Estudo Requer aos Médicos que façam Menos Abortos. Abortos Causam Transtornos Mentais na Mulher

Estudo Requer aos Médicos que façam Menos Abortos. Abortos Causam Transtornos Mentais na Mulher

Publicado em agosto 20, 2009 por Cristiane Rozicki

Estudo na Nova Zelândia Requer aos Médicos que façam Menos Abortos.

Abortos Causam Transtornos Mentais

Comportamentos suicidas, depressão, dependência química, ansiedade e outros problemas mentais, posteriores ao aborto. Aqui no Brasil a mídia, o ministério da saúde e a Presidencia da Republica na pessoa de Dilma Rousseff não avisam sobre as conseqüências  e graves danos do aborto.

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Abortion Causes Mental Disorders: New Zealand Study

May Require Doctors To Do Fewer Abortions Abort -

Sex. 10 de fevereiro de 2006

Pro-Choice Researcher Says Some Journals Rejected Politically Volatile Findings Pro-Choice Pesquisador diz que alguns Revistas Rejeitada Politicamente Volátil Apreciação

Special to LifeSiteNews.com Especial para LifeSiteNews.com
By The Elliot Institute Por O Instituto Elliot
February 10, 2006 10 de fevereiro de 2006

A study in New Zealand that tracked approximately 500 women from birth to 25 years of age has confirmed that young women who have abortions subsequently experience elevated rates of suicidal behaviors, depression, substance abuse, anxiety, and other mental problems. Um estudo realizado na Nova Zelândia que acompanhou cerca de 500 mulheres desde o nascimento até aos 25 anos de idade, confirmou que as mulheres jovens que têm elevadas taxas de abortos posteriormente experiência de comportamentos suicidas, depressão, dependência química, ansiedade e outros problemas mentais.

Most significantly, the researchers–led by Professor David M. Fergusson, who is the director of the longitudinal Christchurch Health and Development Study–found that the higher rate of subsequent mental problems could not be explained by any pre-pregnancy differences in mental health, which had been regularly evaluated over the course of the 25- year study. Mais significativamente, os pesquisadores – liderados pelo Professor David M. Fergusson, que é o diretor do longitudinal Christchurch Health and Development Study – constatou que a maior taxa de problemas mentais posteriores não poderiam ser explicadas por qualquer pré-gravidez diferenças em mental saúde, que tinha sido regularmente avaliado no decurso da 25 – year study.
FINDINGS SURPRISE PRO-CHOICE RESEARCHERS CONSTATAÇÕES surpresa PRO-ESCOLHA INVESTIGADORES

According to Fergusson, the researchers had undertaken the study anticipating that they would be able to confirm the view that any problems found after abortion would be traceable to mental health problems that had existed before the abortion.  At first glance, it appeared that their data would confirm this hypothesis.  The data showed that women who became pregnant before age 25 were more likely to have experienced family dysfunction and adjustment problems, were more likely to have left home at a young age, and were more likely to have entered a cohabiting relationship. Segundo a Fergusson, os pesquisadores haviam realizado o estudo prevendo que eles seriam capazes de confirmar a opinião que os problemas encontrados após aborto deverá ser feita para os problemas de saúde mental que já existiam antes do aborto. À primeira vista, parecia que os dados seriam confirmar esta hipótese. Os dados mostraram que as mulheres que engravidaram antes de menos de 25 anos eram mais propensos a ter experimentado disfunção familiar eo ajustamento problemas, eram mais susceptíveis de ter uma casa na esquerda tenra idade, e foram mais propensos a ter introduzido uma coabitação relacionamento.

However, when these and many other factors were taken into account, the findings showed that women who had abortions were still significantly more likely to experience mental health problems.  Thus, the data contradicted the hypothesis that prior mental illness or other “pre-disposing” factors could explain the differences. No entanto, quando estes e muitos outros factores foram tidos em conta, os resultados mostraram que as mulheres que tiveram abortos foram ainda significativamente mais propensos a experimentar problemas de saúde mental. Assim, os dados contradizem a hipótese de que antes da doença mental ou outro “pré-eliminação” fatores poderiam explicar as diferenças.

“We know what people were like before they became pregnant,” Fergusson told The New Zealand Herald.  “We take into account their social background, education, ethnicity, previous mental health, exposure to sexual abuse, and a whole mass of factors.” “Sabemos que as pessoas eram como eles ficaram grávidas antes,” disse Fergusson A Nova Zelândia Herald. “Levamos em conta a sua origem social, educação, etnia, anterior a saúde mental, a exposição ao abuso sexual, e toda uma massa de fatores.”

The data persistently pointed toward the politically unwelcome conclusion that abortion may itself be the cause of subsequent mental health problems.  So Fergusson presented his results to New Zealand’s Abortion Supervisory Committee, which is charged with ensuring that abortions in that country are conducted in accordance with all the legal requirements. Os dados apontaram persistentemente politicamente indesejável para a conclusão de que o aborto poderá ser a causa de posteriores problemas de saúde mental. Então Fergusson apresentaram seus resultados para a Nova Zelândia do Aborto Comité de Fiscalização, que está encarregado de assegurar que o aborto no país são realizados em conformidade com todas as os requisitos legais. According to The New Zealand Herald, the committee told Fergusson that it would be “undesirable to publish the results in their ‘unclarified’ state.” Segundo o The New Zealand Herald, a comissão Fergusson disse que seria “indesejável para publicar os resultados na sua ‘unclarified” estado “.

Despite his own pro-choice political beliefs, Fergusson responded to the committee with a letter stating that it would be “scientifically irresponsible” to suppress the findings simply because they touched on an explosive political issue. Apesar de suas próprias convicções políticas pró-escolha, Fergusson respondeu à comissão com uma carta afirmando que seria “irresponsável cientificamente” para suprimir os resultados simplesmente porque tocou em uma questão política explosiva.

In an interview about the findings with an Australian radio host, Fergusson stated: “I remain pro-choice. I am not religious. I am an atheist and a rationalist. The findings did surprise me, but the results appear to be very robust because they persist across a series of disorders and a series of ages. . . . Abortion is a traumatic life event; that is, it involves loss, it involves grief, it involves difficulties. And the trauma may, in fact, predispose people to having mental illness.” Em uma entrevista sobre os resultados com um australiano rádio anfitrião, Fergusson declarou: “Continuo pró-escolha. Eu não sou religioso. Sou um ateu e um racionalista. As conclusões não me surpreende, mas os resultados parecem ser bastante robusto, pois eles persistirem em toda uma série de transtornos e uma série de idades…. O aborto é um evento traumático vida, isto é, trata-se de perda, que envolve dor, envolve dificuldades. E o trauma pode, na verdade, predispor as pessoas a ter doença mental. “
JOURNALS REJECT THE POLITICALLY INCORRECT RESULTS REVISTAS REJEITAR OS RESULTADOS politicamente incorrecto

The research team of the Christchurch Health and Development Study is used to having its studies on health and human development accepted by the top medical journals on first submission.  After all, the collection of data from birth to adulthood of 1,265 children born in Christchurch is one of the most long-running and valuable longitudinal studies in the world.  But this study was the first from the experienced research team that touched on the contentious issue of abortion. A equipe de pesquisa do Christchurch Saúde e Desenvolvimento Estudo é utilizada para ter seus estudos sobre a saúde e desenvolvimento humano aceite pelo topo revistas médicas na primeira apresentação. Afinal de contas, a recolha de dados desde o nascimento até à idade adulta de crianças nascidas em 1265 Christchurch é um da mais longa e valiosa de estudos longitudinais em todo o mundo. Porém, este estudo foi o primeiro a partir da investigação experiente equipe que tocou na questão polémica do aborto.

Ferguson said the team “went to four journals, which is very unusual for us — we normally get accepted the first time.” Ferguson disse que a equipa “deslocou-se a quatro revistas, o que é muito incomum para nós – nós normalmente aceite receber a primeira vez.” Finally, the fourth journal accepted the study for publication. Por último, a quarta revista aceita para publicação do estudo.

Although he still holds a pro-choice view, Fergusson believes women and doctors should not blindly accept the unsupported claim that abortion is generally harmless or beneficial to women.  He appears particularly upset by the false assurances of abortion’s safety given by the American Psychological Association (APA). Embora ele ainda mantém uma perspectiva pró-escolha, Fergusson considera as mulheres e os médicos não devem aceitar cegamente o unsupported alegação de que o aborto é geralmente inofensiva ou benéfica para as mulheres. Ele parece particularmente preocupado pelas falsas garantias de segurança do aborto dadas pela American Psychological Association ( APA).

In a 2005 statement, the APA claimed that “well-designed studies” have found that “the risk of psychological harm is low.” Em 2005 uma declaração, a APA afirmou que “bem concebido estudos” constataram que “o risco de dano psicológico é baixo.” In the discussion of their results, Fergusson and his team note that the APA’s position paper ignored many key studies showing evidence of abortion’s harm and looked only at a selective sample of studies that have serious methodological flaws. Na discussão dos seus resultados, Fergusson e sua equipe nota que a posição da APA papel fundamental ignorados muitos estudos que mostram evidências de efeitos nocivos do aborto e olhou apenas em uma amostra seletiva de estudos que têm graves falhas metodológicas.

Fergusson told reporters that “it verges on scandalous that a surgical procedure that is performed on over one in 10 women has been so poorly researched and evaluated, given the debates about the psychological consequences of abortion.” Fergusson disse aos jornalistas que “é escandaloso que raia sobre um procedimento cirúrgico que é realizado em mais de um em cada 10 mulheres tem sido tão mal estudadas e avaliadas, tendo em conta os debates sobre as conseqüências psicológicas do aborto.”

Following Fergusson’s complaints about the selective and misleading nature of the 2005 APA statement, the APA removed the page from their Internet site.  The statement can still be found through a web archive service, however. Na sequência de queixas sobre o Fergusson selectiva e enganosa natureza da declaração APA 2005, a APA removido da página de seu site da Internet. A declaração ainda pode ser encontrado através de um serviço de arquivo na web, no entanto.
STUDY MAY HAVE PROFOUND INFLUENCE ON MEDICINE, LAW, AND POLITICS Estudo pode ter influência profunda sobre medicina, direito, E POLÍTICA

The reaction to the publication of the Christchurch study is heating up the political debate in the United States.  The study was introduced into the official record at the senate confirmation hearings for Supreme Court Justice Samuel Alito. A reacção à publicação do estudo Christchurch é aquecer o debate político nos Estados Unidos. O estudo foi introduzido no registo oficial no senado confirmação audições Supremo Tribunal de Justiça Samuel Alito. Also, a US congressional subcommittee chaired by Representative Mark Souder (R-IN) has asked the National Institutes of Health (NIH) to report on what efforts the NIH is undertaking to confirm or refute Fergusson’s findings. Além disso, uma subcomissão E.U. Congresso presidido pelo representante Mark Souder (R-IN) convidou o National Institutes of Health (NIH) para informar sobre o que está a empreender esforços do NIH para confirmar ou refutar conclusões da Fergusson.

The impact of the study in other countries may be even more profound. O impacto do estudo em outros países pode ser ainda mais profunda. According to The New Zealand Herald, the Christchurch study may require doctors in New Zealand to certify far fewer abortions.  Approximately 98 percent of abortions in New Zealand are done under a provision in the law that only allows abortion when “the continuance of the pregnancy would result in serious danger (not being danger normally attendant upon childbirth) to the life, or to the physical or mental health, of the woman or girl.” Segundo o The New Zealand Herald, o estudo pode exigir Christchurch médicos na Nova Zelândia para certificar muito menos abortos. Aproximadamente 98 por cento dos abortos na Nova Zelândia são feitas ao abrigo de uma disposição na lei que só permite o aborto quando “a continuação da gravidez seria resultar em perigo grave (não sendo normalmente perigo tratador após parto) para a vida, ou para a saúde física ou psíquica, da mulher ou menina. “

Doctors performing abortions in Great Britain face a similar legal problem.  Indeed, the requirement to justify an abortion is even higher in British law.  Doctors there are only supposed to perform abortions when the risks of physical or psychological injury from allowing the pregnancy to continue are “greater than if the pregnancy was terminated.” Médicos realização de abortos na Grã-Bretanha enfrentam um problema jurídico semelhante. Na verdade, o requisito para justificar um aborto ainda é maior no direito britânico. Médicos só existem supostamente para realizar abortos quando os riscos de lesão física ou psicológica de permitir que a gravidez são para continuar “maior do que se a gravidez foi encerrado.”

According to researcher Dr. David Reardon, who has published more than a dozen studies investigating abortion’s impact on women, Fergusson’s study reinforces a growing body of literature showing that doctors in New Zealand, Britain and elsewhere face legal and ethical obligations to discourage or refuse contraindicated abortions. Segundo o pesquisador Dr. David Reardon, que já publicou mais de uma dúzia de estudos investigando o impacto do aborto sobre as mulheres, Fergusson do estudo reforça um crescente corpo de literatura mostrando que os médicos na Nova Zelândia, Grã-Bretanha e noutros países enfrentam obrigações legais e éticas para desencorajar ou recusar contra abortos.

“Fergusson’s study underscores that fact that evidence-based medicine does not support the conjecture that abortion will protect women from ‘serious danger’ to their mental health,” said Reardon.  “Instead, the best evidence indicates that abortion is more likely to increase the risk of mental health problems.  Physicians who ignore this study may no longer be able to argue that they are acting in good faith and may therefore be in violation of the law.” “Fergusson do estudo ressalta que o fato de que a medicina baseada em evidências não suporta a conjectura de que o aborto vai proteger as mulheres de” grave perigo “para sua saúde mental”, disse Reardon. “Pelo contrário, a melhor evidência indica que o aborto é mais provável que o aumento risco de problemas de saúde mental. Physicians ignorar que este estudo pode já não ser capaz de argumentar que eles estão agindo de boa fé e podem, portanto, estar em violação da lei. “

“Record-based studies in Finland and the United States have conclusively proven that the risk of women dying in the year following an abortion is significantly higher than the risk of death if the pregnancy is allowed to continue to term,” said Reardon, who directs the Elliot Institute, a research organization based in Springfield, Illinois.  “So the hypothesis that the physical risks of childbirth surpass the risks associated with abortion is no longer tenable.  That means most abortion providers have had to look to mental health advantages to justify abortion over childbirth.” “Gravar com base em estudos na Finlândia e os Estados Unidos têm provado conclusivamente que o risco das mulheres que morrem no ano seguinte um aborto é significativamente maior do que o risco de morte se a gravidez é autorizada a continuar a prazo”, disse Reardon, que dirige o Elliot Institute, uma organização de investigação com base em Springfield, Illinois. “Portanto, a hipótese de que os riscos físicos de parto superar os riscos associados com o aborto já não é defensável. Isso significa que mais tiveram aborto prestadores de olhar para a saúde mental vantagens para justificar o aborto ao longo do parto. “

But Reardon now believes that alternative for recommending abortion no longer passes scientific muster, either. Reardon Mas agora acredita que a alternativa para recomendar o aborto já não passa científica muster, quer.

“This New Zealand study, with its unsurpassed controls for possible alternative explanations, confirms the findings of several recent studies linking abortion to higher rates of psychiatric hospitalization. depression, generalized anxiety disorder, substance abuse, suicidal tendencies, poor bonding with and parenting of later children, and sleep disorders,” he said.  “It should inevitably lead to a change in the standard of care offered to women facing problem pregnancies.” “Este estudo Nova Zelândia, com a sua insuperável possíveis explicações alternativas para o controlo, confirma as conclusões de vários estudos recentes ligando aborto para taxas mais elevadas de internação psiquiátrica. Depressão, transtorno de ansiedade generalizada, abuso de substâncias, tendências suicidas, pobres e com vínculo de parentalidade mais tarde crianças, e distúrbios do sono “, disse ele.” Há inevitavelmente levar a uma mudança no padrão de atendimento oferecido às mulheres enfrentam problema gravidez. “
SOME WOMEN MAY BE AT GREATER RISK Algumas mulheres podem estar em maior risco

Reardon, a biomedical ethicist, is an advocate of “evidence- based medicine”–a movement in medical training that encourages the questioning of “routine, accepted practices” which have not been proven to be helpful in scientific trials.  If one uses the standards applied in evidence-based medicine, Reardon says, one can only conclude that there is insufficient evidence to support the view that abortion is generally beneficial to women.  Instead, the opposite appears to be more likely. Reardon, um biomédico ethicist, é um defensor da “medicina baseada em evidências” – um movimento de formação médica que encoraja o questionamento de “rotina, aceite práticas” que não tenham sido provado ser útil em estudos científicos. Se um usa o normas aplicadas na medicina baseada em evidências, Reardon diz, só podemos concluir que não há provas suficientes para apoiar a opinião de que o aborto é, geralmente benéfica para as mulheres. Em vez disso, o oposto parece ser mais provável.

“It is true that the practice of medicine is both an art and a science,” Reardon said. “É verdade que a prática da medicina é simultaneamente uma arte e uma ciência”, disse Reardon. “But given the current research, doctors who do an abortion in the hope that it will produce more good than harm for an individual woman can only justify their decisions by reference to the art of medicine, not the science.” “Mas, dada a atual pesquisa, os médicos que fazem um aborto, na esperança de que ele irá produzir mais dano do que bom para um indivíduo mulher só pode justificar as suas decisões por referência à arte da medicina, e não a ciência.”

According to Reardon, the best available medical evidence shows that it is easier for a woman to adjust to the birth of an unintended child than it is to adjust to the emotional turmoil caused by an abortion. Segundo a Reardon, a melhor evidência médica disponível mostra que é mais fácil para uma mulher a ajustar-se ao nascimento de uma criança que não é inesperada para ajustar-se ao turbilhão emocional causado por um aborto.

“We are social beings, so it is easier for people to adjust to having a new relationship in one’s life than to adjust to the loss of a relationship,” he said.  “In the context of abortion, adjusting to the loss is especially difficult if there any unresolved feelings of attachment, grief, or guilt.” “Nós somos seres sociais, por isso é mais fácil para as pessoas terem de se ajustar a uma nova relação de uma vida do que para regular a perda de um relacionamento”, disse ele. “No contexto do aborto, que adapta à perda é especialmente difícil se houver qualquer resolver sentimentos de apego, luto, ou culpa. “

By using known risk factors, the women who are at greatest risk of severe reactions to abortion could be easily identified, according to Reardon.  If this were done, some women who are at highest risk of negative reactions might opt for childbirth instead of abortion. Ao utilizar conhecidos fatores de risco, as mulheres que estão em maior risco de reacções graves ao aborto poderiam ser facilmente identificados, de acordo com Reardon. Se isso foi feito, algumas mulheres que estão em maior risco de reacções negativas podem optar por parto, em vez de aborto.

In a recent article published in The Journal of Contemporary Health Law and Policy, Reardon identified approximately 35 studies that had identified statistically validated risk factors that most reliably predict which women are most likely to report negative reactions. Em um recente artigo publicado no The Journal of Contemporary Health Law and Policy, Reardon identificou cerca de 35 estudos que tinha identificado validado estatisticamente que a maioria dos fatores de risco fiavelmente predizer quais as mulheres têm maior probabilidade de relatar reações negativas.

“Risk factors for maladjustment were first identified in a 1973 study published by Planned Parenthood,” Reardon said. “Os fatores de risco para desajuste foram inicialmente identificados em 1973 um estudo publicado pela Planned Parenthood”, disse Reardon. “Since that time, numerous other researchers have further advanced our knowledge of the risk factors which should be used to screen women at highest risk.  These researchers have routinely recommended that the risk factors should be used by doctors to identify women who would benefit from more counseling, either so they can avoid contraindicated abortions or so they can receive better followup care to help treat negative reactions.” “Desde esse tempo, muitos outros pesquisadores têm mais avançadas dos nossos conhecimentos sobre os fatores de risco que deve ser utilizado para rastrear as mulheres sob maior risco. Estes investigadores têm rotineiramente recomendado que os fatores de risco devem ser utilizadas pelos médicos para identificar as mulheres que se beneficiariam de uma maior aconselhamento, quer para que possam evitar ou contra o aborto, para que possam receber cuidados followup melhor para ajudar a tratar reações negativas. “

Feeling pressured by others to consent to the abortion, having moral beliefs that abortion is wrong, or having already developed a strong maternal attachment to the baby are three of the most common risk factors, Reardon says. Sentindo-se pressionados pelos outros para consentimento ao aborto, com convicções morais que o aborto é errado, ou já ter desenvolvido um forte vínculo materno para o bebê são três dos principais fatores de risco comuns, Reardon diz.

While screening makes sense, Reardon says that in practice, screening for risk factors is rare for two reasons. Embora a análise faz sentido, Reardon diz que, na prática, o rastreio de factores de risco é rara, por duas razões.

“First, there are aberrations in the law that shield abortion providers from any liability for emotional complications following an abortion,” he said.  “This loophole means that abortion clinics can save time and money by substituting one- size-fits-all counseling for individualized screening. “Em primeiro lugar, existem aberrações na lei que escudo aborto fornecedores a partir de qualquer responsabilidade por complicações emocionais após um aborto”, disse. “Esta lacuna significa que o aborto clínicas podem poupar tempo e dinheiro, substituindo uma de tamanho único para todos aconselhamento para individualizadas rastreio.

“The second obstacle in the way of screening is ideological. Many abortion providers insist that it is not their job to try to figure out whether an abortion is more likely to hurt than help a particular woman. They see their role as to ensure that any woman who wants an abortion is provided one.” “O segundo obstáculo no caminho do rastreio é ideológica. Muitos fornecedores insistem em que o aborto não é seu trabalho para tentar descobrir se um aborto é mais susceptível de ferir do que ajudar uma mulher especial. Eles vêem o seu papel como para garantir que qualquer mulher que deseja um aborto é fornecido um “.

“This ‘buyer beware’ mentality is actually inconsistent with medical ethics,” Reardon said. “Este” comprador beware “mentalidade é realmente inconsistente com ética médica”, disse Reardon. “Actually, the ethic governing most abortion providers’ services is no different than that of the abortionists: ‘If you have the money, we’ll do the abortion.’ “Na verdade, a ética que regem a maioria aborto dos prestadores de serviços não é diferente do que o do abortionists: ‘Se você tiver o dinheiro, nós vamos fazer o aborto.” Women deserve better.  They deserve to have doctors who act like doctors. That means doctors who will give good medical advice based on the best available evidence as applied to each patient’s individual risk profile.” As mulheres merecem melhor. Eles merecem a ter médicos que atuam como médicos. Isso significa que médicos que vai dar bons conselhos médicos baseados nas melhores evidências disponíveis, tal como é aplicado para cada paciente individual do perfil de risco. “

Fergusson also believes that the same rules that apply to other medical treatments should apply to abortion. Fergusson acredita também que as mesmas regras que se aplicam a outros tratamentos médicos, deve aplicar-se ao aborto. “If we were talking about an antibiotic or an asthma risk, and someone reported adverse reactions, people would be advocating further research to evaluate risk,” he said in the New Zealand Herald. “Se estivéssemos falando de um antibiótico ou um risco asma, e alguém relatadas as reacções adversas, as pessoas seriam defendem uma maior investigação para avaliar os riscos”, disse ele na Nova Zelândia Herald. “I can see no good reason why the same rules don’t apply to abortion.” “Não vejo qualquer razão para as mesmas regras não se aplicam ao aborto.”
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SOURCES: FONTES:

David M. Fergusson, L. John Horwood, and Elizabeth M. Ridder, “Abortion in young women and subsequent mental health,” Journal of Child Psychology and Psychiatry 47(1): 16-24, 2006. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dop… uids=16405636&query hl=1&itool=pubmed docsum David M. Fergusson, Horwood John L., e Elizabeth M. Ridder, “O aborto em mulheres jovens e subseqüente saúde mental”, Journal of Child Psychology and Psychiatry 47 (1): 16-24, 2006. Http://www. ncbi.nlm.nih.gov / entrez / query.fcgi? cmd = Obter & db = & Pubmed dop … uids = 16405636 & query = 1 & hl = itool Pubmed docsum

Tom Iggulden, “Abortion increases mental health risk: study” AM transcript. http://www.abc.net.au/am/content/2006/s1540914.htm Tom Iggulden, “Aborto aumenta risco a saúde mental: estudo” AM transcrição. Http://www.abc.net.au/am/content/2006/s1540914.htm

Nick Grimm “Higher risk of mental health problems after abortion: report” Australian Broadcasting Corporation. Nick Grimm “maior risco de problemas de saúde mental após o aborto: relatório” Australian Broadcasting Corporation. 03/01/2006 http://www.abc.net.au/7.30/content/2006/s1541543.htm 03/01/2006 http://www.abc.net.au/7.30/content/2006/s1541543.htm

Ruth Hill, “Abortion Researcher Confounded by Study” New Zealand Herald 1/5/06, http://www.nzherald.co.nz Ruth Hill, “Aborto Pesquisador confundidos pelo Estudo” New Zealand Herald 1/5/06, http://www.nzherald.co.nz

APA Briefing Paper on The Impact of Abortion on Women, http://web.archive.org of http://www.apa.org/ppo/issues/womenabortfacts.html APA Perspectiva Livro sobre o impacto do aborto sobre a Mulher, http://web.archive.org de http://www.apa.org/ppo/issues/womenabortfacts.html

http://web.archive.org/web/20050304001316/http:/www.apa.org/p po/issues/womenabortfacts.html http://web.archive.org/web/20050304001316/http:/www.apa.org/p po / questões / womenabortfacts.html

Information on studies showing higher death rates after abortion: http://www.afterabortion.info/news/CDCdeathswrong.htm Informações sobre estudos mostrando maiores taxas de mortalidade após o aborto: http://www.afterabortion.info/news/CDCdeathswrong.htm

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THE NEW ENGLAND JOURNAL OF MEDICINE

 

http://www.nejm.org/

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http://www.nejm.org/doi/full/10.1056/NEJMp068083

 

Perspective

Roe versus Reality — Abortion and Women's Health

Alexi A. Wright, M.D., and Ingrid T. Katz, M.D., M.H.S.

N Engl J Med 2006; 355:1-9July 6, 2006

Article

References

Citing Articles (9)

Audio Interview

Interview with Dr. Watson Bowes on Abortion and Women’s Health. (8:06)

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Audio Interview

Interview with Dr. Kenneth Edelin on Abortion and Women’s Health. (10:49)

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Slide Show

Images from the Abortion and Contraception Clinic of Nebraska and A Woman’s Touch Pregnancy Counseling Center.

Sandra Jones was on her way to a Nebraska operating room to have an abscess drained when she learned that, once again, she had defied medical odds. Six months earlier, doctors had diagnosed breast cancer in the 31-year-old mother of two. Because her test results were positive for the breast cancer susceptibility gene 1 (BRCA1) and she was at high risk for ovarian cancer and recurrent breast cancer, they had recommended bilateral mastectomy, chemotherapy, and a hysterectomy, but Jones (whose name has been changed to protect her privacy) was not ready to give up childbearing. Her doctors warned that though it would be extremely difficult for her to conceive after chemotherapy, she should actively avoid pregnancy for at least six months, since it would complicate her disease and the drugs would increase the risk of serious birth defects. After struggling through treatment, Jones returned home to find that her husband had left her. Now, a few weeks later, routine preoperative tests revealed that she was pregnant. Jones wanted to terminate the pregnancy, but no physician at the hospital was willing to perform an abortion. So several days later, she searched the telephone book and found LeRoy Carhart's Abortion and Contraception Clinic of Nebraska in Bellevue, a small city just south of Omaha. Carhart is famous among abortion providers. He first made national headlines in 2000, when he helped to overturn a Nebraska law banning “partial-birth” abortion. In a five-to-four decision in Sternberg v. Carhart, the U.S. Supreme Court declared the law unconstitutional because it provided no exception for the woman's health and its vague definition of the banned procedure placed an “undue burden” on women. Despite this decision, in 2003 President George W. Bush signed the federal Partial-Birth Abortion Ban Act. Carhart and a nonprofit legal organization called the Center for Reproductive Rights filed a lawsuit in Nebraska, as did others in New York and California; in all three states, district and appeals court judges ruled the ban unconstitutional. This past February, however, after Justice Samuel Alito was appointed, the Supreme Court decided to hear Gonzales v. Carhart. Oral arguments will take place this fall. Carhart is one of the few doctors in Nebraska who performs abortions. Although 35 percent of women in the United States undergo an abortion before they are 45 years of age, providers are increasingly scarce. Each year, 1.3 million women in the United States undergo an abortion, but in 2000 only 3 percent of rural areas in the United States had an abortion provider, and 87 percent of U.S. counties had none. Eighteen states had fewer than 10 doctors willing to perform abortions (see mapAvailability in Each State of Providers Who Perform 400 or More Abortions per Year.).1 In the United States, nearly 20 percent of hospital beds are in facilities with religious affiliations, most of which prohibit physicians from providing abortions.2 According to the Guttmacher Institute, although nationwide about 1 in 14 abortions is sought for health reasons, only two hospitals in Nebraska offer pregnancy terminations, and they do so only under rare circumstances, such as intrauterine fetal death; each of these hospitals performs fewer than 10 pregnancy terminations per year. Nevertheless, in 2004, women from many other states traveled to Nebraska for abortions — at Carhart's clinic. Occasionally, when a hospital refuses, Carhart is asked to terminate a pregnancy that threatens a woman's health. In a recent case, a woman with severe pregnancy-associated renal failure traveled 200 miles by ambulance for an abortion. She arrived with her hospital identification bracelet and an intravenous line in place, underwent the procedure, and was shipped back to her hospital bed. Similar events have occurred in many other states. In 1998, the Louisiana State University Medical Center in Shreveport refused to provide an abortion for Michelle Lee, a woman with cardiomyopathy who was on the waiting list for a heart transplant, despite her cardiologist's warning that the pregnancy might kill her. Hospital policy dictated that to qualify for an abortion, a woman's risk of dying had to be greater than 50 percent if her pregnancy was carried to term; a committee of physicians ruled that Lee did not meet this criterion. Since her cardiomyopathy made an outpatient abortion too dangerous, she traveled 100 miles to Texas by ambulance to have her pregnancy terminated. Some women cross continents to find Carhart's clinic, a small, brown building on the edge of Bellevue. Last year, Carhart and his 10 staff members performed 1250 abortions there. The clinic has three rooms, each equipped with an examination table, an ultrasound machine, and a pulse oximeter. Carhart performs most first-trimester and early second-trimester abortions with a curette and a vacuum cannula, removing the pregnancy sac under ultrasound guidance. He performs abortions up to 24 weeks after conception, the legal limit. A shy man, Carhart speaks softly and rarely smiles or makes eye contact, except when speaking with his patients. Nearly six feet tall, with thick, white hair, he is a quietly imposing figure. Outside the examination room, almost every sentence he speaks is interrupted by his cell phone — on which he is available around the clock since he stopped using an answering service. “I couldn't find enough pro-choice operators,” he explained. “We lost a lot of calls from patients because the service wouldn't put them through.” It's hard to imagine him as a robust young surgeon in the Air Force, where he practiced for two decades — until you witness his dogged determination to keep abortion available and safe. After leaving the military, Carhart opened a clinic for emergency surgery. Abortions were a small part of his practice until 1991, when, on the day the Nebraska Parental Notification Law was passed, his house and stables burned down, killing 17 horses, his dog, and his cat. Although the fire had started in seven different locations on his property, it was never declared arson, and no one was charged with a crime. “Everything we owned except the clothes on our backs and the cars we were driving was destroyed,” said Carhart. “The following morning, I received a letter from someone claiming responsibility, likening the murder of my horses to the murder of children.” The fire transformed Carhart's life. Determined not to “cede a victory to the antis,” he began providing abortions full-time. For a few years, he worked in six states, leaving each day at 6 a.m. and returning home at 11 p.m. Now he moonlights in a Kansas abortion clinic to keep his practice afloat, but his primary office is in Bellevue, situated between a gas station and an antiabortion counseling center for pregnant women called A Woman's Touch. The Catholic school across the street erected a granite tombstone after Carhart moved in; engraved with an image of Jesus holding a baby with angel's wings, it reads: “In Memory of the Unborn Child.” From the outside, Carhart's clinic looks almost abandoned; its windows were boarded up after people shot through them. Nevertheless, cars are parked outside and protestors cluster together at the edge of the parking lot. A large sign on the building reads: “Abortion and Contraception Clinic of Nebraska.” LeRoy Carhart's Abortion and Contraception Clinic of Nebraska, Bellevue. Next door, an even larger billboard above A Woman's Touch advertises free pregnancy testing and confidential counseling. Nationally, such centers outnumber abortion clinics six to one.3 Most are staffed by volunteers and funded by churches, private citizens, or state governments. Thirteen states sell “Choose Life” license plates that help to support these facilities. The Bellevue center was started by Liz Miller, a middle-aged woman with a degree in Biblical studies and training as a licensed practical nurse who used to protest outside Carhart's clinic. A Woman's Touch has an annual budget of $100,000 and serves approximately 60 women per month, free of charge, with the stated aim of providing complete information. “We feel strongly,” said Miller, “that women are not receiving all of the information they need to make their decision.” The center is a two-story pink building that looks airy and inviting. Although it is not a clinic, it offers pregnancy tests and employs a nurse to counsel patients. It has a waiting room and several consultation rooms, including one with an examination table and an ultrasound machine. One of the many brochures available in the entryway suggests that abortion is associated with an increased risk of breast cancer and that “a woman diagnosed with breast cancer while pregnant has a significantly longer life expectancy if she gives birth rather than aborting.” According to the National Cancer Institute, there is no credible evidence to support these claims; indeed, a recent large meta-analysis found no such link.4 Signs advertise workshops and retreats for women with “post-abortion stress syndrome.” This diagnosis is not recognized by the American Psychiatric Association or the American Psychological Association; a study of women's responses to abortions indicated that distress is greatest before the procedure and that there are few severe negative responses afterward.5 The center also offers prenatal parenting classes, baby clothes, and postabortion Bible studies. If a woman is “abortion-minded,” it offers fetal ultrasonography. “Most of the women who see ultrasounds choose to parent,” reported Miller. “Once you watch that little heart beating or see fingers and toes, a sense of regret develops.” Each day, the same protestors assemble outside Carhart's clinic. With signs showing Jesus on one side and mutilated fetuses on the other, they approach each car pulling into the driveway, urging women to visit the center next door instead. “Don't let them destroy the most precious thing inside of you,” they shout. The protestors and Carhart's staff have known each other for years and exchange daily barbs; in March, after sending employees threatening letters, protestors began showing up at their homes as well. The clinic's entryway is flanked by two sets of doors that can lock instantly if the office is threatened. Like most abortion providers, Carhart takes precautions to protect himself and his staff. Each day, he and his wife, Mary, who works with him, drive a different route to work. When they are indoors, they sit away from windows, facing the door. After Barnett Slepian — an abortion provider in suburban Buffalo, New York — was murdered in 1998, police brought the Carharts bulletproof vests. They wore them until, as Carhart drily noted, “we realized that the antis usually shoot providers in the head.” Inside Carhart's office, the atmosphere changes: the walls are covered with thank-you letters from patients, national awards, and portraits of the horses that were killed in the fire. The members of the staff are full of camaraderie. During abortions, they console women, explaining the procedure and chatting with them about their pets, work, or families. The conversation continues in the recovery room, where women sit in recliners while assistants provide antibiotics, postoperative instructions, and contraceptive counseling. Some patients write in the clinic's diary, which was started by a 14-year-old girl who wrote a letter to future patients, sharing her story and reassuring them about the procedure. Before each woman leaves, she must void her bladder, circle the hallway 15 times, and show that her bleeding is slowing; since many patients live hours away, Carhart's staff makes sure that they are stable before they depart. When we met Carhart one recent morning, he had already performed two abortions and had eight more scheduled. His next patient was a woman who had come in the previous day and been sent home because the staff did not think she was emotionally ready. She returned with her brother, who spent most of the time outside with the protestors, coming in occasionally to remind her that she was going to hell. In her purse, she carried protestors' pamphlets featuring pictures of developing fetuses. Before starting, Carhart asked her if she was sure she wanted to do this. She nodded. Throughout the procedure, though, she cried quietly. Afterward, Carhart asked whether the protestors had gotten to her. “No,” she sobbed. “The guilt did.” That day, Carhart saw high-school students, housewives, a patient with breast cancer, and a Native American woman from a South Dakota reservation 12 hours away. Carhart has many patients from South Dakota, which has only one abortion clinic and mandates a 24-hour waiting period for abortions, parental notification for minors who are seeking pregnancy terminations, and state-scripted counseling. The last South Dakota abortion provider retired 10 years ago, so a doctor from Minnesota flies to South Dakota one day each week to perform only first-trimester abortions at the remaining clinic. In March, South Dakota Governor Mike Rounds went one step further, signing into law an outright ban on abortion. The measure, intended as a direct challenge to Roe v. Wade, would make it a felony for a doctor to perform an abortion unless it was necessary to save a woman's life. The bill has no exception for rape, incest, or health — and does not define what constitutes a life-threatening condition. The ban was scheduled to go into effect on July 1, until a grassroots coalition collected the signatures required to send it to a voter referendum in November. Early signs suggest the ban may be overturned: in a survey of registered voters, 57 percent said they would vote against it, 35 percent said they would vote to uphold it, and 8 percent were undecided. At the federal level, in Gonzales v. Carhart, the Supreme Court will decide whether to uphold the Partial-Birth Abortion Ban Act that restricts second-trimester abortions to women with life-threatening conditions. A central question is whether the Court will accept the law's definition of “partial-birth” abortion, a term used by antiabortion forces to describe intact dilation and extraction (D&X). In the act, the definition of “partial-birth” abortion reads:

The person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus.

Physicians who violate the law could face up to two years of imprisonment, be subject to civil lawsuits, and be held responsible for financial compensation of “all injuries, psychological and physical.” Defendants could appeal to their state medical board for a hearing to prove that the abortion was necessary to save the woman's life. However, Carhart notes that “most physicians are not going to risk their careers to prove a woman's condition is life-threatening — not if the only backup they have is a state medical board.” Some abortion-rights activists and physicians, including Carhart, argue that the definition of “partial-birth” abortion is so vague that the law would apply to dilation and evacuation (D&E), the procedure routinely used for second-trimester abortions. In Sternberg v. Carhart, Justice Stephen Breyer wrote: “Even if the [Nebraska] statute's basic aim is to ban intact D&X, its language makes clear that it also covers a much broader category of procedures.” But antiabortion activists insist that the federal law targets intact D&X exclusively. Clarke Forsythe, the former president of Americans United for Life, said that far from being too broad, the law “is so narrowly drafted that it may never be enforced.” Much media coverage has focused on the rarity of intact D&X; in 2000, for example, this procedure accounted for 0.17 percent of all abortions. Introduced as a method for reducing complications in late second-trimester abortions, it is usually performed over the course of two to three days, beginning with the insertion of a laminaria. Once the cervix is sufficiently dilated, the fetus is removed intact; this often requires collapsing the fetal calvaria so the fetal skull can pass through the patient's cervix. In contrast, D&E is a destructive procedure that involves evacuation of the fetus and placenta, usually in pieces, with forceps and a vacuum. Many abortion providers try to keep the fetus as intact as possible while removing it, though, in order to minimize the retention of products of conception. Some abortion providers argue that intact D&X is safest for the woman, since it minimizes the risk of uterine injury, cervical tears, and retained products of conception. However, the procedure is controversial, even among abortion-rights supporters. The antiabortion movement argues that the Court's decision regarding Sternberg v. Carhart does not reflect the people's will. More than half of the states have passed “partial-birth” abortion bans, but the Supreme Court's decision made them unenforceable. “Seventy to 80 percent of the public thinks that this is a barbaric procedure,” argues Forsythe. “Despite this, the Supreme Court swept away 30 state laws.” Forsythe opposes the inclusion of a health exception in the law, arguing that “there is no ban if there's a health exception.” In pre-Roe days, many hospitals offered abortion to women with life-threatening or high-risk pregnancies, despite state laws against it. Physician committees decided who was eligible for abortions and often granted them on psychiatric grounds; poor women had limited access to these procedures. Today, many antiabortion activists believe that late second-trimester abortions should be performed through labor induction so that the fetus will die of prematurity, rather than be killed. But “that is a fine line with a long history,” said Kenneth Edelin, who was convicted of fetal manslaughter in 1975 for performing a second-trimester abortion two years after Roe v. Wade. Edelin, now an emeritus professor of obstetrics and gynecology at the Boston University School of Medicine, was a resident in 1973, when a mother brought her pregnant 17-year-old daughter to the hospital requesting an abortion. Edelin attempted to terminate the pregnancy by infusing saline into the amniotic sac but was unable to reach it because of a low-lying anterior placenta. The mother begged him to try another method. She explained that her abusive husband might hurt their daughter if he discovered she was pregnant. After conferring with his attending physician, Edelin performed a hysterotomy, making a small incision in the uterus and removing the fetus and placenta in a procedure similar to a cesarean section. Four months later, the Boston District Attorney's office discovered the case when it subpoenaed the medical records of 88 women who had undergone abortions. Edelin was indicted. At grand-jury hearings, most of the physicians pled the Fifth Amendment, but Edelin told the truth, believing he was protected by the law. The assistant district attorney who charged him with manslaughter argued that the 20-week-old fetus had become a person once the placenta was detached from the woman and should have been resuscitated. The defense argued that it was stillborn, as indicated at autopsy. Nevertheless, when the case went to trial, Edelin was found guilty. Newspapers nationwide reported on the trial, and there was an immediate chilling effect. “Once I was indicted, hospitals up and down both coasts stopped performing second-trimester abortions,” recalled Edelin. “Many hospital administrators stopped permitting residents to take part in abortion at all.” But there was also an outpouring of support from women who had undergone pregnancy terminations before Roe v. Wade. “I received thousands of letters describing women's experiences — lying on a kitchen table on a sheet of newspaper with a single light bulb overhead, undergoing an abortion alone without anesthesia, antiseptic, or anyone to support her,” said Edelin. “Many women were raped as a part of the process. It's amazing the indignities — the risk to life and future fertility — these women faced when they were alone and frightened.” Edelin appealed to the Supreme Judicial Court of Massachusetts, and eventually the verdict was reversed. Abortion veterans like Carhart fear that Roe may soon be overturned. If that happens, states will have to choose whether to ban or protect abortion. Most have abortion laws on their books, but they are superseded by Roe, as long as it survives. Antiabortion activists are split on whether they should try to overturn it. After Governor Rounds signed the South Dakota ban into law, his approval rating dropped 12 percent. Most of the public still support some form of abortion: polls show that 66 percent of Americans believe that abortion should be legal in the first trimester and that they overwhelmingly support abortion in cases of rape, endangerment of health, or serious fetal anomalies. Yet in 2006, legislators in 12 states introduced bills that would ban nearly all abortions; as of early June, the governor of Louisiana was poised to sign a ban similar to South Dakota's, which will go into effect if Roe is overturned. Number of Reported Abortions in the United States, 1973–2002. Watson Bowes, emeritus professor of obstetrics and gynecology at the University of North Carolina, is among those who argue that Roe v. Wade is a misuse of federal authority: “The Supreme Court used raw judicial power to trump state legislators, and the decision should be overturned on those grounds.” Other antiabortion activists advocate incremental changes in state laws to limit the provision of abortion. These changes include parental consent laws, fetal homicide laws (making it two crimes to kill a pregnant woman), strict regulations for abortion clinics, and legislation requiring physicians to offer women fetal ultrasonography before an abortion. This strategy is already having an effect, argued Katherine Grainger, legislative counsel at the Center for Reproductive Rights. “With each year, more and more restrictions on Roe are being passed.” Ultimately, Grainger said, “we'll see it slowly eviscerated to the point where . . . it's hollow.” Many older abortion providers believe that the complacency of younger women and physicians is partially responsible for the current state of affairs. “They don't remember the thousands of women who died from septic abortions,” argued Edelin. “They don't realize that this is a battle to save women's lives — not a battle for choice.” As new legislation is passed, the courts will hear more cases that challenge Roe, and physicians may increasingly risk their careers and their lives if they choose to provide abortions. With each new decision to limit abortion, more American women lose their access. Whether the Supreme Court ultimately upholds or overturns the Partial-Birth Abortion Ban Act, one thing is certain: poor women in rural America are bearing the brunt of these decisions, and some may pay with their lives.

Interviews with Dr. Watson Bowes, emeritus professor of obstetrics and gynecology at the University of North Carolina in Chapel Hill, and Dr. Kenneth Edelin, emeritus professor of obstetrics and gynecology at the Boston University School of Medicine, can be heard at www.nejm.org.

Source Information

Dr. Wright is a fellow in hematology–oncology at the Dana–Farber Cancer Institute, Boston, and Dr. Katz is a fellow in infectious disease at the Beth Israel Deaconess Medical Center, Boston. Both are editorial fellows at the Journal.