Clarke D Forsythe, in his excellent book Abuse of Discretion: the inside Story of Roe Versus Wade (buy the book on Amazon here) explains at length why legal abortion deaths and injuries do not make it into the published statistics.
“Abortion injuries and deaths are washed out of the US public health system through a series of filters. The first filter is the clinics. Clinics do not take responsibility for injuries if they can avoid it. Standard procedure for clinics is to tell a patient who suffers pain or bleeding to go to the nearest emergency room, not back to the clinic. Only 22 states – less than half – require reporting of complications, but, if they do, neither the clinic nor the ER is inclined to keep records and do so. If clinics urge women to go to the nearest ER, the clinics will not see the injury to report it.
The 2nd filter is the ER. The ER doctor may have no reason to suspect abortion or may simply report the presenting symptoms rather than the underlying cause. A 1992 medical journal study found that 50% of abortion patients conceal their abortions from the medical personnel who interview them about their medical history.”
(RK Jones and K Kost “Underreporting of Induced and Spontaneous Abortion in the United States: an Analysis of the 2002 National Survey of Family Growth,” Studies in Family Planning 38 (2007): 187 – 197)
Payment mechanisms are the 3rd filter. Most abortions performed in the United States are currently paid for in cash. (Only 13% of women use their private insurance for abortion coverage: 74% pay out-of-pocket. Rachel Laser on the Diane Rehms Show, October 5, 2009)
There is no submission of the procedure to a third-party payer and no financial record of the transaction.
Coding procedures are the 4th filter. Even if an ER doctor suspects an induced abortion, coding procedures actually give an ER doctor a financial incentive to report the women’s condition as caused by something else, such as embolism, sepsis, or cardiomyopathy. The ER doctor will be paid more if the ER doctor submits the billing as “treatment for septic shock” rather than “abortion.” Or, given the emotional discomfort associated with abortion, medical personnel might choose an alternative cause to protect the privacy of an abortion patient.
The ER doctor will most likely use codes for fever, abdominal pain, and sepsis to report to the patient’s insurance company, because they do not want to risk the claim being denied because it was related to complications of an elective abortion.
Abortions billed to insurance companies in the United States are billed according to coding requirements (current procedural technology or CPT codes) The CPT codes are created and controlled (by patent) by the American Medical Association. The CPT codes must be linked with an international classification of disease (ICD) code. The ICD codes are controlled by the World Health Organization (WHO). Here are the ICD – 9 codes for abortion complications:
639 .1: Delayed or excessive hemorrhage following abortion, or eptopic and molar pregnancies
639.2 Damage to pelvic organs and tissues following abortion or ectopic and molar pregnancies
639.3 Renal failure following abortion or eptopic and molar pregnancies
639.4 Metabolic disorder following an abortion or eptopic and molar Pregnancies
639.5 Shock following abortion or eptopic and molar pregnancies
639.6 Embolism following abortion or eptopic and molar pregnancies
639.8 Other specified convocations following abortion or eptopic and molar pregnancies
639.9 Unspecified complication following abortion or eptopic and molar pregnancy
The ICD – 9 codes (the current version used in the United States) lump for different events together: spontaneous abortion, elective abortion, ectopic pregnancy, and molar pregnancy. The ICD – 9 codes make it impossible to specifically linked a complication to elective abortion.
The 5th filter is unreliable death certificates. The Federal Bureau of Vital Statistics (B VS) formulates a national death certificate form, which serves as a template for states in creating their own form. The national form omits any history of prior spontaneous abortion (miscarriage) or elective induced abortions. Yet this would be important information to gather in order to analyze data on prior pregnancy history and pregnancy outcome. In addition, the doctor who might certify an abortion death is typically not the one who originally treated the woman. Death certificates are often inaccurate by as much as 30 – 40%. Abortion statistician Willard Cates, Jr., and his colleagues found that “inadequate physician documentation on the death certificate” occurs in about 40% of abortion related deaths.”
(Willard Cates Jr, Jack C Smith, Roger W Rochat, et al. “Assessment of Surveillance and Vital Statistics Data for Monitoring Abortion Mortality, United States, 1972 – 1975” American Journal of epidemiology 108 (September 1978); 204)
The 6th filter is birth certificates. The BVS is also complicit in avoiding any data collection that could link maternal abortion history to adverse pregnancy outcome. During the 1990s, a federal representative from the BVS met with an ACOG committee to review the recommended national birth certificate forms, which served as a template by which states could create their own birth certificates. Notably absent from the form was any history of the mother’s prior spontaneous or elective abortions, and the committee immediately recognize the omission and recommended that this information be included, since it is important information to gather in order to analyze data on prior pregnancy history and subsequent pregnancy outcome and assess women’s health. But the representative from the B VS stated that the federal government did not want to collect any data that might link abortion history to adverse pregnancy outcome, and that there was pressure from Congress to not collect this data; hence, it would not be on the birth certificate data form. The B VS birth certificate recommendations have excluded any reference to prior abortions.
All of the prior filters may make it clear why the 7th filter is haphazard data collection. The federal Centers for Disease Control and Prevention (CDC) in Atlanta has been charged by federal law since 1969 with keeping track of the annual numbers of abortion and keeping track of abortion mortality and morbidity.
The CDC does this through its Abortion Surveillance program; this data is published in the Morbidity and Mortality Weekly Report (MMWR), which covers reasons for death and disease, including abortion. The abortion data that is reported to the CDC comes not from clinics or practitioners but from the states, the states get the data to the CDC voluntarily. Not all states give their data to the CDC; for example, California – which accounts for ¼ to 1 3rd of all abortions the United States – has not reported data to the CDC for several years.… Given the fact that several states do not report abortions to the CDC, neither the total number of annual abortions or the number of deaths can be accurate…
State collection of data is hit or miss. In June 2011, the Chicago Tribune reported that “state abortion records [were] full of gaps” and that “thousands of procedures” and 6 deaths were not reported to the state health department.
(Megan Twohey, “State Abortion Reports Full of Recording Gaps” Chicago Tribune, June 16, 2011 at C1)
It is not surprising that the CDC conceded in 1992 that “data of the AGI [Alan Guttmacher Inst.] demonstrated significantly more abortions each year” that the CDC reported.”
American Medical Association, Council on Scientific Affairs. “Induced Termination of Pregnancy before and after Roe V Wade: Trends in the Mortality and Morbidity of Women” Journal of the American Medical Association 268 (1992): 3231 – 3239
Clarke D Forsythe Abuse of Discretion: the inside Story of Roe Versus Wade (New York: Encounter Books, 2013) 235 – 241
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