Academic journal article Issues in Law & Medicine

Improving the Accuracy of Maternal Mortality and Pregnancy Related Death

Academic journal article Issues in Law & Medicine

Improving the Accuracy of Maternal Mortality and Pregnancy Related Death

Article excerpt


Nearly half of American women experience an unplanned pregnancy by age 45,1 often eliciting the choice to either parent or obtain an induced abortion. With four of every ten unplanned pregnancies ending in abortion,2 induced abortion exists as one of the most common procedures in medicine.3 Women express various reasons for choosing induced abortion, with risk of maternal health serving as the primary motivation for 2.8% of American women and up to 37.9% of women internationally.4 Given these data, understanding the current limitations associated with comparing the safety of induced abortion compared to live birth remains vital to providing informed consent to patients as well as accurate information to physicians.

While current statistics suggest pregnancy and induced abortion are associated with low mortality rates, the relative safety of each event remains heavily debated in the medical literature. In 2012, Raymond and Grimes authored a paper in Obstetrics and Gynecology comparing the live birth mortality rate (8.8 deaths per 100,000 live births) with the mortality rate of induced abortion (0.6 deaths per 100,000 abortions) concluding: "[the] risk of death associated with childbirth is approximately 14 times higher than that with abortion."5 Medscape cites this paper to claim induced abortion poses less threat to the life of the women than childbirth.3 The Royal College of Obstetricians and Gynecologist (RCOG) also state, "abortion is a safe procedure for which major complications and mortality are rare at all gestations."6

Aside from failing to consider the unique health status of the patient, (e.g. past medical history of the mother, gestational age of the fetus, availability and skill of birth attendants, access and transportation to adequate delivery facilities, availability of oxytocin and other medication, method of termination, skill of the abortion provider, number of abortions and health status of the patient prior to termination), comparing the death attributable to induced abortion with live birth remains an impossible task given the current limitations within the CDC Abortion Mortality Surveillance System and International Statistical Classification of Diseases and Related Health Problems (ICD). This article seeks to discuss these problems and provide possible solutions.

Limitations Within the CDC Abortion Mortality Surveillance System

The CDC utilizes the Abortion Mortality Surveillance System to collect data on abortion. However, the CDC explicitly mentions some of the limitations within this system:

1. Reporting abortion-related deaths is not federally mandated. States and reporting areas voluntarily provide the CDC with information regarding induced abortions. Recently California, Delaware, Maryland, and New Hampshire did not report. Since California constitutes nearly a quarter of all the induced abortions in the United States, much of the data regarding induced abortion is entirely immune to analysis.7

2. Some states encourage or mandate reporting the number or outcome of performed abortions, however, the enforcement of these laws varies by state. Therefore, the number of reported abortions does not reflect the actual number of abortions.

3. States lack a standardized reporting form, leaving the CDC with incomplete information about the characteristics of women obtaining abortions (e.g., not every form accounts for age, race, ethnicity, type of abortion, outcome of the procedure, ect.).

4. Abortions are reported by location performed rather than the residency of the patient, leading to underreporting of the number of abortions in states with less abortion providers.

These limitations hinder comparing abortion-related death with pregnancy-related death. Since the United States lacks a coherent system for tracking pregnancy outcomes, the best insight regarding maternal morality arises from countries with comprehensive databases and mandatory reporting of abortion and pregnancy related morbidity and mortality. …

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