August 5, 2010

Editor's note. As part of catching up on important developments while I was on vacation, the following is the July 27 testimony of Congressman Chris Smith [R-NJ] before the International Subcommittee on International Organizations, Human Rights and Oversight Hearing-- Achieving the Millennium Development Goals: Progress through Partnership.

Congressmen Chris Smith

Mr. Chairman, thank you for holding this timely hearing on attaining the Millennium Development Goals. As you know, the Outcome Document for the High-Level Summit on the Millennium Development Goals continues to be negotiated at the United Nations this week. It will be an important roadmap for next steps.

I wanted to take this opportunity to focus our conversation and efforts on achieving MDGs 4 and 5 jointly. We must keep in mind that to achieve MDGs 4 and 5--reducing child mortality and maternal mortality--both mother and unborn child must be treated as co-patients, in need of care, compassion, and, when sick, either patient or both need timely intervention. The life of one cannot be forfeited for the other. We must strive to save them both, and we can.

The April 2010 The Lancet [[1]] medical journal published a groundbreaking study funded by the Bill and Melinda Gates Foundation that shows worldwide maternal mortality has been decreasing since 1980. Progress is being made by many countries and the successful policies must continue. The study analyzed volumes of studies and data, including WHO maternal mortality data, and, using statistical methods now available through advanced computer technology, the study found that the number of maternal deaths per year (as of 2008) is 342,900. That is down from 526,300 in 1980--a 40% dip. The study notes that if the world wasn't suffering from the HIV/AIDS pandemic, the total number would be 281,500--almost 50% down from the 1980 levels.

While still too high, this landmark report is encouraging to governments who have been seriously addressing maternal mortality in their countries by increasing the number of skilled birth attendants, the availability of c-sections for women with obstructed labor, access to health care including safe blood, education of women, and economic development. Many of these countries with very low maternal mortality rates have laws that restrict abortion. The inclusion of legalized abortion or "reproductive health services" defined as abortion in the Outcome Document would be unjust to the littlest humans, intellectually dishonest, and counterproductive to these successful efforts.

In fact, abortion can have a negative effect on the reproductive health of the mother as well as the health of her subsequent children. At least 113 studies show a significant association between abortion and subsequent premature and low birth weight births. For example a study in the International Journal of Obstetrics and Gynaecology showed a 36% increased risk for preterm birth after one abortion and a staggering 93% increased risk after two. [[2]]

Similarly, the risk of subsequent children being born with low birth weight increases by 35% after one and 72% after two or more abortions. [[3]] Another study shows the risk increases 9 times after a woman has had three abortions. [[4]]

What does this mean for the children? Preterm birth is the leading cause of infant mortality in the United States, and causes one-fourth of infant mortality in the world. Preterm infants have a greater risk of suffering from chronic lung disease, sensory deficits, cerebral palsy, cognitive impairments and behavior problems. [[5]] Low birth weight is similarly associated with neonatal mortality and morbidity.[[6]] Abortion hurts both mother and child and can cause sickness--and even death--in future children.

Abortion is child mortality for the child aborted, and can be mortality or morbidity for future children. Abortion methods dismember, chemically poison, induce premature labor or starve to death the fragile life of an unborn child. So terms like "safe abortion" are at best misleading. "Safe abortion" is never safe for the baby.

Additionally, at least 102 studies show significant psychological harm, major depression, and elevated suicide risk in women who abort. A comprehensive 2006 New Zealand study found that almost 80% of the 15-18 year olds who had abortions had major depression as compared to 31% of their peers. The study also found that 27% of 21-25 year olds who had abortions had suicidal ideations compared to 8% of their peers. [[7]]

The Times of London reported in 2006 that, "Senior psychiatrists say that new evidence has uncovered a clear link between abortion and mental illness in women with no previous history of psychological problems." [[8]] They found "that women who have had abortions had twice the level of psychological problems and three times the level of depression of women who have given birth or have never been pregnant." [[9]] Safe abortion is a grossly misleading term. Abortion means dead babies and wounded mothers.

Another major cause of infant mortality that should be addressed in the Outcome Document is birth asphyxia, which kills 1 million newborns each year--more than malaria and five times more than AIDS. There is much we can do, even in resource-limited situations, to ensure that babies take their first breath in that "golden minute" right after birth. Skilled attendance at birth, temperature support, stimulation to breathe and assisted ventilation through the use of low cost resuscitators are interventions we can and should be made available to achieve MDG 4. [[10]]

The MDG Summit Outcome Document will be very important for guiding our steps as an international community over the next five years. Every step counts, and I hope that each of our panelists will use all of your influence to ensure the Outcome Document keeps us on the path of saving both mother and child.

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[2]1 Murray C., Hogan M., Foreman K., et. al, Maternal mortality for 181 countries, 1980−2008: a systematic analysis of progress towards Millennium Development Goal 5, The Lancet, Volume 375, Issue 9726, pp. 1609−1623, 8 May 2010.

[2] Shah P., Zao J. on behalf of Knowledge Synthesis Group of Determinants of Preterm/LBW Births. Induced termination of pregnancy and low birthweight and preterm birth: A systematic review and meta-analyses. International Journal of Obstetrics and Gynaecology (BJOG) 2009; 116:1425−1442.

[3] Ibid.

[4] Brown J., Adera T., Masho S., Previous abortion and the risk of low birth weight and preterm birth, Journal of Epidemiology and Community Health 2008 (Jan.); 16:1, 16−22. Laura Blue, Study Links Abortion and Preemies, TIME Magazine, Dec. 18, 2007 (http://www.time.com/time/health/article/0,8599,1695927,00.html).

[5]See Kessinich, M., Developmental outcomes for premature, low birth weight and medically fragile infants, Medscape 2003 (http://www.medscape.com/viewarticle/461571).

[6]Ibid. See National Center for Health Statistics, Recent Trends in Infant Mortality in the United States, October 2008 (http://www.cdc.gov/nchs/data/databriefs/db09.htm). See also National Center for Health Statistics, More Babies Born at Very Low Birthweight, January 24, 2005 (http://www.cdc.gov/nchs/PRESSROOM/05news/lowbirthwt.htm) and MacDorman, M., Martin, J., et. al., Explaining the 2001−2002 Infant Mortality Increase: Data from the Linked Birth/Data Set, National Vital Statistics Reports 2005, Center for Disease Control; 53:12 (http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_12.pdf).

[7] Fergusson, David M., Horwood, John L., Ridder, Elizabeth M., Abortion in young women and subsequent mental health, Journal of Child Psychology and Psychiatry 2006; 47:1, 16-24.

[8] Rosemary Bennett, "Abortion Exposes Women to Higher Risk of Depression," Times of London, October 27, 2006 (http://www.timesonline.co.uk/tol/news/uk/health/article615150.ece).

[9] Ibid.

[10]See Helping Babies Breathe (http://www.helpingbabiesbreathe.org/).