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Their Last Choice

How Many Women Die?

One consistent pattern in news reporting of abortion deaths is the obligatory assurance that abortion is exceedingly safe, far safer than childbirth. But is this claim true?

We can’t know. We don’t know how many women die from abortion complications in the United States. Nobody is counting.

Until recently, the Centers for Disease Control (CDC) pretended to count abortion deaths. Every year they would release an Abortion Surveillance Report counting reported maternal deaths from abortion, comparing this to the number of reported abortions, and citing the resulting statistic in terms of deaths per 100,000 legal abortions. But as the old saying goes, “Garbage in, garbage out.” If the CDC is not accurately counting the number of abortion deaths, then their reported abortion death rate might just as well be calculated by rolling a set of Yahtzee dice. In fact, the Yahtzee method would be more accurate, since statistically it is possible that the dice would by chance come up with the true number. CDC numbers, on the other hand, have been proven inaccurate. There is statistically zero chance that the numbers released by the CDC reflect the true risks of abortion to the mother’s life.

How did this situation come to be?

There are two reasons that abortion mortality information is inaccurate: practical and political.

From a practical standpoint there are a number of obstacles. The first is simple in practice but complicated to explain. For reference purposes, you might want to open a second browser window and go to Sandra Milton’s death certificate. I will refer back to this document.

The usual means by which the CDC learns of an abortion death is through the National Center for Health Statistics (NCHS). The NCHS gets its information from vital records offices in each state, New York City, the District of Columbia, and the US territories. The vital records offices get their information from death certificates. So NCHS data is only as accurate as the death certificates.

If you scroll about halfway down the death certificate, you will find a section headed “Cause of Death.” This section contains three spaces to list the chain of events leading to death. Each cause of death is given a code from the International Classification of Diseases - 9th Edition (ICD-9). For example, if you died of a heart attack because of high cholesterol because you were overweight, your death certificate would list “myocardial infarction” due to “hypercholerstremia” due to “morbid obesity.” There is a complicated hierarchy for determining the “underlying” or “primary” cause of death from the information listed in these three spaces. There is a lot of leeway for doctors filling out death certificates. For example, a doctor can put “cerebral necrosis” due to “cardiac arrest” due to “respiratory arrest” without technically lying. He just isn’t telling you anything you didn’t know. After all, everybody who dies suffers brain death, and stoppage of heart and breathing. Vital records coding clerks are supposed to return such meaningless death certificates to the doctors to be re-done, but sometimes they still slip through. Even then, he might still be able to fill out the death certificate completely without mentioning the abortion. For example, he might write “cardiorespiratory arrest” due to “adult respiratory distress syndrome” due to “aspiration,.” without mentioning that she aspirated on her own vomit during an abortion.

The abortion, if it is mentioned at all, might go under “Other contributing factors,” a box that is not entered into the database submitted to the NCHS. An abortion listed in this box is effectively invisible to the NCHS.

Even if the abortion is mentioned on one of the “Cause of Death” lines, might be coded in such a way as to make it difficult to determine if the abortion was induced or spontaneous, legal or illegal, or if indeed there was ever a viable fetus present. In fact, since most abortion deaths take place after, rather than during, the abortion, the correct code would be 639 -- “Complications following abortion and ectopic or molar pregnancies.”

Other coding possibilities are the therapeutic misadventure codes. These cover virtually every possible direct cause of an abortion death -- anesthesia complications, foreign material left in surgical incision, complications of pelvic surgery, complications of injections, reactions to medications, infection resulting from surgery, and so on. By simply failing to specify that the surgery is abortion, the doctor renders the abortion invisible to the NCHS.

These pitfalls in detecting abortion deaths can occur even if the doctor knows about the abortion and is not trying to conceal it. The situation becomes even more muddled if the woman seeks treatment after an abortion she is denying ever happened, if she is brought to the hospital unconscious after a secret abortion (this will likely happen more and more as chemical abortions supplant surgical abortions), or if the doctor attending the death has any cause to want to gloss over the abortion, such as concern for a patient’s family, loyalty to a colleague that doesn’t want to be identified as performing abortions, or ideological desire to protect the practice of abortion from negative publicity.

Clearly, the odds are stacked against an abortion death showing up on the death certificate in a way visible to the NCHS unless the doctor filling out the death certificate specifically wants the death to be counted as an abortion death.

The other means by which the CDC counts an abortion death is if somebody -- a member of the public, a maternal mortality review committee, a public health official -- reports the death. Such reports are relayed to Lisa Koonin, who also works for the Alan Guttmacher Institute, the research arm of Planned Parenthood. Lisa requests the death certificate from the state vital records office and “verifies” the death. Since Lisa flatly denies that this task is part of her job (despite the fact that all other CDC employees involved in abortion mortality identify her as the person who performs this task), it is impossible to know how she “verifies” the death. Does she look for abortion on the death certificate? Does she simply verify that indeed a woman died and pass the death certificate on to the investigator? This process is shrouded in mystery.

Even assuming that all Lisa requires is proof that somebody female did indeed die, she is still dependent upon people to report the death. And in order for somebody to report the death, two things have to happen: the person has to know about the death, and the person has to want the CDC to count the death.

The people most likely to know about the death -- the abortionist and his staff, the woman’s family, administrators of hospitals where the abortionist has admitting privileges -- are not likely to be highly motivated to report the death. To a person directly involved in the death, it’s like turning yourself in to the IRS for an audit. For the people tangentially involved, reporting the death could bring potential embarrassent. And the people most likely to be motivated -- prolifers -- are least likely to know about the death. Unless the family suspects malpractice and files suit, nobody is likely to learn about the death. And even if the case is highly publicized, it may still go uncounted.

A case in point is that of Latachie Veal, age 17, who bled to death after an abortion by Robert Crist in 1991. Latachie’s family filed suit, and there was massive publicity about the case both in the Houston area, where Latachie died, and in Missouri, where another abortion patient of Crist’s had died several years earlier. Crist, a National Abortion Federation member, spoke of the death at a National Abortion Federation Risk Management Seminar in Dallas, Texas, in 1992. Two CDC employees responsible for abortion morbidity and mortality data were present at the seminar: Stanley Henshaw and (really!) Lisa Koonin. For Latachie’s death to be any more apparent to the CDC, she would have had to drag herself to Atlanta and collapse and die across Lisa Koonin’s desk, with copies of her postoperative instructions clutched in her hand.. Yet CDC data showed no women at all of Latachie’s race and age group dying from legal abortion in the United States in 1991. Count ‘em -- none. Conclude for yourself how diligently CDC employees were tabulating abortion deaths.

You might be asking yourself why the CDC would be so lackadaisical about counting abortion deaths.

Nobody but the parties involved can tell you their motives. But it is interesting to note that of CDC employees involved in abortion surveillance since 1968, 17 of 48 physicians were readily identifiable as practicing abortionists, and nine others had obvious connections with the abortion industry. That’s 26 of 48, or 54%. And this was not after an exhaustive search of membership rolls of organizations promoting abortion; this was just those who were publically outspoken in their support of abortion. Of the 20 non-physician employees, 8 (40%) had similar intimate connections to the abortion industry or efforts to promote unrestricted, unregulated legal abortion. The most likely scenario is that these folks felt that unfettered abortion was beneficial to women and then set about trying to prove their point, adhering to the old motto, “If the facts disagree with the theory, they must be disposed of.”

Reading CDC monographs on abortion is a study in denial and excuses. CDC pundits have noted that after the Hyde Amendment went into effect, fewer Medicaid-eligible women were hospitalized for abortion complications in states that did not pick up the tab for elective abortions, while in states that funded abortions for these women, the complication rate remained stable. Despite this evidence that denying abortion funding reduced the number of complications, the CDC continued to push for restoration of Federal funds for abortions. CDC pundits called for increased government subsidization of abortion after noting that public-pay patients have a higher complication rate than private-pay patients, even after adjusting for demographics. After noting that abortionists sometimes allow patients to languish and bleed to death rather than risk embarrassment by admitting them to a hospital, CDC authors blamed these patient deaths on laws requiring risky late-term abortions to be done in hospitals, and testified against these laws when they were challenged in the courts by abortion providers. Given this pattern of double-think, is it any wonder that these people whistle past the graveyard when it comes to abortion deaths?

One researcher, Kevin Sherlock, investigated to see how many abortion deaths the CDC might be overlooking. He concluded that during the 1980's alone, the CDC missed at least 45 deaths, an increase of 42% over the 108 deaths the CDC had counted.

In the final analysis, we must ask ourselves why advocates of legalized abortion are so afraid to count their dead.

Stories of women and girls who made the terminal choice
Recommended Reading
From Back-Alley Butcher to Abortion Provider: The Adventures of Jesse Ketchum
What One Researcher Found that the CDC Missed
Post a message at Their Last Choice Forum
Abortion Mortality Chat
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