JAMA Gymnastics: Jumping Through Hoops to Prove Abortion is Safe
- David C. Reardon, Ph.D.
The American Medical Association has long supported legal abortion. Indeed, since 1972, the AMA's amicus briefs to the Supreme Court have generously provided Justice Harry Blackmun and his cohorts with a "medical" justification for abortion on demand. The crux of this "medical" justification is the claim that abortion is "safe" - specifically that the maternal mortality rate for legal abortion is lower than that for childbirth.
But in recent years the Supreme Court has finally begun to recognize that abortion involves other non-fatal risks, such as reproductive damage and psychological sequelae. Acknowledgment of these risks has played an important role in recent Court rulings which allow parental notice, waiting periods, and state established informed consent standards for abortion. Many states are now seeking to enact laws to protect the health of women in the manner allowed by these High Court decisions.
The AMA, however, has and continues to oppose these and any other regulations on abortion. Thus, to bolster its pro-abortion political position, and to provide "new" evidence for pro-abortion lobbyists in their legislative battles, the AMA is going to extraordinary lengths to convince the public, and its own members, that abortion is still safe. An important aspect of this campaign includes publication of propaganda pieces in the AMA's prestigious Journal of the American Medical Association, or simply JAMA. Two examples of this occurred in the last three months of 1992.
Denial of Post-Abortion Trauma
The first piece of propaganda came in the form of a commentary titled "The Myth of Abortion Trauma Syndrome," [JAMA, Oct. 21, 1992]. The author of this commentary, Nada L. Stotland, M.D., begins and ends her piece with the emphatic pronouncement that "there is no evidence" of post-abortion trauma, and that post-abortion trauma "does not exist." Given the abundance of published research to the contrary, and the complaints of thousands of former abortion patients, such absolutist statements display an unnerving abandonment of reason in favor of political ideology. Indeed, her thesis statements are patently inconsistent with the evidence even she herself presents!
As just one example, Stotland cites Lask's findings that 11% of the women studied reported adverse psychological effects six months after their abortions.(1) Rather than expressing concern about the 11 percent of women in this sample who suffered post-abortion psychological sequelae, much less worrying that this short-term study may have revealed just the tip of the iceberg, Stotland insists that this minority reaction is "proof" that post-abortion trauma "does not exist."
Stotland also reports only part of Lask's findings. In fact, Lask reports that 32% of those studied, one of every three abortion patients, had an "unfavorable" outcome to the abortion. This 32% included not only patients who suffered post-abortion mental illness, but also patients who regretted having the abortion, and patients who had moderate to severe feelings of guilt, loss, or self-reproach. It is also notable that these findings provide only a very limited view of unfavorable outcomes since Lask's study involved only short term follow-up. It does not show if these sequelae lessened or worsened over time, nor does it include sequelae among women who experienced delayed reactions as has been reported by other researchers.
Either Stotland sees in the literature only what she wants to see, or she is reporting only what she wants others to see. Another example of this bias is found in Stotland's summary of a study by Belsey and Greer of 360 women. Stotland makes broad claims that this study found that "the majority" felt relief and regained their pre-abortion mental health status. But once again, a reading of all of this study's findings reveals a different picture.(2)
Belsey's main finding is that 49% of the group (still a minority!) had experienced one or more maladjustments within 3 months after the abortion. Most importantly, Belsey found that the women most at risk of experiencing negative reactions could be pre-identified during pre-abortion screening. Belsey grossly summarized these high-risk screening criteria as: 1) a history of psychosocial instability, 2) a poor or unstable relationship with her partner, 3) few friends, 4) a poor work pattern, or 5) failure to take contraceptive precautions. Using these factors, Belsey identified 64% of the abortion patients she studied should have been referred for more extensive counseling. Of this high risk group, 72% actually did develop negative post-abortion reactions, compared to the low risk group of whom 28% experienced one or more maladjustments.
A final example of Stotland's selective bias is her citation of a study by Brewer which reported an incidence of post-delivery psychosis of 1.7 cases per thousand compared to only .3 per thousand post-abortion patients.(3) However, Brewer's study has not only been criticized for serious methodological flaws, it has also been superseded by a much more sound study conducted by Henry David.(4) David's record link of 1.1 million Danish women found that in all categories the psychiatric admission rate was significantly higher for women who had abortions than for women who carried to term, and was almost four times higher among separated or divorced women.(5)
But even these results may under represent the true risks of abortion versus childbirth because David limited his search to three months post-event. This three month period was selected as likely to cover most cases of severe post-partum depression, but according to most experienced post-abortion clinicians this period is inadequate to track severe post-abortion trauma. Post-abortion trauma is often deeply repressed, and its symptoms may not be evident until triggered by much later events, such as the anniversary date of the abortion, or the birth of a later child.
One could write a small book commenting on all the all of Stotland's exaggerated claims and omissions of fact. But the main point here is that the prestige of JAMA is being used to lend credibility to biased and distorted views of post-abortion literature.
Why? Because there is a growing concern among pro-abortionists that the myth of abortions being "safe" is beginning to crumble under the pressure of injured post-abortion women speaking out and the post-abortion research and education efforts of pro-lifers. Thus, pro-abortionists, including the AMA hierarchy, are desperately trying to shore up this myth with a spate of new publications proving abortion's safety.
The AMA Reviving the Old Myths
The second example of JAMA propaganda is Council on Scientific Affairs special abortion report published in the December 9, 1992 issue.(6) The bulk of this report is focused on maternal and post-abortion mortality. Also included are brief presentations discounting any significant physical or psychological morbidity and an "analysis" which argues that state regulations of abortion through parental notice and waiting periods pose a "threat" to abortion safety.
In the mortality rate discussion, the Council Report repeats what is now the thoroughly discredited claim that prior to 1973 there were 1 million illegal abortions per year. It has been frequently demonstrated that this million abortions estimate had no rationale basis and was little more than a nice round number chosen for its propaganda value.(7) When this question is approached through statistical analysis of abortion related deaths, the actual rate of illegal abortions prior to Roe was surely well within the range of 100,000 to 200,000 per year.(8) This estimate is confirmed by the testimony of women seeking abortions which demonstrates that under 10% of patients would seek an abortion if it were still illegal.(9)
The Council Report also uncritically accepts the claim that maternal deaths from legal abortion have been accurately tabulated by the Center for Disease Control. This blind acceptance of official CDC data ignores the testimony of former abortionists who admit covering up of abortion related deaths,(10) and the testimony of pro-life investigators. One such investigator reviewed death certificates in Los Angeles County where the cause of death was listed as "therapeutic misadventure" and found incontrovertible evidence of four abortion deaths during only a twelve month period. During this same time period, the whole state of California reported no abortion related deaths and the CDC reported less than seven for the whole nation. These four deaths were uncovered in only one county, investigating only one hiding place, "therapeutic misadventure."(11) This and other evidence suggests that there is no reason to believe that the CDC numbers have any relationship to reality.
Still, the pro-abortion Council accepts the accuracy of the CDC's abortion data because of a 1978 "study" by pro-abortion activist, and former CDC employee, William Cates.(12) We have previously written a critique of the CDC data which includes a detailed examination of the blatant dishonesty which permeates this "study." In brief, the analysis of Cates, et al., is based on a statistical comparison of CDC data and NCHS data using the "Chandrasekaran-Deming theory" [sic] to prove that the CDC data represents at least 90% of all abortion related deaths. But upon investigation, the original statistical theory of C. Chandra Sekar and W. Edwards Deming (incorrectly cited by Cates), places strict limitations upon its use, all of which are violated in the CDC analysis.(13)
First, the Sekar-Deming theory applies only to independent survey techniques. NCHS and CDC data, however, are heavily interdependent. Second, the theory was developed for estimating the accuracy of national death and birth statistics and is valid only when the number of events being studied is very large, on the scale of hundreds of thousands or millions. But even the severest critics of abortion do not believe that the number of women dying from abortion are in the thousands or millions per year. Third, the Sekar-Deming theory assumes that the data reported from two independent sources represents an honest attempt at accuracy. It makes no allowances for deliberate deception, which critics believe is the primary cause for the underreporting of abortion related deaths.
Cates' inappropriate use of the Sekar-Deming statistical theory to defend the CDC's inadequate abortion surveillance data is an example of either gross stupidity or intellectual dishonesty. We suspect it is the latter. By uncritically parroting such indefensible trash, and ignoring all evidence to the contrary, the AMA Council Report is reduced to nothing more than a propaganda piece.
But the Council Report is flawed not only for what it accepts as facts but also for the facts that it omits. While pretending to have accurate measures of direct abortion related deaths, the Council totally ignores secondary deaths resulting from abortion morbidity. Indirect deaths resulting from latent abortion morbidity include deaths from ectopic pregnancies, complications of labor, breast cancer, ovarian cancer, suicide, drug abuse, and increased smoking patterns among post-abortion women, to name a few. A recent analysis of just a few of these abortion related complications indicates that the number of indirect deaths attributable to abortion morbidity exceeds 25,000 per year.(14)
An Incestuous Relationship
The AMA Council's review of immediate post-abortion complications is even more myopic. The Council deferentially turns to the National Abortion Federation (NAF) for data. The NAF, in turn, graciously supplies an estimate of one complication per 1000 abortions via a memo between the two advocacy groups. But even here, the abortionists can hardly avoid tripping over their own tongues. The same NAF letter which says the total complication rate is 1 per 1000, says that incomplete abortions occur at a rate of 2.3 per thousand, infections requiring intravenous treatment occur at 1.3 per 1000, perforation of the uterus .9 per thousand, and other problems requiring laparoscopy, laparotomy or transfusion occur at 1.1 per thousand, which together would total 5.6 per thousand - far more than the original "total complication rate" of 1 per thousand.
One is also left to wonder how the NAF has compiled these undocumented statistics, especially given the evidence that most injured women go to someone other than the abortionist for treatment because they are filled with shame, anger, and revulsion toward the abortionists.
But even on the face of it, asking the National Abortion Federation (NAF) for complication rates is like asking the American Tobacco Association for their estimate of the health impact of smoking. The only explanation for this deference to the NAF is the fact that the AMA Council is philosophically aligned with the NAF and therefore the NAF trade figures are servility accepted as gospel.
Again, one could analyze every misused or misreported study cited by the AMA Council, but the few samples above are sufficient to call into question the objectivity of the Council Report. As in the case of Stotland's commentary, the Council Report is convincing only if nobody reviews the original sources.
Standing Our Ground
We believe that the AMA and other pro-abortion academic groups are feeling the pressure of pro-life research and education efforts which are successfully beginning to raise public awareness of abortion's risks. These JAMA articles are evidence that the pro-aborts are gearing up a counter-campaign to reassure the public that abortion is "safe" and to portray any regulation of the abortion industry as a threat to women's health.
The actual evidence is not on their side. But they do have lots of money, prestige, and easy access to journals in which to publish their propaganda. This is why it is especially important for the research efforts of experts critical of abortion safety must not only continue, but must be multiplied. We must not let their propaganda go unchallenged. We must continue to uncover, document, and teach the truth of abortion's dangers.
The pro-aborts know better than we do, the public is very uneasy with abortion on a moral level. If public confidence in the safety of abortion is ever shaken, the game is lost. Once pro-lifers succeed in showing how many women are being injured by abortion, public tolerance of this "necessary evil" will evaporate like summer dew.
Is it really worth killing babies, or even "potential" babies, if their mothers, rather than being helped, are actually getting hurt in the process? Of course not.
This is why the safety issue is the Achilles heel of abortion on demand. This is why post-abortion research and education projects need our support.
1. Lask, "Short-term psychiatric sequelae to therapeutic termination of pregnancy," Br J Psychiatry. 1975; 126:173-177 (1975).
2. Greer, Belsey, et al., "Psychosocial Consequences of Therapeutic Abortion: Kings Therapeutic Study III," Br. J. Psychiatry, 128:74-79 (1976); and Belsey, Greer, et al., "Predictive Factors in Emotional Response to Abortion: King's Termination Study - IV," Soc. Sci. & Med. 11:71-82 (1977).
3. Brewer, "Incidence of post-abortion psychosis: A Prospective Study," British Med. J., 1:467-477 (1977).
4. Rogers, et al., "Validity of Existing Controlled Studies Examining the Psychological Effects of Abortion," Perspectives on Science and Christian Faith, 39(1):20-30 (1987).
5. David, et al., "Postpartum and Postabortion Psychotic Reactions," Family Planning Perspectives 13:88-91 (1981).
6. Council on Scientific Affairs, Council Report, "Induced Termination of Pregnancy Before and After Roe v. Wade: Trends in the Mortality and Morbidity of Women," JAMA 268(22):3231-3239 (1992).
7. Grisez, Abortion: The Myths, the Realities, and the Arguments (New York: Corpus Books, 1970) 35-42.
8. Hilgers & O'Hare, "Abortion-Related Maternal mortality: An In-Depth Analysis," New Perspectives on Human Abortion, Hilgers, et al., eds. (Frederick MD: University Publications of America, 1981) 69-91.
9. Reardon, Aborted Women - Silent No More (Chicago: Loyola University Press, 1987) 287-291.
10. Everett, The Scarlet Lady: Confessions of a Successful Abortionist (Wolgemuth & Hyatt, Brentwood, TN, 1991).
11. Feminists for Life amicus curiae brief to the United States Supreme Court, Webster v. Reproductive Health, October Term 1988, p21-22 with supporting documents filed.
12. Cates, et al., "Assessment of Surveillance and Vital Statistics Data for Monitoring Abortion Mortality, United States, 1972-1975," Am J Epidemiology 108:200-206.
13. Sekar and Deming, "On a Method of Estimating Birth and Death Rates and the Extent of Registration," American Statistical Association Journal, March 1949; Vole 44 pp 101-115.
14. Strahan, "Women's Health and Abortion II - Risk of Premature Death in Women From Induced Abortion: Preliminary Findings," Association for Interdisciplinary Research in Values and Social Change Newsletter, 5(2) 1993, available from NRL Educational Trust Fund, 419 7th St. NW, Suite 500, Washington DC 20004 (202) 626-8800.
Originally published in The Post-Abortion Review 1(2),Summer 1993 Copyright 1993 Elliot Institute