The Gross Inaccuracies of Focus on the Family’s Abortion Complications Page, Part I: Physical Abortion Complications

  • Abortion is approximately 14 times safer than childbirth.
  • Those who are denied an abortion feel more regret and anger and less relief and happiness than those who are able to obtain one.
  • The 11% of women who go in for an abortion but do not have one express twice the level of uncertainty about their decision as the women who do have the procedure.
  • The majority of abortions patients in one longitudinal study — 80% — did not report depression two years after their procedure (though a history of depression puts you at higher risk for that side effect, which makes logical sense), 72% said they were satisfied with their decision and reported more benefit than harm from their abortion, and 69% said they would have it again.

Introductory Paragraph

  • This study was done in China, which arguably has a different healthcare system as well as social climate surrounding birth and abortion — in fact, they say specifically that “premarital live birth is rare in China”.
  • The study’s authors acknowledge that “results from previous studies are conflicting,” and that many have not found an increase in miscarriage risk.
  • They also acknowledge that “22% of pregnancies were clinically unrecognized early loss, as compared with 9% which were clinically recognized” and because their study consisted of women who presented with clinically recognized pregnancies, they “do not know if there is any difference in spontaneous abortion rate between women involved in the study and those not involved.” Essentially, they could not tell if the results actually represents an increased risk or if the nature of the study itself means that they’re clinically recognizing miscarriages that would otherwise typically go unrecognized.
  • One of the mechanisms they cite for first-trimester miscarriage after abortion is reproductive track infections, “such as herpes simplex and syphilis.” This is not a case of abortion causality per say, but rather “any abortion procedure (including medical abortion) opens the risk of transmitting bacteria from outside the woman’s body or from the vagina into the woman’s cervix” — if a woman has an untreated STD at the time of an abortion, there is a risk of reproductive track infection that could lead to later miscarriage, which would be caused by the STD and not the abortion itself.

Physical Abortion Complications

  • This study is about the complications of both spontaneous miscarriages and therapeutic abortions that result in presentation to an emergency department.
  • Some of the “side effects” they list are not contained in the study they cite — endo-toxic shock, infection resulting in hospitalization, and ectopic pregnancies. Others (cardiac arrest and death) are only listed as a side effect of accidental intravascular injection of a local anesthetic, not for an abortion itself.
  • They’re implying that these (the complications listed above) are the side effects of surgical abortion, but the “study” they link is on mifepristone, which is also used along with misoprostol to treat miscarriage and induce labor.
  • The author of this “study”, Christopher M. Gacek, is a Senior Fellow in Regulatory Affairs with the Family Research Council. The FRC is a product of James Dobson and is described as “an American fundamentalist Protestant activist group, with an affiliated lobbying organization. FRC promotes what it considers to be family values by advocating and lobbying for policies in government.” It is designated as a hate group by the Southern Poverty Law Center.
  • They are well-known for making false claims “based on discredited research and junk science.” Josh Duggar served as their executive director until his history of molesting underage girls came out in 2015.
  • Their specific claim is that “Overall, medical abortion had roughly four times the rate of adverse events than surgical abortion did: 20.0% of women in the medical-abortion group and 5.6% of women in the surgical-abortion group had at least one type of adverse event.”
  • This is from a 2009 study done in Finland that compared the immediate complications of medical and surgical terminations of pregnancy. Their conclusion is as follows: “Both methods of abortion are generally safe, but medical termination is associated with a higher incidence of adverse events.”
  • This study was done in Madagascar, which the authors say “has restrictive abortion laws with no explicit exception to preserve the woman’s life.” This means that the abortions they’re studying are illegal and unsafe abortions, not legal abortions in a clinical setting.
  • “The majority of abortions involved invasive methods such as manual or sharp curettage or insertion of objects into the genital tract.” No wonder 29% of those women end up with infections — they were having dangerous back-alley and/or self-administered abortions, which will become more commonplace as abortion bans go into effect across this country.
  • The authors also state that “the proportion of women with a history of abortion was significantly lower in rural districts where contraception was available from community health workers than where it was not.”
  • This excerpt again cites the previously-referred-to “study” on mifepristone.
  • A clinical review showed that “ The safety of mifepristone is high; few serious medical complications occur in routine clinical use; Overall, 2.2 per 1000 women experienced a complication, most commonly, heavy bleeding. Mifepristone abortion mortality is estimated to be 1.1 per 100,000 based on one death.”
  • This study includes NOTHING about side effects from abortion. In fact, the study was on the number and characteristics of abortion in the U.S., not the outcomes of abortion or the side effects following it.
  • The conclusion of this study was that “Among the 48 areas that reported data every year during 2005–2014, the decreases in the total number, rate, and ratio of reported abortions that occurred during 2010–2013 continued from 2013 to 2014, resulting in historic lows for all three measures of abortion.”
  • This study is about miscarriages, or “spontaneous abortion” as it’s known in medical terms.
  • “An incomplete abortion is a subtype of spontaneous abortion, along with inevitable and missed abortion. The overall incidence of spontaneous abortion is 10% to 15%.” They’re talking about women whose miscarriages are not complete and who sometimes have to seek medical intervention to prevent infection, not elective surgical abortions.
  • The results of the cited study say that “Most of these women will expel the fragments of conception on their own without the need for further medical or surgical treatment.” and that “In patients with conception fragments at the cervical os, a clinician can remove the fragments with forceps to help initiate the process of hemostasis, facilitate uterine contractions, and decrease vagal stimulation. This will prevent cervical shock.”
  • Hemostasis refers to the stopping of blood flow, not “birthing-like contractions”.
  • The only “removal methods” discussed in the study are in reference to the treatment of incomplete miscarriages in patients who require medical or surgical treatment, including the aforementioned use of forceps to remove retained tissue.
  • The “complications” they mention are related to the management of an incomplete miscarriage, not to the miscarriage itself — “There are several other complications that can arise after the management of incomplete abortion including death, uterine rupture, uterine perforation, subsequent hysterectomy, multisystem organ failure, pelvic infection, cervical damage, vomiting, diarrhea, infertility, and/or psychological effects.”
  • This study was done retrospectively on “perinatal data prospectively collected by obstetricians and midwives from 1990–1999” in Germany.
  • The study’s purpose is to compare “the risks for adverse reproductive outcomes of adolescent nulliparae (those who have not given birth) to teenagers who either have had an induced abortion or a previous birth” in subsequent births.
  • It says that “adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers.”
  • However, in their discussion, they point out that, “We found among adolescents who already had a previous pregnancy a higher risk for the infant than among teenagers who reported to be pregnant for the first time even if relevant confounders are controlled. Among adolescents with a history of an abortion, the risks for stillbirth and preterm birth are increased but this can be explained by confounders.”
  • In the discussion over the limitations of their study, they say, “It may well be that a short inter-pregnancy interval is one of the underlying causes of worse outcomes among adolescents who had a previous pregnancy. Intimate partner violence is another known risk factor for subsequent pregnancies during adolescence that we were not able to examine. Alcohol is a known teratogenic substance that operates under a dose-response mechanism and drug use is associated with adverse pregnancy outcomes as well. We could not access information on these substances. Further known risk factors for adverse pregnancy outcomes such as an unwanted pregnancy, stress, poverty, and vaginal infections also are not assessed in the routine perinatal survey. In summary, it is possible that our findings might be eliminated if we had accessed more confounders or if the study had a longitudinal design.”
  • They also indicate (in reference to comparable U.S. studies) that, “Neither the ethnic composition nor the social context of these U.S. studies and our study can readily be compared.”
  • The same results and the discussion of them from the previous passage applies here.
  • For the second part, “the chance of premature delivery is doubled,” the briefing paper they link is from C-FAM, the Catholic Family & Human Rights Institute.
  • In it, the author “reviews the pertinent literature concerning the risk factors for preterm birth and concludes that medical journals, and particularly some authors, undervalue or even minimize the link between abortions (either spontaneous or induced) and subsequent risk of preterm birth.”
  • In their introduction, they point out that “The majority of the increased Early Preterm Birth appears as a result of multiple gestations due to assisted reproduction.”
  • They acknowledge on the first page that “Although it is not possible to distinguish between the relative effects of spontaneous versus induced abortion on preterm birth from current studies, researchers should not minimize the overall undisputed relationship between abortion and preterm birth. Doing so has thus far resulted in inaccurate conclusions.”
  • They also acknowledge that, “The very medical reasons women miscarry spontaneously may also predispose them to preterm birth. Further, spontaneous abortion is not an avoidable epidemiological risk factor for preterm birth; it is a tragic outcome of a wanted pregnancy for most women. Therefore, to compare spontaneous abortion’s relationship to preterm birth with the relationship of preterm birth to induced abortion is hardly appropriate.”
  • The authors note that “Placenta previa effects 0.3–0.8% of pregnancies and is the leading cause of uterine bleeding in the third trimester and of medically indicated preterm birth. Pregnancies complicated by placenta previa result in high rates of preterm birth, low birth weight, and perinatal death. Both the observational studies included in our review and Ananth et al’s meta-analysis show a link between placenta previa and previous induced abortion.”
  • However, they also state that “Ananth et al speculate that a 50% reduction in induced abortion would be required to avert 1.5% of placenta
    previa cases. Placenta previa is rare enough and the impact of this change is so small that we would not feel obliged to mention this to women contemplating their first abortion. Our advice might change if a woman had had a previous cesarean section, an independent risk factor for placenta previa; or if she were contemplating undergoing a second elective pregnancy termination.”
  • A study they cite says that, “The reported incidence of placenta previa ranged between 0.28% and 2.0%, or approximately 1 in 200 deliveries. Women with at least one prior cesarean delivery were 2.6 times at greater risk for development of placenta previa in a subsequent pregnancy,” and that “Women with a history of spontaneous or induced abortion had a relative risk of placenta previa of 1.6% and 1.7%, respectively.”
  • That’s a 0.1% higher chance of placenta previa in induced abortions versus miscarriages.
  • Nothing contained in the original review or any studies cited within it mentions an increase of “70 percent after one abortion and 200 percent after multiple.”
  • This study was done in China from 1998–2001 and therefore contains the same confounding factors previously mentioned for studies in other countries.
  • It shows a 18.7% higher risk of vaginal bleeding in subsequent pregnancy for women with a history of medical abortion than that in women with no history of abortion (16.5% versus 13.9%) and a statistically comparable risk to that of surgical abortion (17.3%).
  • There is no mention of the 30% to 99% higher risk cited on the Focus on the Family site.
  • Because no study was linked for the 1.8 times increased risk of ectopic pregnancy, I searched for that statistic specifically but found nothing.
  • According to the Global Library of Women’s Medicine, “A history of one abortion is associated in most studies with a nonsignificant, excess risk of ectopic pregnancy of approximately 30%. These observed associations, although real, may be due to chance, as the 95% confidence intervals (CIs) for all the odds ratios (ORs) included 1.0. CIs in four studies were narrow enough to rule out a twofold excess risk. Investigations of the effect of two or more prior abortions experienced small numbers of exposed women.”

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Ashley Peters, Writer

Ashley Peters, Writer

Politics, social justice issues, religion.