Maternal Mortality: A National Embarrassment

Americans spend more money on childbirth than any other country, but we’re not getting a good return on our investment.

Less than a century ago, approximately one mother died for every 100 live births — an occurrence so common that nearly everyone belonged to a family, or knew of one, that was devastated by such a loss. Fortunately, in most nations, those tragedies have declined over the years. In fact, in the decade between 2003 and 2013, only eight countries saw their maternal mortality rates rise.

Unfortunately, the United States was one of those eight countries, joining a club that also includes Afghanistan and South Sudan. Within the 31 industrialized countries of the Organization for Economic Cooperation and Development, an American woman is more likely to die as a result of pregnancy than a citizen of any other country besides Mexico. Among developed countries, the United States has one of the highest maternal mortality rates — and those rates are only getting worse.

Graph: CDC

U.S. maternal mortality has attracted the attention of organizations whose oversight you wouldn’t expect. Amnesty International, which most Americans associate with the fight against human rights abuses in far-flung authoritarian regimes, considers our high maternal mortality rates to be a violation of human rights. Additionally — and pathetically — one of the biggest sources of funding for maternal health in the United States comes not from taxpayers but from the pharmaceutical company Merck. The Economist quoted a Merck spokesperson as saying, “We expected to be doing all our work in developing countries.” Continue reading

Sound Science and Unsound Ideology: Sixty Years of Obstetric Ultrasound

Ultrasound image used in an anti-abortion billboard in Ireland, 2012. Photo: The Vagenda

For decades now, ultrasound technology has been a fixture in the journey from pregnancy to parenthood. It has also become a prized weapon among abortion opponents in the battle over reproductive rights.

Ultrasound, which uses high-frequency sound waves to render images of a developing fetus, had its beginning 60 years ago this week, with the publication of a seminal paper in the British medical journal The Lancet. The development of the technology has a colorful history, one involving flying mammals, German submarines, a desert-dwelling inventor, and countless medical professionals who saw a range of patient care possibilities.


Ultrasound is a powerful tool, which can benefit patients or be used as a cudgel by abortion opponents.


But that colorful history belies the drab and fuzzy appearance of most ultrasounds. That limitation, though, has never stopped it from taking on enormous significance. When the technology was first developed, it gave obstetricians an unprecedented ability to survey fetal development, making it one of the most important advances in their field during the latter half of the 20th century.

By the same token, ultrasound has not only been a valuable medical tool but also a powerful storytelling tool. Today, it is often put to use four or more times before a patient’s due date. While the FDA and other authorities advise against ultrasounds that aren’t medically necessary — recommending just two for a low-risk pregnancy — many patients opt for additional, elective ultrasounds for the sake of having keepsake images. Posting those images online has become a popular way to share their news with family and friends. Continue reading

Mythbusting: Does Abortion Cause Breast Cancer?

breast-examNew England Journal of Medicine. Journal of the American Medical Association. Annals of Internal MedicineJournal of American Physicians and Surgeons.

One of these things is not like the others, one of these things just doesn’t belong. But how can most laypeople differentiate between these medical journals? The dry, pithy titles seem to tell you exactly what’s underneath their covers. So if I told you that, according to a study in the Journal of American Physicians and Surgeons, abortion increases risk for breast cancer, would you believe me? Well, why not? The Association of American Physicians and Surgeons (AAPS), which publishes the journal, sounds legit.


Health decisions must be guided by reliable evidence, and when agenda-driven policies misinform, patients cannot make informed decisions.


Except that AAPS is infamous for its agenda-driven views, and its journal is used to deny climate change and the dangers of secondhand smoking, promote the debunked idea that vaccines cause autism, advocate for closed borders in overtly racist anti-immigration pieces, reject the causal relationship between HIV and AIDS, and perpetuate a far-right political worldview. The organization opposes any government involvement in health care, including the FDA, Medicare, the Affordable Care Act, and regulation of the medical profession.

Medical journals, like all scientific journals, are where researchers share and critique each other’s work. Before anything is published it undergoes “peer review,” in which experts evaluate studies for quality — good study design, reasonable interpretation of results, etc. The Journal of American Physicians and Surgeons, however, has been criticized for placing ideology over the presentation of meticulously gathered scientific evidence, and is not indexed in academic databases like MEDLINE. In 2007, AAPS joined conservative organizations in filing a lawsuit against the FDA, arguing against emergency contraception’s over-the-counter status. So, when the journal publishes articles purporting a link between abortion and breast cancer, we should all be raising our eyebrows in collective skepticism.

You might have heard abortion opponents’ claims that abortion can raise one’s risk for breast cancer later in life. So let’s get something out of the way right now: The very best scientific evidence does not support a link between abortion and breast cancer. Prominent medical organizations, including the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization, have all examined the entirety of the research and found that the largest and most methodologically sound studies fail to reveal a link between abortion and breast cancer. Yet still opponents of abortion include this factoid in misinformation campaigns to instill fear into people making difficult, private decisions, often during periods of vulnerability. Continue reading