Twelve Reasons Women’s Health and Maternal Mortality Will Not Worsen, and May Improve, in States with Abortion Limits

This is Issue 4 of the On Women’s Health Series. 

1. Abortion limits will not prohibit medical interventions for life-threatening emergencies.

Limiting abortion will not prohibit any life-saving medical interventions, as is clearly shown by every pro-life state law having exceptions for the life of the mother. These laws typically specify that a physician may use his or her “reasonable medical judgment” to determine if intervention is necessary in a “medical emergency.” Factually, the necessity for an abortion to save a mother’s life is extremely rare, as pro-choice physicians candidly acknowledged more than half a century ago. Usually, these heartbreaking situations occur in the second half of pregnancy, when a woman’s obstetrician can deliver her in a safe, medically standard way, by induction or cesarean section. Via these procedures, the baby’s life can often be saved, as well. Abortion for a maternal life-threatening condition, in fact, accounts for far less than one percent of all U.S. abortions.

2. Abortion limits will prevent many women from being exposed to the increased risk of death in the year following abortion.

The U.S. Centers for Disease Control (CDC) data on maternal mortality has many limitations, so an assessment of the risk of death after abortion compared to childbirth cannot be accurately measured using U.S. data. Better-quality data obtained from records-linkage studies in Finland, Denmark, and the California Medicaid population, however, all document far more deaths in the year following an abortion than following childbirth, indicating that abortion limits help to lower maternal mortality. Similar trends are observed in Chile and Mexico. Furthermore, significant racial disparity in abortion has been documented amongst Black Americans in the U.S., which may contribute to the high rate of maternal mortality in this minority population.

3. Abortion limits will restrict later, far more dangerous, abortions.

Around 8-10% of abortions in the U.S. occur after the first trimester, and 1% occur in the second half of pregnancy when the baby may survive separated from his or her mother. These abortions are usually performed by dilation and evacuation (D&E), which is much more dangerous than earlier abortion procedures, as it requires forcibly dilating a strong muscular cervix and multiple blind passes of surgical instruments to dismember and remove the fetus and placenta. Risks associated with this procedure include hemorrhage, infection, retained tissue, damage to adjacent organs, anesthetic complications, stroke, heart attack, and death. The CDC documents a 38% increase in maternal mortality for each week that an abortion is performed beyond eight weeks, with 14.7-fold increased mortality early in the second trimester, a 29.5-fold increase in the mid-second trimester, and a 76.6-fold increase in the risk of death after viability (approximately 22 weeks gestation).

4. Abortion limits will reduce the incidence of repeat abortions.

Records-linkage studies document more deaths in the year following an abortion than following childbirth, with increased risks for women who obtain multiple abortions. Moreover, when a woman chooses to end her first pregnancy in abortion, she is at risk for many more abortions. Reducing the incidence of repeated abortions, which account for nearly half of U.S. abortions, should reduce overall mortality in women of reproductive age.

5. Abortion limits will prevent future mental health disorders in some vulnerable women.

Numerous studies demonstrate that abortion is linked to mental health issues such as anxiety, depression, substance abuse or overdose, excessive risk-taking behavior, self-harm, and suicide, all of which have been shown to contribute to maternal mortality through “deaths of despair.” High quality international records-linkage studies demonstrate that the risk of death after abortion compared to childbirth from any violent cause is six times higher, suicide six to seven times higher, accidental death four to five times higher, and death by homicide 10 to 14 times higher. Some subpopulations are at increased risk of mental health harm after abortion, such as those who have a later abortion, abort at a young age, abort a desired pregnancy, have multiple abortions, or have a prior history of mental illness.

6. Abortion limits will prevent some future pregnancy complications.

Surgical trauma to the uterine lining in dilation and suction, curettage, or evacuation abortion procedures may cause an abnormal placental attachment in a subsequent pregnancy. Placental abruption (premature separation) can occur if the attachment is not secure, and placental accreta spectrum disorder (pathologic invasion) can occur if the attachment is too strong. These abnormal placental attachments can lead to life-threatening bleeding at delivery. Also, abortion has been documented to increase the risk of a subsequent preterm birth, which is also associated with higher maternal mortality. Limiting abortion will decrease women’s risk of maternal mortality in subsequent pregnancies for these reasons.

7. Abortion limits will lead to more women giving birth, decreasing their risk of breast cancer later in life.

Since at least the 1970’s, it has been known that childbirth at a young age provides a protective effect against breast cancer and that women who never have children or who have children at older ages have a higher risk of breast cancer. There may also be a direct physiologic effect, if abrupt cessation of pregnancy hormones by abortion arrests breast tissue development in an immature, cancer-prone stage rather than allowing development to a mature, cancer resistant stage.

8. States with abortion limits and pregnancy resource centers within those states have prioritized expanding a broad social support net to assist women during and after pregnancy.

Texas has allocated $140 million in Alternatives to Abortion funding over the next two years, and this action has been reproduced in many other states. Across the U.S., over 2,700 pregnancy resource centers also provide free care and counseling for women in crisis pregnancies, offering them alternatives and the material, emotional, and relational support they may need in order to welcome their children. It stands to reason that these initiatives and resources could have a positive impact on decreasing maternal mortality.

9. Abortion limits are unlikely to result in instrumental “coat-hanger” septic abortions.

The false but frightening narrative that women denied abortion will seek it in an unsafe way, resulting in 5,000 to 10,000 deaths yearly, drove abortion’s widespread legalization before 1973. Yet, in 1972, the year prior to Roe v. Wade, the Centers for Disease Control (CDC) documented only 54 deaths from both legal and illegal abortions. Abortion was becoming safer long before it was legalized nationally in Roe v. Wade due to improved surgical techniques, safer anesthesia, and widespread antibiotic use. In 1960, it was estimated that 90% of abortions were performed by physicians, albeit illegally. Unfortunately, today abortion advocates are aggressively promoting medically unsupervised chemical abortions to women in states with limitations. Although these pills often lead to complications, they are unlikely to lead to maternal deaths due to the widespread availability of emergency services. With mifepristone and misoprostol available, it is unlikely that women will resort to unsterile instrumental abortions.

10. Abortion limits will encourage both men and women to change their sexual behavior, abstain or have fewer sexual partners, and use more reliable contraception.

Studies of changes in state and international laws show that with limits on abortion, the abortion rate goes down immediately. Although the birth rate may rise by a small amount temporarily, it usually decreases with time. As the “cost” of abortion rises, women discover other ways to decrease unwanted births. In the face of limits, couples modify their sexual behavior and use more effective contraception to prevent unintended pregnancies. Less promiscuous sexual activity will increase the likelihood that a couple will welcome their child if an unexpected pregnancy occurs, thereby lowering the risks associated with post-abortion maternal mortality. It’s also possible such limits might begin to motivate more men to take responsibility for their unborn children, helping women to avoid the variety of health risks associated with single motherhood.

11. Abortion limits will reduce unwanted abortions, decreasing the risk of mental health complications and saving the lives of children desired by their mothers.

As many as 64% of women with a history of abortion report feeling pressured into their abortions by others, such as their male partner or parents. “Perceived pressure from others” to have an abortion is one of the risk factors for mental health problems after abortion identified by the American Psychological Association. Consequently, restrictions will likely reduce the abortion rate among women at high risk of negative psychological reactions to abortion, thereby reducing the rate of suicide and self-destructive behaviors among this population.

12. Abortion limits have not been shown to increase maternal mortality in other countries.

The U.S. has the worst maternal mortality ratio (MMR) among developed countries, despite having very high overall abortion rates, and high later abortion rates. This suggests that abortion is not protecting American women from maternal mortality, and in fact may be contributing to the problem. Countries as diverse as Chile, El Salvador, Poland, and Nicaragua all saw their MMR improve after implementing abortion limits. The Republic of Ireland and the United Kingdom (UK), demographically similar countries, until recently had disparate abortion laws, but in spite of this similarity a lower MMR was demonstrated in restrictive Ireland than in the permissive UK.

Conclusion

We should reflect more carefully before doubling down on more abortions as the solution to the complex problem of maternal mortality. Dishonestly blaming state abortion limits as reasons for high maternal mortality, as some pro-abortion media have done, directs attention away from the true causes of the devastating problem of maternal mortality. For the reasons mentioned above, it is likely that abortion limits will improve, rather than worsen, the problem of maternal mortality in states that have chosen to protect unborn life.

Ingrid Skop, M.D., F.A.C.O.G. is vice president and director of medical affairs at Charlotte Lozier Institute.