Christian Medical Comment: How many women really died from abortions prior to the Abortion Act? bit.ly/LZlyXy | Fisk, someone, please
— Anna Hedge (@langtry_girl) June 17, 2012
Christian Medical Comment is a blog written by Doctor Peter Saunders, who says it “deals mainly with matters at the interface of Christianity and Medicine”:
A common argument from the pro-choice lobby is that legalising abortion in 1968 saved thousands of women who would have otherwise died from back-street abortions.
There is a specific example of a European country, Romania, which had legal abortion (from 1957) but in 1966 Nicolae Ceausescu enacted a law that banned abortion. On 26th December 1989, one of the first acts of the new transitional Government of Romania was to repeal Ceausescu’s restrictive abortion legislation. This was done because Romania had one of the highest rates of maternal mortality in Europe.
The “pro-choice lobby” in this instance would be The Royal College of Obstetricians and Gynaecologists (RCOG):
For the twelve years before the Act, abortion was the leading cause of maternal mortality in England and Wales. The first Confidential Enquiry into Maternal Deaths in 1952-54 reported 153 deaths from abortion, which was “procured .. by the woman herself in 58 instances.” The terminal event in 50% of illegal cases was sepsis but in 25% it was air embolus from “the injection under pressure of some fluid, nearly always soapy water, into the cervix or into the vagina.” The Report commented that most of the women were “mothers of families”. After 1968 maternal deaths from illegal abortion fell slowly but did not disappear until 1982.
Before 1968, it is contended, women with unwanted pregnancies who did not want to have their babies had no choice but to seek the help of amateur ‘back-street’ abortionists who carried out their procedures with coat-hangers or other similarly inappropriate ‘instruments’. The result was that women often developed infections and died.
Once abortion was legalised in 1968 women could then obtain abortions that were not only ‘legal’ but also safe.
Again from The RCOG:
Hard facts about abortion in Britain before 1967 are few. Estimates of annual numbers varied from 14,600 (the figure given by the RCOG) to 100,000 (the Home Office estimate). In 1969, the first full year of the new law, 49,829 abortions were performed on residents of England and Wales, the total rising to 108,565 in 1972.
Every year, worldwide, about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 20 million, are unsafe. Some 68,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer long-term health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortion—less restrictive abortion laws and greater contraceptive use—face social, religious, and political obstacles, particularly in developing nations, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and postabortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions.
From the Department of Economic and Social Affairs, Population Division, Romania (doc file):
As a result of the restrictive reproductive health policies enforced in Romania between 1966 and 1989, maternal mortality reached heights unprecedented in Europe. The maternal mortality ratio rose from 85 deaths per 100,000 live births in 1965 to 170 in 1983. Moreover, illegal and unsafe abortion was the major cause of maternal mortality, accounting for more than 80 per cent of maternal deaths between 1980 and 1989. Furthermore, unofficial estimates suggest that nearly 20 per cent of women of reproductive age may have become infertile because, on average, a woman may have undergone at least five illegal abortions by age 40.
I was in Romania in 1977 as a speaker on world population issues. I was warned that I could talk about the population policy of any country of the world except Romania. Government representatives were with me at all times to see that I followed those directions. But I was determined to learn how Romanian women were controlling their birth rate, when every means of control had been denied them.
Finally, at a crowded party, with my official spies momentarily out of hearing range, I had an opportunity to find out. I was talking to the head of obstetrics at a major Bucharest hospital. I told him I wondered how the birth rate had fallen, and then I asked, “What has happened to your maternal mortality rate?”
He looked straight at me. He got my drift. “It has become very, very high,” he said with great sadness. In nearly every country women who die of complications from abortion, legal or illegal, are listed in health statistics as maternal mortalities. Later I saw some actual figures. As the birth rate came down in Romania after Decree 770, the maternal mortality rate tripled.
Ceausescu’s policy to increase the Romanian population failed to achieve its goal. It imposed pain, injury, and death on Romanian women.
Going back to Doctor Saunders’ Christian blog:
The argument is that any move to restrict abortion now would drive women back into the hands of backstreet abortionists leading again to thousands of deaths.
Thousands of deaths from illegal abortion is the reality round the world. As Doctors Haddad and Nour point out in the title of their obstetrics review, every death from illegal abortion is an unnecessary death. Pregnancy and childbirth are dangerous acts – women die of them every day, every minute of every day. Maternal mortality is a risk in every country in the world.
Why would any doctor want to increase that risk?
The reality is much more complex than that. But you have to look at the actual evidence to understand what really happened.
First, maternal mortality from all causes, including abortion fell dramatically long before abortion was legalised as a result of better medical care.
Thanks to a policy of not prosecuting women for having had an illegal abortion, a woman could go to an NHS hospital for post-abortion care. (In New York State, pre-Roe, Samuel R. Delany remembers his wife Marilyn Hacker, who had just had a miscarriage, being interrogated by a policeman in the hospital because she was a criminal suspect; it was assumed that she had got an abortion.)
As RCOG note above, this did not keep illegal abortion from being the leading cause of maternal mortality before the 1967 Act, but this kinder policy in the UK of not aggressively interrogating any woman who might have been supposed to have had an abortion, ensured more women got aftercare and antibiotics and so survived.
Second, many so called ‘back-street abortions were actually carried out ‘illegally’ by ‘skilled professional’ nurses and doctors using surgical instruments in sterile conditions.
Also true. Getting an illegal abortion from a medical professional was the safest (and most expensive) kind of illegal abortion. Where abortion is illegal, safety has always been a matter of money. Richer a woman or her a family is, the more likely she is to be able to afford a safe abortion. When abortions can be obtained on demand via the NHS, safety is every woman’s right.
Third, legalising abortion did not eliminate all maternal deaths, as some women now began to die of legal abortions, and in addition there was still a trickle of illegal abortions.
This is meiosis. As RCOG acknowledge, making abortion legal did not in and of itself immediately end illegal abortions. As for women dying from legal abortions: 491,348 people died in England and Wales in 2009. (You can see a larger version of the graphic by clicking on the link.) No matter how hard you look, you won’t find death from abortion.
The total number of abortions in 2009 for England and Wales was 189,100 (a fall of 3.2% from 2008) of which about 91% were carried out in the first trimester – the vast majority before 10 weeks. 331 abortions were carried out after 20 weeks (about 5%).
In the triennium 2006–2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003–2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02).
If women died in legal abortion at the same rate as women die of other pregnancy-related causes, 8 or 9 women would have died in 2009 because of a legal abortion. As even Doctor Saunders has to admit: this is not happening.
However since 1968 all abortion deaths in Britain have fallen to almost zero.
The two slides I have used in this blog have been taken from a presentation on maternal mortality by Professor Owen Drife of the University of Leeds and can be viewed online.
The first slide (above)shows the dramatic drop in maternal deaths from all causes that happened long before the legalisation of abortion in 1968. This fall was clearly not due to legalising abortion.
What Doctor Saunders will not point out – though you can see it on the graph – is that illegal abortion became safer as women who could afford it would pay for their illegal abortion to be safely carried out (The L-Shaped Room by Lynne Reid Banks and Purposes of Love by Mary Renault both describe how a woman could access safe abortion even though it was illegal) but that although the maternal death rate was falling, illegal abortion became the leading cause of maternal death. Unnecessary deaths.
(The second slide, “Maternal death from abortion”, is taken from Why mothers die 2000-2002, Figure 6.2 – small print at foot of slide.)
The second slide (left) shows deaths from legal abortion, illegal abortion and miscarriage since 1952 (the first slide starts at 1935 so this second slide covers only the last part of this period after rates had already fallen dramatically).
From “Why Mothers Die” (pdf), a 2005 paper by J Drife of the Department of Obstetrics and Gynaecology, University of Leeds, Leeds, England:
The UK maternal mortality rate is now 13·4 per 100,000 maternities, which is much lower than in the developing world but still too high. For 50 years in England and Wales the CEMD has published triennial reports, and since 1985 the Enquiry has covered the whole of the UK. Its latest report, Why Mothers Die 2000–2002, published in November 2004, includes 106 Direct (due to complications of pregnancy) and 155 Indirect deaths (due to pre-existing conditions made worse by pregnancy). Since 1997, Indirect deaths (which are rising) have outnumbered Direct deaths, which fell in the 1990s. The leading Direct cause is thromboembolism, which accounted for 30 deaths.
In the years 1952-4 there were just over 50 women dying per million maternities from illegal abortion. As there were far less than a million maternities per year in 1952 (there are only 700,000 births a year now) this means that the actual number of women dying from abortion per year would have been even less than 50.
In the three years around legalisation (1967-1969) this had fallen to 30 deaths per million maternities but we were also starting to see deaths from legal abortions.
There’s an interesting thing about that graph and this claim of Saunders: within four years of abortion being made legal, the number of deaths from abortion becomes too small to show properly on the graph, even at units of 5 per million maternities. I think what Doctor Saunders is trying to say here is that not that many women were dying of illegal abortions before the 1967 Act was passed. And if not that many, apparently, what did it matter?
More from Why Mothers Die:
When late deaths (up to one year after delivery) are included, the overall leading cause of pregnancy-related death is psychiatric disease, which accounted for 60 deaths in 2000–2002. Suicide due to puerperal psychosis is usually by violent means and shows no social class gradient. The Enquiry also records Coincidental deaths, among which the leading cause is murder. The 11 murders in 2000–2002, all perpetrated by the woman’s partner, highlight the continuing problem of domestic violence.
While prolifers are happy to promote the idea of post-abortion syndrome, a mental illness that doesn’t actually exist, as a thing they want to save women from, suicide due to puerperal psychosis is ignored. Apparently it doesn’t matter if women die of giving birth so long as they do it afterwards.
In the three years after this (1970-1972) the death rate from illegal abortions was about 15 per million maternities falling to 5 per million maternities in 1973-1975.
But the striking point through this six year period is that as many women were dying from legal abortions as from illegal abortions.
I daresay it doesn’t occur to Doctor Saunders that the striking point throughout this period is that the number of women dying unnecessarily from illegal abortion was falling as the number of illegal abortions fell.
From 1976 on deaths from both legal and illegal abortions fell to almost negligible levels. But in each case this was due not to the legalisation of abortion but to improving standards of medical care.
A similar pattern has been observed in all developed countries. US statistics can also be viewed online.
The improving standards of medical care which Doctor Saunders cites includes that with legalisation of abortion (and improved access to abortion via the NHS) women of any income level could have the safest abortion possible.
From British maternal mortality in the 19th and early 20th centuries by Geoffrey Chamberlain, published in the Journal of the Royal Society of Medicine, November 2006:
Figure 1 records maternal death rates (or, to be more mathematically correct, ratios) from 1850 until 1970. There was a period of irregular but general steady maternal death rates until about 1900. These then dipped slightly till the First World War and continued so till the late 1930s. Then a sudden precipitous reduction in maternal deaths occurred which could not be due to any natural factors involved in death. It was, in fact, due to the overcoming of maternal infection by chemotherapy and antibiotics.
The Four Horsemen of Death in maternal mortality were puerperal pyrexia, haemorrhage, convulsions and illegal abortion. They still are—in various proportions—major killers in most of the world, although their effects are greatly reduced in the UK now.
Doctor Saunders goes on to discuss another chart from the National Center for Health Statistics:
The chart shown was used on the floor of the US Senate during the tumultuous debate on abortion in 1981. It was compiled from official US statistics and was not challenged by the pro-abortion lobbyists.
The early sharp drop occurred largely because penicillin became available. Note that after Penicillin became available to control infections, the number of deaths stabilized during the 1950s at about 250/year but by 1966, with abortion still illegal in all states, the number of deaths had dropped steadily to half that number.
In 1973 there should have been a sharp drop in women dying as abortion was made legal that year following the Roe vs Wade Supreme Court judgement. The chart, however, shows that there was no such drop.
Doctor Saunders appears almost disappointed by this. The same reason for the steady fall rather than the sharp drop: safe illegal abortion is expensive. But when it’s your life – women who need abortions, and the people who love them, will try to find the money to pay. Marge Piercy, in Braided Lives, describes how women pre-Roe would find out names of doctors who would perform abortions safely and how they would find the money to pay: Ursula K. Le Guin describes in an autobiographical essay “The Princess”, collected in Dancing at the Edge of the World in 1982, how in the 1950s, her parents paid for “the best abortion in New York City”:
“What was it like, in the Dark Ages when abortion was a crime, for the girl whose dad couldn’t borrow cash, as my dad could? What was it like for the girl who couldn’t even tell her dad, because he would go crazy with shame and rage? Who couldn’t tell her mother? Who had to go alone to that filthy room and put herself body and soul into the hands of a professional criminal?–because that is what every doctor who did an abortion was, whether he was an extortionist or an idealist. You know what it was like for her. You know and I know; that is why we are here. We are not going back to the Dark Ages. We are not going to let anybody in this country have that kind of power over any girl or woman.”
The line didn’t even blip. The previous rate of decline actually slowed, to flatten out in the late 70s and 80s. According to the US statistics legalisation of hardly saved any women’s lives at all.
Only very poor women would have died – women who couldn’t afford to pay a doctor to carry out the abortion. To Doctor Saunders, apparently, those women don’t matter.
But of course what legalised abortion did do throughout the Western world was to increase dramatically the number of babies being aborted.
It’s an interesting effect. When someone who has been treading around on the edge of dishonesty is about to tell a flat lie, they often begin “but of course” or some similar phatic phrase. From The Lancet, January 2012, Induced abortion: incidence and trends worldwide from 1995 to 2008:
The global abortion rate was stable between 2003 and 2008, with rates of 29 and 28 abortions per 1000 women aged 15—44 years, respectively, following a period of decline from 35 abortions per 1000 women in 1995. The average annual percent change in the rate was nearly 2·4% between 1995 and 2003 and 0·3% between 2003 and 2008. Worldwide, 49% of abortions were unsafe in 2008, compared to 44% in 1995. About one in five pregnancies ended in abortion in 2008. The abortion rate was lower in subregions where more women live under liberal abortion laws (p<0·05). [Illustrated by CBS here]
There are now 1.3 million abortions a year in the US and over 200,000 a year in the UK. But these are only a fraction of the total of 42 million carried out annually.
[The global abortion rate] fell precipitously in the 1990s, but recently the rate has not budged, barely dipping from 29 abortions per 1,000 women (aged 15 to 44) in 2003 to 28 abortions per 1,000 women in 2008. Eastern Europe has the highest abortion rate in the world, at 43 per 1,000. The geography of abortions has also shifted. In 2008, 86% of abortions were in the developing world, up from 78% in 1995. The share of unsafe abortions rose as well, from 44% in 1995 to 49% in 2008. Laws that restrict abortion did not seem to lower the number of procedures. On the contrary, restrictive laws were associated with higher rates.
One clear reason for the global abortion rate falling in the 1990s was improved funding for family planning clnics in developing countries. One clear reason for the global abortion rate ceasing to fall in the first decade of the 21st century was that on 22nd January 2001 George W. Bush banned any family planning clinic from receiving any US funding if it offered abortion or if staff would tell a woman how to obtain an abortion. This was the global gag rule – instigated by Ronald Reagan, repeated by George W. Bush, repealed by Bill Clinton and Barack Obama – and reinstated this year by Republican-controlled Congress.
The gag rule was shown to have a detrimental effect on women’s health and on access to family planning services whenever it was enforced: in 2003 George W. Bush expanded the gag rule requiring clinics that wanted to receive US funding to provide abstinence-only counselling for prevention of pregnancy and protection against disease. Representative Nita Lowey (D-N.Y.) noted that
“These provisions will leave millions of women without access to critical and lifesaving services,” Lowey argued. She said the global gag rule has been shown to have led to a doubling in the number of abortions in Africa when it was imposed by the George W. Bush administration. Lowey asserted that the provisions would result in 1.4 million more abortions once women were barred from receiving family planning services.”
(Funding for family planning services was reinstated a week or so later by the US Senate.)
In each of these abortions a human death occurs, that is a baby dies.
A fetus is not a baby. A doctor who is not aware of the substantial biological differences between a fetus – even a late-term fetus – and a newborn baby, has no business practicing medicine: he would kill a baby by suffocation. (Fetuses don’t breathe: they absorb oxygen through the maternal bloodstream via the placenta.)
In fact abortion is the leading cause of human death worldwide by some margin. In fact only 57 million people die each year from every cause other than abortion combined!
About half of all human pregnancies end in miscarriage – medically, spontaneous abortion. Approximately 80 million babies were born in 2011. It follows that – if Doctor Saunders really wants to count each embryo – the leading cause of human death worldwide by a large margin is miscarriage. This is especially the case in the UK: in England and Wales there were 706,248 live births in 2009, 189,100 abortions – and although for most women these miscarriages could have registered only as a heavy / late period – there may have been as many as 517,000 miscarriages. Registered deaths in 2009 (see above for graphic) 491,348.
I don’t know if Doctor Peter Saunders is married. I don’t know a thing about him, other than this article, but if he’s married, does he really insist on giving every heavily-soaked tampon / sanitary towel Christian burial because it might contain a fertilised egg which he apparently regards as exactly equivalent to a dead baby?
From The Onion, 1997:
World Health Organization officials expressed disappointment Monday at the group’s finding that, despite the enormous efforts of doctors, rescue workers and other medical professionals worldwide, the global death rate remains constant at 100 percent.
Death, a metabolic affliction causing total shutdown of all life functions, has long been considered humanity’s number one health concern. Responsible for 100 percent of all recorded fatalities worldwide, the condition has no cure.
Unless you take the view that babies before birth are not human beings with rights then that must make abortion one of the most important human rights issues in the world.
Splendid non-sequitur. A fetus may have all the human rights it can have – but being gestated, making use of a woman’s uterus and all her bodily resources, is not a human right no more than any forced use of a human body is a human right. Rape is not a human right: being an organ donor recipient is not a human right. Doctor Peter Saunders may have two healthy functioning kidneys and a blood type that matches someone dying of renal failure in a hospital near him: that person does not have a “human right” to either of Doctor Saunder’s kidneys.
Back to British maternal mortality in the 19th and early 20th centuries by Geoffrey Chamberlain, published in the Journal of the Royal Society of Medicine, November 2006:
Undoubtedly, illegal abortion was common in the 19th and early 20th centuries rising to a peak in the 1930s. It was often disguised on the death certificates as puerperal sepsis or some other cause in order to save the reputation of the family. It is interesting that in this period, it was not mostly unmarried girls in trouble who resorted to abortion, but the 30-40-year-old married women for whom contraception had failed. In this regard, the work of Marie Stopes (1880-1958) in furthering contraception in Britain in the 1920s must be remembered.
The man who dragged the subject of illegal abortion into the public limelight was Alec Bourne (1886-1974), a gynaecologist at St Mary’s Hospital who, in 1938, was consulted by a mother and her 13-year-old daughter after the girl had been raped, and they requested a termination of pregnancy.20 This he did, having notified the authorities. It was an offence then under the law and he was arrested and tried at the Old Bailey, narrowly escaping a prison sentence. The judge ruled that if two doctors were of the opinion that a woman’s health, physical or mental, would be made worse by continuation of pregnancy, they may recommend and perform an abortion. This then went down as Case Law and was converted to Statute Law in 1967 when the Abortion Act was brought before Parliament and passed on a free vote.
Whatever one’s ethical ideas are on abortion, this act undoubtedly converted abortion into a procedure performed by those trained in gynaecology rather than amateur abortionists, and in association deaths from this cause have gone down in Britain to minute levels. This is not of course true in other parts of the world where, irrespective of faith, illegal abortions still take place and women still die.
But not in such numbers that Doctor Peter Saunders feels he needs to care about them.
Women now travel to the UK (mostly to London) to get safe legal abortion. The majority of abortion visitors are from Ireland, where abortion is banned. The Abortion Support Network was founded in 2009:
a volunteer-run charity that provides financial assistance, accommodation in volunteer homes, and confidential, non-judgmental information to women in the Republic of Ireland and Northern Ireland who are travelling to England to access a safe and legal abortion. Funding is available on a case by case basis depending on circumstance and availability of funding. Accommodation for women is offered as necessary, either the night before or after a procedure or, in the case of later abortion, the night during a procedure.
There are great powers, outside the government and in it, trying to legislate the return of darkness. We are not great powers. But we are the light. Nobody can put us out. May all of you shine very bright and steady, today and always.