Abortion & Premature Birth
Prematurity defined as a birth prior to 37 weeks gestational age, is one of the most challenging public health issues in America. Nearly 13% of all babies born in the Unites States are born preterm. Despite a 3% this past year, the US preterm birth rate has risen 38% from 1980 and 2008. 1,2 In developed nations, premature death is the leading cause of death in newborns. While medical advances allow for infants as young as 22 weeks to survive, surviving premature infants are at risk for multiple complications. The complication rate is highest for those that are very preterm births, or VPBs, (32 weeks), and increases dramatically at the youngest gestational ages. The sever long term complications can be devastating and include autism, vision impairment or blindness, cerebral palsy, and mental retardation.
While preterm rates have soared nationally, there are clear disparities in the effect this epidemic has had on different racial and ethnic communities. The African American community has been most severely affected. From 2004-2006 the rate of prematurity in the black community was 18.3%. The rate for Hispanics was 12.1% and whites, 11.6%. More distressing is the disparity in the rates of very preterm births, the smallest and most vulnerable babies. The rate of such deliveries is 4.1% for blacks, 1.8% for Hispanics, and 1.6% for whites. The black community suffers a VPB rate that is nearly three times that of other groups.3
Preterm birth does not appear to have a single cause or cure. One association which is little discussed but scientifically demonstrated is that of abortion and prematurity. Eighteen studies have shown a statistically significant increase in the risk for VPBs in women who have had a prior induces abortion.4 Similarly, studies have shown an even higher risk for VPB in women with a history of multiple induced abortions.
In 2009 two studies were published that employed rigorous techniques to review 41 prior studies of abortion and prematurity. The first study determined that a single prior induced abortion increases the risk of a future VPB by 64%.5 The second reported that a single prior induced abortion increases the risk by 35%, while more than one induced abortion increases the risk by 93%.6 The established scientific association between abortion and prematurity is sadly news to many, despite the fact that the literature regarding this link is larger and stronger than that for other commonly accepted associations with prematurity.
The rate of abortion of black infants is three times the rate of abortion for white infants.7 The rate of VPBs in the black community is also three times the rate experienced in other groups.8 It is outrageous given the current evidence that this issue is never officially addressed by healthcare policy and political leaders. This crisis manifests itself not only in a high death rate for infants that are of VPB, but in lifelong disabilities that many of the smallest infants and their families endure.9
Following the publication of the 2009 meta-analyses, I told an obstetrical colleague that I felt the medical establishment had betrayed public trust by not communicating this risk of prematurity to women considering abortion. I was told that no one could expect an "emotional woman" considering an abortion to be capable of processing the potential impact an abortion might have on her distant reproductive future. I responded that abortion is far from an emergency procedure, and even in true emergency cases where time is precious, we would consider it malpractice not to offer such information to a conscious and likely distressed patient.
Clearly others think differently, but I have no doubt that patients would prefer that they, not self-appointed medical caretakers, decide what impact the abortion-prematurity link might play in their future reproductive lives.