Public Health Impact of Legal Abortion in the US: 40 Years Later (2012 Study)
Scientifica (Cairo). 2012;2012:980812. doi: 10.6064/2012/980812. Epub 2012 Dec 13.
Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later.
Thorp JM Jr.
During the 40 years since the US Supreme Court decision in Doe versus Wade and Doe versus Bolton, restrictions on termination of pregnancy (TOP) [abortion] were overturned nationwide. The use of TOP was much wider than predicted and a substantial fraction of reproductive age women in the U.S. have had one or more TOPs and that widespread uptake makes the downstream impact of any possible harms have broad public health implications. While short-term harms do not appear to be excessive, from a public perspective longer term harm is conceiving, and clearly more study of particular relevance concerns the associations of TOP with subsequent preterm birth and mental health problems. Clearly more research is needed to quantify the magnitude of risk and accurately inform women with the crisis of unintended pregnancy considering TOP. The current US data-gathering mechanisms are inadequate for this important task.
PMID: 24278765 [PubMed] PMCID: PMC3820464
The natural experiment in abolishing most restrictions on TOP initiated by the US Supreme Court in 1973 has proven the fallacies inherent in expert predictions. First, uptake of this procedure by women was far greater than predicted and in 2012 one out of three women in the US will have a TOP by the age of 45 [310, 311]. Second, a myopic focus on short-term complications has documented, albeit incompletely, the relative safety of the procedure at early gestational ages, but failed to adequately explore the long term health consequences. This is of particular importance with such widespread uptake of TOP where even modest increases in hazard ratios can have a huge impact on a population's health. The example of PTB stated herein is illustrative of this impact. The health impact of TOP is further befuddled by a paucity of reliable epidemiologic data on TOP and an inability to reliably know how often TOP is performed in the US and link administrative databases. Putting aside for a moment ethical considerations on the moral status of the embryo or fetus versus the status of his or her mother (which science is inadequate to address), there is a vacuum in TOP epidemiology and a real need to improve and upgrade our sources of observational data. Respect for maternal autonomy and the difficult decisions a woman faces in an unintended or crisis pregnancy must be considered [sic] cry out for nothing less.