Point of View

Time to acknowledge the connection between abortion and later preterm birth

May 22, 2013 

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    Find information about the science of the abortion-prematurity link fro, the N.C. Family Policy Council at bit.ly/15ZU1R9.

Preterm birth is one of our most challenging public health issues. It is the major cause for infant death in North Carolina and a key reason we rank among the top 10 states in infant mortality.

Senate Bill 132 requires that the state’s health curriculum teach preventable causes of preterm birth including induced abortion, smoking, alcohol consumption, illicit drug use and poor prenatal care. Opponents of SB132 say its purpose is to promote a nonscientific, pro-life agenda in public schools. This is a misrepresentation of the indisputable evidence demonstrating that a prior abortion increases a woman’s risk for future preterm birth.

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.


This evidence dwarfs what the IOM called “modest and inconsistent evidence” that smoking increases risk for preterm birth, yet since 1985 Surgeon General Warnings on tobacco products have warned of an increased risk for preterm birth in pregnant women who smoke. Many are familiar with other commonly discussed risk factors described in SB132. Never discussed is the established abortion-prematurity link, which is estimated to be responsible for 31 percent of all very preterm births.

In 2009, Dr. Phil Steer, the distinguished editor of the British Journal of Obstetrics and Gynecology, commented on one 2009 meta-analysis by Dr. Prakesh Shah: “A key finding is that compared to women with no abortion history, even allowing for the expected higher incidence of socio-economic disadvantage, women with just one abortion had increased odds of future preterm birth. We have known for a long time that repeated abortions predispose to early delivery in a subsequent pregnancy. However, the finding that even one abortion increases the risk of preterm birth means we should continue to search for ways of making abortion less traumatic.”

Steer accepts that abortion increases risk for future preterm birth. He also reports, “We have known for a long time that repeated abortions predispose to early delivery in a subsequent pregnancy.” Who has known this? Planned Parenthood denies any future preterm birth risk from abortion. Why have there been no organized efforts to educate the public on what Steer says we have known for a long time?

The goal of SB132 is to educate potentially sexually active students on the risk that a common birth control method and surgical procedure places on future pregnancies. In his meta-analysis, Shah stated: “More than a million abortions are performed in the U.S. yearly. Of these, more than 75 percent of women wish to get pregnant again. Women should know risks associated with abortion, for their health and their future reproductive potential. Potential areas for knowledge transfer include education of girls and women enrolled at schools or colleges.”

The N.C. Child Fatality Task Force supports SB132, but other major professional organizations have not officially affirmed the abortion-prematurity link. These organizations, and most abortion providers, still deny the truth that abortion imposes future pregnancy risks.

One abortion clinic in Charlotte acknowledges the truth. Its abortion consent form requires that patients agree with, “Cervical Incompetence: I understand that the abortion procedure may result in cervical incompetency which means I may have problems maintaining a pregnancy in the future, possible miscarriage, stillbirth, premature delivery.”

If we are serious about reducing infant mortality and the toll preterm birth takes on our state, we must educate about the abortion-preterm birth link. Those who would stifle education and reduce SB132 to a political battle do a grave disservice to North Carolina residents.

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

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