PCUSA post abounds in undefined terms and fallacious assumptions

In a previous post I exposed the anti-fertility mindset of an article posted on the PCUSA News Service from an outside source and wondered how it could fulfill the stated mission goals of the PCUSA. The article in question, "Latin America lags on reproductive rights," was written by the president of Pathfinder International, Purnima Mane. Today, guest blogger Dr. Patricia Lee June, M.D. responds from her expertise as a Pediatrician. Dr. June writes:

This article from Pathfinder abounds in undefined terms and fallacious assumptions resulting in implications and recommendations that are unsupported by fact.

What is included in “reproductive health”? 

We all agree that it includes a healthy mother and that maternal mortality is one measure of this. But what about the human who results from the act of reproduction? Should not the growth and development of the baby from conception through birth and the neonatal period (if not longer) also be included in “reproductive health”? As a member of the PC(USA) I join with my fellow Christians, both Protestant, Orthodox, and Catholic as well as with Muslims in asserting that this is part of “reproductive health” and as a biologist and physician I know that reproduction occurs with the creation of the zygote and that growth and development of that human takes about 26 years to complete, first in the Fallopian tube, then in the uterus, then assisted by many in the wider family and community. Yet this article appears to include prematurely ending the life of the human who has been reproduced as part of “reproductive health and rights”.

What is “safe abortion”? What is “unsafe abortion”?

Neither term is defined. Of course, as earlier pointed out, from the point of view of the baby there is no such thing as “safe” abortion. Does legality make abortion “safe” from the mother’s point of view? Those who promote making abortion legal have often appeared to assert this, and it seems to be an underlying assumption in this article. But what are the facts?

Maternal mortality rates: what really helps women?   

It is also interesting to note the history of maternal mortality in some countries that have made abortion illegal. Chile outlawed abortion in 1989, when their maternal mortality rate was 41.7/100,000 live births. If lack of “safe legal abortion” contributed to maternal mortality, then the maternal mortality rate should not have continued to drop, reaching a nadir of 12.3/100,000 live births in 2003 and then rising to 16.5 in 2008 (Note for comparison that US rates increased from 14 to 21 between 2000 and 2010). Ireland, Poland, and Malta with the most restrictive abortion laws have some of the lowest maternal mortality in the world.[1] The Pathfinder article listed Uruguay as the lowest Latin American country in maternal mortality rates, but their rates exceed those of Chile (25 per WHO estimate in 2010). So, how did Chile drop their maternal mortality rates so dramatically? Primarily through improved education of women.

Through proponents of legal abortion have long claimed that legal abortion is safer than childbirth, long-term studies have shown the converse. Long term mortality is 3 to 4 times higher in the year following an induced abortion compared to the year following birth (100.5 vs. 26.7 per 100,000 women in the first study[2] and in the following year 83/100,000 after induced abortion compared to 28/100,000 after giving birth, 52/100,000 after spontaneous abortion, and 57/100,000 for non pregnant women in a second Finnish study covering 14 years)[3], and 2 times higher in the 2 years following, and 62% higher in the 8 years following abortion compared to childbirth according to data comparing medical claims for abortion, birth, and death among 1989 Medicaid recipients in California. Following abortion, rates were increased for deaths by suicide, homicide, accident, as well as for natural causes.[4] A Danish record linkage study of 463,473 women in the 10 years following their first pregnancy found An OR of 1.84 (CI 1.11-3.71) at 180 days dropping to 1.39 (1.22-1.61) at 10 years for first semester induced abortions compared to childbirth and for abortions after 12 weeks gestation an OR at one year of 4.31 (2.18-8.54) dropping to 2.41(1.56-) at 10 years. Women who had spontaneous abortions had mortality rates higher than those who gave birth, but lower than those with first trimester induced abortions. [5]

Medical facts about adolescent pregnancy

It is interesting that maternal mortality rates are now increasing in many countries. This may be due in part to childbearing at older ages when women are more likely to have hypertension, diabetes, etc.

Likewise, though there may be social reasons to oppose teen pregnancy, when looked at purely from the perspective of maternal mortality, adolescent childbearing is actually advantageous. In a recent study from Bangladesh comparing women with breast cancer to women hospitalized with other acute illnesses, the risk of breast cancer among the women who had their first child prior to age 22 was 35% that of those who had their first child at over 21. An even larger risk came with induced abortion, which increased the risk of developing breast cancer by 20 times. In considering maternal mortality, it is important to recognize that the mortality rate of breast cancer in many developing nations is around 50%. [info. source]

The real risks of "safe" abortion

Another reproductive risk factor caused by legal “safe” induced abortion is future premature deliveries. Risks for delivering very premature babies (at under 28-32 weeks gestation – babies with poor survival potential in countries with only basic health care, (and within creased mortality and accounting for most of the cerebral palsy in countries such as the US) – are increased by 19-36% with one induced abortion and nearly tripled after 3 abortions. [6].[7]
[For more information about the health risks to women who have abortions go here, here, and here.]

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[1] Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: a Natural Experiment in Chile from 1957 to 2007.  May 4 issue of PLoS ONE. (http://dx.plos.org/10.1371/journal.pone.0036613).   The 2009 rate was 16.9; complications of older mothers such as hypertension and diabetes accounts for this recent increase.

[2] Gissler, M., Kauppila R, Merilainen J, Toukomaa H, & Hemminki E. (1997). Pregnancy associated deaths in Finland 1987-1994: Definition problems and benefits of record linkage. Acta Obstetricia et Gynecologica Scandinavica, 76, 651-657.

[3] Gissler, M., Berg, C., Bouvier-Colle, M., Buekins, P. (2004). Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000. American Journal of Obstetrics and Gynecology, 190, 422-427

[4] Reardon, D. C., Ney, P. G., Scheuren, F. J., Cougle, J. R., Coleman, P. K., & Strahan, T. (2002). Deaths associated with pregnancy outcome: a record linkage study of low income women. Southern Medical Journal, 95(8), 834-841.

[5] Reardon D and Coleman P. Short and long term mortality rates associated with first pregnancy outcome: Population register based study for Denmark 1980–2004. Med Sci Monit 2012; 18(9): PH 71 – 76  accessed on Sept 5, 2012 at http://www.medscimonit.com/index.php?/archives/article/883338 

[6] Shah PS, Zao J.  Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta-analysis.  BJOG 2009;116:1425-1442.

[7] Klemetti R, Gissler M, Niinimaki, Hemminki E. Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland.

Hum. Reprod. (2012) doi: 10.1093/humrep/des294 First published online: August 29, 2012 accessed at http://humrep.oxfordjournals.org/content/early/2012/08/27/humrep.des294 on August 31, 2012.