Abortion : Safe or Not ?

The safety of abortion depends on whom one asks. National data from the Centers for Disease Control and Prevention (CDC) indicate that induced abortion and miscarriage are the safest outcomes of pregnancy. In contrast, abortion opponents routinely claim that abortion is unsafe. They do this by cherry-picking studies, citing obsolete literature, extrapolating inappropriately and misinterpreting results. Moreover, some abortion opponents have double standards: what they report in the medical literature is not what they claim in the newspaper or testify under oath. As a gynecologist, I have had to spend considerable time over the years disabusing patients of these false claims. Here is a sampling of what can be found on the Internet:
Medical abortions performed in the first 9 weeks of pregnancy have a very low risk of complications. This risk is the same as when a woman has a natural miscarriage. These problems can easily be treated by a doctor.

Out of every 100 women that do medical abortions, 2 or 3 women have to go to a doctor, first aid center, or hospital to receive further medical care. In countries where childbirth is safe, 1 in every 10.000 women dies during childbirth. Less than 1 in every 100,000 women who use a medical abortion die, making medical abortions safer than childbirth and about as safe as naturally occurring miscarriages. This means that a safe abortion with Mifepristone and Misoprostol is always lifesaving.

In Europe, more than 1.5 million women have terminated their pregnancies with mifepristone and misoprostol. Medical TOP is proven to be safe and effective, with few serious complications and success rates of 95–98%.2Mifepristone and misoprostol have been on the list of essentialmedicines of the World Health Organization since 2005.

Medical abortion is safer than the use of antbiotics. The risk of fatal anaphylaxis with penicillin has previously been estimated as about 1 in 100 000[1]. Mortality of medical abortion is

“Abortion care can be safely provided by any properly trained health-care provider, including midlevel (i.e.non-physician) providers (3–5, 6). The term “midlevel providers” in the context of this document refers to a range of non-physician clinicians (e.g. midwives, nurse practitioners, clinical officers, physician assistants, family welfare visitors, and others)”

“Abortion care provided at the primary-care level and through outpatient services in higher-level settings is safe, and minimizes costs while maximizing the convenience and timeliness of care for the woman (7).”

“Allowing home use of misoprostol following provision of mifepristone at the health-care facility can further improve the privacy, convenience and acceptability of services, without compromising on safety (8–10). Inpatient abortion care should be reserved for the management of medical abortion for pregnancies of gestational age over 9 weeks (63 days) and management of severe abortion complications
In the early 1970s, the Population Council and CDC conducted large prospective studies of abortion safety; these concluded that abortion was considerably safer than continuing a pregnancy to delivery. By 1975, the Institute of Medicine had concluded that the public health benefits of abortion were well established.

A sentinel report from Planned Parenthood in New York City documented extraordinary safety as well. In 170,000 first-trimester abortions, the complication rate was 1%.

Most recently, researchers at UC-San Francisco used California Medicaid data on 54,911 abortions to see how many women had an emergency room visit or hospitalization as a result. The overall complication rate was 2%, and most complications were minor. Only 0.03% of patients were transferred by ambulance to an emergency department on the day of the abortion.

Abortion-related deaths

The risk of death from abortion plummeted after legalization in the early 1970s. In recent decades, the risk of death from abortion has been around 1 per 100,000 procedures. To put that in some perspective, the estimated risk of death from an injection of penicillin is about 2 per 100,000 injections.

According to national data from the CDC, the risk of death from pregnancy and childbirth is 14 times higher than with abortion. Critics complained that abortion deaths were grossly under-reported, invalidating the comparison. This claim has no merit. Some under-reporting of abortion-related deaths is likely, but under-reporting of pregnancy and childbirth deaths occurs as well. Assume that the true number of abortion-related deaths is three times that reported by the CDC. Pregnancy and childbirth would still have a mortality ratio several times that of abortion. Selective under-reporting of abortion-related deaths cannot account for a difference this large. Moreover, the disparity in risk has persisted for decades.

Pregnancy and childbirth complications

According to the CDC, about 60% of women having live births will develop one or more complications of pregnancy, birth and the post-partum interval. This translates into more than 2 million women per year in the U.S.

Pregnancy and childbirth-related deaths

The risk of maternal mortality continues to increase in the U.S. The pregnancy-related mortality ratio has increased progressively from 7 deaths per 100,000 live births in 1987 to 18 per 100,000 live births in 2009.

Other risks of daily life

Daily life carries risks (indeed, none of us gets out of this alive). These risks may provide benchmarks against which abortion and childbirth can be compared. Riding a motorcycle carries a risk of death of about 100 per 100,000. In contrast, canoeing is associated with a risk of about 1 per 100,000. The risk of death from abortion in the U.S. is similar to that of paddling a canoe. Given this fact, the current preoccupation of state legislatures with gynecology (and not canoes) clearly stems from partisan politics, not concerns about public health.

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