Sunday 2 September 2012
Abortion and premature birth – new Finnish study raises serious questions for UK
However a new landmark study from Finland published last week in the journal ‘Human Reproduction’ has gained the attention of the British media with the Guardian, Daily Mail and even the BBC running the story. The matter can no longer be ignored.
These media reports are all worth reading but one really needs to read the original paper to grasp its full significance.
Data from all 300,858 first-time mothers in Finland between 1996 and 2008 were analysed. They showed that women were three times more likely to have a very premature baby, born before 28 weeks, if they had had three or more abortions.
All ﬁrst-time mothers with a singleton birth were identiﬁed in the nationwide Finnish Medical Birth Register (MBR) for the period 1996– 2008 and linked to the data in the Abortion Register (AR) for the period 1983 –2008.
In total, 300 858 ﬁrst-time mothers with singleton births in the period 1996–2008 were identiﬁed from the MBR. According to the AR, 31 083 (10.3%) had had one, 4417 (1.5%) two and 942 (0.3%) three or more IAs before the ﬁrst birth.
Overall there would be three babies born before 28 weeks for every 1,000 women who had never had an abortion, four per 1,000 who had had one abortion, six in those who had had two abortions and 11 if the woman had had three or more abortions.
What can we make of this and what does it tell us about abortion-related prematurity in the UK? Here are my reflections:
1.This paper is very important
This is a very significant paper. However its findings are not new. Many previous studies and reviews have found a positive association between induced abortion (IA) and risk of preterm birth or a dose– response effect (ie. the risk of preterm birth increased with increasing number of IAs). As I have previously reported there are around 120 articles in the world literature already attesting to an association between abortion and premature birth, and very few indeed that contest the association.
But this Finnish study is very important because of the number of cases it evaluates and also because it controlled for all the major confounding factors which could detract from the strength of the conclusions (eg. adjustment was made for maternal age, marital status, socioeconomic position, urbanity, smoking during pregnancy, previous ectopic pregnancies and miscarriages).
2.UK research is rudimentary by comparison
This kind of research could not have been carried out in the UK because abortion authorisation forms here do not carry NHS patient numbers meaning that birth and abortion data cannot be matched (a story in itself!) This is really inexcusable given that abortion is one of the most common procedures carried out by doctors. Finland, with its quality of reporting, really puts the UK to shame in this area.
3.The problem of abortion related prematurity is much worse in the UK than in Finland
The number of abortion-related premature births is significant in Finland but will be much higher in the UK. This is because UK abortion rates are twice that in Finland (17 compared with 9 per 1,000 women aged 15 to 44) and because the UK population is twelve times greater (60 million cf 5 million). This means that there are many more women in Britain who are at risk of abortion-related premature births.
There were approximately 190,000 abortions in England and Wales in 2011: 122,000 of these women were having their first abortion, 52,000 their second and 16,000 had had three or more.
So if these women went on to have pregnancies we would expect them to have a total of 976 premature births under 28 weeks (122 x 4 + 52 x 6 + 16 x 11) of which 406 (122 x 1 + 52 x 3 + 16 x 8) would be abortion-related. When we consider that there are only about 4,000 babies under 28 weeks born in the UK each year (there were 4,150 in 2005/6) we can see that abortion related prematurity is a very significant problem indeed.
4.Abortion-related prematurity is a significant health problem in the UK
Being born too soon is linked to higher risks of infection, hypothermia and death and the risks are higher the younger the baby. Furthermore, premature births cost the UK an extra £939m a year, according to researchers at the Oxford Centre for Health Economics.
5.UK doctors are in denial about the reality of the problem
In most medical literature on prematurity abortion is not listed as a contributory factor. The Net Doctor information on ‘what causes prematurity?’ are a good example of this. But women have a right to know the facts and the government has a responsibility to address the problem given the cost implications of prematurity.
The Finnish study’s conclusions need to be taken on board here in the UK: ‘In terms of public health and practical implications, health education should contain information of the potential health hazards of repeat IAs, including very preterm birth and low birthweight in subsequent pregnancies. Health care professionals should be informed about the potential risks of repeat IAs on infant outcomes in subsequent pregnancy.’
This all raises significant questions. How many cases of extreme prematurity each year in the UK are abortion-related? What is the cost of this extra burden of care to the NHS? Why are doctors and the government not being honest about the extent of the problem? Why is so little relevant research being done?
I suspect the main reason there are so little answers forthcoming is because abortion is such a deeply political issue that different rules are applied whenever it is evaluated and discussed.
But I wonder how long it will be before the first mother with a prior abortion brings a case against a doctor or health authority for not being told that she was at increased risk of having a premature baby following abortion, especially if that baby suffers one of the more severe and expensive complications of prematurity.
The problem of abortion-related premature birth is very serious and demands answers.