Might the large disparity in premature birth rates between black and white women be partly explained by abortion?

Prematurity is associated with a wide variety of health risks. In the UK, 7.8% of babies are born prematurely (60,000 per year) and this number is on the rise. 

The total cost of preterm birth to NHS is £2.9 billion a year, equivalent to that of smoking, alcohol and obesity. 

Reducing the rate of preterm birth even by a small amount will therefore have a significant impact on reducing this cost.

It is a well-established fact that, both in the US and the UK, black women have preterm birth rates of 15–18%, more than double than that of the white population. But although we know a lot about the causes of prematurity this specific disparity is as yet unexplained.

If you search on pub med you will find a whole host of articles looking at possible explanations. But research attributing the link to factors as diverse as infection, inter-pregnancy interval, nutrient deficiency and inequality remains inconclusive.

Might abortion perhaps play a role?

According the 2013 abortion statistics for England and Wales, published just last week, ‘Black or black British people’ only make up 3.3 per cent of the population but accounted for 9 per cent of abortions.

Furthermore, the percentage of women having an abortion in 2013 who had one or more previous abortions also varied by ethnic group. 49% of Black women having abortions in 2013 had previously had an abortion compared with 36% of White women.

The link between abortion and premature birth is well established but largely underplayed or denied by British authorities including the Royal College of Obstetricians and Gynaecologists (RCOG).

Most doctors and women are therefore not aware of it.

I have previously summarised the medical evidence for the link on this blog and have also highlighted major Finnish, Danish and Scottish studies confirming it.

Last year I drew attention to a paper from North Carolina which has reviewed all the available data on the association between abortion and preterm birth.

In fact there are now over 130 scientific articles reporting on the link between abortion and preterm birth in the subsequent pregnancy and two well-designed meta-analyses now demonstrate that just one prior abortion increases by 36% the risk for a future ‘preterm’ birth and by 64% for a ‘very preterm’ birth. Two or more abortions increase the risk for a future ‘preterm’ birth by 93%.

So might the large disparity in preterm birth rates between black and white women be partly explained by the fact that black women have more abortions?

One would have thought it was an obvious avenue of research. So why isn’t anyone looking into it?

Now there’s a question. 

Women must be informed of the overwhelming evidence linking abortion and later preterm birth

The link between abortion and premature birth is already well established but largely underplayed or denied by British authorities including the Royal College of Obstetricians and Gynaecologists (RCOG).

Most doctors and women are therefore not aware of it.

I have previously summarised the medical evidence on this blog and have recently highlighted major Finnish, Danish and Scottish studies confirming the link.

Now a new paper from North Carolina has reviewed all the available data on the association between abortion and subsequent increased risk for preterm and very preterm birth. 

The author, Martin McCaffrey, is a clinical professor of paediatrics at the UNC-Chapel Hill School of Medicine, director of the Perinatal Quality Collaborative of North Carolina, and member of the NC General Assembly Child Fatality Task Force.

He highlights findings from two recent Systematic Review and Meta-analysis articles.

The two standout conclusions are as follows:

1. The risk of prematurity increases, in a ‘dose effect’ with one or more induced abortions (ie. The more abortions, the higher the risk of prematurity)

2. Abortion is linked with increased risk of ‘preterm’ birth (33-36 weeks), but it is linked with an even higher risk of ‘very preterm birth’ (VPTB) (< 32 weeks) where babies are at much higher risk of morbidities like cerebral palsy.

There are currently 137 scientific articles reporting on the link between abortion and preterm birth in the subsequent pregnancy.

Two well-designed meta-analyses now demonstrate that just one prior abortion increases by 36% the risk for a future ‘preterm’ birth and by 64% for a ‘very preterm’ birth.

Two or more abortions increase the risk for a future ‘preterm’ birth by 93%.

It is long overdue, based on the scientifically proven risk abortion poses for future preterm birth, that we educate sexually active women and men of the serious risk abortion poses for the health of babies born subsequent to abortion.

The article contains two very helpful graphic demonstrations highlighting the inordinate shift of higher risk of VPTB for infants born subsequent to the mother having had an abortion. 

It is a travesty that this information is not disseminated by medical and other organisations dealing with reducing the incidence of preterm birth.

I am grateful to AAPLOG for drawing this report to my attention.

Survival of twins born at 23 weeks and new Inquiry into abortion for disability reopen debate on abortion upper limits

When twins Mackenzie and Cameron Glover were born 17 weeks prematurely on 17 June last year, they were so tiny that their mother said they could ‘fit inside a pint glass’.

Now, after a lengthy battle for life against the most astonishing odds, the boys, born at just 23 weeks and three days gestation, have become one of the most premature sets of twins ever to survive in the UK.

Their mother Pam says her miraculous boys fill her with wonder – but she is left angry and mystified that the law continues to permit the abortion of babies older than her sons were at birth.

Pam said: ‘For us now, the idea that it’s possible to abort a child up to 24 weeks – older than Cameron and Mackenzie were – just doesn’t bear thinking about.’

The story, reported in the Daily Mail this week, has reopened the debate about abortion time limits.

It comes just as Fiona Bruce MP launches a parliamentary inquiry into abortion for disability which will examine the law, professional guidance and information and support given to parents.

Disabled babies can be aborted right up until the time of birth and in 2011, according to Department of Health statistics, 146 were aborted after 24 weeks.

In all 2,307 abortions were carried out in 2011 under Abortion Act 1967 Ground E, for disability. This included more than 500 abortions for babies with Down’s Syndrome although the real number may well be twice as high.

Abortion industry leader Ann Furedi of BPAS has reacted strongly against the consultation saying that abortion should be a women’s choice.

However she has already come in for sharp criticism from Saving Downs, a charity advocating for children with Down’s syndrome, which has welcomed the inquiry saying that it is ‘exactly what the disability community needs: the removal of discriminatory laws against the disabled’.

Last year Health Minister Jeremy Hunt said that he personally favoured a lowering of the upper limit for aborting non-disabled babies to 12 weeks.

He is not alone. 13 of the current 16 Tory MPs in cabinet actually voted for a lowering of the limit in 2008 when the issue was last debated – including 7 for 20 weeks, 2 for 16 weeks and 3 for 12 weeks.

There are currently 16 countries in Europe which have upper limits of 10-12 weeks and that Britain has one of the highest upper limits and highest abortion rates in Europe.

Public and parliamentary opinion is changing on abortion for three main reasons – 4D ultrasounds, debates about fetal sentience and premature babies like the Olivers surviving below 24 weeks in neonatal units.

All this is increasing awareness about the ‘humanity of the pre-born baby’ and heightening concerns about abortion.

Ultimately societies will be judged by the way they treat the most vulnerable, and there is no one more vulnerable, more innocent and killed in greater numbers than a preborn baby.

Last year I was one of nine signatories to a letter to the Telegraph describing the practice of aborting babies for disability as a form of ‘eugenics’ and arguing that the present law is deeply hypocritical and discriminatory.

This consultation will be an opportunity for disabled people and their advocates to speak out against this practice and possibly bring some much needed reform.

Abortion and premature birth – new Finnish study raises serious questions for UK

The link between abortion and premature birth is already well established but largely underplayed or denied by authorities in Britain.

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.

Major British study links premature births to previous abortions adding fuel to calls for independent abortion counseling

The Times and Telegraph have reported this week on new research which shows that women who have had an abortion are more likely to give birth to a premature baby and to suffer several other pregnancy complications when they next conceive.

This is hugely significant just as parliament is about to debate an amendment to the Health and Social Care Bill which would give women the right to independent counselling on abortion. It is doubly significant at a time of financial restraint given the huge financial and emotional costs involved in caring for premature babies.

The Times article reads as follows:

‘A major study that looked at more than a million pregnancies in Scotland over 26 years has revealed that women who have had one termination are 34 per cent more likely to have a premature birth than those pregnant for the first time. Their chances of pre-term delivery are 73 per cent higher than women having a second baby, who are known to have a lower risk of preterm delivery.

The risks of prematurity increase sharply with more than two abortions. One in five women who has had four terminations will give birth before 37 weeks, compared with fewer than one in ten women who have had only one, according to preliminary results from the University of Aberdeen.

Women who had surgical abortions were 27 per cent more likely to have preterm births than those who had medical abortions with drugs, which are more common earlier in pregnancy. The study also linked a previous abortion to slightly higher risks of stillbirth and pre-eclampsia, a blood pressure disorder that can itself lead to pre-term delivery and occasionally threatens the lives of mothers and infants.’

Preliminary results from the research, led by Dr Bhattacharya and Professor Siladitya Bhattacharya, were presented at the European Society of Human Reproduction and Embryology conference in Stockholm yesterday. The work has not yet been published or peer-reviewed.

The study examined the Scottish Morbidity Records for all women in the country aged 15 to 55 who had two pregnancies between 1981 and 2007. They identified 171,208 women who had a second pregnancy after an abortion, 6,098 who had a second pregnancy after miscarriage, 458,337 who had a second pregnancy after a live birth, and 458,339 women pregnant for the first time.

There are actually at least 119 articles in the world literature already attesting to an association between abortion and premature birth, and very few indeed that contest the association (see below). So why is this new study a news story?

What makes it news is the fact that this is the first major British study on the subject – as it is virtually impossible to do research on the health consequences of abortion in this country because abortion authorisation forms do not carry NHS patient numbers (a story in itself!)

We will of course have to wait to see the full study once it is formally published but this is a further huge reason why women seeking abortion must have access to fully informed consent from a neutral party which does not downplay the facts.

The Royal College of Obstetricians and Gynaecologists (RCOG), who were rapped on the knuckles earlier this year by the Health Secretary for trying to sneak through their controversial guidance on abortion without a proper consultation have been heavily criticized in the past for underplaying the physical and psychological consequences of abortion for women.

Among their current recommendations is the following: ‘Women should be informed that induced abortion is associated with a small increase in risk of subsequent preterm birth, which increases with the number of abortions’

Well 34% is not small increase at all. And we know it gets bigger and bigger with each abortion - highly significant given that many young women are using abortion as as form of birth control. If a risk factor raised the incidence of cancer by 34% it would be front page news. I wonder if this will be. I am not holding my breath.

I blogged back in February about an AAPLOG update on the scientific evidence for the link between abortion and preterm birth – a connection which has been constantly underplayed by the RCOG. The new draft continues this misreporting.

The AAPLOG report reads as follows:

'One of the most egregious educational omissions from current medical education/residency program, or just plain from the American medical literature in general, is the association of induced abortion with subsequent preterm birth. It is a kind of ‘denial by silence’.

There are at least 119 articles in the world literature attesting to this association, and very few indeed that contest the association. (see review) And even the admission of the association is trivialized. Iams, a MFM Professor from Ohio State, allows that abortion is followed by ‘a very small but apparently real increase in the risk of subsequent spontaneous preterm birth (PTB)’.

‘Apparently real’ is an interesting way to say ‘119 studies, and all of the recent major studies’. Do we believe in evidence based medicine? ‘Very small’ - (and here Iams references the 2009 BJOG Shaw study that found a 36% increase in PTB subsequent to abortion)—how big is ‘very small?’ With nearly any other serious complication, a 36% increase with one exposure (in this case, to abortion) would be extremely significant. Not so, here. Rather, it is a ‘very small’ association.

And -same Shaw study- women with more than one prior abortion raised their 'preemie' delivery risk by 93% - a HUGE increase (almost double the 'preemie' risk when compared to women with zero prior abortions). See our analysis of Iams article.

We see here an example of a new principle, the ‘abortion distortion’. In legal, and medical, and societal, and governmental arenas-(as in ‘Philadelphia Dept of Public Health’)-, the rules and standards change when the topic is abortion. Overwhelming medical evidence becomes ‘apparently real’, a 36% increase becomes a ‘very small’ increase, Philadelphia public health department responsibilities to women's health become a joke. Worse. An unspeakable travesty.'

Well it will far harder for the abortion industry and RCOG to play down abortion complications now.

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 in a subsequent pregnancy. Especially if that baby suffers one of the more severe and expensive complications of prematurity.