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July 9, 1982, Vol 248, No. 2 >
ARTICLE | July 9, 1982

Mortality From Abortion and Childbirth: Title and subTitle BreakAre the Statistics Biased? FREE

Willard Cates, Jr, MD, MPH; Jack C. Smith, MS; Roger W. Rochat, MD; David A. Grimes, MD
[+] Author Affiliations

Reprint requests to the Family Planning Evaluation Division, Center for Health Promotion and Education, Centers for Disease Control, Atlanta, GA 30333 (Dr Grimes).


JAMA. 1982;248(2):192-196. doi:10.1001/jama.1982.03330020036026
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References

Critics have challenged previous comparisons of mortality from legal abortion and childbirth for containing biases in the crude data that spuriously favor the safety of abortion. To evaluate this concern, we reviewed the sources of mortality data on which these comparisons are based and examined the completeness of abortion mortality statistics, the completeness of childbirth mortality statistics, and the accuracy of the denominators for both these events. We found the evidence to be consistent in two directions: (1) abortion deaths appear to be more completely ascertained than childbirth deaths; (2) use of different denominator estimates has relatively little impact on the comparison. From this evidence, we conclude that the crude data are biased in a direction that overestimates the abortion risks for the woman relative to the risks of childbearing.

(JAMA 1982;248:192-196)

REFERENCES

1 +
Cates W Jr, Grimes DA, Smith JC, et al:  Legal abortion mortality in the United States: Epidemiologic surveillance, 1972-1974 . JAMA 1977;;237:452-455.
2 +
Cates W Jr, Tietze C:  Standardized mortality rates associated with legal abortion: United States, 1972-1975 . Fam Plann Perspect 1978;; 10:109-112.
3 +
Hilgers TW, O'Hare D:  Abortion related maternal mortality: An in-depth analysis , in Hilgers TW, Horan DJ, Mall D (eds): New Perspectives in Human Abortion . Frederick, Md, Aletheia Books, University Publications of America Inc, 1981;, pp 69-91.
4 +
Adamek RJ:  Abortion policy: Time for reassessment , in Burtchaell JT (ed): Abortion Parley . Kansas City, Mo, Andrews & McMeel Inc, 1979;, pp 1-26.
5 +
Testimony of T. W. Hilgers, given before the Royal Commission on Human Relationships, May 21, 1975, Sydney, Australia, reprinted in Hearings Before the Subcommittee on Constitutional Amendments of the Senate Subcommittee on the Judiciary, 94th Cong, 1st sess, post IV, 1975, p 724.
6 +
Willke JC, Willke B: Handbook on Abortion . Cincinnati, Hayes Publishing Co, 1975;, pp 79-90.
7 +
Hilgers TW:  The medical hazards of legally induced abortion , in Hilgers TW, Horan DJ (eds): Abortion and Social Justice . New York, Sheed & Ward, 1972;, pp 57-88.
8 +
Abortion Surveillance 1978 , US Dept of Health and Human Services publication 80-8276. Atlanta, Centers for Disease Control, (November) 1980;.
9 +
Vital Statistics of the United States, National Center for Health Statistics. Government Printing Office, 1974-1981, vol 2: Mortality.
10 +
Henshaw S, Forrest JD, Sullivan E, et al:  Abortion in the United States, 1978-1979 . Fam Plann Perspect 1981;;13:6-18.
11 +
Cates W Jr, Smith JC, Rochat RW, et al:  Assessment of surveillance and vital statistics data for monitoring abortion mortality. United States, 1972-1975 . Am J Epidemiol 1978;;108:200-206.
12 +
Administrative Guidelines for Investigating Abortion Deaths . Atlanta, Centers for Disease Control, 1981;.
13 +
Eighth Revision of International Classification of Diseases, Adapted for Use in the United States . Washington, DC, National Center for Health Statistics, 1967;.
14 +
Smith JC:  The complexity of compiling abortion statistics . Public Health Rep 1975;; 90:502-503.
15 +
Berger GS, Tietze C, Pakter J, et al:  Maternal mortality associated with legal abortion in New York State: July 1, 1970-June 30, 1972 . Obstet Gynecol 1974;;43:315-326.
16 +
Stewart GK, Hance F:  Legal abortion: Influences upon mortality, morbidity, and population . Adv Planned Parenthood 1974;;9:1-7.
17 +
Tietze C: Induced Abortion: A Worldwide Review . New York, The Population Council, 1981;, pp 91-95.
18 +
Shelton J, Schoenbucher AK:  Deaths after legally induced abortion . Public Health Rep 1978;;93:375-378.
19 +
Ziskin LZ, Gregory M, Kreitzer M:  Improved surveillance of maternal deaths . Int J Gynaecol Obstet 1979;;16:281-286.
20 +
Speckhard ME:  Maternal mortality surveillance in Puerto Rico . Presented at the 30th Annual Epidemic Intelligence Service Conference, Centers for Disease Control, Atlanta, April 26, 1981 .
21 +
Barno A, Freeman DW, Bellville TP:  Minnesota Maternal Mortality Study, five-year general summary, 1950-1954 . Obstet Gynecol 1957;; 9:336-344.
22 +
Jewett JF:  Changing maternal mortality in Massachusetts . N Engl J Med 1957;;256:395-399.
23 +
Arthure H, Tomkinson J, Organe G, et al: Report on Confidential Enquiries Into Maternal Deaths in England and Wales, 1970-72. London, Her Majesty's Stationery Office, 1975, pp 122-123.
24 +
Rubin G, McCarthy B, Shelton J, et al:  The risk of childbearing re-evaluated . Am J Public Health 1981;;71:712-716.
25 +
Smith JC, Pekow P, Maze J, et al:  Maternal mortality study, 1974-1978 . Presented at the Annual Meeting of the Association of Vital Records and Health Statistics, Portland, Me, July 31, 1981 .
26 +
 Cases of specified notifiable diseases: United States . MMWR 1975;;24:405-407.
27 +
Levy BS, Mature J, Washburn JW:  Intensive hepatitis surveillance in Minnesota: Methods and results . Am J Epidemiol 1977;;105:127-134.
28 +
Marier R:  The reporting of communicable diseases . Am J Epidemiol 1977;;105:587-590.
29 +
Chung CS, Steinhoff PG, Mi M-P, et al:  Completeness and accuracy of reporting induced abortions performed in Hawaii's hospitals, 1970-1974 . Public Health Rep 1979;;94:454-458.
30 +
Atrash HK, Allen DT, Rochat RW:  Legal abortions in Tennessee, 1974-1978 . J Tenn Med Assoc 1980;;73:855-863.
31 +
Cohen BA, Burkman RT, Rosenshein NB, et al:  Gestational trophoblastic disease within an elective abortion population . Am J Obstet Gynecol 1979;;135:452-454.
32 +
Hayashi K, Bracken MB, Freeman DH Jr, et al:  Hydatidiform mole in the United States (1970-1977): A statistical and theoretical analysis . Am J Epidemiol 1982;;115:67-77.

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1 +
Cates W Jr, Grimes DA, Smith JC, et al:  Legal abortion mortality in the United States: Epidemiologic surveillance, 1972-1974 . JAMA 1977;;237:452-455.
2 +
Cates W Jr, Tietze C:  Standardized mortality rates associated with legal abortion: United States, 1972-1975 . Fam Plann Perspect 1978;; 10:109-112.
3 +
Hilgers TW, O'Hare D:  Abortion related maternal mortality: An in-depth analysis , in Hilgers TW, Horan DJ, Mall D (eds): New Perspectives in Human Abortion . Frederick, Md, Aletheia Books, University Publications of America Inc, 1981;, pp 69-91.
4 +
Adamek RJ:  Abortion policy: Time for reassessment , in Burtchaell JT (ed): Abortion Parley . Kansas City, Mo, Andrews & McMeel Inc, 1979;, pp 1-26.
5 +
Testimony of T. W. Hilgers, given before the Royal Commission on Human Relationships, May 21, 1975, Sydney, Australia, reprinted in Hearings Before the Subcommittee on Constitutional Amendments of the Senate Subcommittee on the Judiciary, 94th Cong, 1st sess, post IV, 1975, p 724.
6 +
Willke JC, Willke B: Handbook on Abortion . Cincinnati, Hayes Publishing Co, 1975;, pp 79-90.
7 +
Hilgers TW:  The medical hazards of legally induced abortion , in Hilgers TW, Horan DJ (eds): Abortion and Social Justice . New York, Sheed & Ward, 1972;, pp 57-88.
8 +
Abortion Surveillance 1978 , US Dept of Health and Human Services publication 80-8276. Atlanta, Centers for Disease Control, (November) 1980;.
9 +
Vital Statistics of the United States, National Center for Health Statistics. Government Printing Office, 1974-1981, vol 2: Mortality.
10 +
Henshaw S, Forrest JD, Sullivan E, et al:  Abortion in the United States, 1978-1979 . Fam Plann Perspect 1981;;13:6-18.
11 +
Cates W Jr, Smith JC, Rochat RW, et al:  Assessment of surveillance and vital statistics data for monitoring abortion mortality. United States, 1972-1975 . Am J Epidemiol 1978;;108:200-206.
12 +
Administrative Guidelines for Investigating Abortion Deaths . Atlanta, Centers for Disease Control, 1981;.
13 +
Eighth Revision of International Classification of Diseases, Adapted for Use in the United States . Washington, DC, National Center for Health Statistics, 1967;.
14 +
Smith JC:  The complexity of compiling abortion statistics . Public Health Rep 1975;; 90:502-503.
15 +
Berger GS, Tietze C, Pakter J, et al:  Maternal mortality associated with legal abortion in New York State: July 1, 1970-June 30, 1972 . Obstet Gynecol 1974;;43:315-326.
16 +
Stewart GK, Hance F:  Legal abortion: Influences upon mortality, morbidity, and population . Adv Planned Parenthood 1974;;9:1-7.
17 +
Tietze C: Induced Abortion: A Worldwide Review . New York, The Population Council, 1981;, pp 91-95.
18 +
Shelton J, Schoenbucher AK:  Deaths after legally induced abortion . Public Health Rep 1978;;93:375-378.
19 +
Ziskin LZ, Gregory M, Kreitzer M:  Improved surveillance of maternal deaths . Int J Gynaecol Obstet 1979;;16:281-286.
20 +
Speckhard ME:  Maternal mortality surveillance in Puerto Rico . Presented at the 30th Annual Epidemic Intelligence Service Conference, Centers for Disease Control, Atlanta, April 26, 1981 .
21 +
Barno A, Freeman DW, Bellville TP:  Minnesota Maternal Mortality Study, five-year general summary, 1950-1954 . Obstet Gynecol 1957;; 9:336-344.
22 +
Jewett JF:  Changing maternal mortality in Massachusetts . N Engl J Med 1957;;256:395-399.
23 +
Arthure H, Tomkinson J, Organe G, et al: Report on Confidential Enquiries Into Maternal Deaths in England and Wales, 1970-72. London, Her Majesty's Stationery Office, 1975, pp 122-123.
24 +
Rubin G, McCarthy B, Shelton J, et al:  The risk of childbearing re-evaluated . Am J Public Health 1981;;71:712-716.
25 +
Smith JC, Pekow P, Maze J, et al:  Maternal mortality study, 1974-1978 . Presented at the Annual Meeting of the Association of Vital Records and Health Statistics, Portland, Me, July 31, 1981 .
26 +
 Cases of specified notifiable diseases: United States . MMWR 1975;;24:405-407.
27 +
Levy BS, Mature J, Washburn JW:  Intensive hepatitis surveillance in Minnesota: Methods and results . Am J Epidemiol 1977;;105:127-134.
28 +
Marier R:  The reporting of communicable diseases . Am J Epidemiol 1977;;105:587-590.
29 +
Chung CS, Steinhoff PG, Mi M-P, et al:  Completeness and accuracy of reporting induced abortions performed in Hawaii's hospitals, 1970-1974 . Public Health Rep 1979;;94:454-458.
30 +
Atrash HK, Allen DT, Rochat RW:  Legal abortions in Tennessee, 1974-1978 . J Tenn Med Assoc 1980;;73:855-863.
31 +
Cohen BA, Burkman RT, Rosenshein NB, et al:  Gestational trophoblastic disease within an elective abortion population . Am J Obstet Gynecol 1979;;135:452-454.
32 +
Hayashi K, Bracken MB, Freeman DH Jr, et al:  Hydatidiform mole in the United States (1970-1977): A statistical and theoretical analysis . Am J Epidemiol 1982;;115:67-77.

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