Search || Home » A.I.R.V.S.C. » Rape and Abortion

Rape and Abortion


A.I.R.V.S.C.
Association for Interdisciplinary Research in Values and Social Change
Volume 25 Number 1
Summer 2013
by Donna Harrison, M.D.
[Executive Director and Director of Research
and Public Policy, American Association of
Pro Life Obstetricians and Gynecologists]
Reproduced with Permission

As a woman, I can hardly imagine a more violent action against a woman than rape. Not only is a rape physically violent, but because this act involves an attack against the deepest, life-bearing part of our psyche, the violence is also psychological and spiritual. Every fiber of our being shouts out the perversion of the event, and we long to help the woman who has been so violated. We want to undo the rape. But nothing we can do will make her "un-raped". The reality is that we can only do our best to help her to heal from the horror.

Our compassion multiplies when we find out that she has an unborn child within her as a result of the rape. We want to make her "un-pregnant". But the harsh reality is that she will never be "un- pregnant" with this child, because she already is a mother; the pregnancy itself is an event that has already forever changed her life. What she chooses to do with the pregnancy will also alter her life in an immutable way. She will become either the mother of a living child or the mother of a dead child. What is the best way to bring healing to help the woman who conceives her unborn child by rape? Is abortion really a better solution for her physically and mentally?

Scope of the problem

One of the few published studies available on the incidence of pregnancy after rape1 estimates that 32,101 pregnancies result from rape each year with a pregnancy rate of 5%. In a sample of 34 rape-related pregnancies in the study, most occurred in adolescents from a known, often related, perpetrator. Only roughly 12% of the girls sought, and received, immediate medical attention, and a little over half received no medical attention related to the rape. A third of these victims did not discover they were pregnant until they were in their second trimester.

What did the women chose to do when they discovered their pregnancy? Roughly half of the victims underwent abortion. A third opted to keep their baby. Only one out of 17 girls placed their baby for adoption. One out of 9 of the girls had a spontaneous abortion. Although roughly half of the women in the study chose to abort their unborn child conceived in rape, the other half did not choose abortion. For a significant number of women, aborting their unborn children was not seen as a solution to their trauma.

What was the outcome for the women who aborted compared to the women who gave birth? Unfortunately, the study does not address that question. However, other studies do shed light on both the physical and psychological outcomes of women who abort compared to the women who give birth. Childbirth is a natural process, and the woman's body is perfectly suited to going through this natural event. The risks of childbirth have been greatly reduced due to the advances of modern medicine. However, abortion interrupts this natural event and can cause both short-term and long-term problems for the women having an abortion.

Immediate risks of abortion

The risks of any surgical procedure are: bleeding, infection and damage to the organ being worked on or the organs nearby. For abortion, the organ being worked on is the womb (uterus), and the organs nearby are her bowels, her bladder and huge blood vessels and nerves. During the process of abortion, especially second trimester abortions, the woman's womb can be perforated by sharp surgical instruments or even by pieces of the baby's bones which have been broken during the extraction. Hemorrhage also is very common during abortion, and the risk of hemorrhage increases as the pregnancy gets further along. The risk of death during an abortion in the late second and third trimester exceeds the risk of death during childbirth2. This is especially pertinent for women, who are pregnant as a result of rape, since such a large percentage of them do not discover the pregnancy until they have reached the second trimester.

Recent studies3,4 from Finland looked at the complication rate from medical and surgical abortion in the first trimester and second trimester. Medical abortion refers to those abortions done using drugs, which are intended to avoid the use of surgery. The study found that in the first trimester, medical abortions with mifepristone and misoprostol resulted in 15 out of every 100 women with hemorrhaging, 7 out of every 100 women with tissue left inside, and 6 out of every 100 women needing additional surgery (due to incomplete abortion with the drugs). In the second trimester, abortions with mifepristone resulted in an increased risk of hemorrhage compared to the first trimester, and additional surgery was needed in 40 out of every 100 women.

The risk of death from an abortion increases as the gestational age of the unborn child increases5. Compared to giving birth in the United States, which has a risk of death of 8.8 in 100,0006, the risk of death with abortion after 21 weeks (late second trimester) is at least 8.9 in 100,000.

A study from the CDC of women, who died after elective abortion, showed a dramatic increase in deaths from abortions done after the first 12 weeks of pregnancy. Compared with women who had abortions in the first 12 weeks, women who had abortions between 13 and 15 weeks of gestation were 147% more likely to die. Women who had abortions from 16-20 weeks were 295% more likely to die; and those who had abortions after 21 weeks were 766% more likely to die from abortion than women who abort in the first trimester. Death from abortion after 20 weeks is greater than death from live birth. Recalling that, in the study on rape and pregnancy, many of the women in the study did not have a diagnosis of pregnancy until the second trimester. This automatically puts these women, who are pregnant as a result of rape, at dramatically increased risk of death, should they choose to abort their pregnancy.7

Abortion and Preterm Birth in Subsequent Pregnancies

Over 130 studies in the medical literature demonstrate that women who abort compared to women who give birth have an increased risk of delivering a child who is very premature in subsequent pregnancies. The more abortions a woman has, the greater her risk of having a premature baby in a later pregnancy. These very premature babies must be maintained in an incubator for months and face many special problems in their lives, including higher risks for cerebral palsy and learning disabilities.

One abortion increases a woman's risk of preterm birth by 36-50%.8,9,10,11 Two abortions resulted in an 80-160% increased risk of preterm birth.12,13,14,15 Since the legalization of abortion, the rate of preterm birth has risen dramatically in the United States. This is especially apparent in the African-American population, where the rate of preterm birth is three times the preterm birth rate in the Caucasian population16. This corresponds to the threefold increased rate of abortion in the African American population compared to the Caucasian population17.

A woman who has been raped must consider the risks involved in choosing to have an abortion as compared with giving birth. Having an abortion can hurt her chances of having a normal pregnancy in the future. This, of course, only adds to the trauma of the rape by putting her at higher risk of prematurity with its attendant health risks when she is ready to have a family later.

Abortion and the Risk of Breast Cancer

In addition to increasing a woman's risk of preterm birth, abortion can increase a woman's risk of breast cancer. Understanding the link between abortion and breast cancer requires some understanding of how the breast is affected by pregnancy. In a first pregnancy, a woman's breast tissue changes so that by the end of the pregnancy, the breast is able to make milk. The most dramatic changes in the breast happen in the first pregnancy. Changing the breast from "never pregnant" to "making milk" requires rapid growth of certain cells in the breast, and then a change in those cells when a woman nears term. The second trimester is the time of rapid growth, and the third trimester is the time when the breast cells, which have grown rapidly in the second trimester, now convert to making milk.

If we look at the 1996 study of women who have been raped, we see that most of the women raped were adolescents; and a significant number were in their second trimester when they discovered their pregnancy. That means that this pregnancy by rape would likely be their first pregnancy. What does that mean for this girl's future breast cancer risk?

A 2004 study from the International Journal of Cancer states this:

"Pregnancy, and especially first pregnancy, appears to represent a critical window in determining future breast cancer risk. The occurrence of a first completed pregnancy and age at first pregnancy are among the strongest known predictors of breast cancer risk."18

This study went on to state "A significant elevation of risk was associated with a history of induced abortion but not spontaneous abortion". In fact, the study showed double the risk for women who aborted as compared to women who gave birth.

Another study from the Journal of the National Cancer Institute examined 845 breast cancer cases from the National Cancer Institute tumor registry matched with 961 controls. There was a significant increased risk of breast cancer in women who aborted as compared to women who gave birth.

"Results: While this increased risk did not vary by the number of induced abortions or by the history of a completed pregnancy, it did vary according to the age at which the abortion occurred and the duration of the pregnancy. Highest risks were observed when the abortion was done at ages younger than 18 years-particularly if it took place after 8 weeks gestation-or at 30 years of age or older."19

The study goes on to state:

"Among women who had been pregnant at least once, the risk of breast cancer in those who had experienced induced abortion was 50% higher than among other women by age 45. Teenagers under age 18 and women over 29 years of age who procure an abortion increase their breast cancer risk by more than 100% by age 45."

But, the most alarming finding was this:

"Teenagers with a family history of breast cancer who procure an abortion face a risk of breast cancer that is incalculably high."

All 12 women in the study with this history were diagnosed with breast cancer by the age of 45.

In a 2012 study by the French equivalent of the National Cancer Institute, the following findings were reported:

"Results: Our results confirm the existence of a protective effect of an increasing number of full-term pregnancies (FTP's) toward breast cancer among BRCA1 and BRCA2 mutation carriers. … Additionally, hazard ratio shows an association between incomplete pregnancies and a higher breast cancer risk."20

Aborting a first pregnancy, especially in the second trimester causes the greatest increase in risk for breast cancer. Thus the subset of adolescents who are pregnant by rape would be the exact subset of women who would be harmed the most. Abortion of this first pregnancy in a teen adds the harm of increased risk of breast cancer to the trauma already caused by the rape.

When we look at the evidence in the medical literature about the physical effects of abortion as compared to childbirth, we see that elective abortion is associated with an increased risk of preterm birth in subsequent pregnancies; and, in some cases, abortion can increase a woman's chance of developing breast cancer. If a woman undergoes an abortion in the third trimester, she has a greater risk of dying during the abortion itself than if she had given birth. Adding the trauma of abortion to a woman already traumatized from the horror of rape is not the answer. We need to look for ways to help these women heal from the trauma and support them in the most healing decision: choosing life.

References

1 Holmes M M, Resnick H S, Kilpatrick D G, Best C L. Rape-related pregnancy: Estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol 1996: 175: 320-5. [Back]

2 Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S and Atrash HK. Risk Factors for Legal Induced Abortion-Related Mortality in the United States. Obstet Gynecol (2004) 103 (4) p. 729-734. [Back]

3 Mentula MJ, Niinimaki M, Suhonen S, Hemminki E, Gissler M, Heikinheimo O. Immediate adverse events after second trimester medical termination of pregnancy: results of a nationwide registry study. Human Reproduction (2011) Feb. doi: 10.1093/humrep/der016. [Back]

4 Niinimaki M, Pouta A, Bloigu A, Gissler M, Hemminki E, Suhonen S, Heikinheimo O. Immediate Complications After Medical Compared with Surgical Termination of Pregnancy. Obstetrics and Gynecology (2009) 114: (4) p795-799. [Back]

5 Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S and Atrash HK, Risk Factors for Legal Induced Abortion-Related Mortality in the United States. Obstet Gynecol (2004) 103 (4) p. 729-734. [Back]

6 Raymond EG, Grimes DA. The Comparative Safety of Legal Induced Abortion and Childbirth in the United States. Obstet Gynecol (2012) 119 (2)Part 1 p. 215-219. [Back]

7 Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S and Atrash HK. Risk Factors for Legal Induced Abortion-Related Mortality in the United States. Obstet Gynecol (2004) 103 (4) p. 729-734. [Back]

8 Shaw P, Zao J. Induced Termination of Pregnancy and Low Birthweight and Preterm Birth: A Systematic Review and Meta-Analysis. BJOG 2009; 116: 1425-1442. [Back]

9 Ancel PY, Lelong N, Papiernik E, Saurel-Cubizolles MJ, Kaminski M; EUROPOP. Epidemiological Research Unit on Perinatal and Women's Health, INSERM U149-IFR69, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex. ancel@vjf.inserm.fr. History of Induced Abortion as a Risk Factor for Preterm Birth in European Countries: Results of the Europop Survey. Hum Reprod. 2004 Mar;19(3):734-40. Epub 2004 Jan 29. [Back]

10 Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, Boulot P, Fresson J, Arnaud C, Subtil D, Marpeau L, Rozé JC, Maillard F, Larroque B; EPIPAGE Group Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG. 2005 Apr;112(4):430-7. [Back]

11 Calhoun B, Rooney B. Induced Abortion and Risk of Later Preterm Births. J Am Physicians and Surgeons 8(2) 2003. [Back]

12 Shaw P, Zao J. Induced Termination of Pregnancy and low birthweight and preterm birth: a systematic review and meta-analysis. BJOG 2009; 116: 1425-1442. [Back]

13 Ancel PY, Lelong N, Papiernik E, Saurel-Cubizolles MJ, Kaminski M; EUROPOP. Epidemiological Research Unit on Perinatal and Women's Health, INSERM U149-IFR69, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex. ancel@vjf.inserm.fr. History of Induced Abortion as a Risk Factor for Preterm Birth in European Countries: Results of the Europop Survey. Hum Reprod. 2004 Mar;19(3):734-40. Epub 2004 Jan 29. [Back]

14 Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, Boulot P, Fresson J, Arnaud C, Subtil D, Marpeau L, Rozé JC, Maillard F, Larroque B; EPIPAGE Group Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG. 2005 Apr;112(4):430-7. [Back]

15 Calhoun B, Rooney B. Induced Abortion and Risk of Later Preterm Births. J Am Physicians and Surgeons 8(2) 2003. [Back]

16 Institute of Medicine (IOM) Preterm Birth: Causes, Consequences, and Prevention. Richard E. Behrman, Adrienne Stith Butler, Editors, Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Available at http://www.nap.edu/catalog/11622.html [Back]

17 Center for Disease Control MMWR Abortion Surveillance United States 2003. Surveillance Summaries November 24, 2006 Vol 55 No. SS-11. [Back]

18 Innes KE, Byers TE. First Pregnancy Characteristics and Subsequent Breast Cancer Risk Among Young Women. Int. J. Cancer (2004) 112: 306-311. [Back]

19 Daling J, Malone K, et Al, Risk of Breast Cancer among Young Women: Relationship to Induced Abortion. J Natl Cancer Inst. 1994 Nov 2: 86 (21): 1584-92. [Back]

20 Lecarpentier J, Nogues C, Mouret-Fourme EM, Gauthier Villars M, Lasset C, Fricker JP, Caron O, et Al. Variation in breast cancer risk associated with factors related to pregnancies according to truncating mutation location, in the French National BRCA ó carrier cohort (GENEPSO). Breast Cancer Research 2012, 14:R99. Doi: 10.1186/bcr3218. [Back]

Top