and ectopic pregnancy.
Chronic salpingitis (inflammation of the fallopian tubes) may follow an acute attack. Subsequent to inflammation, scarring and resulting adhesions may result. Due to blockage of the tubes by scar tissue, women with chronic salpingitis are at high risk of experiencing ectopic pregnancy. As previously discussed, this condition may be life-threatening.
The Connection between Induced Abortion and PID
Normally the cervix produces mucus which acts as a barrier to prevent pathogens (disease causing micro-organisms) from entering the uterus and moving upward to the tubes and ovaries. This barrier may be breached in two ways.
A sexually transmitted pathogen can invade the epithelial cells, alter them and gain entry. Otherwise organisms gain entry as a result of trauma to the cervix. Induced abortion is one of the conditions that can alter or weaken the normal epithelial cells making them more susceptible to infection.
The relationship between induced abortion and PID is well established. Levallois et al (39) report that "Pelvic infection is the most common complication of curettage abortion." Also Sorensen et al conclude in their report (40) that "Pelvic inflammatory disease is the most frequent complication of induced abortion...." They also refer to "...the high incidence of post-abortion PID with potential long-term risks of chronic pelvic pain, infertility and ectopic pregnancy."
Chlamydia trachomatis causes genital infections. According to Elizabeth Ring Cassidy and Ian Gentles, authors of Women's Health after Abortion,40a the abortion procedure can trigger a case of PID, but those post-abortion women who already have chlamydia are at far higher risk of PID than women who do not carry the organism.
Many women only discover that they are carriers of Chlamydia trachomatis pathogen when they develop post-abortion chlamydial pelvic inflammatory disease. By this stage it may be too late to avoid later fertility problems.
Most of the research on the association between abortion and PID has been conducted in Scandinavia and the UK. The research confirms an increase in the range of 6-30% for post-abortion infection.
Equally as worrying, the large Danish study by Nielson (41) found that even administering the antibiotic Ofloxacin before the abortion "did not significantly decrease the rate of post-abortion PID, neither among women with a previous history of PID, nor among those without previous PID."
Endometritis
Induced abortion is a trigger that can often move infection into the uterine cavity and produce effects that chlamydia by itself might not cause. For example Barbacci et al (42) found that 17.6% of patients with a history of abortion at the John Hopkins Hospital, Baltimore, U.S.A., tested positive for chlamydia. The doctors found "a significant correlation between the isolation of C trachomatis from the endocervical canal of patients undergoing abortion, and subsequent development of endometritis within two weeks of the abortion."
Sorensen and colleagues also determined that untreated women with chlamydial infection at the time of abortion had a risk as high as 72% of developing PID. They conclude that these women run the risk of "serious sequelae such as ectopic pregnancy." (40,43)
References
Cervical, Ovarian and Rectal Cancer
8. Brock K E, Berry G, Brinton L A, Kerr C, MacLenann R, Mock P A et al, "Sexual, reproductive and contraceptive risk factors for carcinoma-in-situ of the uterine cervix in Sydney," Medical Journal of Australia 1989 February 6; 150(3): 125-30
9. La Vecchia C, Negri E, Franceschi S, Parazzini F, "Long-term impact of reproductive factors on cancer risk," International Journal of Cancer 1993 January 21; 53: 215-9, p 127
10. Scwartz S M, Weiss N S, Daling J R, Newcomb P A, Liff J M , Gammon M D et al, "Incidence of histologic types of uterine sarcoma in relation to menstrual and reproductive history,” International Journal of Cancer, 1991 September 30;49 (3):362-7
11. Parazzini F et al "Risk of Invasive and Intraepithelial Cervical Neoplasia", British Journal of Cancer, 59:805-809
12. Stewart H l et al "Epidemiology of Cancers of the Uterine Cervix and Corpus, Breast and Ovary in Israel and New York City," Journal of National Cancer Institute, 37 (1):1-96
13. Mc Pherson C P, Sellers T A, Potter J D, Bostik R M, Folsom A R, "Reproductive factors and risk of endometrial cancer. The Iowa Women's Health Study,” American Journal of Epidemiology, 1996 June 5, 143 (12):1195-202 p 1195
14. Negri E et al., “Incomplete Pregnancies and Ovarian Cancer Risk,” Gynecologic Oncology 47:234-238, 1992
14a. Levin et al, "Association of Induced Abortion with Subsequent Pregnancy Loss,” Journal of the American Medical Association 243:2495,1980
15. Albrektsen G, Heuch I, Tretli S, Kvale G, "Is the risk of cancer of the corpus uteri reduced by a recent pregnancy? A prospective study of 765,756 Norwegian women,” International Journal of Cancer; 1995, May 16;61 (4):485-90, p 485
16. Kvale G, Heuch I, "Is the incidence of colorectal cancer related to reproduction? A prospective study of 63,000 women," International Journal of Cancer, 1991, February 1;47 (3):390-5, p 392 Uterine Perforations
17. Mittal S, Misra S, "Uterine Perforation following Medical Termination of Pregnancy by Vacuum Aspiration," International Journal of Gynecology and Obstetrics, 23: 45-50 (1985) 18. Kaali et al, "The frequency and management of uterine perforations during first trimester abortions," American Journal of Obstetrics and Gynecology, 1989 August, 161(2):406-408
18a. White M et al, “A case-controlled study of uterine perforations documented at laparoscopy,” American Journal of Obstetrics and Gynaecology, 129:623, 1977
19. Leibner E C, "Delayed presentation of uterine perforation," Annals of Emergency Medicine, 1995 November; 26(5): 643-6
20. Frank P et al, "The Effect of Induced Abortion on Subsequent Fertility," British Journal of Obstetrics and Gynaecology 100: 575, 1993
21. Nemec D et al, "Medical Abortion Complications", Journal of Obstetrics and Gynecology; Vol 51 No 4 p 433-436 Cervical Lacerations
22. Molin et al, "Risk of damage to the cervix by dilation for first trimester induced abortion by suction aspiration," Gynecological and Obstetric Investigation 1993; 35(3) :152-4 23. Zlatnik F J et al, “Radiological appearance of the upper canal in women with a history of premature delivery,” Journal of Reproductive Medicine; 34(8):525-30
24. Schulz K et al, “Measures to prevent Cervical Injuries during suction curettage abortion,” The Lancet, May 28 1983, pp 1182-1184 Placenta Praevia
25. Anath C V et al, "The Association of Placenta Praevia with History of Caesarean Delivery and Abortion: A Meta-Analysis," American Journal of Obstetrics and Gynecology 177: 1071, 1997 26. Barrett et al, "Induced Abortion: A risk factor for Placenta Praevia," American Journal of Obstetrics and Gynecology, 141:769, 1981 27. Hutchinson F, “The relationship between placenta praevia and history of induced abortion,” International Journal of Obstetrics and Gynecology, May 2003, 81(2):191-8
Pelvic Inflammatory Disease
39. Levallois et al, "Prophylactic antibiotics for suction curettage abortion: results of a clinical controlled trial," American Journal of Obstetrics and Gynecology,158(1):100-5 p 100, 1998 40. Sorenson et al, "A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion," British Journal of Obstetrics and Gynaecology, 1992 May, 99(5):434-8
40a. "Women's Health After Abortion" by the De Veber Institute for Bioethics and Social Research, Toronto, Canada, 2002, p 66
41. Nielson et al, "No effect of a single dose of Olofaxcin on post-operative infection rate after first trimester abortion - A clinical controlled trial," Acta Obstetrica et Gynecologica Scandanavica, 1993 October, 72 (7):556-9
42. Barbacci et al, "Postabortal endometritis and isolation of chlamydia trachomatis," Obstetrics and Gynecology, 1986 November, 68(5):686-90
43. Sawaya et al, "Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis," Obstetrics and Gynecology, 1996 May, 87 (5 pt 2): 884-90
Future pregnancies
Premature Birth
We know that prematurity or preterm birth is a direct consequence of both cervical incompetence and infection. Prematurity is the leading cause of infant death within the first month of life. (28) In the Eugenics Review, (29) Malcolm Potts expressed "little doubt that there is a true relationship between the high incidence of therapeutic abortion and prematurity."
During an abortion procedure, the cervical muscle must be stretched open to allow the abortionist to gain entry to the uterus. If enough muscle fibres are torn, the cervix becomes weakened, causing so-called cervical incompetence. Normally, before birth a woman's body will release a cascade of hormones which cause the cervix to open naturally. After the baby is born and the uterus is empty, the cervix closes tightly again.
When a pregnant woman stands upright her child's head rests on the cervix. The muscle must be intact and strong in order to keep the cervix closed. If it is weak or incompetent (as it can be after an abortion) it will not be able to maintain the seal and opening may occur, resulting in premature birth and sometimes in miscarriage.
Dr Barbara Luke (30) who wrote the book Every Pregnant Woman's Guide to Preventing Premature Birth discusses this:
The procedures for first trimester abortion involve dilating the cervix slightly, and suctioning the contents of the uterus. The procedures for a second trimester abortion are more involved, including dilating the cervix wider and for longer periods, and scraping the inside of the uterus. Women who had had several second trimester abortions may have a higher incidence of incompetent cervix, a premature spontaneous dilation of the cervix, because the cervix has been artificially dilated several times before this pregnancy.
Extent of the Risk
So how well established is this risk? Twenty studies between 1973 and 1999 in seven different countries (Denmark, Great Britain, U.S.A, Hungary, Germany, Greece, and France) show a statistically significant, increased risk of pre-term births after abortion. (Please refer to the reference section to find details of the studies). (31)
Dr Luke continues in her book:
"If you have had one or more induced abortions, your risk of prematurity with this pregnancy increases by about 30%."
The Effects of Prematurity
Premature birth or low birth weight are the most important risk factors for infant mortality or later disabilities, as well as for lower cognitive abilities and greater behavioural problems. A study of 26,000 consecutive deliveries at UCLA California, examined whether previous abortions and premature births had increased the number of stillborn babies and neonatal (after birth) deaths.
The findings of this study were that the incidence of death "increased more than threefold" for those cases in which a previous abortion was involved. (32)
In 2003, Texas became the first state in the U.S. to inform women considering abortion, that the procedure increases the risk of delivering a future baby with cerebral palsy. The Texas Department of Health produced a booklet entitled A Woman's Right to Know which contains this warning about cerebral palsy and other problems to which premature babies are at high risk.
The booklet reads "Some large studies have reported a doubling of the risk of premature birth in later pregnancies if a woman has had two induced abortions." It continues "Very premature babies have the highest risk for lasting disabilities such as; mental retardation, cerebral palsy, lung and gastrointestinal problems, even vision and hearing loss." (33)
Lawsuits
A Canadian court case, Renaerts vs Vancouver General Hospital in July 1991, has drawn attention to the plight of a child who suffered cerebral palsy. The child was an abortion survivor. Born alive, the baby was left without oxygen or medical treatment for 40 minutes until a nurse took her to the neonatal intensive care unit. The hospital involved was found negligent, thus legally responsible for her disabilities and was ordered to pay the plaintiff $8,700,000. (The National Post, Ontario, 31st July 1999).
Ectopic Pregnancy
An ectopic pregnancy occurs when the embryo begins to develop in any part of the woman's reproductive system other than the wall of the uterus, the most common area being the fallopian tube. Ectopic pregnancy is a significant cause of pregnancy related morbidity and mortality.
Failure to diagnose it can result in the death of both mother and child. Approximately 1.5% of all pregnancies are ectopic, and this problem remains the leading cause of maternal death during the first trimester of pregnancy. (34)
If the abortionist's curette scrapes or cuts too deeply across the opening of the fallopian tubes, a scar may develop resulting in partial blockage of the fallopian tube.
Microscopic sperm can still pass through such blockage and fertilise an ovum as it breaks away from the ovary. After fertilisation, the human embryo is several hundred times larger than the sperm and may not be able to return through the narrowed scarred passage. The embryo then nests itself into the fallopian wall leading to a life-threatening situation of an ectopic pregnancy.
Chung and others (35) in the American Journal of Epidemiology, attempted to discover why previous induced abortions lead to ectopic pregnancy. Reasoning that the retention of foetal parts following abortion and subsequent infection "showed a highly significant association" they concluded that these two medical complications were associated with a fivefold increase in ectopic pregnancy after induced abortion.
H Barber, (36) author of Ectopic Pregnancy, A Diagnostic Challenge made an additional connection between abortion and ectopic pregnancy; "The increased risk of Pelvic Inflammatory Disease - especially chlamydia - and induced abortion appear to play leading roles in the dramatic rise in ectopic pregnancy."
Undiagnosed Ectopic Pregnancy
Physicians usually consider the possibility of an ectopic pregnancy when a pregnant woman (who is not seeking an abortion) displays symptoms of acute pain and bleeding.
Women are nowadays alerted to the possibility of such a complication and regular examinations make the condition less life-threatening. But where there is an undiagnosed ectopic pregnancy, a client may leave an abortion clinic believing that the abortionist has successfully terminated her pregnancy and that she is no longer pregnant.
However, if the child is implanted in the fallopian tube, the procedure will not have terminated the pregnancy. Convinced she is no longer pregnant, the woman may neglect to seek proper medical care when she develops the symptoms of a ruptured ectopic pregnancy. There is a high mortality associated with this later event.
Because ectopic pregnancy is a significant contributor to maternal death, calls have been made in the U.S.A for the Center for Disease Control (CDC) to investigate all cases of death from ectopic pregnancy, to determine if they are linked to recent abortions. Any identified cases would move the victim from the maternal death to the abortion-related death category with a resulting increase in the latter.
Subsequent Ectopic Pregnancy
There is a known relationship between induced abortion and subsequent ectopic pregnancy. In a 1992 edition of the International Journal of Obstetrics and Gynecology Michalas and colleagues (37 )noted "...a worldwide epidemic of ectopic pregnancy, particularly in women who have postponed bearing children until later in their reproductive lives, has been taking place." They also found that "Induced abortions were positively related to ectopic pregnancy... ."
The relative risk of ectopic pregnancy was doubled for women who had undergone induced abortions. They referred also to another study from Boston U.S.A which reported a similar finding; a 260% increase in ectopic pregnancy after two or more induced abortions.
In Italy, Parazzini and colleagues (38) found that women faced an increased risk of ectopic pregnancy after induced abortion and that this risk continued to escalate after each subsequent abortion.
They found that the ectopic pregnancy risk in women having multiple abortions was thirteen times greater than for women who gave birth.
References
Premature Birth
28. Martius J A et al, "Risk Factors Associated with Pre-term and Early Pre-term birth, Univariate and Multivariate Analysis of 106,345 Singleton Births from the 1994 State wide Perinatal Survey of Bavaria," European Journal of Obstetrics Gynecology and Reproductive Biology 80 (2): 183-189, 1998
29. Potts M, "Legal abortion in Eastern Europe," Eugenics Review, 58-59:232-250, 1967
30. Luke B, "Every Pregnant Woman's Guide to Preventing Premature Birth," 1995, New York, Times Books, p 32
31. See pages 55 and 56 of "Women's Health After Abortion" by the De Veber Institute for Bioethics and Social Research, Toronto, Canada, 2002
32. Funderburk S et al, "Suboptimal Pregnancy Outcome with Prior Abortions and Premature Births," American Journal of Obstetrics and Gynecology, Sept 1976, p 55-60
33. www.worldnetdaily.com/news/art...
Ectopic Pregnancy
34. Syverson et al, "Pregnancy related mortality in New York City 1980-1984: Causes of death and associated risk factors," American Journal of Obstetrics and Gynecology, February 1991, 164 (2): 603-8
35. Chung et al, "Induced abortion and ectopic pregnancy in subsequent pregnancies," American Journal of Epidemiology, 115 (6):879-87, p 884
36. Barber H, "Ectopic Pregnancy, A Diagnostic Challenge," The Female Patient, Vol 9, p 10-18
37. Michalas et al, "Pelvic surgery, reproductive factors and risk of ectopic pregnancy: A case controlled study," International Journal of Obstetrics and Gynecology,1992,
38(2):101-5, p 101 38. Parazzini et al, "Induced abortions and risk of ectopic pregnancy," American Journal of Epidemiology, 1995, 10(7):1841-4
Maternal mortality after abortion
Women can, and do, die as a result of induced abortion. For a one-year period (1998) the Center for Disease Control (CDC) in the U.S.A reported 10 deaths as a result of legal abortion. (44) Taking this figure as an average and multiplying it by the number of years abortion has been legal in the U.S., gives a total of more than 300 deaths. Investigators believe the true number may be far higher than this, owing to ambiguous and misleading reporting on death certificates.
Evidence for this under-reporting is provided in Mark Crutcher's Lime 5, Exploited by Choice which subsequently became a 20:20 TV documentary exposé on the abortion industry. Even under the best medical conditions, an experienced practitioner performing a routine abortion may puncture the uterus, the bowel or the bladder, leading to haemorrhage, infection and/or possible death.
Abortion-related maternal mortality is generally under-reported. Crutcher and his researchers personally verified 23 deaths from induced abortion in 1992-1993 in the USA. All deaths were reported to State agencies. The documentation from State health departments shows that 18 deaths were reported to the federal Center for Disease Control.
However, the official report of the CDC lists only 2 deaths. At first the researchers attributed the difference to bureaucratic incompetence. After further examination, they documented that the flawed abortion data from the CDC was not due to ineptitude but dishonesty, as "a large percentage of CDC employees had direct ties to the abortion industry." (45)
The Journal of the American Medical Association had the following to report;
"Complications following abortions performed in free-standing abortion clinics are one of the most frequent gynecological emergencies encountered. Even life-endangering complications rarely come to the attention of the physician who per- formed the abortion, unless the incident entails litigation." (46)
A Scandinavian study on six of the countries which formed part of the Soviet Union - Estonia, Latvia, Lithuania, Russia, Belarussia and Ukraine - found the very high frequency of abortion contributes to the "deleterious" population decline and that maternal mortality remained "unacceptably high."
The researchers write:
"It is particularly worrying that induced abortions make up 20% - 35% of all maternal mortality." (47)
Causes of maternal mortality from induced abortion
Causes of maternal deaths, arising specifically from induced abortion, range from haemorrhage and infection to embolism and cardiomyopathy. According to Atrash et al (48) approximately 14% of all deaths from legal abortion in the United States are due to anaesthesia complications.
They define abortion-related deaths as; deaths resulting from a direct complication; an indirect complication caused by events initiated by the abortion, or an aggravation, by the abortion, of a pre-existing condition.
Septic Abortion
Septicaemia is a well-recognised complication in the recently aborted mother. Farro and Pearlman list the infectious complications of abortion in their book Infections and Abortion (49) published in 1992. They listed the infectious complications as including Adult Respiratory Distress Syndrome (ARDS), septic shock, renal failure, abscess formation, septic emboli and even death.
These complications are mentioned also in other reputable text books (50) and Victor Caraballo has written a most enlightening paper (51) on the presentation of severe septic complications in the emergency room setting.
Bleeding
Bleeding and haemorrhage are common after abortion. Blood transfusions are sometimes required. A report entitled Legal Abortion: A Critical Assessment of its Risks reported that 9.5% of post-abortive women needed blood transfusions after excessive bleeding. (52)
Childbirth is a normal process and the body is well prepared in advance for the separation and expulsion of placenta accompanying delivery.
Surgical abortion is an abnormal process that pries the unripe placenta from the muscle wall of the uterus in which it is entwined. This can cause the amniotic fluid to enter into the mother's circulation. Emboli can cause serious damage and even death. Pulmonary thromboembolism was the cause of eight female fatalities, as reported to the U.S. Center for Disease Control. (53)
Finish Study
A 1997 study (54) of pregnancy-associated deaths in Finland has shown that the risk of dying within a year after an abortion is several times higher than the risk of dying after childbirth or miscarriage. This carefully designed record-based study is from STAKES, the statistical analysis unit of Finland's National Research and Development Centre for Welfare and Health.
In an attempt to study the accuracy of maternal death reports, the researchers sought the death certificate records for all women of reproductive age (15-49) who died between 1987 and 1994 - a total of 9,192 women. They then trawled through the National Health Care database to identify any pregnancy-related events for each of these women in the 12 months prior to their deaths.
Since Finland has socialised medical care, it has accurate birth, death and abortion registries, thus allowing STAKES researchers to identify 281 women who had died within a year of their last pregnancy. They found the mortality rate per 100,000 to be 27 for women who had given birth, 48 for women who had miscarriages or ectopic pregnancies and 101 for women who had had abortions.
The table below shows ratios of women who died following childbirth, miscarriage and abortion. Compared to women who carry a pregnancy to term, those who abort are over 3.5 times more likely to die within a year. In other words the maternal death rate after abortion was more than three times greater than the maternal death rate after childbirth.
These findings, which were reported in prestigious British and Scandinavian medical journals, disprove the spurious claim that induced abortion is safer than childbirth.
References
Maternal Mortality
44. Laurie D Elam Evans et al "Morbidity and Mortality Weekly report", Nov 28 2003, Vol 52, No SS-12. Division of Reproductive Health, National centre for Chronic Disease Prevention and Health Promotion; Abortion Surveillance in the United States 2000.
45. Crutcher M, "Lime 5 - Exploited by Choice," Denton, Texas, Life Dynamics Inc, 1996, Genesis Publications, Chapter 4
46. Iffy L, "Second Trimester Abortions," JAMA, Vol 249, No 5
47. Mogilevkina I, Matkote S et al, "Induced abortions and childbirths: Trends in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine during 1970 to 1994," Acta Obstetricia et Gynecologica Scandanavia, 1996 November, 75 (10): 908-11
48. Atrash H K, Hogue C J, "Legal abortion mortality and general anesthesia," American Journal of Obstetrics and Gynecology, 1988 February, 158(2):420-4
49. Faro S, Pearlman M, "Infections and Abortion," New York: Elservier, 1992, p 42
50. Sweet R L and Gibbs R L, "Post-abortion Infection, Bacteremia and Septic Shock in Infectious Diseases of the Female Genital Tract," 3rd edition, Baltimore, Wilkins & Wilkins, 1995, 363-378
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