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“…banning abortion only bans safe abortion.” Forster is right to highlight the risk that illegal abortion poses to maternal health.
As the author emphasizes, legal abortion is a safe practice. It is, in fact, much safer than carrying a pregnancy to term. Between 2013 and 2018, the national case-fatality rate was 0.41 deaths per 100,000 legal induced abortions (Kortsmit et al., 2021), whereas the latest maternal mortality rate published by the CDC is 23.8 deaths per 100,000 births (Hoyert, 2022).
There is less data available regarding the mortality rate of illegal abortions, for the obvious reason that such practice is unlikely to be accurately reported. Globally, there is an association between countries with a higher proportion of abortions classified as “least-safe” (those carried out by untrained individuals using dangerous methods) and a higher case fatality rate (Ganatra, 2017). The illegal abortion suffered by Jacqueline Smith in 1955 is likely to have fit into this category. Contemporary illegal abortions in the United States seems more likely to be in the “less-safe” category (those carried out by an untrained individual using a recognised safe method, or by a trained individual using an unsafe method). In neighbouring Latin America, misoprostol is available over the counter and is a safer alternative to sharp curettage (Dzuba, 2013), though, without guidance from healthcare professionals, may be taken without understanding of dosing regimens and warning signs of complications.
The United States maternity services are already under incredible strain, with the worst healthcare professional-to-patient ratio amongst other high-income countries (Tikkanen et al., 2020). These strained services will now need to be able to support an increased number of complicated illegal abortions, as well as pregnancies that would otherwise not have been carried to term.
The world is indeed radically different to how it was in the 1960s. Safe reproductive care is now low-cost and widely available. To deny women the right to this is a huge step backwards.
References:
Dzuba, I. G., Winikoff, B., & Peña, M. (2013). Medical abortion: a path to safe, high-quality abortion care in Latin America and the Caribbean. The European Journal of Contraception & Reproductive Health Care, 18(6), 441-450.
Ganatra, B. et al. (2017). Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet, 390(10110), 2372–2381. https://doi.org/10.1016/S0140-6736(17)31794-4.
Kortsmit, K., Mandel, M.G., Reeves, J.A., Clark, E., H. Pagano, P., Nguyen, A., Petersen, E.E., & Whiteman, M.K. (2021). Abortion Surveillance — United States, 2019. MMWR Surveillance Summaries, 70 (No. SS-9), 1–29. https://dx.doi.org/10.15585/mmwr.ss7009a1
Tikkanen, R., Gunja, M., Fitzgerald, M., Zephyrin, L. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. Commonwealth Fund Issue Briefs. 2020. https://doi.org/10.26099/411v-9255
Abortion rights: unsafe abortion should be left in the past
Dear Editor,
“…banning abortion only bans safe abortion.” Forster is right to highlight the risk that illegal abortion poses to maternal health.
As the author emphasizes, legal abortion is a safe practice. It is, in fact, much safer than carrying a pregnancy to term. Between 2013 and 2018, the national case-fatality rate was 0.41 deaths per 100,000 legal induced abortions (Kortsmit et al., 2021), whereas the latest maternal mortality rate published by the CDC is 23.8 deaths per 100,000 births (Hoyert, 2022).
There is less data available regarding the mortality rate of illegal abortions, for the obvious reason that such practice is unlikely to be accurately reported. Globally, there is an association between countries with a higher proportion of abortions classified as “least-safe” (those carried out by untrained individuals using dangerous methods) and a higher case fatality rate (Ganatra, 2017). The illegal abortion suffered by Jacqueline Smith in 1955 is likely to have fit into this category. Contemporary illegal abortions in the United States seems more likely to be in the “less-safe” category (those carried out by an untrained individual using a recognised safe method, or by a trained individual using an unsafe method). In neighbouring Latin America, misoprostol is available over the counter and is a safer alternative to sharp curettage (Dzuba, 2013), though, without guidance from healthcare professionals, may be taken without understanding of dosing regimens and warning signs of complications.
The United States maternity services are already under incredible strain, with the worst healthcare professional-to-patient ratio amongst other high-income countries (Tikkanen et al., 2020). These strained services will now need to be able to support an increased number of complicated illegal abortions, as well as pregnancies that would otherwise not have been carried to term.
The world is indeed radically different to how it was in the 1960s. Safe reproductive care is now low-cost and widely available. To deny women the right to this is a huge step backwards.
References:
Dzuba, I. G., Winikoff, B., & Peña, M. (2013). Medical abortion: a path to safe, high-quality abortion care in Latin America and the Caribbean. The European Journal of Contraception & Reproductive Health Care, 18(6), 441-450.
Ganatra, B. et al. (2017). Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet, 390(10110), 2372–2381. https://doi.org/10.1016/S0140-6736(17)31794-4.
Hoyert, D.L. (2022, February 02). Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. https://stacks.cdc.gov/view/cdc/113967
Kortsmit, K., Mandel, M.G., Reeves, J.A., Clark, E., H. Pagano, P., Nguyen, A., Petersen, E.E., & Whiteman, M.K. (2021). Abortion Surveillance — United States, 2019. MMWR Surveillance Summaries, 70 (No. SS-9), 1–29. https://dx.doi.org/10.15585/mmwr.ss7009a1
Tikkanen, R., Gunja, M., Fitzgerald, M., Zephyrin, L. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. Commonwealth Fund Issue Briefs. 2020. https://doi.org/10.26099/411v-9255
Competing interests: No competing interests