the deveber institute for bioethics and social research · subfertility: • 24% of women who have...
TRANSCRIPT
The deVeber Institutefor Bioethics and Social Research
Complications of Abortion
Presentation to:
Health PEI – Board of Directors
Sept 9, 2014
the available scientific research on
the benefits of induced abortion= ZERO
Abortion:
1. Dilate cervix
2. Curettage
3. Suction
What are the complications of induced abortions?
What is a complication?
• An unintended adverse outcome• Immediate or long term
PhysicalMental
Social Spiritual
• ** high frequency or high morbidity**
11% of women who have induced abortions
suffer physical complications
within 6 weeks
RCOG 2003
Are the complications of abortion statistically significant?
YES
In Ontario in the 3 months following an IA- 4x’s increase rate of admission to hospital
overnight for treatment of infection
- 5x’s increase rate of surgical intervention
- 6x’s increase in admission due to mental illness
CPSO 2001
5% of abortions are complicated by severe hemorrhaging
Why? - laceration of cervix- perforation of uterus- tear of blood vessel- retained pieces of placenta
2% of induced abortions go for further surgery because of excessive bleeding
CPSO 2001
Most common and most serious complication of abortion is…..
Infection
Pelvic inflammatory disease following abortion
• 15 –25% of women who seek abortions have chlamydia (depends on SES)
• Even with antibiotic Rx ~ 6% = PID
• CPSO study showed 4X’s increase in admission to hospital for PID following a surgically induced abortion
Shelley
• 26 years old – married x’s 2 years
- teacher
- loves children and children love her
- unable to achieve pregnancy
50% of Pelvic Infections result in:
infertilitysub-fertility
chronic painpremature delivery
Post Abortion Infertility 2nd to PID
~1,000 young women become infertile each year in Canada due
to induced abortionsWHAA 2002
Why are these young women the ones who become infertile?
• Cannot afford antibiotics• Forget to take antibiotics• Do not tolerate side-effects and quit
Subfertility:• 24% of women who have an abortion
experience problems with subsequent pregnancies WHAA 2002
• IA risk by 620 % Hassan 2005
• ~ 12% of women seeking IVF had an IAHemminki 2008
Abortion increases the risk
of a tubal pregnancy
Abortion increases the risk of premature deliveries
Very Low Birth Weight (VLBW) babies ~40%
ELBW babies ~ 70%
Moreau - France 2005Lumley – Australia 1998Smith – Britain 2007Ancel – EuroPop study 2004Zhou – Scandinavia 2003
1. Infection (chlamydia)**
… leading to premature rupture of membranes
& premature onset of labour
??immune related
Moreau ‘05
2. Incompetent Cervix
3. Trauma to the endometrium
• Increase in placenta praevia
• Hemorrhage
• Stillbirth
• Small for Gestational Age ANCEL 2004
BROWN 2007
One induced abortion:
Increases risk of low birth weight babies
&
Prematurity with lung complications
Equal to:
the risk of smoking 1 pack / daily
while pregnant
Abortion increases mortality and morbidity in offspring
Very low birth weight babies <750gm
- 25% develop a serious handicap- 7% have cerebral palsy- 25% of the infants die
Rooney 2003 Ancel 2004 Moreau 2005 Brown 2007
Preterm delivery causes:↑stress
↑dysfunction within a family
↑spousal abuse
and ↑child abuse.
Do we respect women enough to inform them of this risk when they seek
an abortion?
NO
Thorpe 2002
Induced abortion increases the risk of breast cancer
• If you are – under 19 years of ageand have a 1st trimester abortion
You double your life time risk of getting breast cancer
with a 1st degree relative -risk increases by 310%
Women who have an abortion prior to carrying a pregnancy to term increase their risk of having breast cancer by 30%
Brind 1995
What is the hypothesis about the ‘ABC’link?
• Pregnancy causes high circulating estrogens that cause rapid division of cells in the breasts.
• Abortion arrests the differentiation of those cells • Undifferentiated cells more likely to turn
cancerous due to lack of gene that codes for cell death (apoptosis)
• Undifferentiated cells also have increase susceptibility to spontaneous DNA mutation
Are women informed of this risk?
No
Abortion clinics deny the ‘ABC’ connection
Lanfranchi 2013
Royal College warns: abortions
can lead to mental illness RCOP 2008
Abortion, Suicide and Depression
• Post abortion suicide rates 6 x’s from norm
9 x’s > than in women who deliver at termSTAKES 2000
• Suicide attempts increase by 225% following abortion Morgan 1997
• Admissions to Ontario hospitals for depression following abortion 5X’s greater CPSO 2001
Who are these women who are so sad post-abortion that they want to die?
The women at risk of depression and suicidal behaviour following an induced
abortion are…..
• Young - < age of 25• Single• Low income earning potential• Little family support
In contrast:
• Women who carry a pregnancy to term have a decreased risk of suicide
** whether or not the pregnancy was planned or the baby ‘wanted’**
STAKES
Abortion also leads to:
• Illicit drug use
• Excessive alcohol use
• Self- abusive behaviorReardon and Ney 2000
And induced abortion leads to:
• Depersonalization
• Isolation
• Victimization
• Promiscuity
The mental health problems that up to 17% of young women
experience following abortion:
persist over time
risk of parenting problems
risk of dysfunctional relationships
Fergusson 2006
Abortion also increases:
The rate of child abuse!Ney 99
IA’s are associated with more child-directed aggression
Coleman 2007
Abortion increases the risk of mental health problems in children
Due to lack of attachment:
- children at risk of becoming defiant, aggressive and destructive (ODD)
- children at risk of ‘low resiliency’
- children at risk of learning problems
So how do men fare following an abortion?
• Very little research• Reports are taken from men who seek
psychological counseling or who are in ‘mandatory reporting situations’
• Skewed population of the best and the worst at managing life
What do we know?
• Men experience grief and sublimate it into anger
• Anger turns into violence against self or partner or society
• Guilt leads to self abuse – alcohol, smoking, over-eating, drugs
• ‘abortion casts a long and troubled shadow over their future fatherhood’
Ney 99
Post Abortion Violence• the risk of dying from
homicide for post-abortive women was more than four times greater than the risk of homicide among the general population
women who have undergone an abortion in the previous year:
treated 25 percent more often for injuries or conditions resulting from violence
CMA 2005
Abortion is not just a women’s issue!
PEI Health
The right careBy the right provider
In the right place