Sex, death and abortion bans

March 25, 2014

By Matthew E. Milliken
March 25, 2014

Kevin D. Williamson posted an article Saturday morning at National Review about abortion. The piece is titled “The Symbol of a Lie” and subtitled “Wire-hanger abortions pre-Roe are pure myth.”

(Roe, of course, represents Roe vs. Wade, the landmark 1973 U.S. Supreme Court decision which held that states had no right to regulate abortion in the first trimester of pregnancy — but you knew that.)

The headline to Williamson’s piece is a bit misleading. The thrust of his argument is not that abortions induced with wire hangers were rare prior to Roe; rather, it is that illegal abortions were not very dangerous.

Writes Williamson:

We have as a source no less an organization than the butchers’ union itself, Planned Parenthood, whose medical director, Dr. Mary Steichen Calderone, very helpfully compiled a report on deaths from illegal abortions in the pre-Roe era and found very few of them. Her report, “Illegal Abortion as a Public Health Problem,” published in the American Journal of Public Health in 1960, is interesting if grisly reading. In it we learn that in the pre-Roe era, the incidence of maternal deaths resulting from abortion was quite low, nothing like the tens of thousands of deaths in the wire-hanger mythology. “Abortion is no longer a dangerous procedure,” Dr. Calderone writes. “This applies not just to therapeutic abortions as performed in hospitals but also to so-called illegal abortions done by physicians.” And by Dr. Calderone’s estimate, “90 percent of all illegal abortions are presently being done by physicians. Call them what you will, abortionists or anything else, they are still physicians, trained as such; and many of them are in good standing in their communities. They must do a pretty good job if the death rate is as low as it is.” Bear in mind that this comes from an advocate of legal abortion at a time when abortion was broadly illegal.

In a subsequent passage, Williamson continues:

Dr. Calderone noted that the rate of abortion-related maternal death had been declining steeply for some years despite the criminal status of most abortionists, and the general assumption was, and has been, that in an era of legal abortion such maternal deaths would all but disappear. That has not in fact been the case. As the Centers for Disease Control reports, there have been hundreds of abortion-related maternal deaths since 1972, the vast majority of them the result of legal rather than illegal abortions. (See table 25 here.)

Table 25 appears near the end of a 42-page Centers for Disease Control on abortions in the U.S. in 2008. Here’s a copy of the data:

2011-11-25 Abortion-related deaths v 2=MMWR

Williamson’s reading of Calderone’s article, like his examination of the CDC chart, is skewed from start to finish. The 1960 analysis, after all, was titled “Illegal Abortion as a Public Health Problem” (emphasis added). 

But let’s focus on the data. In 1972 and 1973, there were 65 and 47 abortion-related maternal deaths, respectively, for an overall tally of 112 and a fatality rate of 4.1 deaths per 100,000 reported legal induced abortions. There were 33 maternal deaths in 1974 and 34 in 1975, for a case-fatality rate of 3.4 in those years. 

But in no other year did the number of abortion-related maternal deaths exceed 30. After 1975, the highest number of maternal deaths came in 1977 (21) and 1979 (22), yielding fatality rates of 1.6 and 1.8, respectively.

Now consider the column for maternal deaths attributed to illegal abortions. After Roe was decided, in only four years were there more than two such fatalities: 1974 (6), 1975 (4), 1977 (4) and 1978 (7). Or consider this: Of the 95 maternal deaths linked to illegal abortions, 58 occurred the year before and the year in which the Supreme Court issued its ruling in Roe vs. Wade. That’s 61 percent.

It’s also instructive to examine the paragraph by Calderone, whom Williamson calls the medical director of “the butchers’ union itself, Planned Parenthood,” from which Williamson very selectively quotes. Here’s the full passage, with the text that Williamson used italicized and some contradictory information boldfaced:

Fact No. 3 — Abortion is no longer a dangerous procedure. This applies not just to therapeutic abortions as performed in hospitals but also to so-called illegal abortions as done by physicians. In 1957 there were only 260 deaths in the whole country attributed to abortions of any kind. In New York City in 1921 there were 144 abortion deaths, in 1951 there were only 15; and, while the abortion death rate was going down so strikingly in that 30-year period, we know what happened to the population and the birth rate. Two corollary factors must be mentioned here: first, chemotherapy and antibiotics have come in, benefiting all surgical procedures as well as abortion. Second, and even more important, the [1955 abortion] conference estimated that 90 per cent of all illegal abortions are presently being done by physicians. Call them what you will, abortionists or anything else, they are still physicians, trained as such; and many of them are in good standing in their communities. They must do a pretty good job if the death rate is as low as it is. Whatever trouble arises usually comes after self-induced abortions, which comprise approximately 8 per cent, or with the very small percentage that go to some kind of nonmedical abortionist. Another corollary fact: physicians of impeccable standing are referring their patients for these illegal abortions to the colleagues whom they know are willing to perform them, or they are sending their patients to certain sources outside of this country-where abortion is performed under excellent medical conditions. The acceptance of these facts was such that one outstanding gynecologist at the conference declared: “From the ethical standpoint, I see no difference between recommending an abortion and performing it. The moral responsibility is equal.” So remember fact number three; abortion, whether therapeutic or illegal, is in the main no longer dangerous, because it is being done well by physicians.

So abortions, which killed 251 pregnant women in the United States from 1980 through 2007, killed 260 American women in 1957 alone. And most of those deaths came from either self-induced abortions or those performed by untrained abortions.

Pro-life groups want to ban all or most abortions. (Some, of course, are willing to exempt victims of rape or incest and women who face significant risk of death by carrying to term.) But even granting the assertion by Williamson and others that self-induced coat-hangar abortions were always more mythical than factual, it’s unclear to me that abortion foes have adequately grappled with the dangers that abortion bans pose to women.

Information collected by the Guttmacher Institute — a research and advocacy organization with a liberal outlook on contraception, abortion and other matters of women’s and reproductive health — finds that countries with restrictive abortion laws tend to have much higher death rates due to abortion than those with more permissive statutes. In the United States, for many years, there have been fewer than one maternal death per 100,000 abortions performed. Worldwide, the rate is 220 per 100,000; in sub-Saharan Africa, the rate is 460 maternal deaths per 100,000 terminations.

In 2008, there were an estimated 47,000 maternal deaths worldwide linked to unsafe abortions. That accounted for 13 percent of all maternal deaths worldwide. (The World Health Organization defines an unsafe abortion as one performed by an individual without the necessary skills or in an unsanitary environment or both.)

But unsafe abortions have other consequences, too. Estimates for 2005 indicate that 8.5 million women required medical attention due to such procedures. And unsafe abortions can leave women infertile or injured, increasing the financial burden on their families and on the health-care systems from which they seek care.

Somehow, pro-life advocates never seem to engage with this data. Nor do they talk much about the fact that abortion rates tend to be significantly higher in nations with restrictive abortion laws than in ones with permissive statutes.

In closing out his article, Williamson wrote the following:

We cannot build a humane society on a foundation of violence, and we cannot build an intelligent political discourse on a foundation of lies.

Those are words people on all sides of the abortion would do well to heed. Williamson should set a good example for us all by considering the many maternal deaths that have been linked to abortion bans, even if few of them seem to result from the use of coat-hangers.

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