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Abortion: A Healthy Choice

If the roughly 50 million abortions that have occurred in the US sincehad all ended in full-term deliveries, approximately 500 additional women would have died during childbirth.
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Some opponents of reproductive choice, unable to deter women from electing to terminate unwanted pregnancies through moral suasion, have increasingly attempted to scare women away from abortion with specious claims that the procedure is unsafe. In Texas, the Orwellian-named "Woman's Right to Know Act" requires abortion providers to give patients a misleading booklet that suggests a connection between abortion and breast cancer, although the American Cancer Society strongly denies such a link. West Virginia's "informed consent" statute requires that women be told that abortions may lead to an increased risk of eating disorders, suicidal ideation, sexual dysfunction and drug abuse, claims not recognized by the American Psychiatric Association or any leading authorities in the field. Even if these assertions were true -- and years of study have established categorically that they are not -- this data would obscure the larger truth regarding abortion and women's health. What abortion opponents do not want people to know is that decades of evidence prove that abortion is convincingly far safer for maternal health than bringing a fetus to term. Often exponentially so. In fact, if the roughly fifty million abortions that have occurred in the United States since Roe v. Wade had all ended in full-term deliveries, approximately five hundred additional women would have died during childbirth.

The safety disparity between childbearing and abortion is quite staggering. According to the National Center for Health Statistics, the likelihood of an American woman dying in childbirth is approximately 1 in 7,500. In contrast, a 2004 study published in Obstetrics and Gynecology found the risk of dying during an abortion in the first eight weeks of pregnancy, when the majority of terminations take place, to be roughly 1 in 1,000,000. That's safer than a round-trip flight on a commercial aircraft. Even abortions performed at greater than 21 weeks (1.1% of all abortions) have a mortality of 1 in 11,000 -- far lower than live delivery. If one measures only immediate morbidity and mortality, there is no way to spin these numbers to suggest that abortion is less safe than giving birth.

Abortion opponents have attempted to link the procedure with long-term health risks, but here again the scientific evidence undermines their claims. For example, numerous, well-constructed studies have demonstrated no independent link between breast cancer and induced abortions. Most notably, a Harvard University analysis of the Nurses' Health Study looked at 105,716 women over ten years and concluded that abortions did not correlate with future cancer diagnoses. To believe otherwise is no more grounded in evidence that to believe that breast cancer is caused by power lines, or that the polio vaccine impedes virility, or that fluorinated drinking water triggers autism. These are factual questions, not values judgments. Whether or not abortion causes cancer is not a subject for philosophical debate, it is an empirical phenomenon with a correct answer. Rejecting that answer without hard data is no more reasonable than rejecting the heliocentric model of the universe. As the late Senator Pat Moynihan warned us: "Everyone is entitled to his own opinion, but not to his own fact."

So why does this myth persist? The reality is that nulliparity may be related to an increase in breast cancer, so women who abort and never have another child may lose the protective effect that pregnancy has on estrogen levels and breast tissue. However, the overwhelming majority of women who terminate pregnancies eventually to go on to become biological mothers, recovering much if not all of this protective effect. Even the most zealous advocates of the abortion-breast cancer hypothesis, such as born-again-Christian endocrinologist Joel Brind, have been able to show only a minimal correlation between breast cancer and abortion -- even with an agenda that has likely compromised the power of their research. What is most remarkable in this entire debate, of course, is that some abortion opponents seem to want abortion to cause breast cancer or other life threatening illnesses. Data that shows no such risk apparently disappoints them. How devastating for them must be the larger reality that terminating pregnancies actually reduces female mortality rates.

A recent Turkish study, which may gain media traction in coming days, does claim to have found a statistical link between induced abortion and cancer. In their conclusion, the authors posit that the difference between their data and that of other researchers is a yet-unknown characteristic distinctive to Turkish females. A far simpler explanation may suffice. Statistical noise. If you conduct most studies often enough, eventually you will produce a statistical outlier whose results, taking alone, seem to prove your case. In a billion small-scale studies of tobacco smokers, for example, a few might actually demonstrate that smoking is beneficial to the lungs. This does not prove that we should all take up smoking, but that investigators should quit asking the same question over and over again in an effort to muddy the results.

Needless to say, I have read all of the major studies on abortion and women's health. I sincerely wonder if the anti-abortion activists at Operation Rescue have done so. The glory of modern science is that every one of these papers is available at any major research library, and most are accessible on line, so those who sincerely care about the question can judge the scientific evidence for themselves.

The shell game perpetrated by abortions opponents is quite clever. They focus public attention on a comparison between abortion and baseline health, rather than between abortion and pregnancy. Even if some women do suffer post-abortion depression, which anecdotally may be the case, this does not mean that the phenomenon is nearly as widespread or as severe as the well-documented misery of postpartum depression. Postpartum psychosis destroys women's lives and tears apart families; post-abortion psychosis is largely undocumented. Even the risk of multiple terminations to long-term reproductive abilities may be over-hyped. Memoirist Irene Villar's brilliant account of her fifteen abortions, Impossible Motherhood, which concludes with the birth of her two healthy children, should dispel the canard that a few elective abortions will render women barren. That is simply not the case.

Challengers to so-called "informed consent" statues do not need to rest their claims of unconstitutionality on the grounds that these laws interfere with the free speech rights of physicians and the privacy rights of patients. The laws fail the far more rudimentary "rational basis" standard of the Fourteen Amendment because they provide women with information so selective that it leaves any reasonable layperson with a false impression of the relative safety of abortion and childbirth. I oppose such compulsory pre-abortion counseling, no matter what its content. Obstetricians don't need ideologues telling them how to practice medicine or what to tell their patients. However, if state legislatures sincerely want women to have all the facts, then these same mandatory "informational" pamphlets should inform women that, by not choosing an abortion, they are placing their lives at greater risk.

Courts have been reluctant to recognize the significance of this data. If the risk of childbirth is exponentially higher than that of abortion, then all elective abortions are necessary for maternal life and health. From a purely medical standpoint, who wouldn't choose a death rate of 1 in 1,000,000 over 1 in 7,500? Moreover, even if a long-term health risk from abortion ever were established, one would be comparing sudden death in one's childbearing years to affliction with a treatable (and even curable) illness many years later. I suspect that, all other factors being equal, most people would choose the latter. (I am also hopeful that we will eradicate breast cancer entirely, sooner rather than later.) Women are often given the false impression that carrying an unwanted fetus to term, and placing the baby up for adoption, is a relatively safe choice. That depends upon one's understanding of safety. If one is willing to accept the 1 in 11,000 of dying in childbirth to bring happiness to a total stranger, why not donate a kidney, a procedure with a mortality risk of 1 in 3,000, and save a stranger's life?

The significant risks of childbirth may well be worth enduring for the rich joys of motherhood. I am grateful to my own mother for making such a tradeoff. We should all be proud of the brave women who choose to put their lives on the line in our maternity wards. What is harder for me to understand is why anyone would take such risks in order to deliver a baby that they do not want. That should be a woman's choice too, of course. But if you're going to put your own well-being at risk, you should certainly know all the risks.