W.H.O. rules perpetuate myth of ‘safe’ abortion

By Isabelle Bégin
The Interim

To this day, certain members of the world health and political community have accepted or tolerated legal abortion because it was deemed “safe” for women. How was this conclusion drawn? Because very few deaths are ever reported under the category of abortion in cause-of-death publications throughout the world. And why is this the case? Because abortion is safe, you say? Not at all! What no one ever told you, nor I, is that the World Health Organization has two rules against reporting a death due to abortion under abortion.

Coding rule no. 12, together with recommendation no. 7, state that deaths due to medical and surgical treatment must be reported under the medical error or accident, orcomplication of the procedure, and not under the condition for treatment. In effect, this makes abortion a “ghost” category, and makes it almost impossible to code a death due to abortion.

Medical coders have in fact relayed that most attempts to code deaths due to abortion under abortion yield a “reject message” from the computer programs provided by the National Centre for Health Statistics of Washington D.C., a division of the U.S. Centers for Disease Control. (The computer programs are now used in Spain, Australia, Canada, the United States, and will soon be introduced in the United Kingdom and New Zealand; these simply incorporate the same problematic coding rules already used throughout the world.) Only a minute number of abortion-related deaths actually qualify to be declared under abortion, i.e. those for which the medical certificate of death categorically and unequivocally gives abortion as the underlying cause of death. If abortion is mentioned anywhere else on the death certificate then on the specific line for the underlying cause of death, the death gets coded as an accident of some kind, a sudden or unexpected death, an illness (like septicaemia—blood poisoning) or an injury.

Coding rule no. 12 and recommendation no. 7 have to this day remained buried amidst tonnes of coding volumes published by the World Health Organization under the titleInternational Classification of Diseases, Ninth Revision (or ICD9). The discovery of these regulations represents a revolutionary step in the pro-life quest: indeed, it is no longer possible for any organization—not even the WHO—to claim that legal abortion has ever beensafe, as all statistics ever published on the matter are now totally and irrefutably invalidated.

As deaths caused by all medical interventions are included together under categories for complications of all kinds, it is impossible to know, however, just what share of these deaths is attributable to abortion. In Statistics Canada’s Causes of Death publication for 1995, under those categories in which medical coders have admitted to tabulating abortion-related deaths, there are 1,026 deaths of women between the ages of 10 to 50. The categories given by coders include misadventures during surgical and medical care; accidental cut, puncture, perforation or haemorrhage; accidental poisoning by urea, saline solution, prostaglandins, anti-infectives, sedatives and anaesthetics; post-operative shock; post-operative haemorrhage; post-operative infection; convulsions; injuries to abdominal organs/blood vessels; and late and adverse effects of the above.

Some indication of the magnitude of abortion-related deaths, however, is provided by Henry Morgentaler’s very own assessment of the risks of mortality associated with abortion in his book, Abortion and Contraception, published in 1982: “The risk of mortality increases by almost 30% with each week of gestation, and approximately doubles for every two weeks after eight menstrual weeks” (p. 94); “Ten to fifteen percent of all deaths due to abortion are caused by haemorrhage” (p. 77); “Embolism accounts for 24% of abortion deaths” (p. 87); “Infection accounts fully for 25% of all deaths resulting from abortion” (p. 85) ; “Mortality due to hysterotomy [caesarean section for termination of pregnancy] is quite high.” (p. 61); “The reason why pregnancies of less than six weeks carry a higher risk of major complications is that before seven to eight weeks, the cervix has not softened enough and dilatation, therefore, is more difficult and carries more risk of perforation and cervical injury. Also, menstrual extraction, done early in pregnancy, has a high rate of incomplete abortion with retention of tissue.” (p. 69); “Delay of suction curettage from eight to ten weeks gestation increases the risk of a major complication by 60%. Delay of abortion from eight to sixteen weeks gestation increases the risk of a major complication by 300 to 1,300%.” (p. 71). (Emphasis added.)

If all of the above 1,026 deaths were abortion-related, the mortality rate for legal abortion would be close to 1 per cent (1,026 out of 106,458 abortions performed in Canada in 1995). That would make legal abortion no less than 25 times more dangerous than illegal abortion, which, “in developed countries such as the United States or Canada, has an estimated mortality rate of 40 deaths per 100,000 illegal abortions” (0.04%) (Morgentaler, Dr. Henry.Abortion and Contraception, p. 130).

How is this possible? First, women are never able to exert such pressure on themselves as to perforate their own uterus and abdominal organs. Only the dilation required to insert suction canulas, curettes and forceps can create such pressure. Second, rarely are the instruments used by women as potentially damaging as the curette used by doctors (a slotted spoon with a sharp, serrated edge). Third, only in hospitals is it possible to be given general anaesthesia, which dramatically increases complications, such as blood coagulation defects and hence haemorrhage (life-threatening blood loss requiring an immediate blood transfusion) or embolism, regurgitation of and choking on gastro-intestinal contents (a complication specific to pregnant patients), and cardiac and respiratory failure. Fourth, never do women have access to such potent drugs as those available in clinics and hospitals, and never do they ingest as many as the number they are given in clinics and hospitals. In fact, a number of the drugs given are actually classified as “immunosuppressants”: these drugs help kill and expel the baby but also expose the woman’s body to increased risks of infection. Fifth, rarely do women attempt to abort their babies at 5 months gestation or later, as is done in clinics and hospitals.

Sixth, even when legal, abortion is increasingly carried out in private facilities (one out of three in 1995), which (1) are not equipped to deal with emergencies (blood transfusions); (2) are not required to report complications; and (3) have been shown not to observe procedural ethics. Only in Morgentaler clinics is it possible to undergo an abortion – where all the above medical equipment is inserted – without any advance dilation. Indeed, whereas the Society of Obstetricians and Gynecologists of Canada’s Clinical Guidelines for Induced Abortion (1994) requires a two-stage procedure with “pre-insertion of osmotic dilators … which bring about gradual and safe dilation of the cervix with a reduction in rates of cervical laceration and uterine perforation” (p. 5), Morgentaler, in his book of 1982, advocates the one-stage procedure: “My objections to the two-stage procedure are two-fold. First I do not agree with the rationale for it; second, I object to the considerable discomfort women are exposed to, unnecessarily to my mind.” (p. 55). Morgentaler appears to consider himself above the safety guidelines recognized and upheld by his peers. In 1976, he was charged by the Quebec College of Physicians for not taking any patient history or blood or urine tests, and for not examining the tissue after removal; more recently, in 1998, a Nova Scotia woman successfully sued his Halifax clinic because staff allowed her to leave, unattended, within 30 minutes of the operation, even though she was complaining of pain and shakiness: she drove off, fainted and swerved into oncoming traffic. Other complainants have effectively been silence through generous private settlements in three documented cases. In the end, it becomes obvious that abortion is never safe—whether legal or illegal, or whether practised in hospitals or clinics. Other answers simply have to be pursued.

Responses to the unearthing of the problematic rules are encouraging. The International Statistical Institute, based in The Netherlands, agrees intervention is required. “The problem you point out originates from the coding rules issued by the World Health Organization. Since they issue erroneous coding rules, they are responsible for correcting them. ISI would certainly endorse such an approach.”

Also encouraging is the response of the Canadian Medical Association: “Physicians need to know the risks of mortality and morbidity associated with termination-of-pregnancy procedures in order to communicate them to women … As you point out, this information is not readily available, due in part to the World Health Organization’s coding rules. Our work on this issue will depend to a large extent on the responses you receive from Statistics Canada, Health Canada and the WHO. We would greatly appreciate receiving copies of these responses.”

In its response, however, Statistics Canada has simply chosen to avoid the issue, stating that “there is no evidence, based on the most recent Canadian mortality data, of increased risk of death from induced abortion compared to other outcomes of pregnancy … We will consider your suggestions if analysis is conducted on this issue in the future.” From the point of view of women’s welfare, such a response is, of course, unacceptable.

Had enough? Well, yet another, perhaps even more disturbing misinformation problem exists because of WHO data collection rules. On the WHO-prescribed medical certificate of death form, there is a confusing (and optional) maternal death question that reads as follows: “If deceased was a female, did the death occur either during pregnancy (including abortion and ectopic pregnancy) or within 42 days thereafter?” In this way, deaths due to abortion can be attributed to pregnancy in general! Hence, health professionals throughout the world are telling women the outrageous fallacy that it is 7 to 10 times more dangerous to have a baby than to have an abortion.

Meanwhile, young girls and women are not allowed to give truly informed consent to the procedure and continue to die. And while families mourn, statistics continue to show “zero” deaths from abortion. Women have fought hard for what they were told was “safe,” legal abortion; little did they know they would have to do the same for their right to know of the very real risks of death involved.

Soon, as abortion is subtracted from WHO coding rule no. 12 and recommendation no. 7, and the medical certificate of death form is appropriately modified, women will, at the very least, be able to know the true risks involved with legally induced abortion. (A letter requesting the implementation of the above modifications was sent to the WHO in August, 1999.) It is to be hoped, however, that from now on, no country will allow its citizens to be exposed to such risks.

Isabelle Bégin holds a degree in political science and works as a professional translator in Ottawa.