Abortion and Preterm Birth: Educational Campaign Recognizes the Well-Documented Link

Baby Elizabeth was born nine weeks premature. With under-developed lungs, she struggled to breathe and needed to remain in intensive care in the hospital for two and a half weeks. “I couldn’t even hold her for the first five days… We dressed her in doll clothes,” says Jenn, her mother, recalling Elizabeth’s tiny size. Jenn attributes her daughter’s premature birth – and a host of other health complications – to a previous abortion she had, and now shares her story as part of a newly-launched educational campaign called Prevent Preterm.

Prevent Preterm (PreventPreterm.org) was launched this June to educate the public on three known risk factors for preterm, or premature, births: tobacco use, lack of prenatal care, and prior abortion. Despite a large body of medical research showing that abortion increases the risk of a subsequent preterm birth, information on this link is not nearly as accessible to the general public as that of smoking and prenatal care. PreventPreterm.org fills this need by providing a user-friendly, comprehensive chart summarizing more than 100 peer-reviewed published studies that identify abortion as a risk factor for preterm birth.

Preterm birth is a birth that occurs earlier than 37 weeks of pregnancy (i.e., at least three weeks before a full term birth). According to the World Health Organization (WHO), complications related to preterm birth are the leading cause of death among children under five years old across the globe. In any given year, around 15 million babies worldwide – more than one in 10 – are born prematurely, resulting in one million deaths in 2013. In the United States, 35 percent of all infant deaths in 2010 were due to preterm-related complications.

Because preterm birth is a serious public health issue affecting millions of lives, it’s crucial that the general public receive information on its increased risk with prior abortion. “Unfortunately, despite the strength of the research, it’s become hugely politicized,” says Kelsey Hazzard, who founded Prevent Preterm in consultation with medical professionals and families affected by preterm birth. “If women have future children in mind when considering whether or not to have an abortion, knowing about the potential for premature births is obviously crucial.”

A quick survey of other easily accessible resources for preterm birth demonstrates the silence on the abortion-preterm birth link.

The CDC’s main page on preterm birth and its infographic covers 11 known risk factors, but does not mention abortion. The Mayo Clinic does cite “multiple miscarriages or abortions” as a risk factor, yet studies show even one induced abortion increases the odds. As of this writing, Wikipedia’s page on preterm birth incorrectly states that there is no evidence of increased risk of preterm birth with a medical abortion. Prevent Preterm cites a 2011 study examining over 18,000 births that found a 40 percent increased risk of preterm birth after a medical abortion using mifepristone.

Likewise, the World Health Organization’s 128-page “action report” on preterm birth entitled Born Too Soon, which is “produced by a global team of leading international organizations, academic institutions and United Nations agencies” covers a plethora of risk factors, but lacks any mention of induced abortion. What’s really telling is that the document does in fact refer to a major meta-analysis (Shah, Zao 2009) that shows the link between induced abortion and preterm birth, but instead ignores its main findings to report more generally on “appropriate birth spacing after a previous live birth or pregnancy loss.”

The statistical meta-analysis in question, “Induced termination of pregnancy and low birthweight and preterm birth: A systematic review and meta-analyses,” examines 37 studies and found that there is a 36 percent increased odds of preterm birth with one prior induced abortion, and a 93 percent increased odds of preterm birth with more than one prior induced abortion.

The 2012 WHO report does not even reference its own 1979 study published in Lancet that found a 285 percent increased risk of preterm delivery with a prior induced abortion when compared to women with a prior live birth.

As stated on Prevent Preterm’s website: “Prevent Preterm believes that every woman deserves this information, regardless of whether or not she has a medical background. Therefore, Prevent Preterm has done everything possible to make this medical research accessible to laypeople, without sacrificing accuracy.”

Prevent Preterm does this by providing a helpful resource chart summarizing findings from more than 100 peer-reviewed studies, spanning four decades and involving mothers and newborns from 34 countries that identify prior abortion as a risk factor for preterm birth. The major scientific journals that published these studies include The Journal of Maternal-Fetal and Neonatal Medicine, BJOG: An International Journal of Obstetrics and Gynaecology, and Annals of Epidemiology.

In 2012, the Charlotte Lozier Institute examined many of these studies in an On Point series paper entitled “Induced Abortion and Risk of Subsequent Preterm Birth.” In that paper, authors Elizabeth Ann M. Johnson, M.D. and Steven Calvin, M.D. conclude:

[A]s reported in these studies, the increased risk of preterm birth and other adverse subsequent pregnancy outcomes following induced abortion is both clinically relevant and important from a public health perspective. Health care professionals should be informed about the potential risks of induced abortion on subsequent birth outcomes and women considering abortion should be given this information as part of the process of obtaining informed consent. (Emphasis added)

The need for Prevent Preterm’s educational efforts can be seen in the experiences of women who support it, as living examples of the association between abortion and preterm birth. “I didn’t learn about the preterm birth link until after he was born,” says Deborah, whose son was delivered early at 28 weeks due to a placental abruption. Daria, another woman who had difficulties bringing a baby to full term and delivered prematurely after a previous abortion, says, “I don’t want anyone to go through what I went through.” Perhaps with Prevent Preterm’s educational efforts, many women won’t.

If a physician would like to endorse Prevent Preterm, he or she may contact the campaign here.

Genevieve Plaster is a research assistant for the Charlotte Lozier Institute.