Abortion-choice advocates often say, “Abortion is safe.” They believe it’s safe for the mother and some even say it’s safer than childbirth. In this three-part series we address each of these questions: (1) Is abortion safe? (2) Is abortion safe for the mother? And, (3) is abortion safer than childbirth?

In parts 1 and 2 of this series, we’ve seen how abortion is dangerous on many levels. Even when we admit the safety benefits of improved medical knowledge and technology, reasonable people still should not grant that abortion is generally safe or that it’s safe for mothers specifically.

Click here for Part 1: Is Abortion safe?
Click here for Part 2: Is Abortion safe for mothers? 

Another problem remains, however. If abortion is safer than childbirth then pregnant women may still be justified seeking abortions for safety reasons. But is abortion safer than childbirth? Abortion-choice advocates often claim abortion is safer than childbirth, even claiming that “abortion is 14x’s safer.”[1] How are we to understand this bold claim about “safe abortion”?

The Raymond And Grimes Study

It’s a pretty radical claim to say that abortion is 14 times safer than childbirth. It’s so radical, there’s only one source that claims they can prove it. It’s a journal article from abortion-choice researchers Elizabeth Raymond and David Grimes (hereafter, “RG study”).

Elizabeth G. Raymond and David A. Grimes, “The Comparative Safety of Legal Induced Abortion and Childbirth in the United States,” Obstetrics and Gynecology, 119 (Feb 2012), pgs. 215-219.

This article has become one of the most popular citations regarding “safe abortion.” It’s easy to read (5 pages), easy to access (free online), it’s written by one of the biggest names in the pro-choice lobby (David Grimes), and it cites recognized resources (CDC and Guttmacher). Whenever people say, “Abortion is 14x’s safer than childbirth” they are referencing the RG study (like Reuters, USNews, FoxNews, DailyKos, Time, Reddit, Public Radio, Huffington Post, Relias Media, and Slate).

There is a reason, however, why no other study claims to demonstrate that it is 14x’s safer than childbirth. They can’t corroborate that enormous claim. The RG study might be the most famous, and most widely cited paper on the subject, but despite its popularity, it’s pretty much useless.

Now I know people on the internet can exaggerate things going way beyond the evidence. But I’m picking my words carefully here. The RG study is bad methodology, it’s poorly researched, it’s poorly argued, it’s evidentially weak, it doesn’t support its conclusion, and it isn’t even titled right. This paper is pretty much useless because it’s irreparably flawed.

What’s wrong with the Raymond & Grimes Study, you may ask?

1. The data sets don’t compare

The overarching problem for the RG study is they use critically different data sets that don’t compare with each other.

To illustrate this point consider which is healthier, a dozen elementary children or a dozen senior citizens? Before you answer, would it matter if the elementary children all had terminal cancer and the senior citizens were all part of an endurance running club? When two data sets are compared without controlling for the variables you end up with a faulty comparison. That’s what’s happening in the RG study.

More specifically, the RG study compares the mortality rates for birth mothers and for abortion patients but they didn’t show that those data sets are gathered and sorted in the same way.

Comparing two data sets, without accounting for these critical differences is irresponsible research. That’s why the primary source for the researcher’s data, the Center for Disease Control (CDC), was cited in supreme court testimony showing that the data sets don’t compare (in Gonzalez vs. Planned Parenthood, 550 US 124 [2007], pg. 4).

2. The data sets differ in scope.

How does the RG study make a bad comparison between abortion deaths and childbirth deaths? For one thing, it uses abortion numbers from the Center for Disease Control (CDC) yet these stats exclude Maryland, California, New Hampshire, Washington DC, and New York City. Those places haven’t reported their abortion stats to the CDC in years. Meanwhile, all cities and states are required to report childbirths and any related deaths. If RG were serious about aligning their measurement standards for both data sets, they would have excluded childbirths and pregnancy-related deaths from those same areas. This oversight suppresses the stats on abortion-related fatalities, especially since with California it’s size and politics suggest it might have the most abortions of any state.

3. States are required to report childbirths and maternal deaths, but not abortion or abortion-related deaths.

The reason states like California, Maryland and New Hampshire can avoid reporting abortions and abortion-related death is because all abortion reporting is voluntary. Cities and states aren’t required to report abortions or abortion-related deaths to any state or federal authorities. Meanwhile, they are required to report all childbirths and birth-related deaths. We can only expect disparate numbers since childbirths are carefully and extensively counted for the sake of state population records, tax brackets, census data, and insurance claims. But abortion-related deaths, are only reported on a voluntary basis and many states have no great incentive there either.^[2]

It would be monumentally inconvenient to gather and report abortion stats using informal measures since the whole field is steeped in privacy and it’s a political hot button. How can states accurately report on abortion services if they are supposed to stay out of it and not invade women’s privacy on the matter? The RG study overlooks this disparity and offers no balance to correct against it.

4. Voluntary reporting leads to misreporting

Since abortion-related deaths do not have to be reported as such, that means they can be attributed to other causes with no mention of the abortion. When a woman dies from hemorrhaging after an abortion-pill, for example, that abortion might be reported as a miscarriage and the mother’s death chalked up to childbirth-complications. In that way, misreporting can invert the data, faulting childbirth when abortion was to blame.

We don’t currently know how often this may be happening. It could be rare or it could be common. We just don’t know. But we cannot responsibly trust the conclusion of the RG study either till we have some sense of how often those abortion-deaths are masked as childbirth-deaths. Since we are probably only talking about numbers that are a fraction of a percent, then even a small number of misreported abortion-deaths can drastically shift the statistics.[3]

5. The calculations inflate birth-related deaths but not abortion-related deaths.

Another problem is that, compared to abortion mortality rates, the “maternal mortality rate” is inflated. “Maternal mortality is determined by dividing maternal deaths by live births, not by pregnancies. . . . This will necessarily tend to inflate the mortality rate, as many pregnancies end in miscarriage or stillbirth” (Gonzalez vs. Planned Parenthood 2004, pg. 4).[4]

In other words, the maternal mortality rate takes all birth-related deaths (the numerator) and divides them by only live births (the denominator), so all stillbirths and miscarriages are only addressed in the top number and not the bottom. The result is an inflated mortality rate. This problem doesn’t exist, however, with the abortion mortality rate. So, again, these statistics aren’t comparable.

6. The study deals only in mortality rates

Health and safety are more than just death statistics. The RG study claims to talk about health and safety under the banner of “comparative safety” but the body of the study ignores everything but mortality rates. The title is false advertising. Even if Raymond and Grimes were to prove their case, showing that abortion generates fewer maternal deaths than does childbirth, they would still need to expand their study to include at least a representative set of other health risks before the paper could live up to its title. If RG were more modest in their titling it would fit their study, but as it stands, the title claims more than the article is designed to prove.

7. The study counts all fatalities during pregnancy as caused by child-birth.

If the RG study were trustworthy, they would take care to exclude false positives, where pregnant women die of other causes unrelated to childbirth or abortion. The study is careful to avoid false positives for abortion cases, but not so careful with childbirth cases.^[5]

If a woman has an abortion and, on her way home from the clinic, dies in a car accident she would not be included in the RG study. But if the same woman, instead, delivered her child, and was killed in a car accident within one year of giving birth, the RG study would include her as a pregnancy-related death. This is blatant a double-standard. It pads the numbers so RG can make the safety risks in childbirth look worse than they really are. Padded numbers generate bloated conclusions. Not to mention, if an abortion patient dies during the procedure clinicians can chalk that up to “childbirth-related death” so it’s less embarrassing to the family, and they have a better chance of claiming insurance benefits.

This double-standard is all the more troublesome because if the same measure were used for both childbirth and abortion then abortion would appear 2-4x’s deadlier than childbirth.[6] Abortion correlates with higher rates of murder, drug-related death, and suicide, but the RG study excludes those cases from the abortion data while including those cases in the data on childbirth. It’s a flagrant double-standard that, by itself, ruins the credibility of the RG study.

8. The study excludes non-clinical abortion but includes non-clinical childbirth.

Another way the RG stats aren’t comparable is that the study excludes abortions performed outside of a legal clinical setting, while including non-clinical childbirths. All childbirths have to be reported to the state, but abortions do not. Abortion looks safer when it excludes all the Do It Yourself (DIY) abortions, back-alley abortions, and criminal misconduct abortions, such as domestic violence cases killing the mother and child together.

Bear in mind, childbirth is legal in almost any setting, but abortion is not. Some mothers have been known to attempt natural birth at home or in unusual settings like a jacuzzi (water birth), under hypnosis, or in an acupuncture studio. These unconventional approaches can invite obscure risks that don’t reflect the relative safety of childbirth in a conventional hospital delivery.

9. This study is second-hand and less substantial than other works in this subfield.

As far as research articles go, this piece is all icing and no cake. It’s “second-hand” in the sense that the authors rely entirely on borrowed stats (from CDC and Guttmacher) without doing any original research or even reformulating the data to eliminate variables and make them a fair comparison. It’s less substantial in that it’s a short article, drawing a shallow conclusion, from underdeveloped data. It is not pooling and reviewing multiple studies, proposing new insights or refreshing clarity into the field, or pioneering any new or innovative research. It does not have the marks of serious scholarship except that it’s published in a research journal.

It’s no surprise then to see primary sources and original research discrediting the RG study such as the 2013 study by Byron Calhoun and undercutting testimony by the CDC in federal court.

10. Their conclusion isn’t supported anywhere else.

Another test for serious scholarship in medical research journals is whether the conclusion can be verified, by repeating it elsewhere. But the RG study fails here too. No other researchers have been able to verify the bloated claim that “abortion is 14x’s safer than childbirth.” Instead, we find multiple studies point the other way. Abortion patients in Denmark, for example, show a higher mortality rate compared with birthing mothers in a 2012 study by Reardon and Coleman and again in a subsequent study the same year. Another 2004 study in Finland established that abortion patients in Finland showed a 6x’s higher suicide rate, 4x’s higher accidental death rate, and 10x’s higher homicide rate compared to other women. Expert Witness Dr. John Thorp Jr., testifying in Planned Parenthood of Wisconsin v. Van Hollen (2013), mentions these and other studies that are all more extensive in their research method and all of them undermine or contradict the RG study.[7]

11. Past abortions can cause pregnancy complications later in life.

Another glaring oversight in the RG study is that it overlooks how past abortions may have increased increase the chance of complications and death in childbirth, later in life. Abortion is tied to ectopic pregnancies, where the fetal human fails to implant in the uterus.[8] Post-abortion women are 2-4xs more likely to have an ectopic pregnancy, and as many as 12% of all maternal deaths are tied to ectopic pregnancies.[9] If a mother dies giving birth, the RG study would count that as a “childbirth-related death” even if all her complications stem from a past abortion.

Pregnancy complications can also stem from pelvic inflammatory disease, a condition occurring in as many as 30% of women post-abortion.[10] And the risk of miscarriage, stillbirth, premature delivery, malformation (disfigured child), escalates as much as 1,000% for women who’ve had abortions.[11] The rate of placenta previa, a life-threatening condition where the placenta covers the cervix, escalates 500-700% for post-abortion women.[12] While most pregnancy complications don’t directly threaten the mother’s life, they can motivate a cesarean section (C-section), and that’s a lot riskier than conventional delivery.

12. The RG Study does not distinguish between inherent and chosen risks

The RG study doesn’t distinguish between the risks built into the procedures and the risks that mothers choose for the sake of reaching their goals. If her goal is to have a healthy baby, she may be willing to risk personal injury or even death to give her child the best chance possible. In some cases, that decision may be foolhardy, but in other cases, it could be heroic. Either way, the heightened risk was not from the procedure itself but from the mother’s choices directing that procedure. In this way, expectant mothers tend to work from a different moral metric then women who just want to terminate the pregnancy. It’s simplistic, and a bit misleading, to ignore the difference between inherent and chosen risks.

The Problems Go beyond the Raymond & Grimes Study

13. Additional reporting problems skew the data

Besides the problems discussed above, there are many other reporting problems undercutting the conclusions in the RG study and any other study claiming to show that abortion is safer than abortion.[13]

• Additional risk factors: Anorexia, high blood pressure, obesity, or depression, for example, could override abortion and childbirth as the primary threat to the mother’s life.
• Time-Frame: There’s no consensus on the relevant time frame for “abortion-related” or “childbirth-related” fatalities. Six months after? Six weeks after? Six years?
• Incomplete Medical Records: A mother’s death can be attributed to a blood clot, hemorrhage, or sepsis instead of the underlying cause, abortion.
• Swapping Records: Women can experience life-threatening complications with abortion and go to the ER, but if they don’t report their abortion there, it may be chalked up as childbirth-related complications.
• Short-term Bias: Abortion may not be as safe as it looks in the short term because post-abortion women, over the long term, have a higher rate of behavior problems like substance abuse, depression, and suicidal behavior.
• Patient Self-interest: shame, regret, and embarrassment can pressure women to underreport and misreport complications relating to their abortion.
• Clinic Self-interest: abortion clinics, drawing primarily from abortion-seeking patients, can suppress reports of abortion complications to avoid losing clients and hurting profits.
• Meticulous vs. Loose Reporting: John Thorpe explains, “[P]regnancy related deaths are systematically sought and investigated by state government-sponsored commissions and the majority of states formally link birth certificates to death certificates. These efforts, which cannot currently be done for [abortion], double the number of pregnancy-related deaths discovered” (art. 18).

14. There simply is no credible comprehensive comparison study for the health risks of abortion and childbirth.

The available data simply isn’t comprehensive enough to support the kind of sweeping claims the RG study. Only partial, incomplete, and suggestive evidence is available at this point. There is no mandatory reporting on abortions, nor abortion complications. And the many factors listed above need to be considered before a meaningful comparison can be made for the U.S. For these reasons, expert witness Dr. John Thorp concludes “any meaningful comparison between the health risks” of abortion and childbirth “is precluded at this time.”^[14]

So, the Raymond and Grimes study has proven untrustworthy. And any studies that lean heavily on RG or which use similar methodology are likewise discredited. But even if the source isn’t trustworthy source, is it still correct? Could abortion be safer despite those flaws?

Is Abortion Safer?

The best evidence we have so far suggests childbirth in the U.S. is safer than abortion, but that’s suggestive evidence and not a conclusive comparison. As long as states do not have to report abortions, and as long as shame, silence, and politics suppress the data, then we will struggle to find the extensive and reliable stats needed for journal-quality reporting. Thorp concludes, “There are numerous reasons why any comparison between maternal deaths to abortion deaths,” at this time, is not “valid or sound” (Thorp 2013, art. 15). In short, anyone claiming to have statistical proof that abortion is broadly safer than childbirth is wrong. Before a person can wear the mantle of science declaring “Abortion is safer than childbirth,” he or she will need better statistics than are currently available.

On the contrary, we have lots of suggestive evidence and partial reports indicating that full-term childbirth is likely the safer choice. But our conclusions must be tentative since we lean on outside research from other countries (like Finland and Denmark), and we have to use inference and estimation to fill reporting gaps.

1. There are numerous factors suppressing the data, and they overwhelmingly favor abortion by hiding its true danger.

• Patient Shame and Secrecy Favors Abortion: Women often feel moral, social, and cultural pressure to hide their abortion. But childbirth isn’t so easily hidden, for obvious reasons.
• Inconsistent Follow-Up Favors Abortion: Only about ½ to 1/3 of abortion patients return for follow-up care, thus reducing the chance that their complications are reported (Thorp 2013, art. 14). Birthing mothers routinely return for follow-up care.
• Institutional Bias Favors Abortion: Abortion-providers have an institutional bias so that, as far as they are legally allowed, they can benefit from under-reporting abortion complications. There are few or no negative consequences if they under-report. They can, instead, report only positive or negligible consequences while creatively attributing any major complications to extenuating circumstances or prior conditions. Childbirth complications, however, are meticulously reported by law.
• Reporting Limitations Favor Abortion: There is far better reporting on birth-related complications and death than for abortion. The two main sources for abortion stats are the CDC and Guttmacher Institute. The CDC is hampered by two-levels of voluntary reporting. Clinics voluntarily report to the state health boards. And state health boards voluntarily report to the CDC. Poor cooperation at either level handicaps the CDC. And Guttmacher has a conflict of interest, being the research arm of Planned Parenthood
• Complaint Investigations Favor Abortion: Childbirth isn’t the political hot-button that abortion is. With abortion, however, politics and bureaucracy have obstructed responding to abortion complaints.[15] Formal complaints from patients and staff at Kermit Gosnell’s New Jersey clinic fell on deaf ears for more than a decade before authorities investigated. And even then, the original investigation was over drug charges, not abortion.
• Insurance Investigations Favor Abortion: Insurance benefits weigh more favorably towards injuries or death from child-birth instead of from abortion. That financial interest encourages people to report complications from childbirth more than with abortion (an elective procedure).
• Medical Records Favor Abortion: Since abortion carries a stigma that childbirth does not, medical staff, as a kindness to the patient, may obscure the role of abortion in her medical history. For example, they may report, “death by hemorrhage/sepsis/embolism,” without mentioning her attempted abortion (Calhoun 2013, 268). This is similar to saying “death by blunt force trauma,” instead of “He died in drunk-driving accident.”

2. Patients ashamed of their abortion may never report it, or never seek help for short-term or long-term complications.

Abortion is unusual in that patients are typically quite embarrassed about, even to the point of lying about it in surveys and interviews. This “shame factor” does not just suppress statistics, it creates a practical obstacle for women escalating the risks of abortion. In the short term, if the patient refuses to admit the abortion to her friends and family then she is less likely to have the practical support she needs if a complication arises. Abortion doesn’t typically offer the culture of support that conventional motherhood does, with baby showers, announcement parties, and a small community of eager helpers. Abortion patients often face their risk factors alone, isolated by shame, fear, guilt, and embarrassment.

3. Nations with more precise records show a higher mortality risk for mothers who choose abortion over childbirth.

The U.S. has a reporting problem with abortion. But not every country has the same problem. Thorp explains:

“The U.S. has no national health registry identifying and linking all individual healthcare interventions, diagnoses, hospitalizations, births, deaths, and other vital statistics, unlike Scandinavian countries. Accordingly, epidemiological studies using these national data sets from abroad are methodologically superior to U.S. data” (Thorp 2003, art. 19).

Thorp then cites four different studies that prove the opposite conclusion from the RG study Each study is based in Scandinavian countries with socialized healthcare systems where exact reporting is required for the sake of government funding and supervision. All four studies show that abortion has a higher fatality rate for mothers than childbirth. And all four indicate that modern abortion procedures link to more dangerous outcomes than the RG study admits.

4. Cesarean section births are increasing, often by choice.

With advancing medical technology, childbirth should be safer today than ever before but the rate of complications has remained fairly steady. C-sections could be the cause. Cesarean section delivery is more invasive and riskier than vaginal delivery. And the percentage of c-sections has risen dramatically, from about 21% of births in 2003 to 32% today.^[16] Several factors could be cited, and many of these are lifestyle choices rather than inherent risks in childbirth.

• Defensive Medicine: This is when physicians are known to “recommend the most aggressive treatment possible to avoid a negligence lawsuit.”^[17]
• Older mothers: The likelihood of medical complications rises sharply after age 35, and many of those complications hamper and endanger vaginal delivery.
• Overweight mothers: Childbirth is hard on the body, and if the mother has weight-related health problems physicians may recommend inducing delivery and c-section to shorten the length of pregnancy.
• Fertility Treatments: Some patients use fertility treatments to overcome obstacles like old age, infertility, or physical impairments. However, fertility treatments often result in multiple births, which is a cause for c-sections. And they can make a woman pregnant who, otherwise, isn’t healthy enough to carry a pregnancy full-term. Again, a c-section is a strong possibility.
• Patient Request: It’s not uncommon for the patient to request a c-section to avoid the pain of childbirth, for cosmetic reasons, or to fit her delivery into her busy schedule.

Pregnant patients should be aware that defensive medicine, age (35+), weight problems, and fertility treatments can all raise the chances of a c-section, in turn, raising the relative risks for mothers. The mother, requesting a c-section, has only a remote chance of suffering a debilitating injury or death, but it’s still a higher chance than otherwise.

The Final Verdict

Returning to our original question, abortion is not clearly safer than childbirth. And, depending on how one weighs the evidence, it may be far more dangerous. We are left to wonder about “safe, legal, and rare” abortion. If it’s not rare, or safe, why is it still legal? Legalizing abortion has led to roughly 60,000,000 abortions, averaging about 1.3 million a year since 1973. With that kind of demand, we cannot realistically expect all abortion clinics to run safely, nor all pregnant mothers to avoid DIY and back-alley abortions. Abortion procedures could be far safer today than in 1972, but that detail is mitigated by the sheer number of abortions happening on a regular basis. Abortion isn’t rare, or safe.

Advocates still may press the point, claiming abortion is safer than childbirth, 14 times safer. But the source behind that is thoroughly debunked across multiple sources, most notably in court records from John Thorp Jr., a review study by Byron Calhoun, and it’s been contradicted by a number of smaller but more meticulous studies in Scandinavia, where they do not have the same reporting gaps as the U.S. At the ground level, abortion is clearly dangerous to families, to motherhood, and to society as it fosters a culture of death and dehumanizes the most defenseless members of the human race. And of course, it’s deadly to fetal humans. Every year, roughly 1 in 5 pregnancies end in abortion. That fatality rate destroys all semblance of “safe” abortion. Abortion isn’t even safe for the mother since none of the intrinsic risks with abortion are necessary – it’s an elective procedure.

Childbirth does carry health risks, and expectant mothers should be informed and proactive about them. We can admit the need for better data in comparing and clarifying those risks. But the best evidence we have so far suggests abortion is probably more dangerous than childbirth.

Click here for Part 1: Is Abortion safe?
Click here for Part 2: Is Abortion safe for mothers? 

Endnotes

[1] Elizabeth G. Raymond and David A. Grimes, “The Comparative Safety of Legal Induced Abortion and Childbirth in the United States,” Obstetrics and Gynecology, 119 (Feb 2012), 215; Taylor Pittman, “How One Big Myth About Abortion Is Hurting Everyone,” Vox (28 April 2016), https://www.huffpost.com/entry/how-one-big-myth-about-abortion-is-hurting-everyone_n_57212e9de4b0b49df6aa1d4a?guccounter=1; Genevra Pittman, “Abortion Safer than Giving Birth: Study,” Reuters (23 Jan 2012), para. 2, https://www.reuters.com/article/us-abortion-idUSTRE80M2BS20120123; Serena Gordon, “Abortion Safer for Women than Childbirth, Study Says,” HealthDay (23 Jan 2012), at https://consumer.healthday.com/women-s-health-information-34/abortion-news-2/abortion-safer-for-women-than-childbirth-study-claims-661006.html

^[2]See Thorp Jr., “Declaration,” 2013, article 18.

[3] The CDC reports 700 childbirth-related deaths per year. With 3,855,500 childbirths in 2017 (the last year on record). That works out to be 0.0018% chance of death for the mother. The CDC also recorded 638,169 abortions in 2015 (the most recent Abortion Surveillance reporting year) with only 6 reported abortion-related deaths or 0.0000094%.

[4] This point is subtle but important.

^[5]The RG study explains that the stats for deaths related to childbirth include “deceased women who were recorded as pregnant within a specified time period before death” (RG 2012, pg. 215). Whether or not those women died from childbirth and related complications is unknown.

[6] David C. Reardon, et al. “Deaths Associated with Abortion Compared to Childbirth – A Review of New and Old Data and the Medical and Legal Implications,” Journal of Contemporary Health Law & Policy 20, no. 2, art. 4 (2004), 278-327.

[7] The following sources are listed in order of appearance. Priscilla K. Coleman and David C. Reardon, “Abortion and Subsequent Maternal Death Rates: First new Study from Denmark,” Medical Science Monitor 18, no. 9 (2012), PH 71-6; Priscilla K. Coleman, David C. Reardon, Byron C. Calhoun, “Reproductive History Patterns and Long-Term Mortality Rates: A Danish, Population-Based Record Linkage Study,” European Journal of Public Health 23, no. 4 (1 Aug 2013), 569-74; Byron C. Calhoun, “Maternal Mortality Myth in the Context of Legalized Abortion,” Linacre Quarterly 80, no. 3 (17 July 2013), 264-76; Mika Gissler, et al., “Pregnancy-Associated Mortality After Birth, Spontaneous Abortion, or Induced Abortion in Finland, 1987-2000,” American Journal of Obstetrics and Gynecology 190, no. 2 (Feb 2004), 422-7. Dr. John Thorp in written testimony for “Planned Parenthood vs. Van Hollen, et al.” (15 July 2013) cites the following studies, as undermining and or contradicting the RG study: (1) Reardon, D., Strathan, J. Thorp, J. & Shuping, M. Deaths Associated with Abortion Compared to Childbirth – A Review of New and Old Data and the Medical and Legal Implications,” Journal of Contemporary Health Law & Policy 20 (2004), 279-327; (2) Mika Gissler, et al. “Pregnancy Associated Deaths in Finland 1987-1994: Definition Problems and Benefits of Record Linkage,” A Acta Obstetricia et Gynecologica Scandinavica 76 (1997), 651-7; (3) David Reardon, et al. “Deaths Associated with Pregnancy Outcome: A Record Linkage Study of Low Income Women,” Southern Medical Journal 95 (2002), 834-41; (4) Maarit Niinimaki, et al., “Immediate Complications after Medical Compared with Surgical Terminations of Pregnancy,” Obstetrics & Gynecology 114 (2009), 795-804.

[8] Some pro-choice sources dispute the claim that abortion is causally related to ectopic pregnancies. For example, the Ectopic Pregnancy Trust claims outright that “Abortion is not linked to ectopic pregnancy.” See, https://ectopic.org.uk/patients/reasons-for-an-ectopic-pregnancy/ But then, on the same page, they admit the “mini-pill” and “emergency contraception” are “reasons for ectopic pregnancy,” though these can cause an early-term abortion by preventing the human embryo from implanting. Meanwhile, the American Pregnancy Association, which is a pro-choice friendly organization, openly admits the connection listing “multiple induced abortions” as a “risk factor for ectopic pregnancies.”

[9] See, Randy Alcorn, Prolife Answers to Prochoice Arguments, upd ed. (2000), 180.

[10] Alcorn 180.

[11] Alcorn 180-181.

[12] Ibid.

[13] For more on these factors see Calhoun 2013, 269-271

^[14]John Thorp Jr., “Declaration of John Thorp” [testimony/evidence brief] submitted in Planned Parenthood vs. Van Hollen, et al. (2 Aug 2013), article 14, accessed 23 August 2018 at https://rewire.news/wp-content/uploads/2014/11/Thorp-Declaration-Planned-Parenthood-of-Wisconsin-v-Van-Hollen_13cv465_7.13.2013.pdf

[15] Garance Franke-Ruta, “Kermit Gosnell and Intelligence Failures,” The Atlantic (17 April 2013).

^[16]Data compiled from several links found at “Births, Method of Delivery,” Center for Disease Control (CDC.gov, last updated 31 March 2017), accessed 8 August 2018 at: https://www.cdc.gov/nchs/fastats/delivery.htm. See also, Emma L. Barber, et al., “Contributing Indications to the Rising Cesarean Delivery Rate,” Obstetrics & Gynecology, 118, no. 1 (July 2011), 29-38; accessed 8 August 2018 at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751192/

^[17]Aunindita, “15 Reasons C-sections are On the Rise,” BabyGaga.com (15 April 2017), para. 4; accessed 9 August 2018 at https://www.babygaga.com/15-reasons-c-sections-are-on-the-rise/.