Pregnancy Deaths and Abortion in the New Reality

Because of pregnancy, younger women have some unique health issues and costs that do not affect men. Especially the men who seem intent on creating laws that discriminate against them.

As one of the few civilized countries without universal health care, even with the success of the Affordable Care Act, there are many women who cannot afford prenatal care.

In a recent study (MacDorman MF et al., Obstet Gynecol 2016 Sep 128:447) the authors note that maternal death rates (from complications of delivery) in the US are much higher than in other countries. They stated "these data are “an international embarrassment” as they represent the first estimate of maternal mortality in the U.S. since 2007. Chronic underfunding of the public health infrastructure, including vital statistics systems, not only results in poor health outcomes but contributes to lack of understanding of important trends. Globally, the U.S. is among 15% of countries with worsening maternal mortality since 2000."

California (of course) has developed specific interventions to reduce maternal mortality, and death rates have dropped by 25% since 2003. On the other hand, maternal mortality in Texas has doubled since 2010. Whether the sudden increase in maternal mortality in Texas was caused by the closing of Planned Parenthood clinics is unclear, although the events seem temporally related.

When will the politicians understand this? Not soon I think since their children and families get the best care through the excellent (and free) congressional health care policies.

In another study, researchers looked at some of the newer abortion regulations that have begun to try and restrict medical terminations. There is an FDA approved combination of drugs that can induce early pregnancy termination. The combination was originally approved with a specific dose that did not work well and recently the FDA changed its recommendations.

In what seemed to be an attempt to prevent the use of these drugs, the Ohio legislature (you remember John Kasich, our "favorite" republican?) and several other states enacted laws requiring adherence to the original FDA-approved regimen for abortion with these drugs (mifepristone and misoprostol). This is somewhat unprecedented as physicians are almost never mandated by law as to how they use drugs.

So what happened? Compared with women who had abortions prior to the law, those who did so after the law were more likely to require additional interventions (4.9% vs. 14.3%) and additional visits (4.2% vs. 6.8%), report adverse events (8.4% vs. 15.6%), and pay more (16% increase in charges). The proportion of abortions that were medication abortions fell from 22% to 5%. We must also remember that abortion (one of the safest clinical procedures performed in the U.S.) presents less risk to a woman's health than carrying a pregnancy to term. Upadhyay UD et al., PLoS Med 2016 Aug 30; 13:e1002110

In the few countries where abortion is still illegal, the rates of abortion are the same as in legal countries; just the complications and death rates much higher. Whatever your personal feelings are, I cannot condone anyone who feels it is better for a woman to die or have serious complications if she makes that choice. And it should be her choice, not some old man in government.