It is odd that this author is aware of several of my older reviews of the literature but chose not to discuss my 2017 review which demonstrates that analyses from countries with record linkage data clearly demonstrate higher rates of mortality associated with abortion...especially from suicide, accidents, risk taking behavior and longer term cardiovascular diseases. See https://pubmed.ncbi.nlm.nih.gov/29163945/
Thank you for your question. I apologize for the delayed response.
My intent was to clarify the Raymond and Grimes paper and explain that the finding that legal induced abortion has a lower mortality rate than birth is robust to some uncertainties in the data.
Raymond and Grimes calculated the legal induced abortion-related mortality rate and live birth mortality rate based on the number of deaths "during or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy.” These risks are identified as causally related to pregnancies that end in birth or legal induced abortion and therefore related to the relative safety of birth and legal induced abortion.
In contrast, you and your colleagues reported results for pregnancy-associated deaths - death from all causes within a year postpartum. As you note in your review, correlation is not causation; risk of death in the year after birth or abortion is not the same as the risk caused by pregnancies that end in birth or abortion. Deaths that are not causally linked to birth or abortion (accidental and incidental deaths) cannot be attributed to birth or abortion.
Registry-based studies are extremely limited in their ability to assess any causal links between pregnancy associated deaths and birth/abortion. Registries do not have the information that is necessary to establish causation (temporality, link to behavior change, consideration of alternate explanations and isolation of the event) and frequently are not able to account for underlying or antecedent risk factors (like pre-existing mental illness as a risk for suicide), so they cannot disaggregate the impact of abortion or birth as opposed to other key factors and confounders.
This is why Gissler (lead author of 7 of 11 studies in your review) and colleagues have repeatedly cautioned that the Finnish Health Registry cannot provide the necessary context that would be required to make causal claims about abortion and pregnancy-associated deaths in the studies you review. Gissler and his co-authors have specifically written that, based on their secondary analyses, their findings do not support the hypotheses that abortion itself causes suicides, violent or accidental deaths and are more consistent with shared risk factors (for abortion and suicide and violent death) and protective factors related to childbirth (for injury related deaths).
Gissler has spoken with particular vehemence about the importance of contextual factors in the context of abortion and suicide ("[I]t's quite clear it's not the abortions").
It is nothing but a false assurance of abortion safety that carefully ignored all evidence to the contrary and especially the fact that the U.S. data is incomplete and inadequate for making such comparisons. Indeed, Gissler studies are especially important in that they have conclusively demonstrated that such comparisons of mortality rates are unreliable without record linkage.
Moreover, the definition of abortion related deaths includes deaths from suicide, but without record linkage and investigation of deaths from suicide, it is obvious that abortion related deaths have not been adequately investigated.
You, I and Gissler are all right that correlation is not causation. But proof of direct causal connections are NOT required for any other medical treatment before warning patients that the risk MAY exist. See: https://afterabortion.org/all-abortion-risks-must-be-disclosed/ wherein a federal appeals court upheld the necessity of informing abortion patients that abortion is associated with increased risk of suicide.
The most important fact, in my view, is that substantial numbers of women women themselves report that abortion has contributed to suicide attempts and suicidal ideation.
These are intelligent, self-aware witnesses. Self-attribution of abortion as a contributing factor in suicide attempts is DIRECT evidence of a causal connection.
Does it prove that every suicide following abortion is at least in part due the abortion, of course not! But it is absurd for pro-abortionists to pretend that abortion NEVER contributes to suicide when there is both correlational and direct evidence that it does contribute to at least some suicides. And in my view, it is very good evidence that the elevated rates of suicide and deaths from accidents and other risk taking evidence revealed in record linkage studies is identifying a causally connected risk. But as mentioned above, it is not necessary to prove a causal connection before women are entitled to know, by law, that there is a statistically associated risk. All claims to the contrary are an attempt to deceive women through false assurances.
“There is a dose effect, with exposure to each pregnancy loss associated with increasing risk of death. Higher rates of death from suicide, accidents, homicide and some natural causes, such as circulatory diseases, may be from elevated stress and risk taking behaviors.” That doesn’t mean the procedure itself is less safe than a whole pregnancy and childbirth. A lot of indirect factors and confounding variables. Mental health may by definition be worse in people who miscarry and have unwanted pregnancies than people who have live births of wanted pregnancies. Life circumstances may look totally different in these groups. Doesn’t make the procedure itself unsafe. Also, other countries may have different standards for abortion care than the US, thereby biasing the study and making the conclusions irrelevant for public health decisions in the US. Finally, only data from 11/900+ studies (from before 2017) on mortality related to pregnancy loss so this study is inconclusive at best.
For example, a recent survey we did of a random national population of found that of women reporting a history of abortion, 33% identified it as wanted, 43% as accepted but inconsistent with their values and preferences, and 24% as unwanted or coerced. On average, only the women the minority of women whose abortions were freely wanted, and consistent with their values and preferences, reported any benefits associated with their abortions. Unsurprisingly, the more pressure women faced to have abortions the more negative outcomes they had. See https://www.cureus.com/articles/146123-the-effects-of-abortion-decision-rightness-and-decision-type-on-womens-satisfaction-and-mental-health#!/
Also, your final two assertions are ridiculous. The data from other countries is not "irrelevant for public health decisions in the U.S." It is very important as it clearly establishes trends that should be considered relevant unless there is equally rigorous record based data from the U.S. proving that the results are differences that can be fully demonstrated by nationality. Moreover, if you read the review, you saw that record linkage between death certificates and U.S. Medicaid data from California ALSO demonstrated higher mortality rates among women similar to those shown in Finland and Denmark. That disproves your theory that these data points have nothing to tell us about abortions in the U.S.A.
Finally, you assert that "only data from 11/900+ studies (from before 2017) on mortality related to pregnancy loss so this study is inconclusive at best." But the whole point of systematic reviews and meta-analyses is to narrow down a wide range of studies to the small number that are meaningful and relevant. The fact that 889 studies DID NOT bother to look at death certificates associated with all pregnancy outcomes underscores why the 11 that did are the most important to consider.
The strong statistical results from multiple countries are hardly "inconclusive." Surely, they can be better understood with more research. But they are also clearly the benchmark that must be presumed to be the most accurate data at least until better research has been conducted that shows why those results are in error. But no such studies have been published, despite the easy availability of the data to pro-abortion researchers who would, if they could, be able to produce similar or better analyses. The fact that so few are willing to publish their findings on this question underscores that there is little or no interest in the truth...just as this article prefers to spin out false reassurances rather than address the hard and indisputable fact that abortion is associated with an ELEVATION in premature deaths among women, not a reduction in deaths. I agree, that most of the deaths do not occur within 48-hours, but they do become apparent within as little as six months, and become more apparent after the first anniversary data...when anniversary reactions begin to contribute to suicide rates and other self-destructive and risk taking behaviors.
It is odd that this author is aware of several of my older reviews of the literature but chose not to discuss my 2017 review which demonstrates that analyses from countries with record linkage data clearly demonstrate higher rates of mortality associated with abortion...especially from suicide, accidents, risk taking behavior and longer term cardiovascular diseases. See https://pubmed.ncbi.nlm.nih.gov/29163945/
Thank you for your question. I apologize for the delayed response.
My intent was to clarify the Raymond and Grimes paper and explain that the finding that legal induced abortion has a lower mortality rate than birth is robust to some uncertainties in the data.
Raymond and Grimes calculated the legal induced abortion-related mortality rate and live birth mortality rate based on the number of deaths "during or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy.” These risks are identified as causally related to pregnancies that end in birth or legal induced abortion and therefore related to the relative safety of birth and legal induced abortion.
In contrast, you and your colleagues reported results for pregnancy-associated deaths - death from all causes within a year postpartum. As you note in your review, correlation is not causation; risk of death in the year after birth or abortion is not the same as the risk caused by pregnancies that end in birth or abortion. Deaths that are not causally linked to birth or abortion (accidental and incidental deaths) cannot be attributed to birth or abortion.
Registry-based studies are extremely limited in their ability to assess any causal links between pregnancy associated deaths and birth/abortion. Registries do not have the information that is necessary to establish causation (temporality, link to behavior change, consideration of alternate explanations and isolation of the event) and frequently are not able to account for underlying or antecedent risk factors (like pre-existing mental illness as a risk for suicide), so they cannot disaggregate the impact of abortion or birth as opposed to other key factors and confounders.
This is why Gissler (lead author of 7 of 11 studies in your review) and colleagues have repeatedly cautioned that the Finnish Health Registry cannot provide the necessary context that would be required to make causal claims about abortion and pregnancy-associated deaths in the studies you review. Gissler and his co-authors have specifically written that, based on their secondary analyses, their findings do not support the hypotheses that abortion itself causes suicides, violent or accidental deaths and are more consistent with shared risk factors (for abortion and suicide and violent death) and protective factors related to childbirth (for injury related deaths).
https://doi.org/10.1177/14034948990270010201
https://pubmed.ncbi.nlm.nih.gov/16051655/
Gissler has spoken with particular vehemence about the importance of contextual factors in the context of abortion and suicide ("[I]t's quite clear it's not the abortions").
https://mashable.com/article/abortion-mental-health-science
You will find my rebuttal of the Raymond and Grimes paper here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6027034/
It is nothing but a false assurance of abortion safety that carefully ignored all evidence to the contrary and especially the fact that the U.S. data is incomplete and inadequate for making such comparisons. Indeed, Gissler studies are especially important in that they have conclusively demonstrated that such comparisons of mortality rates are unreliable without record linkage.
Moreover, the definition of abortion related deaths includes deaths from suicide, but without record linkage and investigation of deaths from suicide, it is obvious that abortion related deaths have not been adequately investigated.
You, I and Gissler are all right that correlation is not causation. But proof of direct causal connections are NOT required for any other medical treatment before warning patients that the risk MAY exist. See: https://afterabortion.org/all-abortion-risks-must-be-disclosed/ wherein a federal appeals court upheld the necessity of informing abortion patients that abortion is associated with increased risk of suicide.
The most important fact, in my view, is that substantial numbers of women women themselves report that abortion has contributed to suicide attempts and suicidal ideation.
https://abortionrisks.org/index.php/Self-Destructive_Behavior#Suicide
These are intelligent, self-aware witnesses. Self-attribution of abortion as a contributing factor in suicide attempts is DIRECT evidence of a causal connection.
Does it prove that every suicide following abortion is at least in part due the abortion, of course not! But it is absurd for pro-abortionists to pretend that abortion NEVER contributes to suicide when there is both correlational and direct evidence that it does contribute to at least some suicides. And in my view, it is very good evidence that the elevated rates of suicide and deaths from accidents and other risk taking evidence revealed in record linkage studies is identifying a causally connected risk. But as mentioned above, it is not necessary to prove a causal connection before women are entitled to know, by law, that there is a statistically associated risk. All claims to the contrary are an attempt to deceive women through false assurances.
“There is a dose effect, with exposure to each pregnancy loss associated with increasing risk of death. Higher rates of death from suicide, accidents, homicide and some natural causes, such as circulatory diseases, may be from elevated stress and risk taking behaviors.” That doesn’t mean the procedure itself is less safe than a whole pregnancy and childbirth. A lot of indirect factors and confounding variables. Mental health may by definition be worse in people who miscarry and have unwanted pregnancies than people who have live births of wanted pregnancies. Life circumstances may look totally different in these groups. Doesn’t make the procedure itself unsafe. Also, other countries may have different standards for abortion care than the US, thereby biasing the study and making the conclusions irrelevant for public health decisions in the US. Finally, only data from 11/900+ studies (from before 2017) on mortality related to pregnancy loss so this study is inconclusive at best.
The "procedure itself" should be performed only when there is evidence that the benefits outweigh the risks. That is why abortion providers should screen for the 15 risk factors identified by the American Psychological Association that identify women at highest risk of negative mental health outcomes following abortion. See https://www.cureus.com/articles/146123-the-effects-of-abortion-decision-rightness-and-decision-type-on-womens-satisfaction-and-mental-health#!/
For example, a recent survey we did of a random national population of found that of women reporting a history of abortion, 33% identified it as wanted, 43% as accepted but inconsistent with their values and preferences, and 24% as unwanted or coerced. On average, only the women the minority of women whose abortions were freely wanted, and consistent with their values and preferences, reported any benefits associated with their abortions. Unsurprisingly, the more pressure women faced to have abortions the more negative outcomes they had. See https://www.cureus.com/articles/146123-the-effects-of-abortion-decision-rightness-and-decision-type-on-womens-satisfaction-and-mental-health#!/
Also, your final two assertions are ridiculous. The data from other countries is not "irrelevant for public health decisions in the U.S." It is very important as it clearly establishes trends that should be considered relevant unless there is equally rigorous record based data from the U.S. proving that the results are differences that can be fully demonstrated by nationality. Moreover, if you read the review, you saw that record linkage between death certificates and U.S. Medicaid data from California ALSO demonstrated higher mortality rates among women similar to those shown in Finland and Denmark. That disproves your theory that these data points have nothing to tell us about abortions in the U.S.A.
Finally, you assert that "only data from 11/900+ studies (from before 2017) on mortality related to pregnancy loss so this study is inconclusive at best." But the whole point of systematic reviews and meta-analyses is to narrow down a wide range of studies to the small number that are meaningful and relevant. The fact that 889 studies DID NOT bother to look at death certificates associated with all pregnancy outcomes underscores why the 11 that did are the most important to consider.
The strong statistical results from multiple countries are hardly "inconclusive." Surely, they can be better understood with more research. But they are also clearly the benchmark that must be presumed to be the most accurate data at least until better research has been conducted that shows why those results are in error. But no such studies have been published, despite the easy availability of the data to pro-abortion researchers who would, if they could, be able to produce similar or better analyses. The fact that so few are willing to publish their findings on this question underscores that there is little or no interest in the truth...just as this article prefers to spin out false reassurances rather than address the hard and indisputable fact that abortion is associated with an ELEVATION in premature deaths among women, not a reduction in deaths. I agree, that most of the deaths do not occur within 48-hours, but they do become apparent within as little as six months, and become more apparent after the first anniversary data...when anniversary reactions begin to contribute to suicide rates and other self-destructive and risk taking behaviors.