Dorries, The Times and Abortion/Preterm Delivery

Short version: Another day, another example of Nadine Dorries talking absolute rubbish.

Long version:

There’s a new post up at Nadine Dorries’s pseudoblog about an article which appeared in The Times yesterday, which reports on the preliminary results of a new epidemiological study by researchers at the University of Aberdeen which looks ta the association between abortion and the subsequent risk of preterm delivery.

Almost all the content of the post is lifted directly from The Times; all Dorries adds is an ‘Awww, look at the wickle premature baby’ photo and the following ridiculous comment:

This has been lifted directly from the Times – just as news reaches me that someone at the Times is furious the story ran and is re writing the research to provide a pro-abortion perspective. Really? Is this true? Can we trust any newspaper anymore?

The obvious retort here is ‘far more than we can trust you’ but in any case, the actual report that follows carries the byline of Mark Henderson, the paper’s science editor and it is neither pro-choice nor anti-abortion in tone for all that it does use the opposing quotes trick towards the end, offering it readers comments from Ann Furedi of BPAS and Josephine Quinatvalle of the Prolife Alliance.

For once, I’m not going to do over the statistics given in the article because what its reporting on is conference paper based on preliminary findings from as yet unpublished study. The report does cite a variety of statistical findings for apparent increases in the risk of a subsequent preterm delivery in women who have previously had one or more abortions. Unfortunately, all the statistical information is given in the form of relative increases in risk which, as research by Gerd Gigerenzer and others has shown, if by far the least reliable method of reporting health statistics as it tends to create a false picture of the actual levels of risk.

What I will note, however, is the key section of The Times report which sets out the limitations of this study’s findings [my emphasis]:

Sohinee Bhattacharya, who led the research, said women considering abortion should be told about the link to pre-term birth, though she cautioned that the vast majority can still expect a normal healthy pregnancy.

“I think that it’s something that should be brought to the notice of women, but the absolute risk isn’t large,” she said.

As the risk of pre-term delivery in a first pregnancy is about 6 per cent, the overall risk to women who have had one abortion is still less than 10 per cent, so more than 90 per cent will not give birth prematurely.

Some or even all of the effect, she added, could be explained by risk factors such as smoking, age and lower social class that are more common among women who have abortions, and which are also causes of preterm birth. The study did not control for the effects of smoking, a major cause of prematurity, because of insufficient data.

“The risk factors that are present in women who go for a termination are also the same risk factors that are responsible for preterm delivery,” Dr Bhattacharya said. “The group of women who have a termination are also possibly the same group of women at highest risk for pre-term delivery.

“The other possible explanation is the method of termination. Surgical terminations had a higher risk of pre-term delivery than medical terminations, so it could be that trauma to the opening of the uterus could result in some kind of damage that possibly results in increased risk.”

The risks of prematurity are also similar following both abortion and miscarriage, suggesting that similar effects may be responsible. Women who have had an abortion were also less likely to have an ectopic pregnancy or miscarriage than those with a previous miscarriage.

As with all previous studies looking at possible links between abortion and preterm delivery, the biggest issue facing researchers is the presence of a number of confounding factors which make it extremely difficult, if not impossible, to establish causality with any real degree of confidence. Several of the known risk factors for preterm delivery, such as smoking, age and low socio-economic class, are also ‘risk factors’ for abortion, i.e. women who exhibit those characteristics are more likely to have, or have had, an abortion than women who don’t. As a result, its extremely difficult to control adequately for confounding and arrive at anything approaching a reasonable estimate of the actual degree of addition risk that can be directly attributed to abortion.

That doesn’t mean that there is no risk, what it means is that there is a small additional risk of subsequent preterm delivery in women who have previously had an abortion but that that degree of risk is difficult to quantify with any reliability.

Dorries seems to think that this is a significant piece of new information and, based on her comment, one that pro-choice activists will be keen to suppress in order to ensure that women don’t learn the ‘truth’, i.e. she’s projecting, as usual.

That is just not how pro-choice advocates operate. We firmly believe is giving women honest and truthful information to help support them im making their own informed choices, a fact borne out by the contents of RCOG’s draft guidelines – which Dorries’ clearly hasn’tread – which includes the following section:

RECOMMENDATION 42

Women should be informed that induced abortion is associated with a small increase in risk of subsequent preterm birth, which increases with the number of abortions.

Evidence supporting recommendation 42

A systematic review and meta-analysis by Shah et al. (2009)180 suggests that a history of abortion is associated with a small increase in the risk of preterm birth giving an adjusted odds ration of 1.27 (95% CI 1.12–1.44) increasing to 1.62 (95% CI 1.27 to 2.07) with more than one abortion. A large Australian population study of 42269 births comparing term with pre-term deliveries supports these findings. In this study, women with a history of previous abortion had 1.25 (95% CI 1.13–1.40) times the risk of preterm birth compared to those with no history, increasing with number of previous abortions. The evidence increasingly supports the findings of previous studies which suggest a significant increase in the odds of preterm birth following abortion that lies somewhere between 1.2 and 2.0. Nonetheless these results should be interpreted with caution since few of the studies in the review controlled for confounders such as socio-economic status which is also associated with preterm birth. In addition no distinction is made between methods of abortion (medical versus surgical) or gestation where degrees of cervical dilatation vary widely and there is insufficient evidence to draw conclusions about the relative risks associated with medical and surgical procedures or the relationship with gestation.

The evidence also increasingly points to a relationship between miscarriage and preterm delivery. Whilst this has been conflicting in the past, systematic review evidence suggests that odds are similarly increased for both miscarriage and induced abortion. It is postulated that the increased risk is related to instrumentation of the cervix and uterus at the time of surgical evacuation, but further research is needed to increase understanding of the risk factors and the effects of gestation and abortion methods.

In short, tell us something we don’t already know and haven’t already openly acknowledged.

What this new study adds to the picture outlined by RCOG is confirmation – the strength of which has yet to be assessed – that the risk of subsequent preterm deliveries associated with early medical abortion is, as suspected, lower than that associated with surgical abortion, adding to the general picture which shows that if women are going to have abortions then its much safer that these should be done as early in the pregnancy as possible. That’s valuable information and the researchers are to commended for designing their study in such as way as to address an important question for which we previously lacked sufficient reliable evidence.

Dorries has, of course, consistently opposed liberalising measures intended to make it easier for women who do choose to have an abortion to have the procedure carried out early in pregnancy, i.e. during the first trimester, when the evidence shows that the risks of any subsequent complications or other sequelae are at their lowest.

The other interesting piece of evidence in both the article and in RCOG’s draft guidelines is that relating to miscarriage, which shows that the risks of preterm delivery are broadly the same for women who have had an abortion as they are for those who have a miscarriage.

Reliable statistical information for miscarriages is difficult to come by, although the excellent charity Tommy’s does provide some sobering estimates:

Miscarriage statistics

It is extremely difficult to obtain accurate statistics on miscarriage for several reasons, the main one being that the majority of miscarriages occur before the mother realises she is pregnant. If these unrecognised miscarriages are included, it is estimated that 40–60% of pregnancies ends in miscarriage. However, even if we restrict the figures to recognised pregnancies, the miscarriage rate is difficult to determine because many remain unreported. The following statistics are our best estimates based on the most reliable sources available. They may well be underestimates.

Incidence of miscarriage

– 1 in 4 women who get pregnant will experience a miscarriage.

– At least 15% of all pregnancies ends in a miscarriage.

Relative risk of miscarriage.

First Pregnancy: 5%

Last pregnancy a live birth: 5%

All previous pregnancies resulted in live birth: 4%

Last pregnancy miscarried: 19%

All previous pregnancies miscarriaged: 24%

For what its worth, from my own analyses of conception, birth and abortion statistics for teenagers in England and Wales, the data indictates a discrepancy between recorded conception rate and the combined figure for abortion and live birth rates of a little over 30 percentage points, i.e. 30% of teenage conceptions don’t result in either a live birth or an abortion. At least some of that discrepancy will stem from stillbirths and its possible that some teenagers disappear from the statistics because, having recorded a conception in England/Wales, either the birth or abortion takes place in another country. Nevertheless, it seems reasonable to assume that by far the largely component in this discrepancy stems from miscarriage.

So, for anyone who takes the view that abortion is morally wrong because life begins at conception, the estimate that anything from 40%-60% of pregnancies end in miscarriage when one takes into account unrecognised miscarriages early in pregnancy has to come as something of a shocker as – from a religious perspective that I personally don’t share – it rather suggests that ‘God’ is an abortionist par excellence who disposes of foetuses as rate that even the most enthusiastic pro-choice clinician would struggle to get anywhere close to.

I’m being facetious in that last paragraph, of course, but the serious point here is that one of the more obvious inferences from the data relating to miscarriage – in addition to the question RCOG raises about the possible impact of surgical evacuation on the cervix and uterus – is that miscarriage, like abortion, shares many of the same risk factors as preterm delivery. If true, this would lend further weight to argument that much of the reported increase in risk is due to the confounding effects of these risk factors and not directly attributable to abortion.

So, bearing all that in mind, what are we to make of Dorries unsubstantiated claim that moves are afoot to rewrite the article from a ‘pro-abortion’ perspective?

Given what I’ve shown you of the content of the draft RCOG guidance, the only foreseeable – and entirely reasonable – amendment that could be made to original article would be the inclusion of a statement from RCOG noting that the issues raised by this new research are pretty much already covered by its draft guidance, save for the new information on the differences in risk associated with early medical abortion and surgical abortion.

That, as should be obvious, would not amount to a ‘pro-abortion’ rewrite at all, it would merely add a statement of fact to the article – but then we already know perfectly well that Dorries has an extremely casual relationship with facts.