The Gross Inaccuracies of Focus on the Family’s Abortion Complications Page, Part I: Physical Abortion Complications
How data is being misrepresented to mislead and manipulate pro-life voters
After the Supreme Court allowed Texas’s most recent abortion laws to stand last week, there have been many conversations about the dangerous precedence it sets for anti-abortion legislation.
Unsurprisingly, though, it has also spurred a renewed debate over the morality of abortion between those who support choice and those who are anti-abortion. As per usual, both sides are firm in their stances; however, the fact that this law leaves zero room for compromise (in practice, it amounts to a total abortion ban past six weeks with no exceptions for rape or incest) has meant that both sides are equally unyielding in their views, despite the fact that the majority of Americans — 77% — believe abortion should be allowed in cases of rape and incest during the first trimester.
Because the issue is so split along party lines — 74% of Republicans now identify as pro-life, while 70% of Democrats describe themselves as pro-choice, it is not inaccurate to think of it as a right versus left issue.
One thing that has come up in the ensuing debates, though, is how people are getting their information on health issues (which, of course, is not relegated to abortion specifically given the politicization of COVID) and how the bias and accuracy of their information sources might play a role in their views therein. Therefore, it’s also a misinformation versus information accuracy issue.
In one such conversation, someone who considers themselves pro-life provided a link to a website from Focus on the Family in support of their view that abortions are dangerous with an array of potential negative side effects both physically and mentally, despite the myriad studies available that show just the opposite:
- 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.
More concerning than the anecdotal overstatement of the dangers of abortion, though, is the fact that Focus on the Family has so manipulated the study results they report to uphold their biased views that they have entirely overstepped ethical and moral boundaries, which is completely antithetical to both their stated mission — “To be led by the Holy Spirit in sharing the Gospel of Jesus Christ with as many people as possible by nurturing and affirming the God-ordained institution of the family and proclaiming biblical truths worldwide” — and to the Christian faith as a whole.
If the truth does, indeed, support their views, why are they manipulating and lying to people in order to sway their opinion and garner their donations?
I’ve decided to provide a point by point rebuttal of the the gross inaccuracies presented on their abortion complications page because I believe in academic honesty and that people should form their opinions based on truthful and factually accurate information.
If you consider yourself pro-life because of your personal beliefs, fine. If you’re anti-abortion because you’ve been manipulated by biased and unreliable information, I think you should consider the points I’m outlining here. If, after that, you still maintain your previously held views, that is your prerogative — but either way, your personal religious views should not dictate public policy.
How to read this analysis: the bold titles correspond to paragraph titles on the Focus on the Family site. The italicized passages to the right of the vertical bar are direct quotes. I have linked the same studies they’ve cited, along with point by point explanations of the actual study contents and commentary on Focus on the Family’s use of the data. Because of the comprehensive nature of this analysis and the sheer amount of information it requires, I will split this into two parts — Part I covers the physical complications cited by Focus on the Family, while Part II covers the psychological ones.
There are many physical and psychological abortion complications that every woman should know about. This study shows a direct increased risk of miscarriage for post-abortive women, only scratching the surface of possible complications.
Study Cited: Induced abortion and risk of subsequent miscarriage
- 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.
They inaccurately present the results of this study as if they represent a clear and documented risk of miscarriage following abortion, leaving out that the study authors themselves point out the limitations of the study and its results.
Physical Abortion Complications
D&C abortions are among the most commonly performed surgeries in the country. Still, frequency doesn’t eliminate the potential of serious physical complications for women. Side effects may include hemorrhaging, perforation of the uterus, cardiac arrest, endo-toxic shock, injuries to adjacent organs, infection resulting in hospitalization, convulsions, ectopic pregnancy, cervical laceration, uterine rupture and even death.
Study Cited: Abortion Complications Clinical Presentation
- 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 are representing the “potential of serious physical complications” cited in the study as if they are specific to abortion, when in reality the study encompasses natural miscarriage as well. It’s interesting that they confirm a surgical abortion is the same as a D&C, which is a procedure used to treat miscarriages. Also interesting is the fact that the same people aren’t warning women who have miscarriages to not have D&Cs for the same reasons…nor are they out there talking about the maternal mortality rate in the U.S. (particularly for women of color) or the other risks of women who are giving birth and/or having a c-section, all of which, again, present more and more severe risks than a D&C.
20 percent of post-abortive women experience these and other side effects, ranging from mild to severe in gravity.
Study Cited: RU-486 (MIFEPRISTONE) SIDE-EFFECTS, 2000–2012
- 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.”
Again, they are (a) conflating study objectives and results, and (b) overstating the risks when the studies themselves confirm the general safety of abortion.
Another study indicates that signs of potential infection followed over 29 percent of abortions.
- 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 is not the “evidence” against abortion that Focus on the Family is painting it to be, but rather evidence in favor of keeping abortion legal and safe and providing access to affordable birth control.
Though seemingly less harmful, a study performed by the FDA concludes medicated abortion has four times the rate of complications than its surgical counterpart.
- 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.”
Study after study has confirmed the safety and efficacy of mifepristone for both abortions and miscarriages, especially when combined with misoprostol.
This suggests the two-thirds of women that have early abortions are much more likely to suffer from negative side effects.
Study Cited: Abortion Surveillance — United States, 2014
- 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 was done in 2014, during the Obama administration. Notably, abortion rates have reliably historically decreased under Democratic presidents and remained steady or increased under Republicans, pointing to the efficacy of providing affordable, accessible health care and birth control as well as comprehensive sex education in preventing abortions and decreasing the abortion rate.
10 to 15 percent of patients will experience an incomplete abortion or only partial removal of the baby’s tissue. If the remaining tissue does not expel from the woman’s body, it typically requires a physician with forceps initiating hemostasis (birthing-like contractions).
Study Cited: Incomplete Abortions
- 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”.
Only two explanations exist for their use of this data— the first is that these people have no medical knowledge or understanding and do not realize that natural miscarriages are referred to medically as “abortions”, and the second is that they know this and are manipulating people by including the results of studies on natural miscarriages to support their views on abortion.
Either way, their citation that “10 to 15 percent of patients will experience an incomplete abortion or only partial removal of the baby’s tissue” is patently wrong, as the 10 to 15% figure is associated with the incidence rate of miscarriages, not for “incomplete abortions” as they have stated. Their incorrect medical definitions are further evidence against their status as a trusted source for health information.
Not including the removal methods, incomplete abortions host their own myriad of complications, such as shock, uterine rupture or perforation, multisystem organ failure, infertility and severe hemorrhaging, to name a few.
Study Cited: Incomplete Abortions (the same study used previously)
- 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.”
The study authors’ conclusion is that “Patients should not delay seeking medical care if they experience bleeding during pregnancy, as this can lead to increased morbidity and mortality,” again confirming that this entire study is on miscarriage and warning of the potential complications an incomplete miscarriage presents.
Impact on Future Pregnancy
Abortion can also adversely affect future fertility and pregnancies. First, post-abortive women are 2.7 times more likely to later give birth to children with an extremely low birth weight.
- 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.”
While the Focus on the Family and Nebraska Family Alliance sites claim that “post-abortive women” are “more likely to later give birth to children with an extremely low birth weight”, this study was done in reference to teenage births, which differ greatly in terms of the relative risks that both pregnancy and birth present for them. The study’s authors also acknowledge that the increased risk related to teens who had previous abortions could be related to confounding factors, which could “eliminate [their] findings.”
The likeliness of losing a baby during delivery, or stillbirth, is 3.3 times higher for subsequent pregnancies in post-abortive women, and the chance of premature delivery is doubled.
Reproductive outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents’ first pregnancies (the same study used previously)
- 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 bias in this paper should be evident. The author clearly chose studies that confirmed his preconceived biases with no regard for objectivity, which is ironic given his accusations of the scientific community doing just that. Given that they admit that spontaneous abortions (miscarriages) are indistinguishable from induced abortions, their conclusions are suspect. Furthermore, the study cited within the briefing paper wherein the chance of premature delivery is “doubled” found that a previous c-section presented a 49% greater risk for preterm birth than a previous induced abortion, but none of these sources mention that.
Placentia previa, where a baby’s placenta covers the cervix, increases 70 percent after one abortion and 200 percent after multiple.
- 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.”
Aside from the points I’ve outlined above, no study I could find showed those results. One study said that “Mifepristone-induced abortion itself is not associated with placental complications in subsequent pregnancy, but other factors related to medical abortion — such as a gestational age >6 weeks at abortion, a curettage after abortion, and a longer interpregnancy interval — may increase the risk of abruptio placenta.” It also said that, “The risk of abruptio placenta in women with a mifepristone-induced abortion was nearly double that of women with no abortion, although this apparent increased risk was not statistically significant.”
Abortion also produces a 30 to 99 percent higher chance of bleeding during subsequent pregnancy, expanding the risk of perinatal mortality. Ectopic pregnancy, a fertilized egg implanting and growing outside of the uterus (the normal home), is 1.8 times more likely.
- 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.”
This seems to be an example of citing a study that showed a small increased risk in vaginal bleeding in subsequent pregnancies, it is unknown whether the results were statistically significant and/or confounded by other factors since the full text of the study is not available online without a medical reference subscription. No comparable studies could be found to compare or confirm the results.
Similarly, nothing exists outside of the Focus on the Family site that contains the specific statistic that a woman who has an abortion has a 1.8 times increased risk of ectopic pregnancy. A review of four separate studies show that the risk of ectopic pregnancy after abortion is nonsignificant.
Follow this link for Part II, Psychological Abortion Complications.