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Thursday, March 9, 2006

News coverage of this study just out in the New England Journal of Medicine raises a number of questions. The study is about the impact on abortion rates of parental notification legislation in Texas.

The main questions are:

What does Ted Joyce, an economist at Baruch College in New York and lead author of the NEJM study, really believe, and why did he tell reporters at the New York Times for an article that ran on Monday that parental involvement laws have "little impact"?

Are second-term abortions riskier than first-term abortions? How much riskier? Are abortion clinics in Texas providing prospective abortion clients with accurate information about the additional risks associated with later-term abortions?

Let's look at the details.

The NEJM study shows a significant decrease in teen abortions in Texas after passage of the parental notification law. That fact is emphasized in the headlines and content of every article I've seen on the study.

These include Laura Beil's article in the Dallas Morning News, Teen Abortion Down Since Notification Law Passed, and Lisa Falkenberg's article in the Houston Chronicle, Texas parental law might lower, delay teen abortion, as well as the Associated Press coverage which has been picked up all over the place.

What the NEJM study establishes is:

The researchers found that the abortion rate among 15-year-olds was 18 percent lower in the three years after the law went into effect than it was in the two years before. For 16-year-olds, the rate dropped 25 percent, and for 17-year-olds it fell 22 percent.
Laura Beil at the DMN puts this into context:

Abortion rates in Texas and nationally have been falling for more than a decade, but the new study, published today in the New England Journal of Medicine, suggests that the law has accelerated this trend. Among 18-year-olds – girls closest in age to minors but unaffected by parental notification – the decline was 7 percent.

The larger drop in rates among younger girls suggests the law may be making the difference.
Ted Joyce, lead author of the study, says in articles about the NEJM piece:

The law has definite behavioral effects," said lead researcher Ted Joyce, a Baruch professor of economics.
And yet, on Monday, in the article in the New York Times that says that parental involvement laws have "scant impact" on teen abortion rates, Ted Joyce is quoted as saying:

"There are ongoing trends that are pushing both birth rates and abortion rates down significantly, and those larger trends are more important than the effect of these laws," said Ted Joyce, an economist at Baruch College in New York who has studied parental involvement laws. He found they had limited effects on small subgroups of minors but little impact over all.
In fact, that's the money quote in the NYT article on which rests much of its credibility.

Asked by a Reuters reporter to account for the difference between the NYT results and the NEJM study, Joyce himself avers:

Joyce said that analysis [--the analysis in the NYT--ed.] had a different outcome because it included two states with tiny populations, one state where the law was overturned, and two states near areas where abortion is easily accessible without parental involvement.
But that comment doesn't explain why Joyce himself told the NYT that such laws have "little impact" overall.

I've written to Mr. Joyce to ask him about this.

Now, about the finding of the study that some 17-year-olds appear to be delaying abortions into the second-trimester in order to avoid their parents being notified about the abortion...

According to the Dallas Morning News story, the bottom line is that:

While this group's overall rate of abortion fell, the data suggested that many girls were postponing the procedure. The study found a spike in second-trimester abortions for those who became pregnant within six months of their 18th birthday, when they would be past the law's reach.

The numbers work out to about 70 extra second-trimester abortions each year in Texas.
Different news stories have said different things about what this means in terms of added medical risk.

Laura Beil in the Dallas Morning News says:

Later abortions can carry a higher risk of complications.
Lisa Falkenberg in the Houston Chronicle writes that second trimester abortions are "much riskier".

The Associated Press story says that:

Abortion later in pregnancy carries a much higher rate of deadly complications, though the overall risk is still extremely small.
The Houston Chronicle quotes Lawrence Finer of "the nonpartisan Guttmacher Institute" (the Guttmacher Institute is the research arm of Planned Parenthood, the nation's largest abortion provider) saying that:

"Abortion is a safe procedure, but it's less safe later in the pregnancy."
Lead study author Ted Joyce tells the Associated Press that later term abortions are:

...more difficult, more expensive and potentially more risky...
The questions that come to mind are:

(1) how much less safe is a second-trimester abortion, and what are the exact safety risks?

(2) of the seventy Texas women who waited until they were 18 in order to have a second-trimester abortion, did they suffer an adverse health impact due to these riskier abortions?

(3) most of all, what I'd like to know is whether Texas abortion clinics provided these young women with informed consent about the safety risks that go along with later-term abortions. It definitely sounds like second-term abortions carry health and safety risks to a greater extent than first-trimester abortions. What are those risks and were these young women informed of them? What research is being relied on to assert a higher level of risk?

I've written to Ms. Beil at the DMN and to Ms. Falkenberg at the Houston Chronicle and suggested that it would be worthwhile to do a follow-up article examining what young women are being told by abortion clinics about these increased risks, as well as determining whether there were any adverse health outcomes among the young women who did undergo second-trimester procedures.

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