Legal Abortion Deaths: Unreported, Misreported, & Covered Up

LEGAL ABORTION DEATHS: UNREPORTED, MISREPORTED & COVERED UP by James A. Miller According to the U.S. Centers for Disease Control (CDC)[1], the principal gatherer of United States abortion mortality statistics, there have been 240 maternal deaths due to legal abortion in the United States during the years 1972-1987 (See Table 1, below). The CDC began issuing Abortion Surveillance Reports in 1969 and a specific abortion death surveillance system was initiated in 1972. The death surveillance system came into being somewhat late; by 1971 abortion had been legalized in at least 16 states, particularly California and New York where legal abortions, essentially on demand, began on November 8, 1967 and July 1, 1970, respectively. Soon after legalization in the various states, medical journal articles and newspaper reports of legal abortion-related deaths began appearing with some regularity, but nearly two years elapsed before the CDC began its "official" death count. The CDC, however, had collected, and reported on, at least some of the data regarding maternal abortion deaths that occurred before 1972. Despite such collection, the CDC has never officially recorded any abortion deaths prior to that year and thus all CDC abortion death compilations begin with the year 1972. Maternal abortion deaths prior to 1972 The CDC's 1970 Abortion Surveillance Report dealing with "more than 180,000 legal abortions ... performed in the United States," stated that in New York City alone "eight deaths associated with legal abortion were reported between July 1 and December 31 1970," the first six months of legalization in New York State.[2] A ninth New York City abortion death in January 1971 was also reported.[3] The 1970 CDC abortion report also took note of a Joint Program for the Study of Abortion (JPSA) "based on 42,598 abortion case reports from 64 institutions" including four abortion clinics. That study, reported by the late Dr. Christopher Tietze, the abortion industry's chief guru of abortion statistics, disclosed that one death had occurred among the cases studied. However, "three additional deaths [we]re known to have occurred among...2,753 women excluded from the analysis of complications because of preexisting medical conditions and/or concurrent tubal sterilizations."[4] Those "three additional deaths" are apparently the earliest instance in the medical literature of an attempt to push legal abortion-related deaths out of the abortion category and to palm them off as either pregnancy-related or due to "pre-existing" conditions. Later on we shall meet additional examples of the ongoing efforts to whittle down the numbers of legal abortion-related deaths. Those defending legal abortion are basically arguing that, although deaths did result in certain abortion cases, the abortions themselves were perfectly safe and proper-it was the patients who were unhealthy! Of course, no such considerations are ever made in the case of pregnancy and childbirth-related maternal deaths; every such death, regardless of whatever pre-existing conditions may exist, is blamed on the attendant pregnancy or birth and invidious comparisons are often made with the allegedly greater safety of legal abortions.

In any event, 13 instances of legal abortion-related deaths were known and reported on by the CDC in its 1970 Abortion Surveillance Report. Yet, as already noted, not a single one of these deaths was ever officially recorded by the CDC in subsequent lists of abortion deaths. Actually, according to various reports, there were at least 16 legal abortion-related deaths in the year 1970: four in California[5], three in Maryland[6], one in Pennsylvania[7], and eight in New York City including one victim who made it home to Indiana and actually died there.[8] In 1971 the numbers of legal abortions reported to the CDC soared to over 480,000 but the CDC's annual Abortion Surveillance Report for that year took note of just one abortion death. The lone death reported was that of an "18-year-old woman in Arkansas [who] died of staphylococcal septicemia 10 days after she had a legal abortion induced by saline amniotic fluid exchange in a New York City hospital."[9] Somehow the CDC managed to ignore the increasing numbers of reported abortion deaths, particularly in New York City, which were appearing in the medical literature and newspaper articles. For the year 1971, there were at least 21 deaths reported in legal abortions: five in California[10], one in Hawaii[11], and 15 in the State of New York, three of whom actually died out-of-state.[12] For the two-year period 1970-71, therefore, a review of the available literature reveals that a minimum of 36 deaths occurred in the "safe and legal" abortions performed in the two years prior to when the CDC began its abortion death count. Abortion deaths covered-up in New York As seen above, at least 23 of the 36 reported abortion deaths during the years 1970-71 occurred as a result of abortions that took place in New York State, primarily in New York City. During those earlier years of legalized abortion in the United States, New York City quickly became not only the "abortion capital of the nation" but also the abortion death capital as well. On July 21, 1970, just three weeks after New York's new liberalized abortion law became operative, The New York Times reported the first legal abortion death in New York City.[13] The very next day, the Times reported two additional New York City abortion deaths.[14] In each of these three cases, attempts were made to minimize and explain away the tragic occurrences.[15] Although abortion legalization was supposed to usher in a new era in which bad old "back alley" abortions were replaced by new "safe and legal" procedures, the embarrassingly high numbers of New York abortion deaths were a problem that abortion proponents had to address. A new ploy soon emerged to cope with the situation: despite the newly-won legalization of abortion, as many abortion deaths as possible would be blamed on the alleged continuance of "illegal" or "criminal" abortions. Artificial distinctions were made between abortion deaths which followed procedures performed by a physician "under known auspices" (legal), and those which occurred subsequent to abortions performed "under unknown auspices" (illegal). In other words, if a woman died following an abortion performed by an unknown abortionist, the death would automatically be classified as one resulting from an "illegal" abortion. Additionally, those deaths which occurred out of state as a result of New York City abortions, while often noted in articles regarding New York abortions, seldom were included in the calculation of New York abortion death rates even when the "auspices" under which the abortion was performed were known.[16] By "sanitizing" the abortion mortality statistics in this manner, the number of New York City abortion deaths and the city's abortion death rate, were markedly lowered, leading to a false and far rosier picture of the safety of abortion in New York. A new element soon entered the picture: beginning October 19, 1970, all New York City abortions performed in physician's offices were branded as illegal under a new regulation added to the city's health code. Although New York State law allowed abortions to take place anywhere-hospitals, clinics or doctor's offices-New York City changed its regulations and "immediately forbade office abortions" following "two deaths [that] occurred ... as a result of abortions in medical offices ..."[17] Now the locale at which an abortion took place would be the determinant of the "legality" of the procedure. Articles regarding New York City abortion deaths occurring subsequent to the ban on office abortions, routinely distinguished between abortions performed in hospitals (legal) and those performed outside of hospitals (illegal). Little note however was taken of the newly opened so-called "freestanding" abortion clinics where an increasing number of the city's abortions were being performed, especially on nonresidents. One article spelled it out precisely: the Chief Medical Examiner of New York City stated that 7 of 12 deaths in a 6-month period had been due to "criminal abortions performed outside of the hospital" (emphasis added).[18] There it is-the abortions are "criminal" because they were performed outside a hospital. Seven abortion deaths were thereby dropped from the legal category-and thus excluded not only from the city's legal abortion death totals, but, more importantly, from the calculation of the city's abortion death rate. Similarly, another article reviewing the first six months of legal abortion in New York City presented a detailed table of "maternal deaths associated with abortions" which enumerated not only the "legal" abortion deaths, but also those designated as "illegal." Of the 12 cases presented, six were alleged to be "criminal" because they were "extramural," i.e., performed outside a hospital.[19] This article, incidentally, appears to be the only one in the medical literature that specifically identified-by initials of the name, age, etc.-victims of allegedly "illegal" abortions. Usually, as the CDC does in its listings, one is simply given the number of how many illegal abortion deaths occurred and left with no way of checking further. Accepting for the sake of argument that one death described in the article as "self- induced" was indeed so, that would still leave five deaths stricken from the legal abortion lists and shoved into the "criminal" category simply because of where the abortions happened to have been performed. (One "extramural" death was allegedly the result of a "lay person performed abortion," but, in view of the continued on next page sloppy and slipshod work so often done by "real" licensed abortion doctors, one wonders on what basis such a determination was made). Ectopic pregnancy deaths subsequent to induced abortion Through the years a number of ectopic pregnancy deaths have been identified as closely following an induced abortion, and, until the CDC changed its ground rules in 1979, such deaths were usually noted as abortion-related and at least included in abortion death totals. Such inclusion would seem to be entirely proper. After all, if the unfortunate victim had not elected to undergo an abortion but had instead sought non-abortive care and treatment of the pregnancy, the ectopic condition probably would have been diagnosed and timely, corrective action taken. The average abortionist, however, has little or no time to undertake such a diagnosis; in many, if not most instances, the abortionist first meets his patient on the operating table after she has been prepped for the abortion. Indeed, when the patient has elected general anesthesia, it is quite common, especially in a high-volume abortion clinic, for the abortionist never to see the patient while conscious. In such instances, the abortionist goes to work on an unconscious woman, performs the abortion procedure, and leaves before the patient awakens, perhaps to perform yet another abortion on another unconscious woman. A large number of abortion malpractice suits brought against various unknown "Doctor X's" afford vivid examples of the utter lack of prior examination or consultation between many abortionists and their prospective patients. Under such conditions, is it any wonder that many ectopic pregnancies were never identified among patients undergoing an abortion? Furthermore, many abortionists never bother to send to a pathology lab for examination whatever tissue is collected during the abortion procedure if any tissue is indeed collected. Little if any tissue would be extracted in an ectopic pregnancy situation, a sure sign that something was amiss with the abortion. Finally, having undergone an "abortion," even if nothing had actually happened nor any tissue collected, the woman involved would doubtless be lulled into a false sense of security since she supposedly was no longer pregnant. Under the circumstances any tell-tale signs of her ectopic condition might well be ignored and any gynecological examination deemed unnecessary. Yet all the while a proverbial time bomb was ticking away within her. Among the CDC Abortion Surveillance Reports which counted ectopic pregnancy deaths subsequent to induced abortions as abortion-related, were the reports of 1978, which identified 10 such deaths, 1979-1980 (19 deaths), and 1981 (21 deaths).[20] Although at first the CDC did include these ectopic pregnancy/induced abortion deaths in its abortion death totals, such deaths were regulated to a "separate subcategory of legally induced abortion" and excluded from the "calculation of legally induced abortion death-to-case rates," Accordingly, induced abortion-related deaths from ectopic pregnancy were "not ... aggregated with the other causes of death from legally induced abortion ... [as it was] felt that the pathophysiological process leading to death from ectopic pregnancy was not causally related to either the woman's choice of induced abortion or the physician's choice of the abortion procedure."[21] Thus, although the ectopic/abortion deaths were counted in the 'yearly legal abortion death totals, such deaths were counted out when it came to actually determining abortion death rates. Legal abortion was again made to appear far safer than it had actually proven to be. Next month: Abortion deaths in Maryland and others in New York.

U.S. legal abortion deaths as reported by the CDC 1972 24 1973 25 1974 26 1975 29 1976 11 1977 17 1978 9 1979 22 1980 9 1981 8 1982 11 1983 11 1984 12 1985 10 1986 10 1987 6 Total: 240 Source: CDC Morbidity and Mortality Weekly Report (MMWR), Vol. 41, No. SS-5, 4 Sept. 1992, p. 33.

ENDNOTES 1 The CDC, a division of the U.S. Department of Health and Human Services, has undergone a small name change but still uses the old acronym: Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333 2 CDC Abortion Surveillance Report Annual Summary 1970, pp. 1. 26-7. 3 Ibid, p. 29. 4 Ibid, p. 25 5 "Therapeutic Abortion-The California Experience," , Harper and Row, New York, 1973, p. 170. 6 Report on Therapeutic Abortions for Fiscal Year July 1, 1969 to June 30, 1970, Department of Health and Mental Hygiene, State of Maryland, issued Nov. 30, 1970, p. 4. 7 "Disseminated Intravascular Coagulation Complicating Hysterotomy in Elderly Gravidas," , Vol. 38, No. 6, December 1971, p. 844. 8 Note #2, op cit. 9 CDC Abortion Surveillance Report Annual Summary 1971, p. 25. 10 Note #5, op cit. 11 "The Hawaii Experience," , op cit, p. 179. 12 "Maternal Mortality Associated with Legal Abortion in New York State: July 1, 1970- June 30, 1972, , vol. 43, no. 4, March 1974, pp. 315-326. 13 "Abortion Death Reported By City," , July 21, 1970, p. 32. Although this death on July 19th, 4 days after a saline abortion, was the "first reported" abortion death in New York City, it was actually preceded by an abortion death on July 12th following a hysterotomy abortion on July 6. This death was one of two "new" deaths reported in the next day's paper. 14 "Abortion Curbs Put Off By City" , July 22, 1970, p. 38. The hysterotomy death case was incorrectly reported as occurring on July 6, the date of the abortion. 15 Ibid. In the "first reported death" case both of the articles in the Times reported that a heart aliment was "a contributory cause" of the death. The death subsequent to the hysterotomy abortion, which was performed under a general anesthetic, was described by the city's Chief Medical Examiner as "really an anesthesia death." In the third death case, which occurred on July 20th, "six days after a dilation and curettage abortion," it was prominently reported that the decedent "suffered from sickle cell anemia." The Times noted that New York City "medical authorities ... emphasized that the 3 deaths were not directly caused by the abortions themselves ..." 16 "A Report On the Abortion Capital Of the Country," "The New York Times", Section 6 (Sunday magazine), April 11, 1971, p. 10. The article reported that in the "over 100,000 legal abortions [which had] been performed in New York City" since legalization, there had been "14 deaths." The deaths were enumerated: "Seven resulted from procedures performed in hospitals and one from an abortion performed in a doctor's office. In addition, at least two deaths are known to have occurred out of state as a result of New York City abortions, one in Indianapolis and one in New Jersey. The Health Services Administration counts only those deaths occurring in New York City under known auspices>; this yields a rate of 8 deaths per 100,000 abortions...." (emphasis added). Note what has happened here: 14 deaths have been reduced to 8 by the simple expedient of eliminating 2 cases in which the victims managed to return home out of state, and 4 other deaths have been arbitrarily dropped because there was no known trail to the abortionist. (Because the New Jersey abortion death could not otherwise be verified. it is not included among our 36 deaths in 1970-71.) 17 "Editorial: Abortion Alert," , Vol. 42, No. 3, September 1973, p. 452. The article's author, Dr. Albert Altchek, an abortionist who admitted performing "approximately 5,000" abortions (p. 453), is the only source for the assertion that "two [office] abortion deaths" led to the change in the city's Health Department Regulations. All other articles regarding the early days of abortion legalization in New York City which mention an abortion death in a doctor's office, cite one such incident. Most of those articles specifically note that this particular death, which occurred on October 10, 1970, was a legal abortion only because it happened nine days before the new regulations went into effect. Because the second death could not be otherwise verified, it is another instance of a reported death not included in our total of 36 U.S. abortion deaths in the years 1970-71 (see note #16). 18 "Symposium on Legal Abortion," , Vol. 14, No. 1, March 1971, p. 316. 19 "Surveillance of the Abortion Program in New York City: Preliminary Report,"