Safe, Legal, and Rare, Part 1: Safe?

In the historic debate over abortion, the “pro-choice” mantra was “Safe, Legal, and Rare”: the argument being that if abortion were legalized, it would be both safer than oft-cited “back alley” abortion, and, coupled with an expansion of sex education and access to contraception, would become increasingly rare.

In light of the continuing release of videos exposing the actual practice of abortion by Planned Parenthood, it’s now fair to assess: 40 years following Roe v. Wade, is abortion in America “Safe, Legal and Rare”?

First, Safe:

The first thing to be aware of is that there is literally no way of knowing how safe abortion is in America, because—unbelievably—even where they exist, reporting requirements are not enforced, and no source has established any meaningful method of tracking abortion. While the Centers for Disease Control and Prevention (CDC) maintains an “Abortion Surveillance Unit,” it in fact has no systematic means of collecting data on abortion-related statistics—including deaths.

Abortion practitioners are thus, basically, just assumed to be safe.

The most egregious example that they are not, Dr. Kermit Gosnell, operated for decades, performing very late term abortions that necessitated actively killing babies viable outside the womb by snipping their spinal cords after delivery, fudging documentation, and operating under incredibly unsanitary and unsafe conditions. Neither his clinic nor any in Pennsylvania, where he primarily operated, were inspected for 17 years. Prior to this moratorium, however, he had failed to pass inspections, but with no consequence. And despite numerous complaints, his practice was never investigated, and was eventually shut down only as a result of a drug raid.

Similar conditions have been uncovered wherever anyone has looked: Fourteen of the 22 abortion clinics operating in Pennsylvania were cited for violations when inspected following the moratorium, and two were closed. Four abortion clinics in Maryland were shut down after a patient died, and 12 of the state’s 16 abortion facilities failed to meet state health and safety regulations. In Illinois, two of nine licensed abortion clinics were closed when backlogged inspections were finally made, and similar reports have been coming out of Texas, Delaware, Alabama, Michigan, New Mexico, New York, North Carolina, Minnesota, Colorado and elsewhere.

So, if abortion clinics were simply “cleaned up” and subject to oversight—ideally, by one or more competing, private third-party certifiers—would abortion then be “Safe”?

The primary reason the Supreme Court cited in affirming abortion rights in Roe v. Wade was the State’s interest in protecting the life and health of the woman involved. The court’s ruling specifically expressed its understanding that:

abortion in early pregnancy, that is, prior to the end of the first trimester, although not without its risk, is now relatively safe. Mortality rates for women undergoing early abortions, where the procedure is legal, appear to be as low as or lower than the rates for normal childbirth. Consequently, any interest of the State in protecting the woman from an inherently hazardous procedure, except when it would be equally dangerous for her to forgo it, has largely disappeared.

The studies upon which the Supreme Court drew in forming this opinion have been cited as faulty. That’s not particularly surprising, given that abortion was only legal in scattered areas, with presumably less data on which to draw. However, in the 40 years since Roe, the data set is not much improved. Again, no agency or organization systematically tracks and keeps records of abortion-related statistics, and there is extensive documentation, from journalists to medical researchers, that a large proportion of deaths from abortion are not recorded as such. However, four of five recent studies’ findings conflict with those the Supreme Court drew on, showing that there are significantly increased risks of death for women from abortion vs. childbirth.*

Finally, while stating the obvious, abortion as practiced is certainly not “safe” for the unborn, and may well be causing them pain and suffering. What too many do not want to know is that 95% of all second-trimester abortions use the so-called “dismemberment abortion” procedure: dilating the cervix and “using forceps, clamps, scissors or similar instruments on a live fetus to remove it from the womb in pieces.” So far, attempts to ban the practice have been unsuccessful.

And this is the focus of much of the discussion by the Planned Parenthood representatives in the Center for Medical Progress videos: how to alter the abortion procedure to position the baby’s body and place the forceps to optimize the retrieval of the parts of the baby’s body wanted to use for research. Needless to say, altering the procedure to maximize the “quality” of the babies’ body parts retrieved for sale to researchers—is not putting the health and safety of the mother first.

Finally, given that legal abortions are regularly being provided much later than the “first trimester” standard cited in Roe v. Wade, the “safety” grounds for that ruling are completely irrelevant to today’s debate. This is thus not an issue to delegate to courts or policy makers—it’s for each of us to stop looking away, inform ourselves and help inform others:

Abortion. It’s not what you think.


*Studies drawing on 30 years’ records of legal abortion in the U.S., as well as data from Finland and Denmark (where abortion is also legal) have all found significantly increased risks of death for women from abortion vs. childbirth:
• Among other findings, this 2004 paper published in the Journal of Contemporary Health Law and Policy included a study of 173,279 low income women in California: “Specifically, we found an elevated relative risk of death associated with abortion for all causes (RR=1.62), suicide (2.54), natural causes (1.44), circulatory diseases (2.87), and cardiovascular disease (5.46). Moreover, these effects persisted over several years.”
• A study of the entire population of women in Finland found the mortality rate was far lower for women during pregnancy and within 1 year following delivery of a baby than for those who had an abortion.
• Two studies were based on data from Denmark. The first, comparing against women who deliver a first pregnancy, found that women who abort a first pregnancy have a significantly elevated risk of death within the first 180 days and this elevated risk of death persists for at least ten years. The second revealed that there is also a “dose” effect associated with abortion, with each exposure of abortion contributing an additional 50% (approximately) increased risk of death over the period examined.

In contrast, a study published in 2012 claimed to find that: “Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.” However, disputing this study’s findings, a co-author of the 2004 study (above) faults (see Comment at bottom of page) its methodology: the 2012 study drew on unconnected sets of data. The 4 studies drawing opposing conclusions above all drew on linked data sets. Citing the Finland study, he says: “Without record linkage, 94% of deaths associated with abortion (in the first year alone) could not be identified.”

Mary L. G. Theroux is Senior Vice President of the Independent Institute. Having received her A.B. in economics from Stanford University, she is Managing Director of Lightning Ventures, L.P., a San Francisco Bay Area investment firm, former Chairman of the Board of Advisors for the Salvation Army of both San Francisco and Alameda County, and Vice President of the C.S. Lewis Society of California.
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