But no one is "pro" abortion. Part 1.

I am.

I know two things to be true.
1.  Pregnancy is inherently dangerous.
2.  Children are vulnerable and fragile, and should be brought into the world on purpose.

A disclaimer.  This post will discuss maternal mortality and other issues in both industrialized and developing nations.  Most importantly, women everywhere deserve the same rights and the same benefits of healthcare.  Further, a full picture of pregnancy cannot be ascertained without witnessing the disparate effects in different life circumstances.

Pregnancy results, inherently, in a compromised immune system.  It frequently results in a variety of life-threatening conditions: high blood pressure, gestational diabetes, hemorrhage, seizure, stroke, embolus, infection, rupture...  the list goes on.  And that's before labor begins.  Obstructed and prolonged labor also kills.  The US is better at counting maternal mortality and we identify mortality causes related to pregnancy better.  This means we get a better picture of actual pregnancy-related death than other countries... which also means the maternal mortality rate we boast is higher than other countries.  We also have a significant problem with uninsured women who have difficulty accessing appropriate, lifesaving prenatal care--despite providing medicaid to a vast segment of pregnant women.  We also have a higher rate of fertility than many industrialized countries.  Our rate of assisted reproduction also increases the risk of mortality.  A brief selection.

United States 2.06
Germany 1.41
Italy 1.40
United Kingdom 1.91
Spain 1.48
Netherlands 1.78
Sweden 1.67
(2012 Est. CIA Factbook)

Mother Jones reviewed a report specifically on California that also discussed US rates.  The article highlights racial disparities, which reflect a variety of factors.

African-American women suffer maternal mortality rates far higher than any other ethnic group: about 46 of 100,000 African-American mothers die due to childbirth, as compared to much lower rates in Whites (12.4), Hispanics (12.8), and Asians (9.3). The authors of the report are still not sure exactly why African-American women are four times as likely to die than women of other races, but they suspect a combination of higher obesity rates, lower use of prenatal health care, less adequate care, and various risk factors as a result of lower socioeconomic status (e.g. higher stress) (Quraishi, 2011).

The census data shows a bigger picture.

(Census Bureau, 2012)

So that we know what our terms mean, the maternal mortality rate is the number of maternal deaths divided into the total number of women of childbearing age (pregnant or not) during the observed period.  Lifetime risk is the likelihood each woman has of eventually dying as a result of pregnancy or childbirth.

The lifetime risk of maternal mortality in the US was 1 in 2100 in 2008 (UNICEF, 2010).  Just for an idea of what that means, the US population in 2011 (est.) was 311,591,917.  50.8% were female (Census, 2012).  So that's 158,288,694 women of all ages.  The population under 18 was 24.0%.  Let's presume that there is roughly the same percentage of males and females under 18 (this may not be the case).  That means that there are 37,989,287 women under 18.  Each of those women is calculated into the risk, whether she eventually experiences pregnancy or not.  That means, based on the population in 2011, we can expect 18,090 American female children alive in 2011 will die as a result of childbearing.  If we run that rate through the full female population (a little disingenuous because it includes women who are no longer at risk of childbearing), that expectation is 75,375.  That's a lot of dead women.

This table lists the adult lifetime maternal mortality risk (risk of a woman who is 15) worldwide.

(WHO, 2007)

Here's a look at maternal mortality in industrialized nations since 1900.  It's gotten better.

Albanesi, 2011

And what about the whole world?

[Maternal mortality r]ates decreased 34% from 1990 to 2008. In 1990, an estimated 546,000 women died from complications during pregnancy and childbirth, while 358,000 women died from the same causes in 2008 (Green, 2011 citing WHO, 2010).

What many people don't know is that, as dangerous as pregnancy is, two pregnancies is even worse.  Worse?  Three.  Four.  Five.  Each subsequent pregnancy increases the risk of death (for mother and fetus).

In 1984, it was calculated that increased spacing between pregnancies could reduce maternal mortality by 21%.  Eliminating fifth and higher order births would reduce mortality by 4% and eliminating fourth and higher order births would reduce it by 8%.  Limiting childbearing to ages 20-39 would reduce maternal death by 11%.

A study published in 2011 (poignantly entitled "A Woman Cannot Die from a Pregnancy She Does Not Have") showed that reducing fertility has the potential to halve maternal mortality.

To highlight the role of fertility decline in reducing maternal deaths, we conducted an exercise using historical data on fertility and maternal mortality to create two hypothetical scenarios. In the first scenario, fertility levels in a population stayed the same between the early 1900s and the early 2000s, while maternal mortality ratios fell to 2005 levels. This scenario estimated the impact of improved obstetric care on maternal mortality. In the second scenario, we reversed the situation, using century-old maternal mortality rates in combination with current TFRs; this allowed us to estimate how reducing fertility affects the number of maternal deaths.

...

Our analysis focused on Sweden, one of the few countries for which long-term, high-quality, age-specific data on fertility and maternal mortality ratios are available. We used data from 1911 and 2005 (or as close to these years as possible) for women aged 15–49. 

...

Through these calculations, we estimated that in our standard population, more than 30,000 maternal deaths would occur if the TFR and maternal mortality ratio were both at 1911 levels. Changing both measures to their 2005 values reduced the number of deaths to 104. Improving obstetric care alone, so that the maternal mortality ratio declined to the 2005 level but fertility remained at its 1911 value (scenario 1), had a larger impact on the number of maternal deaths than did reducing only the fertility rate (scenario 2); nevertheless, fertility decline alone halved the number of maternal deaths, to fewer than 15,000 (Diamond-Smith & Potts, 2011). (emphasis mine)  

Children are deeply affected by maternal mortality.  Beyond what should be obvious psychological and emotional impact, children who lose their mothers die.  They also have diminished educational and likely economic capacity.  Maternal mortality is bad for the future.  (Do I really need to say this?)

Maternal Mortality and Morbidity – Larger Implications

Maternal mortality has immediate and serious consequences for young children. The risk of death for a mother’s children under age five can increase by as much as 50 percent if the mother dies in some less developed countries. Over three million neonatal deaths occur each year during the first week of life due to inadequate or inappropriate care in pregnancy and during and following delivery.

Maternal mortality continues to affect the woman’s children as they become older. A recent study in Bangladesh, for example, found that children up to ten years old are three to ten times more likely to die within two years of their mother’s death than their counterparts with living parents. Another study in the Kagera region of Tanzania demonstrated that the death of a prime-aged female adult resulted in delayed school enrollment for 7-11 year-old children and early dropout rates for 15-19 year-olds (Bayer, 2001).

Also according to Bayer, family planning can prevent 25% of maternal deaths.

All of this calls for decisive and careful family planning.  And, no contraceptive is 100% effective.  The 18,090 American women under 18 who will die as a result of pregnancy deserve to have full election to that risk.  They should not, in any way, be coerced or stigmatized or pressured or accidented into that risk... not to mention the far greater numbers that risk such demise in developing nations.  Of course, we have a grave failure in our society in that we fail to be informed of the risks of pregnancy and birth and pretend that because it happens naturally that it is safe.  It is anything but.

Because I know that pregnancy kills, and more pregnancies kill more, and I believe in a woman's right to ensure her own survival (if for nothing else but to care for existing children), I strongly believe that women should have affordable, safe access to any and all measures to prevent and terminate pregnancy and the social support to utilize these measures.  Women should be in absolute control of when and under what conditions they put their lives at risk to bear a child.  And we should value their lives enough to respect that agency.

For comparison, the death rate in any abortion procedure between 1993 and 1997 was .6 per 100,000 (Kaiser, 2002).  This makes ANY abortion, including late term, overall ten times safer than pregnancy and childbirth.  As it happens, this rate is still accurate, with more risky surgical abortion risk at .625 per 100,000 (NAF, 2006).

The takeaway on this is pregnancy is risky.  It may be less risky in wealthy nations when women have access to excellent medical care.  But it is always risky.  Women should be free to only take on this risk willingly and enthusiastically.  As such, all family planning services, contraceptive and abortive, are basic lifesaving healthcare and should never be denied to women.


Any denial of this lifesaving care is to presume that the life of a woman is less important than that of her potential offspring.  

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In my next post I will address the second thing I know to be true.  Children are vulnerable and fragile,  and should be brought into the world on purpose.  Try not to decide I've judged unintended parents before you read it.