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Abortion and pre-term birth

(Previously named "Having an abortion dramatically increases the risk for preterm birth afterward. This in turn leads to greater incidence of maternal mortality, infant mortality, low birth weight, autism, developmental disabilities, cerebral palsy, etc.", complain at my talk page if you think it was inappropriate for me to rename it.) Triacylglyceride (talk) 18:35, 1 June 2013 (UTC)

This article reads from start to finish like it was written by the director of an abortion facility, and leaves out so much science and so many facts (those that such a person would likely find troubling) that the biggest problem here is knowing where to even start. But let's start with this one, already present on the preterm birth article. People can of course disagree with whether abortion is morally defensible, but deliberately suppressing medical science to do so is absurd under any circumstance. This is especially true given the gravity of this issue, and the results it has already had on many people. Mechanisms include damage done to the cervix as it is forced open, knives pushed through, and the infant's body parts dragged or sucked out. The greater incidence of infections are also suspected here, which also lead to some women who undergo abortions never being able to carry a child to term again in the future.

List of sources
The following discussion has been closed. Please do not modify it.
"Previous abortion is a significant risk factor for Low Birth Weight and Preterm Birth, and the risk increases with the increasing number of previous abortions. Practitioners should consider previous abortion as a risk factor for LBW and PB. " http://jech.bmj.com/content/62/1/16.abstract "Induced and spontaneous abortion are associated with similarly increased ORs for preterm birth in subsequent pregnancies, and they vary inversely with the baseline preterm birth rate, explaining some of the variability among studies" http://www.ncbi.nlm.nih.gov/pubmed/19301572 "Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1–2.0); the risk was even higher for extremely preterm deliveries (<28 weeks)" http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2004.00478.x/abstract "This study shows that a history of induced abortion increases the risk of very preterm birth, particularly extremely preterm deliveries. It appears that both infectious and mechanical mechanisms may be involved." This study showed that women who gave birth between 28 and 32 weeks of pregnancy were 40% more likely to have had a previous abortion, and mothers who gave birth to extremeley preterm infants from 22 to 27 weeks were 70% more likely to have had an abortion. http://journals.lww.com/obgynsurvey/Abstract/2005/10000/Previous_Induced_Abortions_and_the_Risk_of_Very.3.aspx "A consent form that simply lists such items as "incompetent cervix" or "infection" as potential complications, but does not inform women of the elevated future risk of a preterm delivery, and that the latter constitutes a risk factor for devastating complications such as cerebral palsy, may not satisfy courts" http://www.jpands.org/vol8no2/rooney.pdf "Previous induced abortions significantly increased the risk of preterm delivery after idiopathic preterm labour, preterm premature rupture of membranes and ante-partum haemorrhage, but not preterm delivery after maternal hypertension. The strength of the association increased with decreasing gestational age at birth." http://www.ncbi.nlm.nih.gov/pubmed/14998979 "The latest statistics in the USA (2007) show a preterm (less than 37 weeks) birth rate of 12.6%. Of these, Early Preterm Birth (EPB—under 32 weeks, infants weighing under 1500 grams, or about three pounds.) is at 7.8%, the highest rate in the past 30 years of stats. As noted in the studies above, previous induced abortions’ have an inordinately increased association with “extreme” (<27 wk) and “early”(<32 wk) premature deliveries (compared to 32 – 37 week premature births.) Thus, it follows that abortion will also have an inordinately increased association with cerebral palsy and other disabilities linked to extreme prematurity." http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/general-comments-on-the-increased-risk/ Of the first-time mothers, 10.3% (n = 31 083) had one, 1.5% had two and 0.3% had three or more Induced Abortions (IAs). Most IAs were surgical (88%) performed before 12 weeks (91%) and carried out for social reasons (97%). After adjustment, perinatal deaths and very preterm birth (<28 gestational week) suggested worse outcomes after IA. Increased odds for very preterm birth were seen in all the subgroups and exhibited a dose–response relationship: 1.19 [95% confidence interval (CI) 0.98–1.44] after one IA, 1.69 (1.14–2.51) after two and 2.78 (1.48–5.24) after three IAs. http://www.ncbi.nlm.nih.gov/pubmed/22933527 Thirty-seven studies of low-moderate risk of bias were included. A history of one Induced Termination of Pregnancy (I-TOP) was associated with increased unadjusted odds of Low Birth Weight (LBR) (Odds Ratio 1.35, 95% Confidence Interval 1.20-1.52) and Preterm Birth (PT) (OR 1.36, 95% CI 1.24-1.50), but not Small for Gestational Age (SGA) (OR 0.87, 95% CI 0.69-1.09). A history of more than one I-TOP was associated with LBW (OR 1.72, 95% CI 1.45-2.04) and PT (OR 1.93, 95% CI 1.28-2.71). Meta-analyses of adjusted risk estimates confirmed these findings. A previous I-TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I-TOP increased. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0028978/

The abortion/preterm birth link has been established in so many published studies that - here again - it is difficult to find a beginning and an end. There was a study published in the NEJM that suggested the link was false, but that study was very small, it's own data showed a small increased risk, and the methodology was completely flawed from the start because it did NOT count Danish women who had abortions before the Roe v. Wade decision in 1973. Yes, it failed to consider that an American court precedent had no bearing on women in DENMARK - who had been having legal abortions for years before 1/73! Why this was the one study published in the NEJM medicine says much more about that publication than it does the actual science.

I suggest we start with this. Because it is at least tied with the most important omission in the article for anyone trying to get reliable and unbiased information on this topic. — Preceding unsigned comment added by YourHumanRights (talk • contribs) 05:39, 30 May 2013 (UTC)

Your belief that induced abortion involves "knives pushed through" the cervix leads me to question your understanding of the procedure. And your belief that a pro-life advocacy group (AAPLOG) is more scientifically reliable than the New England Journal of Medicine leads me to question your understanding of this site's sourcing guidelines. But leaving that aside for a moment...

our site guidelines on medical content generally discourage the selective citation of individual journal articles, as you've done above, because it is trivially easy to support all kinds of ideas by cherry-picking the medical literature. Instead, we look at how reputable expert groups have synthesized the evidence. Do you have some such sources you'd like to present? I understand that there's a political effort to publicize this idea, and that such political efforts often coincide with a drive to raise the visibility of an aspect of this topic on Wikipedia, but it's probably best to focus on what reputable expert groups have to say here.

I'll give you an example to start the discussion. Guidelines from the Royal College of Obstetricians and Gynecologists state: "Women should be informed that there are no proven associations between induced abortion and subsequent ectopic pregnancy, placenta praevia or infertility... Women should be informed that induced abortion is associated with a small increase in the risk of subsequent preterm birth, which increases with the number of abortions. However, there is insufficient evidence to imply causality." ([1]) I haven't exhaustively reviewed other expert bodies (e.g. ACOG, the WHO, etc.), but I suspect they've reached similar conclusions given the conflicting literature (only one side of which you've highlighted above). MastCell ^Talk 20:33, 30 May 2013 (UTC)

If you are unaware of what a curette is, it is an abortion instrument that has looped knives on the end of it to cut the infant off of the uterine wall. When necessary, these are also used to dismember him or her to ease removal from his or her mother. Knives are are sharpened metal blades used for cutting through flesh (in this case), and such knives are what is found at the end of curettes. Naturally, they must first be inserted through the cervix - which itself has been forced open in most all abortion procedures. I hope that clears up any confusion regarding the actual mechanics of the procedure.

AAPLOG is a group of over 2,500 OB/GYN's. If you doubt their honesty or the reliability of their work, or their meta analysis of the published literature on this topic, then by all means feel free to point out the errors they have made therein. I did so and pointed out a rather laughable flaw in one study published in the NEJM. I invite you to critique that as well. Suggesting that one group of doctors is dishonest but that others are not is one thing. Being able to demonstrate that is very much another. I have done my part. In addition to other peer reviewed published studies on this topic, I have included three meta-analyses. That is, detailed analysis of multiple studies. Here again, if all these META-analyses are completely wrong regarding the published science here, then perhaps you can share with everyone why that is? I invite you (and anyone else) to do so, as I am sure all those involved in those studies would as well. You understand that a meta-analysis is a far better determining tool in science than a single study, right?

The Royal College of Obstetricians and Gynecologists and ACOG are both groups of doctors who advocate for abortion on demand, and indeed include many of the doctors who routinely perform them in two countries where abortion is commonplace. You can suggest that their conclusions are superior to those of other groups of doctors who have different political opinions, but here again that is merely an accusation made on your part that - so far at least - has no date or methodology behind it. But yet, the RCOG quote you included itself recognizes the link between abortion and preterm birth! The expert groups that you prefer are acknowledging the link, as are the ones you dismiss (without any scientific reasons to dismiss them beyond their political stances).

Again, I invite you or anyone to demonstrate why and how it is that both AAPLOG, RCOG, and the AAPS are all groups of doctors who have this issue totally wrong. Unless someone can do so, then this very important health risk needs to be included in this article. Calhoun, Shadigian, and Rooney have concluded from their meta-analyses of published medical studies on this topic that abortion can be attributed to an increase of 31.5% in the rate of early preterm births (less than 32 weeks gestation). Statistically speaking, it is thus probable that hundreds of thousands of children – at the very least – are now needlessly living with various mild to severe birth defects due directly to their mother’s previous abortion(s). Meanwhile, the total preterm birth rate for women in America prior to 1970 was approximately 6%; preliminary data for 2010 indicates a preterm birth rate of 11.99%.

I don't think that - especially given the gravity of these issues - that all the meta-analyses and doctors groups can or should be able to be kept quiet because some you or anyone has decided to dismiss them. Either you can demonstrate why and how they are all wrong, or it is you that is wrong. I think you are wrong, and the doctors groups and published science is correct. I invite you to show me and everyone else that I am incorrect. In the meantime, the abortion/preterm birth link has already been accepted on the page regarding preterm birth. And it should be included and accepted here on this page as soon as possible also. YourHumanRights (talk) 18:01, 31 May 2013 (UTC)

I know what a curette is. It's quite different from a knife. For example, curettes are used to remove impacted earwax, but the procedure is not generally described as "shoving a knife into your ear canal". Furthermore, the vast majority of induced abortions in the Western world are not performed via curettage; they are either medically induced or performed via vacuum aspiration. Were you aware of that? Actually, don't answer that, it's irrelevant.

Your posts are composed of 90% politically-charged rhetoric and 10% substance, which is a suboptimal ratio. Insofar as the substance of your post, you are free to make the case that ACOG, RCOG, or the WHO are unreliable sources of medical information. You are free to make the case that the New England Journal of Medicine is a biased and unreliable source of medical information. I don't think you'll get much traction, but it's your time. MastCell ^Talk 18:52, 31 May 2013 (UTC)

Sharpened metal edges used to cut flesh are knives, regardless of their configuration. Any further debate on such a topic is a nonsensical waste of time. It would be like debating if a knife handle was part of a knife, or of a scalpel was a knife or not. I can provide a link to videos of these knives in abortion action if anyone really wants me to, but I doubt anyone will find this particular tangent about knives interesting.

My posts have dealt very deliberately with the published science regarding this topic, and in particular with the meta-analyses thereof. Much as you would like to dismiss all of it and insult me personally for trying to make this being biased and incomplete article factually correct, I will remind you that even the RCOG guide you provided yourself said the following:

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

MastCell, you seem to be very keen here that people NOT be informed of any such thing in this article. So, it is YOU that is disagreeing with RCOG regarding this issue - not me. Furthermore, I challenged you to discredit the three meta-analyses that have been published - none of which have been challenged and unpublished. You clearly want no part of that. I have backed my claims up here with lots of published science. You have backed up your wish to keep this issue off of this page with a PDF from a doctor's group who themselves say that "Women should be informed.." So, you really haven't come up with ANYTHING to counter my claims here.

Because you think that you can simply declare that one group of doctors is unreliable and other groups are, that doesn't make any of your claims true. Again, if you can explain how and why all the meta-analyses on this topic are all completely wrong - please do so. If you cannot, then don't expect everyone else to simply take your word for it. That's not how science works. Science works by challenging the published and per reviewed literature, and clearly you cannot. I didn't say that RCOG was wrong, although they may indeed be bending as much as they can to keep the numbers and the risk as low as they can given their political position on the topic. On the contrary, I am trying to get what RCOG and other groups of doctors have had to say on this topic into this article. the bottom line is that the article gets much better if we include what the published science has to say..

YourHumanRights (talk) 22:51, 31 May 2013 (UTC)

This thread is fringe nonsense written by someone unfamiliar (and seemingly uninterested) with how Wikipedia works (look at the length of the title!) and pushing a blatant, unacceptable POV. It should be at least hatted, or probably better, deleted right now. HiLo48 (talk) 22:56, 31 May 2013 (UTC)

I see one review article in the list and summary of it recommends caution. "This review concluded that the risk of a child having a low birth weight or preterm birth increased for women with a history of pregnancy termination compared with those without such a history. This conclusion should be treated with caution due to the presence of clinical heterogeneity, confounders, and publication bias between the studies." We typically just go with just high quality secondary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:03, 31 May 2013 (UTC)

Reading this one article would give anyone a firm idea of how wikipedia works with regard to controversial topics. That is, one side will get to use the article as an advertisement, and the article itself will be "protected" from edits by those up the wiki food chain. We can attempt to twist words this way or that way, but I certainly am not doubting this medical science when one commenter after another fails to offer up anything whatsoever to refute it. Scientific debates usually involve quoting competing published studies, but nobody seems to be able to even come up with a meta-analysis that would attempt to make the other three vanish somehow. It seems those opposing including the published science here cannot find a single meta-analysis to henpick themselves..

I'll separate the three meta-analyses below. Please, anybody, post a meta-anaysis that refutes these conclusions if indeed you can find one. Please also have a look at the numbers regarding the increased risks inside these analyses of the published literature. Do they look "small" to you? If they do, I guess the next question would be what the definition of "small" is.. In my opinion, a risk that doubles is not a small increased risk.

"Induced and spontaneous abortion are associated with similarly increased ORs for preterm birth in subsequent pregnancies, and they vary inversely with the baseline preterm birth rate, explaining some of the variability among studies"

http://www.ncbi.nlm.nih.gov/pubmed/19301572

Thirty-seven studies of low-moderate risk of bias were included. A history of one Induced Termination of Pregnancy (I-TOP) was associated with increased unadjusted odds of Low Birth Weight (LBR) (Odds Ratio 1.35, 95% Confidence Interval 1.20-1.52) and Preterm Birth (PT) (OR 1.36, 95% CI 1.24-1.50), but not Small for Gestational Age (SGA) (OR 0.87, 95% CI 0.69-1.09). A history of more than one I-TOP was associated with LBW (OR 1.72, 95% CI 1.45-2.04) and PT (OR 1.93, 95% CI 1.28-2.71). Meta-analyses of adjusted risk estimates confirmed these findings.

A previous I-TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I-TOP increased.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0028978/

A literature review retrieved 49 studies that demonstrated at least 95 percent confidence in an increased risk of preterm birth (PB), or surrogates such as low birth weight or second-trimester spontaneous abortion, in association with previous induced abortions. A list of these studies, which probably does not comprise all such studies, is appended to this article. If these 49 statistically significant associations were the result of chance alone, as may happen in 5 of 100 tests, IA should be associated with a reduction in PBs, with P<.05, in an equivalent number of tests. Not one such instance has been found in the literature.”

"A consent form that simply lists such items as "incompetent cervix" or "infection" as potential complications, but does not inform women of the elevated future risk of a preterm delivery, and that the latter constitutes a risk factor for devastating complications such as cerebral palsy, may not satisfy courts"

http://www.jpands.org/vol8no2/rooney.pdf

YourHumanRights (talk) 23:55, 31 May 2013 (UTC)

YourHumanRights - please stop wasting your time and ours. The changes you're asking for are not going to get into the article. This is a reality. You may see this as some sort of evil conspiracy, and you are entitled to that view (I think you're wrong, of course), but whatever the reason, you're wasting your time. HiLo48 (talk) 00:06, 1 June 2013 (UTC)

Are the cited studies looking at curettage? The available methods differ greatly, and if curettage is folded into the statistics then such numbers are not relevant to aspiration or other methods. Binksternet (talk) 00:07, 1 June 2013 (UTC)

And, once again, the opponents of the published science regarding this topic can offer no science of their - just personal insults and a very open and proud declaration that anyone actually presenting the facts here is wasting their time. Why would presenting scientific facts be a waste of anyone's time if this supposedly is a site dedicated to doing exactly that?

Binksternet, some of the studies do indeed separate the methods of abortion, but others do not. Indeed, we are speaking of surgical abortions here rather than chemical abortions that poison, kill, then expel the infant (and have occasionally also killed mothers such as Holly Patterson).

The latest published study on this topic comes from McGill College in Canada just a few months ago. They found the same results as just about everyone before them has in their study of 17,916 women's reproductive histories.

"Women who reported one prior induced abortion were more likely to have premature births by 32, 28, and 26 weeks; adjusted odds ratios were 1.45 (95% CI 1.11 to 1.90), 1.71 (95% CI 1.21 to 2.42), and 2.17 (95% CI 1.41 to 3.35), respectively. This association was stronger for women with two or more previous induced abortions."

http://jogc.com/abstracts/201302_Obstetrics_5.pdf

I have now provided TEN sources. Zero have been presented to refute these ten, and indeed none of them have been challenged and unpublished. Oh, and this will not be a waste of time - one way or the other.. I am well aware that the likelihood is that those who wish to keep women in the dark about this due to their affinity for abortion on demand will ultimately make this entire thread vanish. I hope that they realize what a cruel thing that would be to do and not do that, but I am keeping a careful record of every word posted here. In the event that those near the top of the wikipedia pyramid of editors want to use their delete buttons, there will be a detailed record of how this went down that I will be happy to share in the blogosphere.

YourHumanRights (talk) 01:06, 1 June 2013 (UTC)

Yawn. HiLo48 (talk) 07:40, 1 June 2013 (UTC)

Of the ten sources provided,

• Five are WP:PRIMARY (1, 3, 6, 8, and 10).
• One is a duplicate (4 duplicates 3)
• Two are not WP:RS (5 and 7)
• One includes spontaneous abortion (i.e., miscarriage) (2 - "Induced and spontaneous abortion are associated with similarly increased ORs for preterm birth in subsequent pregnancies, and they vary inversely with the baseline preterm birth rate, explaining some of the variability among studies.").
• One includes a word of caution (9 - "This review concluded that the risk of a child having a low birth weight or preterm birth increased for women with a history of pregnancy termination compared with those without such a history. This conclusion should be treated with caution due to the presence of clinical heterogeneity, confounders, and publication bias between the studies.").

None show a causal link between induced abortion and preterm birth. As noted by the author of source 8,

"To put these risks into perspective, for every 1,000 women, three who have had no abortion will have a baby born under 28 weeks," said Dr Klemetti. "This rises to four women among those who have had one abortion, six women who have had two abortions, and 11 women who have had three or more."

She added that there might still be social factors that they had not allowed for, related to some women's way of life, life habits, and sexual and reproductive health. She said also that the study could show a link, but not prove that abortion was the cause. — source

Also...Holly Patterson was killed by a rare bacterial infection (C. sordellii) that is not specific to or caused by medical abortion (see this). Making such false, misleading, inflammatory, and unsourced statements is not helpful. — ArtifexMayhem (talk) 09:32, 1 June 2013 (UTC)

I wonder if they took into account confounders like smoking? Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:09, 1 June 2013 (UTC)

So now we have 5 people who have responded to the medical science on this topic, and zero have offered up published studies to refute it. All we have is people making excuses, trying to dismiss meta-analyses, and pretending that forcing open a cervix and inserting steel knives through a vagina and into a uterus to cut and tear at flesh shouldn't have any negative affects afterward regarding whether that cervix can stay closed in a future pregnancy. The infection mechanism is also a VERY common sense mechanism here, but given the politics surrounding this topic, some not all) are squeamish about noticing the elephant sitting on the coffee table. Claiming that Holly Patterson's demise had nothing to do with the very powerful poison she took just a few days previous is a great example of the blinders people are willing to put on here. I respect your right to disagree with me here, but that is really absurd. Holly is not the only woman to have died from RU-486, but alas chemical abortions are not what we are talking about in this thread. But we really don't know how many there have been due to the wanton unreliability of the abortion industry.

http://articles.chicagotribune.com/2011-06-16/news/ct-met-abortion-reporting-20110615_1_abortion-providers-fewer-abortions-national-abortion-federation

But that is for another thread and another edit of this article - not this one. Alas, there is no evidence linking early chemical abortions to preterm birth later on. I included that fact in my edits on the preterm birth page. I am not the one here trying to include some information and repressing other information.

The National Academy of Science is just the latest group to have finally given up the ghost on these facts, folks, although they too do what they can to diminish it's visibility. Have a look at what is listed third here as a cause of preterm birth:

http://www.nap.edu/openbook.php?record_id=11622&page=625

But wikipedia editors atop the pyramid here know better, right? Reminder: Every peer reviewed, published study that has not been successfully challenged matters. There are indeed some that attempt to explain away their own numbers, but I invite anyone to find and link to a study that does not show higher preterm birth numbers for women who have had abortions in the past. Yes, that includes miscarriages, because of course that is a traumatic event for a human body also. This process is very similar to the one that transpired when the tobacco industry was first accused of hiding evidence that its products caused cancer. Then as now, sooner or later the science and the numbers will prevail. Does wikipedia really want to make a stand here, on this topic? If you have any doubts, here's some more facts from AAPLOG - an organization of over 2,000 OB/GYN's..

"The latest statistics in the USA (2007) show a preterm (less than 37 weeks) birth rate of 12.6%. Of these, Early Preterm Birth (EPB—under 32 weeks, infants weighing under 1500 grams, or about three pounds.) is at 7.8%, the highest rate in the past 30 years of stats. As noted in the studies above, previous induced abortions’ have an inordinately increased association with “extreme” (<27 wk) and “early”(<32 wk) premature deliveries (compared to 32 – 37 week premature births.) Thus, it follows that abortion will also have an inordinately increased association with cerebral palsy and other disabilities linked to extreme prematurity.

The total prematurity rate for women in America before 1970, before abortion became legal and common, was approximately 6%. It is of interest to note that in Ireland, where induced abortion is illegal, the prematurity rate in 2003 was 5.48%, less than half the U.S. rate of 12.3%. Is there a message here??

Further very interesting statistics come from the Polish experience. Between 1989 and 1993, Poland’s induced abortion rate decreased 98% due to a new restrictive abortion law. The Demographic Yearbook of Poland reports that, between 1995 and 1997 the rate of extremely preterm births (<28 weeks gestation) dropped by 21%. Is there a message here??"

The stubborn refusal of ACOG to accept the abortion/preterm link - from a doctor's group that includes the abortionists themselves - is perhaps the best example currently of politics trumping science..

YourHumanRights (talk) 16:40, 1 June 2013 (UTC)

Four things: 1. Everybody, please be aware that a similar discussion is taking place on talk:preterm birth under both talk:preterm birth#bacterial vaginosis and abortion and talk:preterm birth#Abortion - preterm birth link. RoyBoy and YourHumanRights are posting similar lists of sources, and the preterm birth article contains claims of relation. 2. Because I wanted to refer to this section from elsewhere, I renamed it. The new name has the benefit of not being obnoxiously long and of being neutral. YHR, feel free to complain about this on my talk page. 3. If this entire section is meant to be closed for discussion, the declaration of that should be moved out of the list of sources and to somewhere more visible -- it's currently unclear if it applies to the section, or just to the list of sources. 4. Given that it's unclear, I just want to throw in my hat that YourHumanRights isn't even trying to approach this neutrally. YHR, if you were, you would not keep saying that "knives" are "pushed through" the cervix. It's like if I used trauma shears to take off someone's underwear and you said a knife was pushed into their genitals. It is not the case that anything with a sharp edge on it is considered a knife; when you use the word "knife," people will think of a handle attached to a free blade. A curette is very different from a knife. You could not put a knife into a cervix without damaging it. One can put a curette into a cervix without damaging it. If you were interested in having an actual discussion, you would not use misleading language to color the debate. Triacylglyceride (talk) 18:35, 1 June 2013 (UTC)

Well, YHR has done at least one useful thing here. He's made it obvious that the curette and dilation and curettage articles badly need improvement. LeadSongDog come howl! 04:12, 2 June 2013 (UTC)

Recent textbook chapter, RCOG guideline, N.C. Senate bill

Sections of the following 4-year-old medical reference textbook chapter discuss several of the studies published prior to 2009 mentioned by YourHumanRights:

• Hogue, Carol J Rowland.; Boardman, Lori A.; Stotland, Nada (May 11, 2009). "Chapter 16. Answering questions about long-term outcomes", pp. 252–263, in Paul, Maureen; Lichtenberg, Steve; Borgatta, Lynn; Grimes, David A.; Stubblefield, Phillip G.; Creinin, Mitchell D. (eds.) Management of unintended and abnormal pregnancy: comprehensive abortion care. Oxford: Wiley-Blackwell. ISBN 978-1-4051-7696-5. DOI: 10.1002/9781444313031.ch16.
  • Abortion and future reproductive health
    • Does having one abortion imperil the woman's future reproductive health?
      • Preterm delivery
  • If one abortion does not harm reproductive health, are multiple abortions also safe?

A section of the following 18-month-old RCOG clinical guideline discusses several of the studies published prior to 2011 mentioned by YourHumanRights:

• Royal College of Obstetricians and Gynaecologists (November 2011). The care of women requesting induced abortion, 3rd revised edition. Evidence-based Clinical Guideline Number 7. London: RCOG Press, pp. 44–45:

  Chapter 5 Adverse effects, complications and sequelae of abortion: what women need to know
  5.5 Future reproductive outcome
  Preterm birth
  RECOMMENDATION 5.12 Women should be informed that induced abortion is associated with a small increase in the risk of subsequent preterm birth, which increases with the number of abortions. However, there is insufficient evidence to imply causality. (Grade B recommendation).

  Evidence supporting recommendation 5.12.
  A systematic review and meta-analysis by Shah et al. in 2009¹⁹⁹ reported that a history of abortion is associated with a small increase in the risk of preterm birth, giving an adjusted odds ratio of 1.27 (95% CI 1.12–1.44) increasing to 1.62 (95% CI 1.27 to 2.07) with more than one abortion. A recent large Australian population study of 42,269 births²⁰⁰ comparing term with preterm deliveries supports these findings. Among women with no history of miscarriage or induced abortion, 7.1% had a preterm birth compared with 8.9% of women who had one or more induced abortion (OR 1.25, 95% CI 1.13–1.40). Among women with a history of one or more miscarriages, 8.4% had a preterm birth, which also represents a borderline increased risk (OR 1.11, 95% CI 1.00–1.23).
  However, these findings should be interpreted with caution since few of the reviewed studies controlled for important confounders associated with preterm birth (such as socioeconomic status), and the associations have not yet been shown to have a causal relationship.
  In addition, the Shah review was confined to surgical methods of abortion. Where medical (mifepristone and prostaglandin) and surgical methods have been compared, there has been no significant difference reported in the risk of preterm birth.^201–203
  Furthermore, evidence increasingly points to an association between miscarriage and preterm birth. While previous reviews have been conflicting,^189,204,205 a recent systematic review²⁰⁶ suggests that the odds of preterm birth are similarly increased for both miscarriage and induced abortion. It has been postulated that the increased risk may be related to instrumentation of the cervix and uterus at the time of surgical evacuation.
  Further research is needed to understand this and other risk factors for preterm birth as well as abortion methods and gestation.
  
  189. Thorp JM Jr, Hartmann KE, Shadigian E. (Jan 2003). Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obst Gynecol Surv 58 (1): 67–79. PMID 12544786.
  199. Shah PS, Zao J; Knowledge Synthesis Group of Determinants of preterm/LBW births (Oct 2009). Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and metaanalyses. BJOG 116 (11): 1425–1442. PMID 19769749.
  200. Freak-Poli R, Chan A, Tucker G, Street J. (Jan 2009). Previous abortion and risk of pre-term birth: a population study. J Matern Fetal Neonatal Med 22 (1) :1–7. PMID 19085629.
  201. Chen A, Yuan W, Meirik O, Wang X, Wu SZ, Zhou L, et al. (Jul 15, 2004). Mifepristone-induced early abortion and outcome of subsequent wanted pregnancy. Am J Epidemiol 160 (2): 110–117. PMID 15234931.
  202. Virk J, Zhang J, Olsen J. (Aug 16, 2007). Medical abortion and the risk of subsequent adverse pregnancy outcomes. N Engl J Med 357 (7): 648–653. PMID 17699814.
  203. Gan C, Zou Y, Wu S, Li Y, Liu Q. (Jun 2008). The influence of medical abortion compared with surgical abortion on subsequent pregnancy outcome. Int J Gynaecol Obstet 101 (3): 231–238. PMID 18321519.
  204. Henriet L, Kaminski M. (Oct 2001). Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey. BJOG 108 (10): 1036–1042. PMID 11702834.
  205. El-Bastawissi AY, Sorensen TK, Akafomo CK, Frederick IO, Xiao R, Williams MA. (Mar 2003). History of fetal loss and other adverse pregnancy outcomes in relation to subsequent risk of preterm delivery. Matern Child Health J 7 (1): 53–58. PMID 12710800.
  206. Swingle HM, Colaizy TT, Zimmerman MB, Morriss FH Jr. (Feb 2009). Abortion and the risk of subsequent preterm birth: a systematic review with meta-analyses. J Reprod Med 54 (2): 95–108. PMID 19301572.

A better example of "politics trumping science" may be North Carolina Senate Bill 132: "An act to include instruction in the school health education program on the preventable causes of preterm birth, including induced abortion as a cause of preterm birth in subsequent pregnancies."
which passed the North Carolina Senate on May 13, 2013 by a vote of 48–10 (Republicans 42–0; Democrats 6–10),
and was referred to the North Carolina House Committee on Health and Human Services on May 15, 2013
(Republicans have a 77–43 majority in the North Carolina House, so it looks like the curriculum in North Carolina from the 7th grade up will be revised beginning in the 2013–2014 school year).

• Leslie, Laura (May 8, 2013). "Senate to debate abortion 'risk' bill". Raleigh, N.C.: WRAL.com.

  But UNC School of Medicine Clinical Professor of Obstetrics and Gynecology Dr. David Grimes called the bill "unnecessary and uninformed."
  "Senate Bill 132 would establish a state-sponsored ideology," he said. "The statement is scientifically false."
  Grimes formerly directed abortion surveillance efforts at the U.S. Centers for Disease Control and Prevention.
  "The World Health Organization, the CDC, the American College of Obstetricians and Gynecologists, the American Academy of Pediatricians and the American Public Health Association all have uniformly concluded that abortion does not cause prematurity, " he told the committee. "How did they all get it wrong?"

• Bowden, Carol (May 16, 2013). "Senate bill controversy". Goldsboro, N.C. Goldsboro Daily News.

Bobigny (talk) 21:50, 1 June 2013 (UTC)

The tangential discussion about whether a sharpened blade used to cut and tear flesh and remove limbs is a knife or not is perhaps not a waste of time at all. Perhaps it is indicative of the philosophical backflips that must be done in order to defend the violence of dismemberment in uetro. All manner of nonsense is game here, and that includes pretending that the procedure itself is *not* a violent and bloody one that always results in at least one dead body to dispose of. The comments of former abortion doctors on this topic are easily found online, and I need not repeat them here any more than I need to explain what a cranioclst is used for. But the image/diagram in this article is woefully inaccurate, and the deletion of an actual image of an infant at 8 to ten weeks gestation is further proof of how far the folks controlling this page are willing to go to keep people in the dark about things.

Back to the issue at hand, what we have here is a repeat of what the tobacco industries were up to back in the 1960's and 1970's. The doctor's groups who include OB/GYN's actually doing the abortions themselves have very keen interest in covering up the science here - for both legal and financial reasons. This includes the AMA, who went as far recently as to defend a woman in Alabama who had used many powerful illegal drugs while pregnant - arguing that nobody existed in utero - so there is no victim of what she did (Ankrom v. State of Alabama). ACOG used to publicly state that the abortion/preterm link did not exist also. That would come in handy if any of their abortionists got sued by a woman for being denied informed consent before having an abortion. The denial has since vanished from the ACOG literature, but not been replaced with a reversal to their earlier errors. Interesting, huh?

On the other side we have groups of doctors - AAPLOG, AAPS, etc. - who refuse to perform abortions and instead adhere to the Declaration of Geneva as reaffirmed following the Nazi Doctors Trial, The Nuremberg Code, and the UN Declaration of the Rights of the Child addendum to the Universal Declaration of Human Rights. These groups are slandered regularly on wikipedia. Just have a look at the AAPS page!

With reference to Senate Bill 132 in North Carolina, the same denials of the science regarding this matter have come into play by the folks doing the abortions themselves. (There is also a draft bill on this bouncing around the desks of the Virginia General Assembly, but it has not been introduced yet) The University of North Carolina-Chapel Hill has recently started abortions in house, and will do them in the first AND second trimester..

http://www.med.unc.edu/obgyn/Patient_Care/specialty-services/Womens_Options_Center

Abortionists at colleges are just as aware as their colleagues in small private abortion facilities how explosive this issue could be for them legally and financially. At this point, all they can do is fall back on a few doctors groups that include the abortionists themselves claiming that the link doesn't exist in spite of all the evidence. But, just as we can see here, they can't come up with much of anything to thwart the meta-analyses and large studies such as the ones I have linked to here. If indeed these or any sources and published studies are from such corrupt organizations and that produced such flawed studies, then why can't anyone refute them or point out their errors? I know lots of people have probably been trying, but ZERO of them have been challenged to date.

This is a slam dunk, folks. It's just the folks with great interest in keeping it quiet, many who have very keen legal and financial interests in doing so, who are engaging in such childish philosophical backflips about study authors and causality who are trying so hard to deny women informed consent here. Not surprisingly, wikipedia's upper echelon of editors is doing everything they can to assist them. They should either post and present the alternative view in well done meta-analyses, or they should give up the ghost here and update this article to present the scientific facts. Looks to me so far that they have no intention of doing either, but instead fall back upon a childish "because we can" philosophy.

YourHumanRights (talk) 16:54, 3 June 2013 (UTC)

At this point it is quite evident that you have little or no interest in crafting a serious, neutral treatment of this subject, and instead are intent on using this talkpage as a platform for your personal views on the subject, in violation of this site's guidelines. Your posts are a mix of false assertions (for example, the UN does not take an anti-abortion stance) and politically charged rhetoric which, I think it is fair to say, is aimed at provoking a strong emotional reaction from other editors rather than improving our article. I'm not willing to interact with you further, barring a major change in your approach, per WP:SHUN. MastCell ^Talk 17:10, 3 June 2013 (UTC)

When advocates for a political position are confronted with scientific fact that makes that position less tenable, and they have great difficulty refuting, they can tend to want to change the subject. In this thread, this has taken the form of an entirely tangential discussion of what is and is not a knife - and now we have the accusation that I have made up something regarding foundational human rights accords. MastCell, you will be more familiar than most regarding these foundation human rights documents, as you intervened to delete them from the AAPS Page a few years back - even though the leaders of that organization were AOK to have them included on their page..

“I will maintain the utmost respect for human life, from the time of its conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity; I will practice my profession with conscience and dignity”

Hippocratic Oath Declaration of Geneva Following the Nazi Doctors Trial at Nuremberg

“WHEREAS the child, by reason of his or her physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth”

United Nations Declaration of The Rights of the Child Universal Declaration of Human Rights

“The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision”

The Nuremberg Code

You can accuse me of whatever you want, MastCell. The record is clear that you have taken a great interest in this topic yourself, and have strong feelings about it. We disagree, clearly. The difference here is that you are threatening to censor someone who disagrees with you. I have no need to try and censor you. You have offered up absolutely nothing here to refute the findings of any of the large scientific studies and meta-analyses I have linked here. I could post more.. Perhaps you could be less personal and more scientific in your future responses?

Now then, BACK TO THE ACTUAL TOPIC:

It seems that the University of North Carolina is experiencing an interesting battle between two of its doctors at present. Bobigny quoted one doctor at UNC above regarding Senate Bill 132. As an OB/GYM, he is perhaps the man actually performing the abortions at UNC. If so, the worry about the legal and financial ramifications of this issue certainly would come into play here - even if he is just defending his colleagues who are performing the abortions inside a publicly funded facility. As I said above, the tact he employed was again is to simply fall back on the larger organizations who have denied the link in the past. What he fails to mention is that ACOG has most recently removed the denial, but has not replaced it with a confirmation of the link. The RCOG and the National Academy of Sciences, both rather large organizations, have finally accepted that there is a link!

Here is the *other* opinion of a doctor at UNC that was absent from Bobigny's post above:

BEGIN

"UNC School of Medicine Associate Professor of Pediatrics Dr.Marty McCaffrey is a member of the state's Child Fatality Task Force. He spoke in support of the bill, calling the evidence that abortions increase risk of later preterm births "immutable."

Citing studies and meta-studies of data, McCaffrey said evidence shows abortion as a risk factor for preterm birth "dwarfs" smoking as a risk factor.

"It’s been estimated abortion may be responsible for 31 percent of preterm births in North Carolina," he told the committee. "It’s time to educate our young citizens about preterm birth.""

END

Note the crucial reference to "Citing studies and meta-studies of data,.."

Now then, can anyone *here* do that and demonstrate why and how myself, AAPLOG, the RCOG, and the NAS are all wrong about this??

YourHumanRights (talk) 17:54, 3 June 2013 (UTC)

Link to the article quoted..

http://www.wral.com/senate-to-debate-abortion-risk-bill/12425226/

YourHumanRights (talk) 18:04, 3 June 2013 (UTC)

Read and ignored per WP:SHUN. — ArtifexMayhem (talk) 22:12, 3 June 2013 (UTC)

I agree. Gandydancer (talk) 22:23, 3 June 2013 (UTC)

Sources

Most of the sources proffered by YourHumanRights were analyzed by User:ArtifexMayhem here. In the interest of moving this discussion in a more productive direction, a brief and non-comprehensive roundup of some reputable secondary sources regarding abortion and subsequent preterm birth would include the following:

• The American Congress of Obstetricians and Gynecologists (ACOG) does not list induced abortion as a risk factor ([2]).
• The Royal College of Obstetricians and Gynaecologists (RCOG) states that abortion is associated with a small increase in the risk of subsequent preterm birth, which increases with the number of abortions. However, RCOG emphasizes that there is insufficient evidence to imply that induced abortions cause prematurity. That is, the association may reflect common risk factors which predispose to both abortion and prematurity. ([3])
• The Centers for Disease Control does not list abortion as a risk factor for subsequent preterm birth ([4]).
• The Mayo Clinic lists "multiple miscarriages or abortions" as a risk factor for preterm birth ([5])
• Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice (6th edition, 2009, which I believe to be the current edition) states: "The magnitude of the risk of preterm birth related to elective abortion is small but appears to be real."

This list isn't intended to be comprehensive, but rather a starting point for an informed discussion. Additional sources would be most welcome. MastCell ^Talk 19:02, 3 June 2013 (UTC)

As consistent as the numbers are in study after study, the Moreau study suggests that they are actually smaller than the reality due to under-reporting of previous induced abortions.

"As commonly reported in fertility surveys based on women's reports, it is likely that induced abortion was under-reported. The extent of under-reporting varies between 40% and 65% in the literature.23 However, in this study, data on previous induced abortion were taken from hospital records that were filled in prior to enrolment, which reduces the risk of differential recall according to gestational age. In a specific study addressing this question in relation to cancer, Tang et al.24 found no differential reporting of induced abortion between cancer cases and controls. In addition, under-reporting varies according to women's social and demographic background and is more common among older women and women living alone, with a low educational level.25–27 Thus, we would expect more under-reporting among cases than among controls, and consequently, an under-estimation of the association."

Their discussion also includes the mechanisms, which of course blend in with the causality issue - which seems to me to be very much a matter of common sense given the process of forcing open a cervix and the violence taking place inside of the uterus. This study's authors also into detail regarding other maternal details (smoking, poverty, etc.) and says that the link consistently remained even when all of those other factors were subtracted out. This would be a second reason why all these numbers in all these studies are probably themselves smaller than reality. But even with them, the RCOG claim that the risk is small doesn't appear in any of the meta-analyses. Nor does it appear in the large Moreau study.

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2004.00478.x/full

ACOG's silence on the issue these days (in contrast to what some in North Carolina have suggesting in a continuing denial of the link) as well as RCOG's current stance that it does indeed exist but is "small" seems to me to be the result of both legal and financial worries on the members of both these organizations who are themselves doing the abortions themselves. They would obviously have a very keen interest in not giving lawyers across the world a golden opportunity to sue them for the denial of informed consent *and* for the costs associated with raising a child with severe developmental disabilities.

AAPLOG has no such concerns, and is itself *a part* of ACOG. AAPLOG doctors are members of ACOG.. If ACOG could indeed refute what AAPLOG has been saying regarding this topic, I would think they would have done so by now over the past several years - but they haven't. Anyone else here is invited to do the same, and do their job for them. Indeed, I'll repeat my request for anyone to show us a single published study that does *not* show women who've had abortions later having more preterm deliveries in their DATA. I have reviewed dozens of studies on this topic, and have never found one that showed such numbers in its actual numbers/results.

Falling back on the curious statements of a few doctors groups who themselves have been dragging their feet on this topic for years (the same ones who publicly support abortion on demand and have members that perform them) is not the same thing as demonstrating via published studies that the link is fictitious. All these days and all these paragraphs later, and nobody has been able to come up with even ONE as of yet.. If that situation continues, there is no reason not to update this article.

YourHumanRights (talk) 21:00, 3 June 2013 (UTC)

"There are 137 studies reporting on the abortion-prematurity link. In 2006 the Institute of Medicine published the most complete review of preterm birth. The IOM called abortion an “immutable risk factor for preterm birth,” meaning a woman having an abortion always has an increased chance for future preterm birth.

Two well-designed meta-analyses in 2009 combined data from 41 abortion-prematurity studies. A meta-analysis combines multiple studies on a research topic. It is the gold standard for establishing association between a risky behavior, like abortion or smoking, and an outcome like preterm birth.

The results showed that after one abortion, risk for a future preterm birth before 37 weeks increases by 36 percent and risk for a future very preterm birth before 32 weeks increases by 64 percent. When a woman has multiple abortions, risk for a future preterm birth increases by 93 percent. There are no meta-analyses that refute this association. The abortion-preterm birth link is settled science."

Martin J McCaffrey, M.D., a retired U.S. Navy captain, is a professor of pediatrics at the UNC School of Medicine.

Read more here: http://www.newsobserver.com/2013/05/22/2910986/time-to-acknowledge-the-connection.html#storylink=cpy

YourHumanRights (talk) 04:37, 4 June 2013 (UTC)

The author Martin J McCaffrey, M.D [%27%2Fpediatrics%2Fturnersyndrome%27%2C+%27%2Fpediatrics%2Fspagnolilab%27%2C+%27%2Fpediatrics%2Fcmep%27%2C+%27%2Fpediatrics%2Fsulab%27%2C+%27%2Fpediatrics%2Ftransition%27&parent_only=false] Gandydancer (talk) 10:45, 4 June 2013 (UTC)

As best I can discern from Gandydancer's latest post, all I can do is suggest he try a bit harder to locate Dr. McCaffrey at UNC. I've seen lots of tangents and diversions on this talk page, but trying to suggest that some people either don't exist or don't work where they say they do is really off the deep end. Not surprised, though..

YourHumanRights (talk) 22:32, 4 June 2013 (UTC)

Here's a more detailed review - excellent bar graphs of how many children who have paid the price for their mother's previous abortions included - from the (mystery) doctor McCaffrey. Note the addition quotes he includes from a doctor at ACOG, and another at the RCOG.

"Expert opinion has openly acknowledged that the evidence demonstrates the association of abortion with preterm birth. Dr. Jay Iams, maternal fetal medicine specialist, world renowned authority on prematurity and IOM Preterm Birth Committee member, stated in 2010:

'Contrary to common belief, population based studies have found that elective pregnancy terminations in the first and second trimesters are associated with a very small but apparently real increase in the risk of subsequent spontaneous preterm birth.17'

Dr. Phil Steer, Editor of the British Journal of Obstetrics and Gynecology, commenting on the 2009 Shah study editorialized:

'A key finding is that compared to women with no history of termination, even allowing for the expected higher incidence of socio-economic disadvantage, women with just one TOP (termination of pregnancy) had an increased odds of subsequent preterm birth. We have known for a long time that repeated terminations predispose to early delivery in a subsequent pregnancy. However the finding that even one termination can increase the risk of preterm birth means that we should continue to search for ways of making termination less traumatic.18'"

http://www.ncfpc.org/FNC/1305-FNC-Spring13-Abortion%27sImpactOnPrematurity2.pdf

YourHumanRights (talk) 22:39, 4 June 2013 (UTC)

Looks like a simple error of including "M.D" in the search string. Try: http://pediatrics.med.unc.edu/@@search?SearchableText=Martin+J+McCaffrey%2C&subsite_paths=[%27%2Fpediatrics%2Fturnersyndrome%27%2C+%27%2Fpediatrics%2Fspagnolilab%27%2C+%27%2Fpediatrics%2Fcmep%27%2C+%27%2Fpediatrics%2Fsulab%27%2C+%27%2Fpediatrics%2Ftransition%27]&parent_only=false

No further comment on the usability at this time. LeadSongDog come howl! 22:55, 4 June 2013 (UTC)

While others continue to spend their time trying to get me banned from commenting (even on a talk page!), arguing about what a knife is, and where a single professor of pediatrics works - I have updated the article on preterm birth itself. For the purpose of transparency if not consistency (the abortion/preterm birth link now clearly appears on one wikipedia, but not the other), I will paste what I just posted to the talk page there below. For the moment at least, the folks fighting the science here and running to the censors have not prevailed - but I suspect they will soon enough.

BEGIN

I finally updated the redundant citations (9 and 10) and changed # 9 to the Shah and Zao meta-analysis of 37 studies that they published in 2009. I will probably add a few more when I have the time. Alas, there are so many.. I also removed the word "slightly" that had been recently inserted before 'increased risk,' as that is NOT what the ANY of the meta-analyses show in their results. Among the primary results of the Shah & Zao meta-analysis, it was discovered that women with one previous induced termination of a pregnancy were 35% more likely to have a low birth weight child and 36% more likely to give birth before 37 weeks gestational age. In the case of women who had had more than one abortion, these rates rose to 72% and 93% respectively. The researchers themselves describe these as "significantly increased risks.” Such a word would never be inserted regarding the link to smoking and preterm birth, even though the numbers with that link are dwarfed by the abortion link.

I have also attempted to insert this very real link and very serious risk onto the abortion article itself, but that article is 'protected' from edits to a select few. My attempts to get this issue spotlighted on the talk page of the abortion article have thus far been met with an avalanche of baseless accusations that, essentially, the published science is nonsense and the sources unreliable. No evidence has been offered to refute any of the science, but rather there is now a very concerted effort to silence me and get me banned from even posting on the talk page and/or wikipedia itself. So the abortion/preterm birth link is here on this preterm birth page, but totally absent from the abortion article that at present reads just as if Cecile Richards wrote it!

Thank you, Mikael Häggström for your earlier edit reinserting the science here. I just noticed the term "slightly" had been inserted by someone else since then. So for now it looks like wikipedia will simply contradict itself. I suspect that I will soon be banned altogether from commenting, as this science has riled up a lot of folks who clearly have very strong political views on the topic of abortion. Nothing wrong with that, but when that is used as an excuse to run to the censors and try to get published science squelched and silenced - that tells us all we need to know about them. And it obviously doesn't make wikipedia too look good either.

YourHumanRights (talk) 01:17, 5 June 2013 (UTC) — Preceding unsigned comment added by YourHumanRights (talk • contribs)

The Settled Science Here Should Be Added ASAP

Now that the opposition has come up with a basket full of zeros to refute the numerous sources, statements, meta-analyses, and systematic reviews statements I have provided, can anyone make sense of why the abortion/preterm birth link appears on the preterm birth page - but still does not on this one?? Considering the magnitude of the issues and risks we are discussing here (maternal mortality, infant mortality, low birth wight, cerebral palsy, autism, developmental disabilities, etc), what rationale can anyone offer up as to WHY this article remains PROTECTED from warning people about such things so they can perhaps be avoided to a greater degree by more people as we go forward??

YourHumanRights (talk) 02:38, 6 June 2013 (UTC)

You mean something like "A history of spontaneous (i.e., miscarriage) or surgical abortion has been associated with a small increase in the risk of preterm birth, although it is unclear whether the increase is caused by the abortion or by confounding risk factors (e.g., socioeconomic status). Increased risk has not been shown in women who terminated their pregnancies medically. Pregnancies that are unwanted or unintended are also a risk factor for preterm birth. " Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:17, 6 June 2013 (UTC)

No, I mean something like the language written by the actual researchers in the meta-analyses and the systematic reviews of the published science. Bending over backwards to diminish and dilute their findings is dishonest - especially given the non reporting rate (40% - 60%) suggests that the already "significantly increased risks" are likely much greater in reality than they were observed in the dozens of studies - most of which had to depend on women telling the truth years later about whether or not they had had an abortion(s). Grasping instead for the comments of doctors groups who themselves support and preform the abortion procedures themselves is not as good as quoting from the actual published scientific conclusions. YourHumanRights (talk) 20:53, 6 June 2013 (UTC)

The language proposed by DocJames mirrors almost exactly the guidance provided by the Royal College of Obstetricians and Gynaecologists ([6]), and thus reflects expert medical opinion. MastCell ^Talk 21:06, 6 June 2013 (UTC)

You could propose a version you consider preferable and then we could start a RfC to gather wider input. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:11, 6 June 2013 (UTC)

Both of you were resisting any mention of this science being mentioned in this article just a few days ago. Now you are appointing yourselves in charge of updating it using the most diluted and biased language you can come up with? Your affinity for the opinion of a single doctors group in a single country that itself has ben forced to finally accept the link years after it was obvious should not make anyone at RCOG the go to source here. Again, these are the same folks doing the abortions themselves, and thus have a very big worry about what litigation they may face regarding informed consent. Even if that were not the case - and it is - this group publicly supports the political position of abortion on demand, and their statement on the topic does NOT reflect the findings of the published science in this matter! Since you were both against adding any mention of this link to the article, but now have given in regarding that, I don't think this qualifies either of you to write the update. Indeed, I am not suggesting I should be either. Nor am I insisting that AAPLOG or AAPS' (anti-abortion doctors groups) words on the update update the article.

WHY don't we just repeat, word for word, what the published meta-analyses and systematic reviews say??????????? I suggest Mikael Häggström have a go at it, since he was the one who updated the preterm birth page. He is qualified to do so, make a reasonable few sentences regarding what the published science itself says, and apparently has no strong position regarding these issues as the rest of clearly do. That is, other than believing that informed consent is a fundamental tenet of good medicine.

YourHumanRights (talk) 23:50, 6 June 2013 (UTC)

No I have not resisted having mention of this issue in the article. What I was suggesting was wider input. We must paraphrase to avoid copyright issues. And the content suggested here is the same as on preterm birth. Happy to have Mikael involved. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:54, 6 June 2013 (UTC)

I have been in contact by email with two of the researchers I have quoted above in the last few days. I am confident I can get their permission to repeat things, but alas I don't see how quoting a scientific study and promoting its findings would ever gather the ire of the people who published it. Same goes for a published article. It's hardly something they want to keep a secret (unlike some folks here). I have sent a polite request to Mikael's talk page. I do not know this man at all, and only know who he is because he updated the preterm birth page. We have never spoken or communicated in any way. He is a medical student in Sweden with an impressive edit history that gives no indication of strong feelings or bias regarding these issues. I move that he be allowed to edit the abortion article.

YourHumanRights (talk) 00:06, 7 June 2013 (UTC)

YHR, you just got invited to start an RfC with a proposed edit -- I'm confused why you're asking for somebody else to be allowed to edit. I'm especially confused because you support Häggström (tjenare Mikael! Vad tänker du?) editing the article because he edited preterm birth, while opposing DocJames suggesting almost the exact same wording that is on preterm birth.

I think that MastCell and DocJames have been perfectly reasonable. I've made an additional comment on your talk page about how your discussion style could be more constructive.

If you want to do an RfC, go for it. If Häggström wants to propose an edit, he should go for it. You've made your case, you were very inflammatory about it, and I strongly recommend other editors that they practice WP:SHUN for your future comments in this vein, not because of what you're talking about, but because of how you're talking about it.

Triacylglyceride (talk) 00:52, 7 June 2013 (UTC)

In order for the abortion article to begin to even appear as if it fair and unbiased (this will be the first addition that might make it so), the sections and subsections need to be totally changed also. "Risks of abortion" might be a good idea for a start, and make preterm birth the first one. I suggested Mikael because I am not optimistic about *any* of the other editors that have commented here will do anything other than try and dilute and soften the science here. Doc James' first go at it confirmed my pessimism in this regard. To be fair, I have to admit that I have strong feelings about this myself. So I suggested a med student review the science and craft something - rather than myself. But perhaps I can help Mikael by giving him a an alternate draft. This is a FIRST DRAFT that I am throwing together right now, sans citations. I am surprised that the folks opposing this have thrown in the towel and to be honest I was ill prepared to take Yes for an answer. At the end of the day, this new section should look similar to a section on smoking causing preterm births - or any less controversial connection to increased risk of preterm births.

BEGIN

A girl or woman having a surgical abortion dramatically increases her chances of giving birth preterm and extremely preterm later in life. This is turn leads to a increased risks of maternal death, infant death, and a large range of both moderate and severe developmental disabilities and other birth defects for her future children. These include cerebral palsy, autism, low birth weight, learning disabilities, intraventricular hemorrhage, transient hyperammonemia of the newborn, retinopathy of prematurity (ROP), hypoxic-ischemic encephalopathy (HIE), apnea of prematurity, respiratory distress syndrome (RDS or IRDS), chronic lung disease, hypoglycemia, feeding difficulties, rickets of prematurity, hypocalcemia, inguinal hernia, and necrotizing enterocolitis (NEC), sepsis, pneumonia, urinary tract infection, anemia of prematurity, thrombocytopenia, and hyperbilirubinemia (jaundice) that can lead to kernicterus. (***Any more?***) All of these preterm birth related risks increase with the number of induced abortions she has in her lifetime.

Two well-designed meta-analyses in 2009 combined data from 41 abortion-prematurity studies. The results showed that after one abortion, the risk for a future preterm birth before 37 weeks increases by 36% and risk for a future very preterm birth before 32 weeks increases by 64%. When a woman has multiple abortions, risk for a future preterm birth increases by 93%. There are no meta-analyses that refute this association. The abortion-preterm birth link is settled science. With the non-reporting rate common with abortion related studies, these significantly increased risks may actually be approximately double those figures in reality. Even with the verified data as it is, about 31% of all preterm births can be attributed to previous abortions.

The link between surgical abortions and preterm birth has not been proven with regard to chemically induced abortions involving steroid injections or pills such as mifprestone/RU-486.

END

In a new section under risks, we can then add placenta previa, placenta acretta, and so on.

Regarding the other risk issues for which there is not conclusive scientific proof - or at least still a vigorous dispute, another section should be added entitled "plausible risks." The under-reporting of complications and even deaths from abortions needs to be considered throughout. None of the data in the article takes into account what the Chicago Tribune found in just one state's abortion records.

YourHumanRights (talk) 04:05, 7 June 2013 (UTC)

Your proposed text deviates substantially from the relevant expert medical groups, and misrepresents the current understanding of abortion risks. I'm opposed to it as written on the principle that we should not convey medical misinformation to our readers. I also think you should reconsider your current communication style, which appears to consist entirely of lengthy, angry rants. MastCell ^Talk 05:45, 7 June 2013 (UTC)

The proposed text is factually incorrect and misleading, to say the least. — ArtifexMayhem (talk) 08:22, 7 June 2013 (UTC)

Oppose that text as it is not supported by the best available literature. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:08, 7 June 2013 (UTC)

Preterm birth

In the wake of the recent topic-ban, I was thinking about rebooting a discussion of abortion and subsequent pre-term birth - hopefully a more serious discussion with fewer violations of Godwin's Law. After a quick look, I came up with the following in terms of secondary sources:

• The American Congress of Obstetricians and Gynecologists (ACOG) does not list induced abortion as a risk factor ([7]).
• The Royal College of Obstetricians and Gynaecologists (RCOG) states that abortion is associated with a small increase in the risk of subsequent preterm birth, which increases with the number of abortions. However, RCOG emphasizes that there is insufficient evidence to imply that induced abortions cause prematurity. That is, the association may reflect common risk factors which predispose to both abortion and prematurity. ([8])
• The Centers for Disease Control does not list abortion as a risk factor for subsequent preterm birth ([9]).
• The Mayo Clinic lists "multiple miscarriages or abortions" as a risk factor for preterm birth ([10])
• Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice (6th edition, 2009, which I believe to be the current edition) states: "The magnitude of the risk of preterm birth related to elective abortion is small but appears to be real."

This list isn't intended to be comprehensive by any means, but rather a starting point. Additional sources would be most welcome. DocJames had suggested the following text:

"A history of spontaneous (i.e., miscarriage) or surgical abortion has been associated with a small increase in the risk of preterm birth, although it is unclear whether the increase is caused by the abortion or by confounding risk factors (e.g., socioeconomic status). Increased risk has not been shown in women who terminated their pregnancies medically. Pregnancies that are unwanted or unintended are also a risk factor for preterm birth. " MastCell ^Talk 05:01, 8 June 2013 (UTC)

Motivation

Our article states, "The reasons why women have abortions are diverse and vary dramatically across the world." Is this actually true and does our article back it up with factual information? Of course, I think it goes without saying that the reasons are diverse, but do they really vary dramatically across the world? Gandydancer (talk) 18:55, 8 June 2013 (UTC)

that sentence was in the original article as the lead sentence in the section on "Personal and social factors". The word "dramatic" bothered me too but I decided to leave it - differences across countries for "health" as the reason do appear to vary dramatically. I added the cites from that sentence to this sentence. But I would not object to taking out "dramatic" because it is, well, dramatic. Jytdog (talk) 19:10, 8 June 2013 (UTC)

I have take it out. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:29, 8 June 2013 (UTC)

No need for "dramatically". Binksternet (talk) 21:42, 8 June 2013 (UTC)

I wonder about these sentences: Additionally, unintended pregnancy itself may be considered a disease.[96]:205-207 Feminists have described pregnancy as a disease.[97] I think they should be deleted. Gandydancer (talk) 01:00, 9 June 2013 (UTC)

They are both true and sourced. What is the basis in policy or guideline for removing them? Thanks! Jytdog (talk) 01:09, 9 June 2013 (UTC)

See WP:V for ref 96 and WP:RS for ref 97. I've removed the lot. — ArtifexMayhem (talk) 07:41, 9 June 2013 (UTC)

I don't agree but I will let the reversions stand. I don't intend to spend a lot of time on this article so probably will not be around much. Glad you are leaving the new structure and the broad description of what the health exemption means in US law. I actually spent about an hour yesterday trying to find examples for what conditions come up in pregnancy that lead to decisions to abort. Had a very hard time finding RS for that, but then came across the description of the decision on Doe v Bolton that I was ignorant of - so wonderful to learn about that. But all that is a model where the unwanted pregnancy itself is not a condition that needs medical treatment -- you need some other condition to justify the abortion. I think the "unintentional pregnancy is a medical condition that needs treatment" idea is really powerful. I friend of mine "lives" there - super careful about contraception and every month she is again grateful to see her period - she is very clear that getting pregnant would be a malady that she would want - and deserve - the medical treatment of an abortion for. It took me a while to understand where she was coming from and it was eye-opening, that unwanted pregnancy itself is a medical condition that requires treatment. And as I thought about it, yes - public health agencies around the world definitely treat unintended pregnancy under the preventable disease model, like washing your hands and covering your mouth when you cough prevents transmission of infectious disease and exercising prevents CV disease. I especially disagree with the deletion of the public health content. I know Rush Limbaugh et al make political football of that but he is, well, a dick. But like I said I am not invested in this article. Thanks again for talking! Jytdog (talk) 20:35, 9 June 2013 (UTC)

New resource

NYT reports on a new study about women denied abortions. Do you think this would best fit in this top-level article, or is there a sub-article where it might belong? –Roscelese (talk ⋅ contribs) 15:21, 12 June 2013 (UTC)

Abortion and mental health, I imagine, but also this one. I'm also surprised that The New York Times is reporting on this when the research has not been peer-reviewed yet. Dr. Foster seems like an eminently qualified researcher, but I would still hesitate to give this too much weight for now. NW (Talk) 16:03, 13 June 2013 (UTC)

KillerChihuahua (talk · contribs) posted a news item about this study at Talk:Abortion and mental health back in November of last year ([11]), so it's been mentioned here and there. I tend to agree with NW; while this project is interesting, it hasn't yet generated any publications in the scholarly literature, at least not that I can identify, so I'd lean toward waiting to mention it. It may be notable on the basis of the coverage in the Times and elsewhere even without scholarly publications, but it seems too fine-grained of a topic to include in this top-level article on abortion. It might fit better at abortion in the United States, abortion debate, or abortion and mental health. MastCell ^Talk 17:01, 13 June 2013 (UTC)

OK, we may as well wait. –Roscelese (talk ⋅ contribs) 19:22, 13 June 2013 (UTC)

Roscelese, MastCell: I just happened to run into PMID 23122688. That's from November 2012 (so it fits with around when KC originally posted), and in it, they say "We have recently presented preliminary results on the consequences of receiving an abortion compared to having an unwanted birth at the 2012 American Public Health Association meeting, and the publications of our findings are forthcoming." NW (Talk) 15:06, 3 July 2013 (UTC)

Request to add section

Could a controversy section be added? - Billybob2002 (talk) 18:15, 22 June 2013 (UTC)

Redundant to abortion debate section etc. in the article. –Roscelese (talk ⋅ contribs) 18:26, 22 June 2013 (UTC)