Nearly 50 years ago, as a new doctoral student at Johns Hopkins University, I had my first meeting with my faculty adviser: Dr. Ernest Lyman Stebbins, dean of the school and a luminary in international public health. The school wing where we met was already named after him!
“Stebbie” turned out to be approachable and supportive. This great and wise man, even at our initial meeting, treated me as a colleague. He also offered advice that has guided my career: “The passion of advocacy can be an important influence on social change. But science must always lead. Advocacy which denies or distorts science is a fraudulent exercise which undermines both the society and the conduct of science.” I could never have imagined how relevant his remarks would prove a half-century later.
This weekend in Denver, science and advocacy will joust over one of the most contentious issues: induced abortion. The keynote speaker at the annual meeting of the American Public Health Association (APHA) will be Cecile Richards, president and CEO of Planned Parenthood. Her selection demonstrates the strong advocacy position organized public health takes regarding legal abortion.
What Cecile Richards Won’t Talk About
Richards will likely discuss “access to health services,” “reproductive freedom,” and a “woman’s right to choose,” or the importance of “safe abortions.” She may mention the political divide over legal abortion, and exhort APHA attendees to vigorously support pro-abortion legislative initiatives.
But she will not talk about the actual abortion procedure—that there is no “safe” abortion for the developing child. She will not mention the potential negative consequences of abortion for mothers and their future children. She certainly will not use the word “death” in referring to abortion.
But what is the science? No credible scientific group disputes that a new, genetically distinct organism begins with fertilization, the union of the male sperm and the female egg that forms the zygote (embryo). Simply stated, human life begins at conception.
Nor is there any doubt that, barring miscarriage or induced abortion, conception usually results in a live birth. Therefore, no matter the gestational period at which it occurs, abortion ends an individual human life. Abortion is a cause of death. Even staunch advocates concede that abortion is death, that denying this scientific fact is self-delusional, and that their goal is to morally justify that death.
Abortion: The Leading Cause of Death in the United States
Causes and patterns of mortality are key metrics of public health science. Health promotion activities focus upon populations where morbidity and mortality rates are extreme, or where large racial, ethnic, gender, socioeconomic, or geospatial differences exist among subpopulations. Along with migration and fertility, mortality is a principal determinant of the size and demographic composition of society, and cause-specific mortality patterns crucially influence where lawmakers and agencies spend public money.
As a proximate cause of death, induced abortion is stunningly consequential. The incidence (number of deaths) dwarfs other causes, with immense racial and ethnic disparities. In the United States in 2009, integrating official government reports on pregnancy outcomes (including abortions) and all causes of death, induced abortions were the leading cause of death for the total society, representing 32.1 percent of all deaths.
By contrast, all diseases of the heart represented 16.7 percent, and malignant neoplasms 15.8 percent, of all deaths. Induced abortions were only 16.4 percent of all deaths for non-Hispanic whites (NHWs), but 61.1 percent and 64.0 percent of all deaths for non-Hispanic blacks (NHBs) and Hispanics, respectively. For Hispanics and NHBs, deaths from abortions were 79.3 and 57.5 times, respectively, the number of homicides. For NHWs, deaths from abortion were 12.4 times the number of suicides.
Yet, despite conclusive science to the contrary, high incidence, and huge racial and ethnic disparities, induced abortion is not reported as a cause of death in U.S. vital statistics. This enables abortion to be scrubbed from the nation’s research agenda, discouraging comprehensive reporting and limiting funding to serious abortion researchers.
Good Science Drives Out Bad Ideology
Three states (California, Maryland, and New Hampshire) do not report abortions to the Centers for Disease Control and Prevention, and reporting is uneven among states that do report. The pro-abortion Guttmacher Institute has stressed the need for complete, valid data in addressing abortion as a public health issue and informing research on unintended pregnancies and contraceptive method effectiveness.
Guttmacher endorses a coordinated federal and state effort to build a robust abortion reporting system that is “similar to the existing systems for other vital statistics such as births and deaths.” However, given the current exclusion as a cause of death and the paucity of valid abortion data despite its huge mortality burden compared to other causes of death, abortion research is essentially unfunded.
In the absence or denial of available science, public dialogue will be driven by ideology. We see, in Stebbins’ words, this “fraudulent exercise” when euphemisms such as “access to health services” are used in an attempt to deny the objective reality of fetal deaths.
This ideologically driven denial also has a corrosive effect on conducting science. The editor of a well-known public health journal, declining to use a manuscript on this subject, explained (direct quote), “In the tradition of [journal name withheld], the reviewers were all staunch advocates of ‘choice’ and were unhappy with your point of view.” This blatant bias chillingly affirms Stebbins’ warning.
An induced abortion is the death of a human being, determined and carried out by other human beings in a conscious, deliberate process. In this respect abortion is similar to capital punishment and subject to the same clash of religious, political, and ideological values. The appropriate role of science is to inform the societal dialogue with objective information.
One hopes that partisans on either side of the abortion legality debate would prefer to avoid taking a life. Thus, the general consensus that abortion should be “rare.” Public health science has a special contribution to make, since an abortion is a preventable death. However, refusing to acknowledge abortion as a death undermines the role of science and the transparency so fundamental to a free society.