The Texas abortion study on maternal mortality has several holes

Written by: Ana Maria Dumitru, new national chair for Medical Students for Life

Maternal mortality rates are up in Texas, and according to abortion advocates, it’s the fault of pro-lifers who slashed family planning budgets. Before getting swept away in the current of modern liberal thought and reasoning (or lack thereof), there are several key points about this study by Marian F MacDorman and colleagues. and about the coverage their study has received.

For starters, maternal mortality ratios and maternal mortality rates are not the same thing. The problems start in the introduction where MacDorman and colleagues state that “the United Nations’ Millennium Development Goal 5a was to reduce the maternal mortality rate by 75% from 1990 to 2015.” (emphasis added)

In fact, the UN Goal 5a was to reduce maternal mortality ratios, not rates. The difference, as defined by the World Health Organization (WHO) is that the maternal mortality ratios are obtained by dividing the number of maternal deaths in a population 787px-Texas_flag_map.svgfor a given time interval by the number of live births occurring in the same population at that time.

Maternal morality ratios give an idea of the risk of death once a woman becomes pregnant, which can then lead to determining the quality of the healthcare system that the woman is in.

The maternal mortality rate is calculated by dividing the average annual maternal deaths in a population by the average number of women of reproductive age who are alive during the specified time interval in that population. As a result, the maternal mortality rate also factors in the fertility of the population, and both direct and indirect causes of death for a pregnant woman (for instance, pre-existing medical conditions).

Another major issue, as the authors acknowledge, is that the United States has not reported national maternal mortality data since 2007. Part of the problem is that before 2000, there was very little standardization for reporting the cause of death on death certificates. Between 2000 and 2014, most states gradually adopted a revised death certificate which included a pregnancy status question. During this time, as some states changed over sooner than others, maternal death data were confusing at best, making national calculations increasingly difficult to perform. What MacDorman and colleagues thus attempt to do is to take state-by-state maternal mortality data and create their own adjustments in order to facilitate comparisons over that time period.

This is where Texas comes in to play. When the authors analyzed their data, Texas stood out like a sore thumb. Specifically, the authors found that while Texas tracked similarly with the national maternal mortality data between 2000-2010, the calculated data after 2010 showed a doubling in adjusted maternal mortality rates. In their discussion, the authors then speculated as to what could be driving the changes they calculated, and they mentioned that Texas did have “some changes in the provisions of women’s health services” between 2011-2015.

Here the authors reference two sources, both of which are quite problematic in and of themselves. One is a New York Times article covering the Supreme Court’s hearing of oral arguments on this year’s Texas abortion case. By citing this article, perhaps the authors are implying potential restrictions to abortion access, although it ought to be noted that the Supreme Court struck down the intended law before it went into effect, so no restrictions were actually put into place. Therefore the purported changes to women’s health services were not due to changes in access to abortion in Texas during this time interval.

The second reference is a study by Amanda Stevenson and colleagues, and it evaluates changes in Planned Parenthood in Texas after state-wide cuts in funding for family planning services. Texas slashed its general state funding for family planning services by 66% in 2011, but Planned Parenthood was not the organization most negatively affected by this cut. Two-thirds of the clinics that closed after these funding cuts in fact were not affiliated with Planned Parenthood. Furthermore, Texas provided transition funding through 2012, which means that the cuts only kicked in during fiscal year 2013.

What’s truly remarkable is that the MacDorman study cited this as evidence of changes that could have contributed to the maternal mortality doubling of 2011, even though the changes wouldn’t have gone into effect until 2013, at which point their calculated maternal mortality in Texas has begun to go down again.

Even aside from all of these issues, there’s still one more obvious problem. According to the Houston Department of Health and Human Services, “from 2001 through 2006, the MMRatio for Texas was higher than that of the United States.” Which means that Texas was already aware that it had this problem, and it was a problem well before any changes were made to any kind of purported changes to access of family planning services. Also, between 2005-2006, Texas Planned Parenthood’s budget was cut by 31.2%, causing some closings of clinics – and according to the Macdorman article, during that time and the four subsequent years, there were no increases in maternal mortality (in fact some slight decreases).

There’s more that could be said about this article, but the bottom line is that while political ideology is getting busy misrepresenting facts, women in the United States are losing. It’s time for us as a nation to get our act together. We need to collect uniform data about maternal mortality so we can know where we actually stand, and then we need to mobilize to decrease our MMRatios – in Texas, and also from sea to shining sea.

New Study Confirms Post-Abortive Women Have Increased Risk of Mental Health Disorders

A new study published in July of 2016 confirms that abortion is consistently associated with increased risk of mental health disorders and substance abuse in late adolescence and early adulthood. Dr. D. Paul Sullins of the Catholic University of America released the results of an analysis conducted on data collected from 8,005 women in the United States who were followed over the course of thirteen years. The article was published in Sage Open Medicine, a peer-reviewed open-access journal, and can be accessed for free here.

Abortion activists have repeatedly denounced attempts to link abortion with any adverse events. In medical schools across the country, students are taught that there are no long-term consequences of abortion, and that abortion is a safe procedure. However, these statements are misleading at best. One of the major problems with abortion statistics in the United States is that each state sets its own reporting laws, which means that some states, like California for instance, don’t require any public reporting of abortion statistics. So for starters, we don’t know what we don’t know. Additionally, of the states that do report abortion statistics to the CDC, not all of those states report the same amount of information. Furthermore, the private pro-abortion Guttmacher Institute has consistently reported much higher (as much as 30% higher) abortion rates than those listed in the CDC reports, which calls into question the reliability of state reporting. Another major issue is that only 16 states require reporting information on abortion complications, and only 8 of these states actually publish abortion complications in their public abortion reports. Only 4 states inquire about maternal mortality post-abortion, and only one state inquires about any follow-up care provided to post-abortive mothers.

If your head is spinning with these numbers, that’s understandable, because the conclusion is that it’s shockingly difficult to get any straight answers on nationwide abortion statistics. Why are we being taught that there are no long-term consequences of abortion if we don’t have reliable reporting systems with which to track this information?

Here’s what you need to know about the Sullins study:

  • The Sullins study followed 8,005 women and tracked them across three average age time points: age 15, age 22, and age 28. All 8,005 of these women were examined at all three time points (the initial study had about a 20% dropout rate, but Sullins only included the women who completed all of the evaluations).
  • These data were from the National Longitudinal Study of Adolescent to Adult Health (ADD Health), which was funded by 18 federal agencies and was initiated in 1994 with the intent of being “the largest and most extensive study of the health-related behaviors of U.S. adolescents during the transition to adulthood.”
  • Extensive adjustments for possible confounding variables were made, including adjustments for age, race, region of origin, childhood family conditions, socioeconomic status, educational status of participant and of participant’s parents, history of abuse, and preexisting mental health conditions.
  • It’s not the first longitudinal study to conclude that there’s a significant link between abortion and mental health disorders. Two examples of similar studies were Fergusson and colleagues’ New Zealand study (link) and Pedersen’s Norway study (link), both of which followed cohorts of women from adolescence into their late 20s. Both of those studies also concluded that there was a clear connection between abortion and “affective and addictive disorders, including depression, anxiety, suicidal ideation, and abuse of marijuana, alcohol, or other illicit drugs.”
  • The conclusions of the Sullins study are that even after adjusting for over twenty demographic variables and covariates, there is still a clear, significantly increased relative risk of mental health disorders for women who have abortions.
  • Importantly, the Sullins study compares across all pregnancy outcomes too (abortion, live birth, or unintended pregnancy loss). Even when comparing a woman who chooses abortion to a woman who loses a pregnancy for any other reason, the relative risks of mental health disorders are higher in post-abortive women.
  • Table 5 from the Sullins study is shown below and lists the relative risks associated by category:

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Abortion, Substance Abuse and Mental Health in Early Adulthood: Thirteen-Year Longitudinal Evidence from the United States. D. Paul Sullins, 2016, Sage Open Medicine.