The deVeber Institutefor Bioethics and Social Research

Complications of Abortion

Presentation to:

Health PEI – Board of Directors

Sept 9, 2014

the available scientific research on

the benefits of induced abortion= ZERO

Abortion:

1. Dilate cervix

2. Curettage

3. Suction

What are the complications of induced abortions?

What is a complication?

• An unintended adverse outcome• Immediate or long term

PhysicalMental

Social Spiritual

• ** high frequency or high morbidity**

11% of women who have induced abortions

suffer physical complications

within 6 weeks

RCOG 2003

Are the complications of abortion statistically significant?

YES

In Ontario in the 3 months following an IA- 4x’s increase rate of admission to hospital

overnight for treatment of infection

- 5x’s increase rate of surgical intervention

- 6x’s increase in admission due to mental illness

CPSO 2001

5% of abortions are complicated by severe hemorrhaging

Why? - laceration of cervix- perforation of uterus- tear of blood vessel- retained pieces of placenta

2% of induced abortions go for further surgery because of excessive bleeding

CPSO 2001

Most common and most serious complication of abortion is…..

Infection

Pelvic inflammatory disease following abortion

• 15 –25% of women who seek abortions have chlamydia (depends on SES)

• Even with antibiotic Rx ~ 6% = PID

• CPSO study showed 4X’s increase in admission to hospital for PID following a surgically induced abortion

Shelley

• 26 years old – married x’s 2 years

- teacher

- loves children and children love her

- unable to achieve pregnancy

50% of Pelvic Infections result in:

infertilitysub-fertility

chronic painpremature delivery

Post Abortion Infertility 2nd to PID

~1,000 young women become infertile each year in Canada due

to induced abortionsWHAA 2002

Why are these young women the ones who become infertile?

• Cannot afford antibiotics• Forget to take antibiotics• Do not tolerate side-effects and quit

Subfertility:• 24% of women who have an abortion

experience problems with subsequent pregnancies WHAA 2002

• IA risk by 620 % Hassan 2005

• ~ 12% of women seeking IVF had an IAHemminki 2008

Abortion increases the risk

of a tubal pregnancy

Abortion increases the risk of premature deliveries

Very Low Birth Weight (VLBW) babies ~40%

ELBW babies ~ 70%

Moreau - France 2005Lumley – Australia 1998Smith – Britain 2007Ancel – EuroPop study 2004Zhou – Scandinavia 2003

1. Infection (chlamydia)**

… leading to premature rupture of membranes

& premature onset of labour

??immune related

Moreau ‘05

2. Incompetent Cervix

3. Trauma to the endometrium

• Increase in placenta praevia

• Hemorrhage

• Stillbirth

• Small for Gestational Age ANCEL 2004

BROWN 2007

One induced abortion:

Increases risk of low birth weight babies

&

Prematurity with lung complications

Equal to:

the risk of smoking 1 pack / daily

while pregnant

Abortion increases mortality and morbidity in offspring

Very low birth weight babies <750gm

- 25% develop a serious handicap- 7% have cerebral palsy- 25% of the infants die

Rooney 2003 Ancel 2004 Moreau 2005 Brown 2007

Preterm delivery causes:↑stress

↑dysfunction within a family

↑spousal abuse

and ↑child abuse.

Do we respect women enough to inform them of this risk when they seek

an abortion?

NO

Thorpe 2002

Induced abortion increases the risk of breast cancer

• If you are – under 19 years of ageand have a 1st trimester abortion

You double your life time risk of getting breast cancer

with a 1st degree relative -risk increases by 310%

Women who have an abortion prior to carrying a pregnancy to term increase their risk of having breast cancer by 30%

Brind 1995

What is the hypothesis about the ‘ABC’link?

• Pregnancy causes high circulating estrogens that cause rapid division of cells in the breasts.

• Abortion arrests the differentiation of those cells • Undifferentiated cells more likely to turn

cancerous due to lack of gene that codes for cell death (apoptosis)

• Undifferentiated cells also have increase susceptibility to spontaneous DNA mutation

Are women informed of this risk?

No

Abortion clinics deny the ‘ABC’ connection

Lanfranchi 2013

Royal College warns: abortions

can lead to mental illness RCOP 2008

Abortion, Suicide and Depression

• Post abortion suicide rates 6 x’s from norm

9 x’s > than in women who deliver at termSTAKES 2000

• Suicide attempts increase by 225% following abortion Morgan 1997

• Admissions to Ontario hospitals for depression following abortion 5X’s greater CPSO 2001

Who are these women who are so sad post-abortion that they want to die?

The women at risk of depression and suicidal behaviour following an induced

abortion are…..

• Young - < age of 25• Single• Low income earning potential• Little family support

In contrast:

• Women who carry a pregnancy to term have a decreased risk of suicide

** whether or not the pregnancy was planned or the baby ‘wanted’**

STAKES

Abortion also leads to:

• Illicit drug use

• Excessive alcohol use

• Self- abusive behaviorReardon and Ney 2000

And induced abortion leads to:

• Depersonalization

• Isolation

• Victimization

• Promiscuity

The mental health problems that up to 17% of young women

experience following abortion:

persist over time

risk of parenting problems

risk of dysfunctional relationships

Fergusson 2006

Abortion also increases:

The rate of child abuse!Ney 99

IA’s are associated with more child-directed aggression

Coleman 2007

Abortion increases the risk of mental health problems in children

Due to lack of attachment:

- children at risk of becoming defiant, aggressive and destructive (ODD)

- children at risk of ‘low resiliency’

- children at risk of learning problems

So how do men fare following an abortion?

• Very little research• Reports are taken from men who seek

psychological counseling or who are in ‘mandatory reporting situations’

• Skewed population of the best and the worst at managing life

What do we know?

• Men experience grief and sublimate it into anger

• Anger turns into violence against self or partner or society

• Guilt leads to self abuse – alcohol, smoking, over-eating, drugs

• ‘abortion casts a long and troubled shadow over their future fatherhood’

Ney 99

Post Abortion Violence• the risk of dying from

homicide for post-abortive women was more than four times greater than the risk of homicide among the general population

women who have undergone an abortion in the previous year:

treated 25 percent more often for injuries or conditions resulting from violence

CMA 2005

Abortion is not just a women’s issue!

PEI Health

The right careBy the right provider

In the right place