Effects on Womens Health After Abortion

Abortion Harms Women's Health

Table of Contents: Further Readings

"In North America ... there is a pronounced bias against reporting bad news about induced abortion."

Ian Gentles is a professor of history at York University's Glendon College in Toronto and the coauthor of Women's Health After Abortion: The Medical and Psychological Evidence, which argues that the health risks of abortion are downplayed in the United States. In the following viewpoint Gentles summarizes some of the main arguments of his book. According to him, abortion is associated with an increased risk of breast and other cancers, sterility, pelvic inflammatory disease, and complications with future pregnancies. Gentles believes that reporting on the health risks of abortion has become taboo in the United States because special interests do not want abortion banned.

As you read, consider the following questions:

1. How much greater was the risk of breast cancer among women who had abortions compared with those who did not, according to the study by the National Cancer Institute that Gentles cites?
2. How much more likely are women to have a premature birth if they have previously had an abortion, according to the author?
3. What is the goal of most of the researchers who conduct post-abortion research, in Gentles's opinion?

[In 2002] a great deal of anxiety was provoked in the media by the publication of a medical report on the long-term consequences of hormone replacement therapy for women. Among the several negative effects of HRT, the one that caused the greatest distress was the increased risk—about 25 per cent—of breast cancer. The incidence of breast cancer among women has certainly risen alarmingly in the past three decades. Many explanations for this rise have been suggested: a more polluted environment, changes in diet, smoking, the postponement of childbearing, the contraceptive pill, and other drug therapies.

The Link Between Abortion and Breast Cancer

But the media have paid almost no attention to the many studies that have documented a significantly higher incidence of breast cancer among women who have abortions, in particular those who abort their first pregnancy before the age of 20. At least 27 studies in ten countries have discovered an increased risk of 30 per cent—significantly higher than the increased risk of 25 per cent reported in the single study of the effects of HRT.

Strange to say, the authors and sponsors of several of these studies have shied away from the implications of their findings. The National Cancer Institute in the U.S., for example, sponsored a major study which showed a 36 per cent increased risk (rising to a disturbing 50 per cent among women under 20 who abort their first pregnancy) of breast cancer among women who undergo abortions. In fact, given that young women who carry their first pregnancy to term reduce their chances of breast cancer by 30 per cent, the consequences are even more dramatic. The lifetime chances of a woman in North America being diagnosed with breast cancer are currently about ten per cent. A woman who has a child before age 20 has a seven per cent chance. On the other hand, if she aborts that first early pregnancy, she more than doubles her lifetime chances to fifteen per cent. Yet the National Cancer Institute, and other establishment voices such as the prestigious New England Journal of Medicine stoutly continue to deny that there is any link between abortion and breast cancer.

Curiously, the establishment on the other side of the ocean is much less reluctant to recognize the link. In April 2000, Britain's Royal College of Obstetricians and Gynecologists acknowledged that studies demonstrating the abortion-breast cancer link "could not be disregarded." Writing in the London Times a year later, Dr. Thomas Stuttaford declared that "an unusually high proportion" of the women diagnosed with breast cancer in the U.K. each year "had an abortion before eventually starting a family. Such women are up to four times more likely to develop breast cancer."

There are solid physiological reasons for the association between induced abortion and the later development of breast cancer which have to do with the hormonal effects of pregnancy on a woman's breast tissue. A surge of the hormone oestradiol at conception reaches twentyfold in the first trimester, triggering an explosive growth of breast tissue—a period when breast cells are most likely to be affected by carcinogens. When a woman completes her first full pregnancy, further hormonal changes propel these newly produced breast cells through a state of differentiation, a natural maturing process that greatly reduces the risk of future breast cancer. An early, abrupt termination of pregnancy by abortion arrests this process before the cancer-reducing evolution of hormone release can occur, leaving a large population of dangerously-stimulated breast tissue cells in place, enormously raising future cancer risk. On the other hand, "... an early first, full-term pregnancy would provide the greatest protection against breast cancer by drastically reducing, early on, the presence of undifferentiated and hence vulnerable breast cells, thereby decreasing the risk of subsequent transformation." A fascinating animal study supports this line of reasoning. Two groups of rats were exposed to a chemical carcinogen before mating. The group that carried a first pregnancy to term developed mammary tumours at a rate of six per cent. The group whose pregnancies were aborted, however, developed mammary tumours at an astounding rate of 78 per cent.

These are among several dramatic findings dredged up from the obscurity of scientific journals and presented in Women's Health After Abortion: The Medical and Psychological Evidence, a new book I co-authored with Elizabeth Ring-Cassidy. In it, we review and summarize over 500 studies which have appeared in medical and professional journals, most of them over the past twenty years. What follows here is a brief overview of our work.

Other Cancers and Maternal Mortality

Cancers of the cervix, ovaries and rectums. Research in this area is in its early stages, but a few studies from the past decade point to a link between abortion and subsequent cancers of the reproductive system, as well as colorectal cancer. Cervical cancer in particular seems to be directly associated with induced abortion. Studies of cancer of the ovary have presented conflicting evidence. A strong association has been discovered between abortion and cancer of the rectum. What is remarkable is that with the increase in cancers of the breast and reproductive system in women over the past thirty years, there has as yet been so little interest in investigating the link with induced abortion. Despite the overwhelming weight of the studies pointing to such a link, their conclusions have been generally ignored by the research establishments in North America. The rationale for this may be that for some it is more important for abortion to remain accessible than for women to be informed about a clear threat to their health. Thus, the politicized and controversial nature of the subject, and the desire of some powerful groups to keep abortion "safe, simple, and easily available," have militated against the objective consideration of data pointing strongly to a link between abortion and various cancers.

Maternal mortality. In both Canada and the U.S. there is a general and systematic underreporting of maternal deaths, whether from abortion, pregnancy, or during delivery. Not least among the reasons for this is the fact that more and more abortions are now performed in free-standing clinics. A woman whose post-abortion condition is life threatening generally goes to a hospital, not back to the clinic. The attending emergency room doctor may not record a subsequent death as resulting from an abortion. The practice of coding the immediate rather than the underlying cause of death also causes underreporting: an induced abortion may result in bleeding, embolism, cardiac arrest or infection, or it may lead to a subsequent ectopic pregnancy. But the death certificate of a woman who dies from these conditions may make no reference to abortion.

A recent, large-scale Scandinavian study found that within one year of the end of a pregnancy, women who had induced abortions suffered a mortality rate that was almost four times greater than that for women who delivered their babies. And their rate of suicide was six times greater. A recent study in Wales found that women who had induced abortions were 2.25 times more likely to commit suicide than women admitted for normal delivery. A large-scale California study just recently published reported similar findings. These studies, using record linkage and involving many hundreds of thousands of cases, authoritatively refute the oft-repeated fiction that induced abortion is safer for women than giving birth.

Ectopic pregnancy. While overall health has generally improved in the past century, there has been a disturbing rise in ectopic pregnancies [in which a fertilized egg implants outside the uterus, usually in the fallopian tubes]. Between 1970 and 1990 they doubled, trebled or quadrupled in frequency, depending on the country, so that they now account for two per cent of all pregnancies in the areas studied. The rise of ectopic pregnancy coincides almost exactly with the steep rise in the frequency of induced abortion during the same period. Studies from Italy, Japan, Yugoslavia and the U.S. have documented a much higher risk of ectopic pregnancy among women who have had one or more abortions. Yet the authors of an American study that uncovered a 160 per cent increased risk arrived at the strange conclusion that abortion "does not carry a large excess risk" of ectopic pregnancy. This is one of many examples in the literature of abortion researchers making statements in the abstracts or conclusions of their articles that flatly contradict their findings.

PID and Other Risks

Uterine perforations, pelvic inflammatory disease, and infertility. Among the other risks involved in surgical abortion are uterine perforation, uterine adhesions, retained fetal fragments and infections that lead to pelvic inflammatory disease (PID). PID is now epidemic in Canada and much of the rest of the world. Nearly 100,000 women contract it each year in Canada alone. The disease is difficult and expensive to treat, and causes infertility in women. The link between PID and abortion is well established in the sense that women who undergo surgical abortions suffer a much higher incidence of PID afterwards. The link is even stronger among women who have had two or more abortions.

Pain and abortion. Some abortion clinics attempt to reassure their patients that the pain they are about to suffer will resemble nothing greater than heavy menstrual cramps. A large study conducted in Montreal paints a different picture. Pain is the most subjective of experiences, yet when the pain scores of these abortion patients were checked against other acute and chronic pain syndromes, "they were found to be higher than fractures, sprains, neuralgia or arthritis, and equal to those of amputees experiencing phantom limb pain and patients with cancer." When it comes to mental pain, abortion is often touted as bringing relief from the depression caused by pregnancy. Not necessarily so. The Montreal study found that 50 per cent of the women who had high depression scores "remained clinically depressed and anxious two weeks after the procedure."

Chemical abortions. Chemical or drug-induced abortions have been hailed in some quarters as a less traumatic solution to an unwanted pregnancy than surgical abortion. Yet these are not without their own difficulties. A variety of studies have found failure rates ranging from 6 to 45 per cent, necessitating a second, surgical abortion. There are unpleasant side effects, including prolonged bleeding, diarrhea, fevers and nausea, as well as the inconvenience of several visits to the doctor and the lack of immediate confirmation of the success of the procedure. Typically, the abortion is not triggered until twenty-four days after the drug has been administered. Furthermore, the pain is reported to be even greater than surgical abortion.

Risks to future children. The most recent studies point to an approximately 85 per cent increase in premature (or "very preterm," meaning less than 33 weeks' gestation) births to women who have had a previous induced abortion. This risk increases sharply with every additional abortion that a woman undergoes. Premature infants suffer a very high incidence of disability. Their rate of cerebral palsy for example, is thirty-eight times greater than that of the general population. Induced abortion, therefore, has appalling implications for women who subsequently wish to bear a child. It is the direct cause of many thousands more cases of cerebral palsy in North America than otherwise would have occurred....

Covering Up the Bad News

Much post-abortion research is conducted by those committed to preserving unrestricted access to induced abortion. Their tendency is to cite only the work of those who share their political outlook on the question. Most post-abortion research is short-term, with the result that long-term consequences tend to be ignored. Many women, especially those who abort late in pregnancy, are unwilling to participate in follow-up studies. Finally, in North America, unlike in European and other countries, there is a pronounced bias against reporting bad news about induced abortion.

In a surprising number of North American studies data on abortion are downplayed or omitted from the discussion or conclusion sections of the paper. Here are a few examples from the highly contentious field of breast cancer and abortion. In 1995 Lipworth and colleagues found that there was a 100 per cent increased risk of breast cancer for women whose first pregnancy ended in abortion. In the discussion section the author downplayed this increase as "at most statistically marginal." In another study Ewertz and Duffy found that induced abortions were associated with an almost fourfold increased risk of breast cancer. In the discussion section this finding was not commented upon, the authors confining themselves to the observation that "pregnancies must go to term to exert a protective effect against breast cancer." A study by Daling and colleagues found a 2.5 risk—in other words a 150 per cent increase in the risk of breast cancer for women whose first pregnancy was aborted before age eighteen—but in their Discussion Section said that their findings "give only slight support to the hypothesis that there is an increase in breast cancer incidence among women of reproductive age."

The investigation of abortion's after-effects is also bedeviled by coding and diagnostic problems. International Disease Classification codes prevent cross-referencing between ectopic pregnancy and induced abortion, even though a clear link has been demonstrated. Pelvic inflammatory disease or Asherman's Syndrome (intra-uterine adhesions, a complication of surgical curettage) may arise from an abortion but not be identified in that way either.

All the adverse effects of abortion put together affect perhaps twenty per cent of the women who undergo the procedure. Though a minority, they are a substantial one. The question that Women's Health After Abortion raises is: Are women entitled to know about the risks? Or are those who draw attention to them merely sowing unnecessary despondency and alarm, as some would claim? Fortunately the courts have already established that informed consent must be an essential ingredient of good patient care. Elective procedures—and induced abortion is an elective procedure—require from the physician a greater degree of disclosure than emergency procedures. Common but minor risks must be disclosed. Extremely rare risks must also be disclosed if they have serious or fatal consequences.

The Right to Make an Informed Choice

I co-authored this study because of a conviction that the increased risks associated with induced abortion—breast cancer, death, sterility, ectopic pregnancy, pelvic inflammatory disease, emotional distress, harm to subsequent children, the impact on partners and other children—are serious enough to merit dissemination beyond the pages of professional journals. If women have the right to choose, surely they also have the right to make their choice an informed one.
Source Citation:
Gentles, Ian. "Abortion Harms Women's Health." Opposing Viewpoints: Abortion. Ed. James D. Torr. San Diego: Greenhaven Press, 2006. Opposing Viewpoints Resource Center. Gale. Wayne State University Library System. 13 Apr. 2010 .