Friday, February 25, 2005

The De-regulation and Safety of Elective Abortion in the U.S.

This article will be addressing abortion safety and mortality in the United States.

The regulation of elective abortion procedures, like many issues in the contraversial abortion debate has become ensnared in a political battle between two opposing political forces, pro-life and pro-choice.

Currently the majority of abortions are preformed on women at outpatient clinics, under minimal regulation and close political scrutiny. On one side, the abortion-rights movement, re-named pro-choice fight tooth and nail against regulations. On the other hand, the pro-life movement calls for stringent regulations and limiting access to obtaining an abortion. Regardless of political stance, an induced abortion is a medical procedure and therefore providers should be required to adhire to the same medical laws and ethical guidelines as any other medical procedures in order to protect the patient from medical malpractice. I applaud the pro-life movement for lobbying for better regulation, however the pro-life movement needs to focus on the betterment of mother as well as child. And I can see how abortion-rights activists would consider regulations as a threat to limiting abortion. However, have they become so enruptured in the politics of keep abortion legal that they've neglected safety? I've noticed that the only ones reporting injuries and deaths of women at abortion providers have been the pro-life movement. Many would question whether their motivations for reporting are only in the interest of restricting abortion. On the other hand, neither abortion-rights activists blogs nor NARAL Pro-Choice America website feature in their activism any of the incidences of medical malpractice and neglect at abortion providers. However, with a little research, one can find cases with documentation in death certificates, autopsy reports, newspaper articles, and medical journals. Yet there is plenty of uproar that clinics pushing the limits of the law are investigated and clinics have *gasp* medical regulations. Some abortion-rights activist have even gone so far as to callously minimize the injuries and deaths of women and tout abortion as the safer option, often citing statistics from the CDC and Alan Guttmacher Institute.
The claim "Abortion is safer than childbirth" comes from 2002 CDC statistics. In 2002, the CDC recorded 9 deaths out of 845,573 abortions. That's a little over 1 in 100,000. Also in 2002, the CDC recorded 8.9 maternal deaths for every 100,000 live births. From there, they deduct carrying a child to term is about 9 times more dangerous than having an abortion. However, there are some issues with this approach and deduction, with the comparison of abortion mortality and maternal mortality rates. According to the U.S. Centers for Disease Control report for pregnancy-related mortality rates: "In this report, a woman's death was classified as pregnancy-related if it occurred during pregnancy or within 1 year of pregnancy and resulted from 1) complications of the pregnancy, 2) a chain of events that was initiated by the pregnancy, or 3) the aggravation of an unrelated condition by the physiologic effects of the pregnancy or its management" (source). This means pregnancy-related mortality rates are broadly defined to included the following: aggravation of a maternal pre-existing, non-pregnancy-related medical condition, pregnancy-induced maternal medical condition, miscarriage, ectopic pregnancy, molar pregnancy, still birth, post-partum complications, and includes induced abortion. Therfore the maternal mortality rates are inflated and we are not comparing with the pregnancy mortality rate alone. In addition, regarding the CDC and AGI reports for Induced Abortions, mortalities resulting from induced abortion are typically under-reported as such. One reason is that a medical examiner may code the underlying cause of death on the autopsy report as the complication alone, i.e. embolism, septsis, hemorrhage, or anesthesia complications, rather than correctly as a legally induced abortion with specified complication. A good explination of this can be found here. Therefore it is misleading to compare pregnancy-related mortality rates to abortion mortality rates to obtain the conclusion that abortion is safer than childbirth.

According to E-Medicine: Abortion Complications, complications of spontaneous and therapeutic abortions include (1) complications of anesthesia, (2) postabortion triad (ie, pain, bleeding, low-grade fever), (3) hematometra, (4) retained products of conception, (5) uterine perforation, (6) bowel and bladder injury, (7) failed abortion, (8) septic abortion, (9) cervical shock, (10) cervical laceration, and (11) disseminated intravascular coagulation (DIC). Frequency of complications depends on gestational age at time of abortion and method of abortion. Complication rates according to gestational age at time of abortion are as follows: for 8 weeks and under - Less than 1% or less than 17,300 women will experience complications, for 8-12 weeks - 1.5 to 2% or 25,950 to 34,600 women, 12-13 weeks - 3 to 6% or 51,900 to 103,800 women, Second trimester - Up to 50% or 865,000 women, possibly higher.
Mortality and morbidity depend on gestational age (GA) at time of abortion. In the US, mortality rates per 100,000 abortions are as follows: (1) fewer than 8 weeks, 0.5; (2) 11-12 weeks, 2.2; (3) 16-20 weeks, 14; and (4) more than 21 weeks, 18. Let me put this into perspective for you. Consider that in 2002, 1.3 million abortions were preformed and and 430,000 spontaneous abortions occured in the United States, (source: Unintended Pregnancy Statistics) for this purpose, a total of 1.73 million, correlating the number of total spontaneous and elective abortions to the above mortality rates for spontaneous and elective abortions <-- 0.5 in 100,00 is equivalent to 1 in 200,000, divide 1.73 million by 200,00 and so on --> this translates to the following statistic number of mortalities (or deaths) which occur for spontaneous and elective abortions (but keep in mind the actual numbers may be higher or lower), (1) fewer than 8 weeks, 8.7 deaths, (2)11-12 weeks, 38 deaths, (3) 16-20 weeks, 242 deaths, 4) more than 21 weeks, 311 deaths. To put a face on these deaths, the Real Choice website features the names and cases of women killed during abortions.

A Few Bad Apples?
"Some folks have argued that women's abortion deaths, even when caused by gross malpractice by abortion providers, aren't a sign of widespread problems. These guys are just a few bad apples. Are they?"

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