Misleading: While it is possible for early delivery to preserve both the life of the mother and child in the event of a life-threatening condition, as the video suggests, it does not mention that this is only applicable when a fetus’ gestational age is advanced enough that its survival outside the womb is possible (generally >24 weeks old). In situations where a fetus has not developed sufficiently, it would not be possible for expedited delivery to save its life.
FULL CLAIM: Abortion is never medically necessary
SUMMARY
This video, which has been shared more than 6,000 times and is currently trending on Facebook, records part of a speech by Lila Rose at a Young America’s Foundation event. In this video, she claims that “abortion is not medically necessary”.
Physicians who evaluated this claim found it to be inaccurate. They explained that there are many medical conditions, such as pre-eclampsia, HELLP syndrome and placenta previa, in which abortion could become medically necessary in order to save the life of the mother. Incidentally, abortion is medically defined as a procedure to end a pregnancy – this definition does not change depending on the reasons for an abortion, i.e. whether the procedure is motivated by an unwanted pregnancy or medical emergency or some other situation has no effect on its medical definition. However, Lila Rose redefines the meaning of abortion to exclude the cases when abortion is medically necessary in order to bolster her claim that “abortion is never medically necessary”. This is akin to the No True Scotsman fallacy in which the definition of a word/phrase is modified from its actual meaning to make a point. For example, Rose claims that treating an ectopic pregnancy is not an abortion, even though termination of the pregnancy is the result of the procedures that treat ectopic pregnancies.
Lila Rose’s further comments suggesting that physicians “could perhaps do an early delivery if [the mother] is experiencing pre-eclampsia or she has a very severe condition that you need to deliver that baby early” instead of performing abortion also lacks context so as to be misleading. In order for early delivery to save both the life of mother and child, the fetus first needs to have developed sufficiently that it stands a chance of surviving outside of the womb. This caveat is not mentioned in the video. The comments do not take into account the fact that a fetus may not have reached a sufficiently mature gestational age during a maternal emergency – in such cases, abortion would be the fastest and safest way to terminate the pregnancy.
Studies have shown greater harm to women who are not able to receive an abortion during an unwanted pregnancy compared to women who are able to receive an abortion. The Turnaway study in particular has done much to shed some light on this subject, collecting data from about 1,000 women in the United States to examine not only physical health, but also mental health and socioeconomic outcomes for women unable to receive an abortion for an unwanted pregnancy (therefore carrying it to term), as well as the impact this had on their children[1,2,3,4,5,6].
[See below for updates made to this article since it was first published, as well as the outcome of a third-party review of our findings, which supports the fact-check’s original conclusions.]
SCIENTISTS’ FEEDBACK
Daniel Grossman, Professor (Obstetrics & Gynecology) and Director, Advancing New Standards in Reproductive Health, UCSF:
[At the time of commenting, Prof. Grossman served on the board of directors of the NARAL Pro-Choice America Foundation.]
These comments made by Lila Rose, who is not a clinician, are not medically accurate. The piece that is missing in her comments is the gestational age of the pregnancy. If the pregnant woman develops a life-threatening condition at a gestational age when the fetus is likely to survive, it is true that in most cases, obstetricians would proceed with expedited delivery. But if the pregnant woman develops a serious condition at 20 weeks, such as ruptured membranes with signs of infection or heavy bleeding from a placenta previa, it is critical to terminate the pregnancy quickly to save her life. There is no chance that the fetus can survive, and an abortion would be the fastest and safest way to terminate the pregnancy.
Robyn Schickler, Obstetrician-Gynecologist and Fellow, Physicians for Reproductive Health:
[At the time of commenting, Dr. Schickler was affiliated with Physicians for Reproductive Health, an advocacy group with a pro-choice stance.]
As an obstetrician-gynecologist who provides abortion care as a part of the full spectrum of reproductive health care, I know thanks to my medical education and my professional experience that there are many reasons why abortion care is medically necessary. There are a number of reasons why people need abortion care. Below are just a few examples from the many people I have cared for.
I have seen patients who develop dangerously elevated blood pressures and lab abnormalities consistent with pre-eclampsia and HELLP syndrome (HELLP syndrome is a constellation of elevated blood pressures and lab abnormalities which can include severe anemia, abnormal liver labs [indicating liver swelling], and abnormal blood clotting [meaning the patient can bleed out]). If you are not treated for HELLP syndrome, you are at absolute risk of dying. After counseling, deciding to terminate the pregnancy, and having the abortion, these patients’ blood pressure and labs immediately began to return to normal.
I have seen patients whose water breaks very early, well before fetal development has completed to the point where survival is possible outside of the pregnancy. Usually in that situation, we offer termination because the pregnant person is at risk of developing severe infection, and the fetus’ lungs do not develop without fluid, so outcomes are very poor. Some of these patients come to us and already have severe infection, with fever and abdominal tenderness and develop sepsis which is the body’s response to a bad infection and includes very low blood pressure. It can result in damage to the organs and sometimes death. In this case, the only option to treat sepsis and save the life of the pregnant person is to perform an abortion. After completing the abortion, the fever immediately stops, blood pressure stabilizes, and labs became normal.
I take care of and have taken care of several patients with hyperemesis (severe nausea and vomiting in pregnancy). These patients usually lose a significant amount of weight and cannot hold ANY food or liquid down, even after trying treatments with every nausea medication we have. They therefore become very malnourished, and may be admitted to the hospital for IV nutrition. Not only is this harmful for the pregnant person, but the fetus also is not getting the nutrition it needs to grow normally. In pregnancies that are not yet viable, we offer termination of pregnancy. The patients for whom I have performed an abortion have recovered instantly after the abortion, meaning that they are able to eat and drink in the recovery room, 30-40 minutes after the abortion. In these patients, the abortion was the only thing that allowed them to recover and regain their health.#
It’s also important to note that a non-partisan, rigorous scientific report from the National Academies of Sciences, Engineering and Medicine (NASEM) affirms that abortion is safe and effective in all forms[7] (link to report highlights). In fact, they noted that the biggest threat to quality abortion care is the litany of medically unnecessary regulations that raise costs and delay procedures, ultimately putting health at risk.
Alexis Shub, Associate Professor, Department of Obstetrics and Gynaecology, University of Melbourne:
There is no doubt that abortion is necessary to save the life of a woman when she is at a previable gestation, usually before 23 or 24 weeks, or has a very growth-restricted fetus at a slightly later gestation, for example with a 300-gram fetus at 24 or 25 weeks, and the mother has a life-threatening condition which can only be improved by delivery.
This can occur in the context of severe pre-eclampsia or eclampsia, with bleeding from placenta previa or abruption, or with preterm ruptured membranes with infection (chorioamnionitis). This was demonstrated very clearly in the widely reported case of Savita Halappanavar. Savita was a 31-year-old woman living in Ireland who developed infection after her waters broke at 17 weeks. Termination of pregnancy was refused by her treating doctors, in the interests of preserving the life of the fetus, and she died the next day.
READ MORE
Dr. Jen Gunter’s article explains in detail why a C-section for expedited delivery is not always safe for the mother (its safety is greatly dependent on her medical condition and the gestational age of the fetus), and why an abortion can sometimes be safer than a C-section.
UPDATE (03 Sep. 2019):
1) We have added clarification about the argumentative technique used by Lila Rose that might confuse readers.
2) We also note the following statements by professional associations that further support this fact-check.
The American College of Obstetricians and Gynecologists (ACOG) also clarified their position in a 2012 article published by USA Today on similar claims regarding abortion’s medical necessity made by then-US Representative Joe Walsh:
“Abortions are necessary in a number of circumstances to save the life of a woman or to preserve her health. Unfortunately, pregnancy is not a risk-free life event.”
In the same USA Today article, several obstetricians/gynecologists interviewed also highlighted potential conditions that might make abortion medically necessary to save the mother’s life, such as “severe infections, heart failure and severe cases of preeclampsia”.
ACOG reiterated this point in 2019, stating that “abortion later in pregnancy may also be necessary when complications severely compromise a woman’s health or life, conditions which may also reduce the possibility of fetal survival. These might include premature rupture of membranes and infection, preeclampsia, placental abruption, and placenta accreta”.
Current European Society of Cardiology guidelines do not recommend that women with pulmonary arterial hypertension (PAH) become pregnant, owing to the high maternal and fetal mortality (30–56% and 11–28% respectively) associated with the condition during pregnancy, despite the availability of advanced therapies. In the event that a woman with PAH does become pregnant, the Society recommends “therapeutic abortion should be seriously considered”. This is not to imply that women with PAH have never successfully carried a pregnancy to term without dying or developing complications, nor that women with PAH should choose to have an abortion, but to highlight the fact that abortion can become a medically necessary procedure in many such cases – once again disproving the claim that “abortion is never medically necessary”.
UPDATE (11 Sep. 2019):
1) Dr Alexis Shub’s comment was received and included after the initial publication. This comment further supports the original verdict and did not modify it.
2) We have also added a link to Dr. Jen Gunter’s article under the Read More section, which explains why an abortion may sometimes be a preferred procedure to a C-section depending on the mother’s medical condition and the fetus’ gestational age.
3) # – We also received additional feedback indicating that hyperemesis serious enough to necessitate an abortion is actually extremely uncommon (if modern medical care is available), although not unheard of.
UPDATE (01 Oct. 2019):
On 25 Sep. 2019, the American College of Obstetrics and Gynecology released a joint statement with Physicians for Reproductive Health, which concluded that: “Without question, abortion can be medically necessary.” Read the full statement here.
Following this fact-check’s publication, anti-abortion advocacy groups and several U.S. Senators alleged that potential bias from two reviewers played the defining role in our fact-check’s verdict. The review was therefore referred to the International Fact-Checking Network (IFCN) for further investigation, announced on 11 Sep. 2019. The IFCN published its findings on 28 Sep. 2019, concluding that:
“1. The findings of Science Feedback’s fact-check were based on publicly available scientific evidence and [were] not the result of any bias. The claim that “abortion is never medically necessary” is false and inaccurate.
2. The process used by Science Feedback to select the original claim to review was sound and not the result of any systemic bias, and a review of the 10 last fact-checks indicates no systemic bias in the selection of claims to check.
3. The failure to declare to their readers that two individuals who assisted Science Feedback, not in writing the fact-check but in reviewing the evidence, had positions within advocacy organizations, and the failure to clarify their role to readers, fell short of the standards required of IFCN signatories. This has been communicated to Science Feedback.”
In short, no changes to our verdict or retraction of our fact-check are warranted. In keeping with the IFCN’s recommendations, we have added information in this fact-check to clarify to readers Prof. Grossman and Dr. Schickler’s affiliations. The following statement has also been removed from Dr. Schickler’s comment: “We should remember that while these medical reasons for abortion are very serious, all reasons for deciding to seek abortion care are valid; no one reason is better than another.”
REFERENCES
- 1 – Gerdts et al. (2016) Side Effects, Physical Health Consequences, and Mortality Associated with Abortion and Birth after an Unwanted Pregnancy. Women’s Health Issues.
- 2 – Biggs et al. (2017) Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA Psychiatry.
- 3 – Roberts et al. (2014) Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion. BMC Medicine.
- 4 – Foster et al. (2017) Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. American Journal of Public Health.
- 5 – Foster et al. (2019) Effects of Carrying an Unwanted Pregnancy to Term on Women’s Existing Children. Journal of Pediatrics.
- 6 – Foster et al. (2018) Comparison of Health, Development, Maternal Bonding, and Poverty Among Children Born After Denial of Abortion vs After Pregnancies Subsequent to an Abortion. JAMA Pediatrics.
- 7 – National Academies of Science, Engineering and Medicine. (2018) The Safety and Quality of Abortion Care in the United States.
