Dr. Jeff Hersh
Q: Aside from “to save the life of the pregnant woman,” I have not heard much about the health of the pregnant woman in the abortion debate. Isn’t this an issue as well?
A: Great point. Being pregnant, as well as carrying a pregnancy to term/delivering a baby or terminating a pregnancy, all have many potential health implications for the woman. All these things must be considered to assess the overall impact to the woman, specifically also including psychosocial issues. So, today’s column will focus on the pregnant woman.
Per the Centers for Disease Control data there have been around 600,000 to 700,000 abortions per year in recent years. The overall abortion-related complication rate is about 2%, with almost all of these complications being treatable (things such as minor bleeding, pain, infection, other). Unfortunately, severe complications do rarely occur; for example, the mortality rate is about 0.6 per 100,000 abortions, so about 35 to 40 women die per year as a complication of an abortion. These numbers represent abortions performed by medical professionals; estimates of “unsafe abortion” mortality rates have been reported to be as high as 10% or more (so over 15 times greater risk).
There are medical risks of being pregnant, for example, hypertension, bleeding, preeclampsia, infections, blood clots, others. The risk of a woman developing one of these complications depends on many factors (for example her age, other medical conditions, etc.), and is overall about 8%; thankfully most of these complications are treatable. It is sad to say that the U.S. has the single highest rate of maternal mortality of any wealthy nation, with about 20 maternal deaths per 100,000 live births (over triple the rate of any other wealthy nation, and over 30 times higher than the rate of death from complications of an abortion). Given that there are about 3.75 million live births per year in the U.S., this means over 750 women in the U.S. die per year as a complication of giving birth.
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Unfortunately, the medical complications, and especially the psychosocial complications, of unintended, unwanted or forced (denied an abortion) pregnancies (although there are huge differences between these, they will simply be referred to as “unintended pregnancies” for the rest of this column) are much more pronounced. For example, although post-partem depression is overall fairly common, affecting up to 10% or more of women after childbirth, the risk of post-partem depression for unintended pregnancies is about double this rate.
There are implications for the entire family from unintended pregnancies. For example, babies born from an unintended pregnancy have a significant risk of cognitive delay as compared to those born from an intended pregnancy. Siblings of a baby born from an unintended pregnancy have significantly increased behavioral problems and an increased risk of substance abuse. Moms who have had an unintended pregnancy have a significantly higher risk of subsequently developing mental health issues.
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The incidence of sexual assault (rape, attempted rape or any unwanted sexual touching) is staggeringly high; 1 in 6 women (including over 1 in 9 girls under age 18) and 1 in 33 men (including over 1 in 50 boys under the age of 18) are victims. It will not be surprising to anyone that people (both women and men) who are victims of sexual assault have a huge risk of developing psychosocial issues. For example, one study noted that as many as 70% developed post-traumatic stress disorder (PTSD, an anxiety disorder that may cause symptoms including physical pain, agitation, fatigue, flashbacks, headaches, sleep issues, changes in thoughts/cognition, increased risk of substance abuse, other psychiatric disorders, and other symptoms). Tragically, the complications for sexual assault victims who become pregnant are even more pronounced, including the risk of PTSD and of complications from the pregnancy.
Women who have unintended pregnancies, including those having forced pregnancies because of being denied access to abortion care, should be evaluated to see if they would benefit from cognitive behavioral therapy, support groups, and/or other interventions. This is especially true for anyone who has been a victim of sexual assault.
A thoughtful discussion of reproductive issues must include consideration of all issues for both the pregnant woman and the fetus. The discussion above by no means addresses all (or even most) of the issues for the pregnant woman, but hopefully it brings up some of the things that should be added to an open and transparent discussion.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
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