Is Abortion ever Medically Necessary?

Most abortions laws in the United States of America have exceptions for cases of rape, incest, and “life of the mother.” Whatever the restrictions on abortion are in the particular law, cases of rape, incest, or endangerment of the mother’s life are still legal.

Let’s examine the legal meaning of “medically necessary” abortions and whether they are the same thing as abortions for the life or health of the mother. We’ll also look at what types of health conditions fall under “medical necessity”, how often they are performed, and who pays for them. We’ll also study the pro-life response to “medically necessary” abortions. “Medically necessary” abortions are typically performed starting in the middle or late second trimester and may be performed throughout the third trimester. We’ll conclude by examining possible complications of these late-term abortions.

What is the Legal Definition of “Medically Necessary”?

Pro choice advocates claim that abortion must be legal because some abortions are not elective, and are in fact “medically necessary.” The term “medically necessary” originated in the 1940s, “to ensure that hospitals and physicians were paid for the services they performed.” [1] It was a vague catchall phrase used by insurance companies that mostly relied on physician judgment about what services were necessary for a patient’s care. Abortion rights advocates ever since Roe v Wade and Doe v Bolton in 1973 have argued that “medical necessity” is an objective standard based on medical judgment. But in reality, “medical necessity” is more nuanced because “doctors often differ in their estimation of comparative health risks and appropriate treatment.” [2]

Is “Medically Necessary” the same as “Life of the Mother”? What about “Health of the Mother”?

“Health of the Mother” and “Life of the Mother”

As we’ll see by the legal definition of maternal “health” below, “medically necessary” abortions can technically include abortions for the life of the mother or the health of the mother.

Abortions to “save the (physical) life of the mother” are recommended for a variety of maternal reasons, including the mother having preexisting heart disease or uncontrolled diabetes or cancer. Sometimes, the mother develops pregnancy complications like preeclampsia or eclampsia (toxemia of pregnancy) or chorioamnionitis. [3]

Abortions to “save the life of the mother” also may be recommended when something goes wrong with the fetus itself, as in ectopic or molar pregnancies.  Abortions for the “health of the mother” generally refer to medical conditions which cause the mother illness and varying degree of physical discomfort. One example is gestational diabetes (diabetes that develops during pregnancy and goes away when the fetus is delivered). Another example is hyperemesis gravidarum (severe nausea and vomiting during pregnancy). “Health of the mother” conditions do not endanger the mother’s life.

Doe v Bolton

“Mary Doe” in Doe v Bolton was a Georgia woman who sought an abortion at 9 weeks pregnant in 1968. “Bolton” in Doe v Bolton was Arthur Bolton, Attorney General of Georgia. Mary Doe wanted an abortion because she was financially unable to provide for another child. She also did not have custody of any of her three other children. She had been a patient of a mental hospital. Finally, she had recently been left by her husband. At that time, Georgia law allowed for an abortion only in the following cases: 1) endangerment of or serious and permanent injury to the woman’s life 2) pregnancy because of rape 3) baby “very likely” to be born with a grave mental or physical defect. [4]

The Doe v Bolton case started in a district court and went all the way to the Supreme Court. The case was decided on the same day in 1973 as Roe v Wade. Doe v Bolton set a legal precedent, or legal definition of a term that is used in other court cases on similar topics in the future. That legal precedent says that the “health” of the mother includes her physical, emotional, psychological, and familial health, and her age. This Supreme Court ruling struck down many state restrictions on abortion. [5] So, any pregnancy that could impact the mother’s physical, emotional, psychological or family health could be grounds for a “medically necessary” abortion. Likewise, presumably a woman who is older than 35 years or younger than, say, 18, could also have grounds for a “medically necessary” abortion.

How often are Abortions performed for “Medical Necessity”?

The Alan Guttmacher Institute has published several studies on reasons that women have abortions. One of these was published in 1987, and another was from 2004. In both studies, “mother has health problems” was cited in 2.8-4% of cases. “Mother has health problems” is another term for “medically necessary” cases and includes both life-threatening and non-life-threatening cases. So, the total of abortions done for the life of the mother is, at the most, less than 4% of all abortions. The most recent abortion statistics are from 2014, and there were 652,639 abortions that year. At the most, then, somewhere between 13,053 and 26,106 abortions were for “medically necessary” reasons, and a portion of these would have been for “life of the mother” cases. [6]

Are Tax Dollars used for “Medically Necessary” Abortions?

Medicare and Medicaid

Tax dollars pay for both Medicare and Medicaid. [7] Medicare is a federal health insurance program available to all American citizens over age 65. Tax payer money goes directly to Medicare at the federal level. Every American citizen who gets a paycheck pays a small percentage of their earnings directly into Medicare. Since Medicare covers Americans over age 65, there is no argument about it covering abortions since all women participants are past child-bearing age.

Medicaid is a health insurance program for poor Americans. Medicaid has both federal and state branches. Each state has its own office and its own rules for eligibility. Some funds from incomes taxes go to Medicaid at the state level. Other federal funds support Medicaid at the national level. [8]

Hyde Amendment

The Hyde Amendment states that federal Medicaid funds cannot be used for abortions except in cases of rape, incest, or the mother’s life being endangered. [9] The Hyde Amendment was originally passed in 1976. Every president since then has either repealed or reinstated the Hyde Amendment depending on his political affiliation.

In 17 states, only state Medicaid money is used to pay for medically necessary abortions. No federal funds are used in these states. In the other 33 states of the 50 states total, federal Medicaid funds are used for some “medically necessary” abortions. [10]

A research study of 25 abortion providers in 6 different states found that in many cases Medicaid did not reimburse them for abortions that qualified under the Hyde Amendment. Many providers reported that going through so much paperwork only to be turned down was a waste of their time. In the few cases where they did actually get reimbursed, the amount of money was so small that it was not worth their time to keep applying. [11]

What is the Pro-life Response to “Medically Necessary” Abortions?       

Moral Principle of Double Effect

Pro-lifers respond that the goal of medical interventions should always be to save life. In select rare cases, the fetus may die as a result of interventions to save the mother’s life. However, the goal is never to purposefully end the life of the fetus. [12] This concept is called the moral principle of double effect, a good action is done that has a foreseen bad side-effect. [13] So, in the case of a woman with uterine cancer, she might have to have her uterus removed to get rid of the cancer. The fetus would unfortunately die as a result, but the woman was helped as a result of the uterus being removed and not because of the fetus’ death.

Moral Principle of Double Effect and Flight 93

Let’s take another example of the moral principle of double effect. Recall the passengers of Flight 93 on September 11, 2001? When they learned that the plane had been hijacked, they made a decision to resist and to prevent the plane from hitting the hijackers’ target. Their goal was to save lives, even though they knew that in the process they would lose their own. So, the goal was to save lives, even though they foresaw that the bad side effect would be their own deaths. Each passenger was granted the Congressional Medal of Honor for this bravery. Pro-lifers abide by this same principle when a mother’s life is in danger.

The Dublin Declaration

The Dublin Declaration on Maternal Healthcare was written in 2012 and signed by over 1,000 Irish obstetricians and other healthcare professionals. It states that:” direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman. We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child. We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.” [14]

What about Abortion for Maternal Health Conditions?

Some medical problems may be exacerbated by pregnancy. These include preexisting heart disease and diabetes and a known or new diagnosis of cancer. Typically, close monitoring and treatment of heart disease or diabetes by a maternal-fetal medicine specialist, also known as a high-risk pregnancy doctor, can prevent threats to the mother’s life. In rare cases where the mother’s life is in danger the longer that the pregnancy continues, the fetus can be delivered early either through induction of labor or a cesarean section.

Generally, a fetus is viable, or can live outside the womb with medical assistance, starting around 24 weeks (less than 6 months pregnant). If a woman has cancer and needs treatment, the treatment could either be started promptly and potential birth defects be managed after delivery, or treatment could be delayed until an early delivery is achieved. Either of these options ensures effective treatment of the woman’s health conditions, and respects the life of the fetus to the fullest extent possible.

Occasionally, a mother decides to forego medical treatment altogether, to give her baby the best chance at a healthy life. While this is not necessary from an ethical standpoint, it is consistent with mothers throughout history who have given their lives to save their children. Mothers have run into burning buildings to rescue children, carried them on their backs through flooded waters, and jumped into dangerous waters to save a drowning child. [15]

What about Abortion for Preeclampsia or Eclampsia?

Preeclampsia, also known as toxemia of pregnancy, develops after 20 weeks of pregnancy and involves high blood pressure and oftentimes kidney, liver, heart, lung, or eye damage. Preeclampsia plus seizures is considered eclampsia. Uncontrolled high blood pressure can lead to seizures, stroke, and even death of the mother. Liver, kidney, heart, or lung failure can also be life-threatening.

Once symptoms start, they do not generally go away until the pregnancy ends. Typically, goals of treatment include outpatient medications to control blood pressure, and frequent doctor’s office monitoring of fetal wellbeing. If symptoms are severe enough, the mother has to be hospitalized until delivery. She is often on intravenous (IV) medication to prevent seizures.

Once a fetus reaches the age of viability, labor can be induced or a Cesarean section performed. If the mother progresses to eclampsia before 24 weeks, the fetus must be delivered regardless. This would not be considered a direct abortion because the goal would be to end the pregnancy by delivery, not to kill the fetus. The preterm fetus would not be expected to live outside the womb, but its death would not be directly caused. [16]

Preeclampsia occurs in between 5 and 8 pregnancies out of 100, but progression to life-threatening eclampsia is rare with proper treatment. [17]

What about Savita Halappanavar?

In 2012, a woman named Savita Halappanavar who was living in Ireland went into the hospital at 17 weeks pregnant with symptoms of a miscarriage. Her situation was unusual from the beginning, as only 1-2% of all miscarriages occur during the second trimester.

Unfortunately, the miscarriage was related to an uterine infection called chorioamnionitis, which was not diagnosed and treated appropriately and in a reasonable timeframe. Chorioamnionitis is typically treated by intravenous (IV) antibiotics, and spontaneous miscarriage of the fetus often occurs. If spontaneous miscarriage does not occur, the fetus may have to be delivered regardless of gestational age because infection in the fetus can progress to life-threatening systemic infection via the mother’s bloodstream. This would not be considered a direct abortion because the intent was to deliver the pregnancy, though the fetus was not expected to survive due to prematurity.

By the time that the spontaneous miscarriage completed, Savita’s untreated infection had progressed to her entire bloodstream and caused organ damage, a condition known as sepsis. Her sepsis worsened to severe sepsis and then septic shock. Her heart stopped, causing her death, seven days after she entered the hospital.

Abortion advocates called for a repeal of Ireland’s abortion laws. They argue that if Savita had received an abortion then she would not have developed sepsis. Unfortunately, the facts lead to a different conclusion in Savita’s case. The investigation into her death found that the real problems were that she was not monitored closely enough, that the fetus’ infection was not treated appropriately, and that her own possibility of infection was not anticipated correctly.  By the time her treatment team realized just how sick she was and responded, it was too late. [18]

What about Abortion for Ectopic Pregnancies?

An ectopic pregnancy occurs when the embryo implants somewhere other than the woman’s uterus, oftentimes in a Fallopian tube. Because the Fallopian tube is small, the pressure of the growing embryo on the Fallopian tube can cause it to rupture. Fallopian tube rupture can lead to life-threatening complications.  Ectopic pregnancy affects about 1 in 50 to 1 in 100 pregnancies. [19]

Ectopic pregnancies can be treated in three ways. Two of these ways arguably constitute a direct abortion. Methotrexate is considered a direct abortion because it stops production of the trophoblast. The trophoblast is produced by the embryo and normally develops into the placenta. [20] Salpinogotomy is also considered a direct abortion. The Fallopian tube is sliced open and the embryo is scooped out and dies. The woman’s Fallopian tube may still function correctly in the future.

Salpingectomy is not considered direct abortion because the whole diseased section of the Fallopian tube is removed. The death of the embryo inside is an undesired but expected side effect. Because a section of the Fallopian tube is removed, that tube will not be functional in the future. Having only one functional Fallopian tube reduces the woman’s fertility. [21]

What about Abortion for Hydatidiform Mole or Molar Pregnancies?

A hydatidiform mole, also known as a molar pregnancy, may be a partial (or incomplete) molar pregnancy or a complete molar pregnancy. Something goes wrong during fertilization of the egg by the sperm. The placenta develops abnormally and the fetus develops only partially (partial molar pregnancy) or not at all (complete molar pregnancy). In rare cases, the placental mass that develops from the molar pregnancy may become cancerous. This cancer can be life threatening, but is generally treated successfully with chemotherapy. [22]

Complete molar pregnancies occur in about 1 in 1,000 pregnancies. [23] Incomplete or partial molar pregnancies occur less frequently. If the embryo does not develop, a dilation & curettage procedure is recommended to clean out the uterus. This would not be considered a direct abortion because there is no life there. If an embryo does partially develop, the woman will typically miscarry.

What kind of Complications can occur during “Medically Necessary” Abortions in the 2nd or 3rd Trimester?

Late term abortions, or abortions performed in the second half of the second trimester or anytime during the third trimester, require several days to dilate the cervix. Risk of death from abortion increases by 38% each week starting in the second trimester. [24]  Serious, documented risks for late-term abortions include:

  • Cervical injury
  • Uterine perforation
  • Infection (may become life-threatening)
  • Life-threatening hemorrhage (bleeding)
  • Uterine rupture
  • Incomplete abortion due to body parts or placenta or other tissue left inside the uterus
  • Disseminated intravascular coagulopathy (life-threatening blood clotting and bleeding)
  • Anesthesia-complications such as respiratory depression[25]

So, is abortion ever medically necessary?

We see from the examples above that direct abortion is never medically necessary to save the life of the mother. In rare cases where the mother’s life is in danger if the pregnancy continues, the baby can be delivered via induction or cesarean section. If the baby has not yet reached the age of viability, the mother and her medical team may anticipate the baby’s death after delivery as an unintended consequence. In these unfortunate cases, perinatal hospice programs can help facilitate and guide the woman and her family through the bonding and grieving process. This approach respects the lives of both the mother and her child. [26]

Abortion Risks, Side Effects and Complications

We’ve all heard the mantra ‘safe, legal and rare’ from abortion advocates. In this article, we look into the medical research on side effects, complications and injuries that can happen from each type of abortion. Here you will learn the facts and statistics about the risks of abortion procedures. This often overlooked topic is very important to women’s health.

How often do complications occur from abortions?

The short answer to this question is that we really do not know how often complications occur after abortions. Dr Lenora Berning, a physician from North Carolina, sums up the situation this way: “(Complications of U.S. abortions) are under-reported because there is no accurate process in place today to quantify the harmful repercussions of abortion. The abortion industry has successfully kept abortion and abortionists free from the type of review, regulation, and accountability that is an integral part of the rest of the medical profession”. [1]

A 2017 study from Sweden found that from 2008 to 2015, first trimester abortion complication rates actually doubled, from 4.2% in 2008 to 8.2% in 2015. [2] According to the study authors, “The cause of this (doubling) is unknown but it may be associated with a shift from hospital to home medical abortions.” Home medical abortions refer to abortion by pill or medication abortions, and have been on the rise in the United States especially in the last 10 years. Between 2001 and 2014, medication abortions went from 6% to 31% of all non-hospital abortions, and represented almost half of abortions before 9 weeks gestation. [3]

Where do maternal mortality rates and abortion mortality rates come from?

According to the Central Intelligence Agency (CIA), the maternal mortality rate is: “the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).” [4] Abortion mortality rate is a general, not a technical, term for the annual number of maternal deaths due to abortion-related complications, whether during or directly after the procedure, or in the weeks and months following. Different studies quantify the abortion mortality rate differently. Many times, death certificates are assumed to be the definitive source for determining abortion mortality rates. However, research has shown that death certificates identified a current or recent pregnancy only about 50% of the time. [5]

Maternal mortality rates numbers come from the Centers for Disease Control and Prevention’s (CDC) Pregnancy Mortality Surveillance System. Abortion mortality rates numbers come from the CDC’s Abortion Mortality Surveillance System. [6]

What’s wrong with the national reporting system for abortion statistics?

First, the number of abortions done in the United States each year is an estimate, not an actual, accurate number. This is because only two national organizations collect abortion data, and reporting to both is voluntary. These two national organizations are the Centers for Disease Control and Prevention (CDC), a federal government agency, and the Alan Guttmacher Institute, formerly the research arm of Planned Parenthood. States are not mandated to provide their numbers to either organization, though the Alan Guttmacher Institute’s statistics are considered the most accurate.

The CDC’s most recent abortion statistics report, based on data from 2014, can hardly be called representative of the total number of abortions done in that year. One of the reasons this number cannot be accurate is because California has not provided their numbers to the Centers for Disease Control for over 15 years. The CDC report also excluded numbers from Maryland and New Hampshire.

The Alan Guttmacher Institute estimated that about 157,350 abortions were performed in California in 2014, about 17% of all abortions nationally. [6] They estimated around 2,540 abortions that same year in New Hampshire, and around 28,140 in Maryland for a total of 3.3% of the national total. So, these three states not reporting their data to the CDC represents under-reporting of abortion rates by at least 21%.

What’s wrong with the national reporting system for abortion-related complications, injuries, and deaths?

The biggest problem with the national reporting system for abortion-related complications, injuries, and deaths in the United States is that reporting is not mandatory. Only 27 states require abortion providers to report injuries and complications from abortion to the CDC’s Abortion Mortality Surveillance System. [7] In studies from Denmark, Finland, and California that included multiple information sources rather than just death certificates, women who aborted were more likely to die than women who had a live birth. [8][9]

Other problems include deaths due to abortion being reported instead as due to the complication. For example, the World Health Organization’s International Classification of Diseases (ICD) medical coding for a woman who died from an abortion-related infection would be coded as dying from infection, not from the abortion. Also, many women who experience abortion-related complications will go to the emergency room for care, not back to the abortion clinic. Hospital staff may or may not ever find out that the woman had an abortion. Additionally, state death reporting does not usually trace suicide back to reasons like abortion. [10]

The World Health Organization recognizes that determining abortion-related deaths may be difficult because “this requires information about deaths among women of reproductive age, pregnancy status at or near the time of death, and the medical cause of death. All three components can be difficult to measure accurately, particularly in settings where deaths are not comprehensively reported through the vital registration system and where there is no medical certification of cause of death.” [11]

Surgical Abortion Complications:

Surgical abortion complications generally fall into one of three categories. The first category is uterine complications. Uterine complications come from either incomplete removal of some part of the fetus, amniotic sac, placenta, or other tissue, or from uterine atony (failure of the uterus to contract after the abortion) causing hemorrhage (large amount of bleeding). The second category is infection. The third category is injury because of medical instruments used during the abortion. [12]

Uterine Complications:

Incomplete or Failed Abortion

  • Retained fetal body parts or tissue, placenta, or amniotic sac can lead to pain and infection of the uterus, and may require hospitalization.

Uterine Atony

  • Hematometra is a collection of blood inside the uterus that causes symptoms such as low blood pressure and pain. [13]
  • Hemorrhage is an abnormal loss of blood that can become life-threatening, requiring hospitalization, blood transfusions, or even surgery to stop the bleeding. [14]
  • Disseminated intravascular coagulopathy (DIC)  is a life-threatening blood clotting and bleeding disorder. DIC is also a complication of Amniotic Fluid Embolism (listed below).

Infection

  • Incomplete or failed abortion (see above) can lead to life-threatening infection.
  • Infection of the uterine lining is typically caused by a combination of normal vaginal bacteria and an active sexually transmitted infection traveling up through the dilated cervix. [15]
  • Medication abortion or abortion pill medication (Mifepristone and Misoprostol) has been associated with a very rare but deadly infection by a bacteria called Clostridium Sordelli. All but one woman who have developed this infection have died from it. [16]

Injury

  • Uterine perforation, or puncturing a hole in the side of the uterus, may lead to hemorrhage.
  • Injury to the uterus can lead to preterm labor or miscarriage in future pregnancies A weakened or damaged cervix may lead to preterm labor or preterm premature rupture of membranes (bag of waters breaking) in future pregnancies. [17] Either one of these conditions can end in miscarriage or in the baby being born before 37 weeks and having brain, lung, heart, and other problems.
  • Bladder injury can occur due to perforating the uterus. [18]
  • Amniotic fluid embolism occurs when amniotic fluid from the fetal amniotic sac enters the mother’s blood stream and causes vital organs to shut down. [19] Once an AFE occurs, death is almost always inevitable.
  • Injury to the bowels or other organs may occur from the curette (sharp, scraping tool used to remove tissue and fetal body parts) breaking through the wall of the uterus. [20] Bowel injury may impact the large intestines or small intestines.
  • Asherman syndrome is scarring of the uterine lining or in the cervical canal. Asherman Syndrome can cause infertility, miscarriage, or preterm delivery in future pregnancies.

Some general notes about surgical abortion complications include:

  • Non-white women undergoing surgical abortion are more than twice as likely as white women to die from the procedure.
  • Obese women undergoing surgical abortions are more likely to have greater blood loss and the abortion takes longer.

Several other complications can occur after an abortion due to changes in the woman’s blood circulation during pregnancy. These include deep venous thrombosis (DVT), which is a blood clot in one of the major veins of the body, often a leg vein. Blood-thinner medication has to be given in order to prevent the clot from causing a stroke or heart attack or pulmonary embolism (blood clot in the lungs). Pulmonary embolism sometimes develops on its own, without breaking off from a DVT. Pulmonary embolism can cause sudden death if it is large enough. [21]

Medication Abortion Complications:

  • Pain, may be severe [22]
  • Cramping
  • Bleeding
  • Uterine rupture, or the whole uterus ripping apart, causing life-threatening bleeding and possibly death. This is an emergency. Risk of uterine rupture is generally low in first trimester abortions, but still exists for women with uterine scars already, like from a previous Cesarean section. [23] Women generally deliver at home after taking pills, where there would be no access to specialized medical care if uterine rupture occurred.
  • (as mentioned above) Medication abortion or abortion pill medication (Mifepristone and Misoprostol) has been associated with a very rare but deadly infection by a bacteria called Clostridium Sordelli. All but one woman who have developed this infection have died from it. [24]
  • In total, 22 women who took the abortion pill have died since 2000. 2 of those women died from ruptured ectopic pregnancies, even though the FDA insert says that no woman with an ectopic pregnancy should take RU-486.

Anesthesia-related Complications:

Finally, general anesthesia may be used in a small percentage of cases. General anesthesia has its own set of side effects. General anesthesia affects the whole body and requires being on a breathing machine. [25] In contrast, local anesthesia, which is much more common during abortions, refers to temporary relief of pain in a specific area. Complications of general anesthesia may include: low blood pressure requiring special intravenous (IV) medications, dizziness or confusion, nausea and vomiting, sore throat from the breathing tube, and, in very rare cases, a life-threatening condition called [26] malignant hyperthermia. [27]

“Conscious” sedation or “IV conscious sedation” is another method of pain relief and relaxation that has some complications. Medicine given through an intravenous (IV) line that takes away pain and relaxes the patient. It may also cause amnesia, or inability to remember the events of the actual abortion procedure. The goal is for the woman to be in a twilight-zone state, able to move arms and legs but relaxed and comfortable. Risks of sedation include getting too much sedation and needing oxygen or extra breathing support and abnormally low blood pressure requiring specialized medication and hospitalization. Every woman is different, and every woman responds to sedation medications differently. [28]

Have women ever died from an abortion?

As mentioned above, 22 women who took the abortion pill have died since 2000. Women who have had surgical abortions have died also. Just to name a few: Antonesha Ross died on May 8, 2009 in Chicago of untreated respiratory complications that should have prevented her from having an abortion in the first place. Ying Chen died on July 28, 2009 in California after an anesthesia reaction that went unnoticed. Karnamaya Mongar died in November of 2009 in Philadelphia after unlicensed personnel administered her sedation medications and oversedated her. Jennifer Morbelli died on February 7, 2013 in Maryland because of an amniotic fluid embolism. Tonya Reeves hemorrhaged to death in Chicago in July of 2012. On February 13, 2013, Maria Santiago died in Maryland of sedation complications. Given the reasons above for underreporting, these cases represent an unknown but small fraction of actual complications or deaths related to abortion. [29]

Late-Term Abortion Complications

While only about 10–15% of all abortions are done in the second trimester, they are responsible for roughly two-thirds or 66% of all major complications. [20][21] Risk of death from second trimester abortion is over 20 times higher than from first trimester abortion. [22] Risk of death from abortion increases by 38% each week starting in the second trimester. [23]

Abortion is not as safe as it may seem when judged by political rhetoric. It’s important to hear these warnings of the risks, side effects and complications related to abortion procedures.

 Citations:

3. Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2014, Perspectives on Sexual and Reproductive Health, 2017, 49(1):17–27, doi:10.1363/psrh.12015.

5. Horon, I. (2005). Under-reporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality. American Journal of Public Health, 2005, 95, 479

11. World Health Organization (2004). Maternal Mortality in 2000-Estimates by UNICEF, WHO, & UNFPA. Geneva, Switzerlincand: Department of Reproductive Health & Research.

13. Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 230.

14. Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 230-231.

19. Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 244-264.

21. Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009),

23. Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 128.

28. Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 92-98.