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Re: Why the pro-choice "Rights of Woman vs. Rights of ZEF" argument is a fallacy [W:
Still replying.
I do not support the Grimes/Raymond study, per se. There have been many attempts to calculate the safety of legal abortion relative to the safety of childbirth for women, and a major problem on both sides remains the problem of reportage of deaths in or as a direct result of legal abortion and in or as a result of late pregnancy/childbirth. While critics of Grimes and Raymond stress that the reportage related to legal abortion is flawed, Grimes stresses that the reportage related to late pregnancy/childbirth is also flawed, and both gripes are correct. In the US, there are no federal requirements to report maternal deaths in childbirth, so that the number of deaths could be twice as high as those reported. The only states where report of pregnancy-related deaths is mandatory are FL, IL, MA, NY, PA, and WA, and even there, it has not focused on childbirth-related deaths, but on abortion-related deaths.
Underreporting of Maternal Deaths on Death Certificates and the Magnitude of the Problem of Maternal Mortality has found that, in the US, perhaps 38% of maternal deaths are unreported, and that it could be 50% or more if women were undelivered at time of death, experienced a fetal death or therapeutic abortion, died more than a week after delivery, or died as a result of a cardiovascular disorder (notwithstanding the fact that such a disorder in a common way in which women die during delivery).
The problem for reportage in the case of late pregnancy/childbirth deaths is serious because so many problems that cause them can be reported as if they are not due to late pregnancy or childbirth at all even though the deaths, e.g., heart attack, stroke, infection, would never have occurred if the women had not been in late pregnancy or giving birth.
I noticed that there was even one problem related to reportage which one of the sources you cited here or just above is that there is a certain amount of ambiguity in death certificates even in Finland clarifying that some death is a pregnancy- or childbirth-related maternal death.
One issue for the comparison is that early term abortion by either medical or surgical means is an outpatient procedure, while childbirth is the most common reason for hospitalization, at least in the US (Statistical Brief #110). In the US, doctors recommend more than a 24 hour stay for the mother who has just given birth, and this is for her health, not just for the infant. Doctors typically recommend that a woman not have sex for 2-4 weeks after an abortion and 4-6 weeks after childbirth, or longer if there is discomfort - the difference in recommendation relates to the medically perceived seriousness of what happens to the body. There is also a greater variety of common postpartum problems than common post-abortion problems if the induced abortion occurred in early pregnancy.
Back to Finland -
I read the suicide study but not the others until the links you provided just above (thanks for these). However, I could not find free full texts for the latter, only the abstracts. The natural causes study thus seemed problematic for me without details because I needed a definition of "natural causes." I certainly wondered why "only in 22% of the death certificates was the pregnancy or its end mentioned" - was it because of reportage problems as in the US or because pregnancy is so much safer with socialized medicine or what? As for the issue with medical abortion having a higher incidence of adverse events, that is not a real surprise to me - patients have to be relied on to follow instructions, which they may not, for example.
The general comparison that led to the claim of a 4 times higher risk of dying within a year after an abortion than after miscarriage or childbirth seems clearer if one also notes that this included suicide, homicide, and death by injury as well as natural causes. I found an abstract for this one also: Injury deaths, suicides and homicides associated with pregnancy, Finland 1987
This study used data on women aged 15-49 for 1987-2000. Of course mortality during pregnancy and within one year of termination was lower than for non-pregnant women. The increased risk for women after abortions especially 15-24 years related to higher suicide and homicide rates. Suicide was already addressed in an earlier study. As for homicide - since girls and women are more likely to have abortions when they are in less stable situations, have less understanding parents, or have unstable partners, there are more homicide risks for them - e.g., parental abuse, partner abuse. younger women without infants are also more likely to engage in dangerous jobs or avocations. The abstract says nothing about injury-related deaths, but one would expect them to be higher also, for just that reason.
Only the deaths from natural causes are of interest to me, as I would like to see both childbirth/late pregnancy- and induced abortion-related deaths reported as such and clearly compared in sufficient detail, ideally in two distinct countries, so that reliable results can be seen.
On Grimes, Raymond, and Shuping - Grimes and Raymond are both trained and board-certified in obstetrics and gynecology and in preventative medicine, Grimes at Harvard and I think Raymond at Columbia. Grimes has been a clinical professor at four significant universities, taught research methods to over 1600 ob/gyns, and has membership in honored academies of science in both the US and England. He made safe legal abortion a primary concern when he had to deal with a case of a girl seriously injured in an illegal abortion and wanted to prevent such horrors (while recognizing that bans on abortion only drive them underground), so he is not just an abortion doctor. He and Raymond both have numerous peer-reviewed studies to their credit. In contrast, Shuping is a psychiatrist, trained at Michigan State U and Wake Forest University, and has collaborated on almost no peer-reviewed articles. She has collaborated with D C Reardon, who received his PhD in bioethics from Pacific Western, an unaccredited correspondence school with no non-correspondence classes. Both have been involved with the abortion-mental health link studies that have been justifiably discredited.
So please pardon me if I seemed too skeptical about any studies lauded by Shuping and questioned in any way by Grimes and Raymond. I am interested in the Finnish studies and am trying to get full texts.
Still replying.
I do not support the Grimes/Raymond study, per se. There have been many attempts to calculate the safety of legal abortion relative to the safety of childbirth for women, and a major problem on both sides remains the problem of reportage of deaths in or as a direct result of legal abortion and in or as a result of late pregnancy/childbirth. While critics of Grimes and Raymond stress that the reportage related to legal abortion is flawed, Grimes stresses that the reportage related to late pregnancy/childbirth is also flawed, and both gripes are correct. In the US, there are no federal requirements to report maternal deaths in childbirth, so that the number of deaths could be twice as high as those reported. The only states where report of pregnancy-related deaths is mandatory are FL, IL, MA, NY, PA, and WA, and even there, it has not focused on childbirth-related deaths, but on abortion-related deaths.
Underreporting of Maternal Deaths on Death Certificates and the Magnitude of the Problem of Maternal Mortality has found that, in the US, perhaps 38% of maternal deaths are unreported, and that it could be 50% or more if women were undelivered at time of death, experienced a fetal death or therapeutic abortion, died more than a week after delivery, or died as a result of a cardiovascular disorder (notwithstanding the fact that such a disorder in a common way in which women die during delivery).
The problem for reportage in the case of late pregnancy/childbirth deaths is serious because so many problems that cause them can be reported as if they are not due to late pregnancy or childbirth at all even though the deaths, e.g., heart attack, stroke, infection, would never have occurred if the women had not been in late pregnancy or giving birth.
I noticed that there was even one problem related to reportage which one of the sources you cited here or just above is that there is a certain amount of ambiguity in death certificates even in Finland clarifying that some death is a pregnancy- or childbirth-related maternal death.
One issue for the comparison is that early term abortion by either medical or surgical means is an outpatient procedure, while childbirth is the most common reason for hospitalization, at least in the US (Statistical Brief #110). In the US, doctors recommend more than a 24 hour stay for the mother who has just given birth, and this is for her health, not just for the infant. Doctors typically recommend that a woman not have sex for 2-4 weeks after an abortion and 4-6 weeks after childbirth, or longer if there is discomfort - the difference in recommendation relates to the medically perceived seriousness of what happens to the body. There is also a greater variety of common postpartum problems than common post-abortion problems if the induced abortion occurred in early pregnancy.
Back to Finland -
I read the suicide study but not the others until the links you provided just above (thanks for these). However, I could not find free full texts for the latter, only the abstracts. The natural causes study thus seemed problematic for me without details because I needed a definition of "natural causes." I certainly wondered why "only in 22% of the death certificates was the pregnancy or its end mentioned" - was it because of reportage problems as in the US or because pregnancy is so much safer with socialized medicine or what? As for the issue with medical abortion having a higher incidence of adverse events, that is not a real surprise to me - patients have to be relied on to follow instructions, which they may not, for example.
The general comparison that led to the claim of a 4 times higher risk of dying within a year after an abortion than after miscarriage or childbirth seems clearer if one also notes that this included suicide, homicide, and death by injury as well as natural causes. I found an abstract for this one also: Injury deaths, suicides and homicides associated with pregnancy, Finland 1987
This study used data on women aged 15-49 for 1987-2000. Of course mortality during pregnancy and within one year of termination was lower than for non-pregnant women. The increased risk for women after abortions especially 15-24 years related to higher suicide and homicide rates. Suicide was already addressed in an earlier study. As for homicide - since girls and women are more likely to have abortions when they are in less stable situations, have less understanding parents, or have unstable partners, there are more homicide risks for them - e.g., parental abuse, partner abuse. younger women without infants are also more likely to engage in dangerous jobs or avocations. The abstract says nothing about injury-related deaths, but one would expect them to be higher also, for just that reason.
Only the deaths from natural causes are of interest to me, as I would like to see both childbirth/late pregnancy- and induced abortion-related deaths reported as such and clearly compared in sufficient detail, ideally in two distinct countries, so that reliable results can be seen.
On Grimes, Raymond, and Shuping - Grimes and Raymond are both trained and board-certified in obstetrics and gynecology and in preventative medicine, Grimes at Harvard and I think Raymond at Columbia. Grimes has been a clinical professor at four significant universities, taught research methods to over 1600 ob/gyns, and has membership in honored academies of science in both the US and England. He made safe legal abortion a primary concern when he had to deal with a case of a girl seriously injured in an illegal abortion and wanted to prevent such horrors (while recognizing that bans on abortion only drive them underground), so he is not just an abortion doctor. He and Raymond both have numerous peer-reviewed studies to their credit. In contrast, Shuping is a psychiatrist, trained at Michigan State U and Wake Forest University, and has collaborated on almost no peer-reviewed articles. She has collaborated with D C Reardon, who received his PhD in bioethics from Pacific Western, an unaccredited correspondence school with no non-correspondence classes. Both have been involved with the abortion-mental health link studies that have been justifiably discredited.
So please pardon me if I seemed too skeptical about any studies lauded by Shuping and questioned in any way by Grimes and Raymond. I am interested in the Finnish studies and am trying to get full texts.
Let's try to add something further to debate rather than repeating this.