NARAL Pro-Choice Missouri : Issues : Fact Sheets

I. THE ALLEGED “MEDICAL RISKS” OF ABORTION ENUMERATED IN THE BILL ARE NOT RISKS AT ALL, BUT JUNK SCIENCE CONJURED FOR POLITICAL MOTIVES.

A. The Laundry List of “Complications” and “Risks” Has No Basis in Fact.

S.B. 793 is replete with problems for the relationship between patients and their doctors. The bill operates from predicate assumptions that have been demonstrated to be medically false. Section 188.027 (1) b. requires that the same doctor who is to perform an abortion deliver to the patient, in writing, a laundry list of complications that are statistically infinitesimal in terms of risk analysis. It further directs that physician to make written disclosure of at least all of the following: “[t]he immediate and long-term medical risks to the woman associated with the proposed abortion method including, but not limited to, infection, hemorrhage, cervical tear or uterine perforation, harm to subsequent pregnancies or the ability to carry a subsequent child to term, and possible adverse psychological effects associated with the abortion.” These requirements exist without regard to the doctor's medical judgment as to appropriate communication of realistic risks to the patient.

Although these requirements may “sound like” the language of informed consent, so-called abortion trauma syndrome (surely encompassed in the language “adverse psychological risks,”) has been proven to be a political, not a medical condition. The American Medical Association, and many other regulatory medical organizations, agree that there is no such thing as “abortion trauma syndrome” and that in reality, the emotion most often experienced by women post-abortion is relief. [1]^,[2] Likewise, “harm to subsequent pregnancies or the ability to carry a subsequent child to term” is politically manufactured and not an actual significant risk to a woman having an abortion. Not one sound scientific study has divulged any link between a safe, legal abortion and subsequent unhealthy pregnancies.[3]

Nor has any reputable study established any link between abortion and breast cancer, a favorite myth of anti-choice activists; indeed, the United Kingdom's Cancer Research Institute studied 83,000 women post-abortion and found a correlation of zero between abortion and breast cancer. As to S.B. 793's emphasis on “cervical tears” and “hemorrhage,” medical authority shows these risks to be extremely negligible. Cervical tears make up 0.6%-1.2% of complications from surgical abortion, punctures of tears of the uterus comprise less than 0.4% of complications from surgical abortion, and excessive bleeding medically indicating a transfusion makes up 0.02-0.3% of complications from surgical abortion.[4]

Abortion is a safe medical procedure. Induced abortion in the first trimester causes approximately one death per million abortions.[5] In fact, a woman is ten times more likely to die during childbirth than when having an abortion.[6]

Couching further unnecessary work for doctors in the language of informed consent cannot cloak the bill's true purpose of giving the state's imprimatur to coercing women, through guilt and shame, to bear children they do not want. Further evidence of the bill's purpose is found in the requirement that medical professionals provide color photographs of a fetus at two-week gestational increments; requiring them to tell the woman that she can view an ultrasound or hear the fetal heartbeat at state-approved facilities without charge; the fetal anesthesia provision; and the requirement that facilities providing abortion care post statements about alternatives to abortion and the biological father's legal duty to pay child support.

Despite the obvious intent of such provisions to induce guilt and shame, and thereby deter the woman from obtaining an abortion, they may be found constitutional depending on the jurisdiction in which one lives, or even the court by which a case is heard. Courts disagree on the permissible limits of a wide range of Targeted Regulations of Abortion Providers (TRAP) laws, and they also are not uniform in how far a state may go in defining the contours of informed consent.

Courts may yet draw a distinction between mandating that a medical facility show a woman an ultrasound and asking her if she wants to see one, and between mandating fetal anesthesia and asking the woman if she wants it. Other courts might find the whole enterprise insidiously coercive. Still other courts might examine 22-week fetal anesthesia provisions and find them prima facie manipulative or misleading, regardless of whether the anesthesia were mandatory or at the woman's option, because the weight of reliable research suggests that a fetus could not feel pain at 22 weeks.[7]

State-mandated “informed consent” laws survive constitutional muster only if they are truthful and not misleading.[8] This precept applies to state-required physician “scripts,” state-written materials as required by S.B. 793, and statutorily mandated “optional” fetal ultrasounds and fetal heartbeat experiences for the abortion-care patient. As discussed above, the courts have tended in TRAP cases and cases involving a claim of state-coerced speech to weigh statutorily language differently and to assign importance to different factors. There is no sure predictor of how a reviewing court would treat the question of mandatory versus optional ultrasounds, the 22-week requirement for optional fetal anesthesia, or even the veracity of state-prepared materials (which have not yet been prepared). It is always possible that a court could examine the totality of requirements embodied in S.B. 793 and find that, in the totality of the circumstances, the law fails under Casey's “truthful and not misleading” test, or under Casey's coterminous “undue burden” test (considering as well the particular requirements on waiting periods and other highly specific requirements on physicians).

Regardless of any legal analysis, the bill largely rests on specious science and for that reason, reflects poor policy choices.

[1] Scotland, Nada, “The Myth of Abortion Trauma Syndrome.” JAMA 1992, 268 (15), 2078-79.

[2] Broen, Anne, et al. “Course of Mental Health After Miscarriage and Induced Abortion: A longitudinal, Five-Year Follow-Up Study.” BMC Medicine 2005, 3:18.

[3] See, e. g., http://www.washingtonpost.com/wp-dyn/content/article/2007/08/15/AR2007081501737.html (summarizing studies, including a large-scale 2007 JAMA study).

[4] Henshaw SK, Unintended pregnancy and abortion: a public health perspective, in: Paul M et al., eds., A Clinician's Guide to Medical and Surgical Abortion, New York: Churchill Livingstone, 1999, pp. 11–22.

[5] Bartlett, L.A., et al. “Risk Factors for Legal Induced Abortion-Related Mortality in the United States.” Obstetrics and Gynecology, 2004, 103 (4): 729-37.

[6] “Fact on Induced Abortion.” http://www.guttmacher.org/pubs/fb_induced_abortion.html. See also: Grimes DA (1994). "The morbidity and mortality of pregnancy: still risky business". AJOG (2004) 170 (5 Pt 2): 1489–1494.

[7] Section 188.027 (5) requires that the medical facility inform the woman that fetal anesthesia is available. It also requires the facility to inform the woman that by 22 weeks' gestational age the fetus has the necessary anatomical structures/apparatus to feel pain, and that at 22 weeks' gestational age a fetus may be observed in a study to evade stimuli that the researchers in that particular study interpreted as a response to pain. The weight of scientific research, however, suggests that a fetus could not feel pain earlier than 23-29 weeks' gestational age, largely because neural receptors are insufficiently developed. See, e. g., Richardson, C.T. & Nash, Elizabeth, “Misinformed Consent: The Medical Accuracy of State-Developed Counseling Materials,” Guttmacher Policy Rev., v. 9, n. 4 (fall 2006).

[8] Planned Parenthood of Pa. v. Casey, 505 U.S. 833 (1992).