Preterm Birth and Abortion

Implications of the Costs to Society Due to Damage from Induced Abortion

Until recently, little has been written about induced abortion as a public health issue.(14,15) The recent publication of two summaries of salient articles raises concerns about induced abortion and preterm birth adding a new dimension to the discussion.(5,15) It should be noted that this study does not include all the excess obstetrical costs, emotional costs to families, and the long term costs of disabled preterm infants.

The increase in hospital expenses due to abortion raises the national neonatal hospital expenditure by a total of over $1.2 billion [living ($1.1 billion) and non living ($112 million)] and, theoretically this expense is avoidable. However, this is only the immediate expense for these children and the additional expenses in caring for these children will fall on the families. All women, especially those facing a crisis pregnancy, deserve to be informed of the substantial impact of an induced abortion that the current pregnancy has on the next pregnancy and the entire family. The overwhelming evidence that she may deliver before 32 weeks will substantially impact her cost of raising children, particularly those children who may have conditions such as cerebral palsy and other conditions related to preterm birth. The cost impact for a particular woman, if she does deliver before 32 weeks, varies by the week of delivery, but ranges from $27,000-$145,000. Informed consent prior to elective abortion must include the above information and should stratify the risk of one previous induced abortion and multiple induced abortions.

It should be noted that the risk for cerebral palsy has been reported to increase by some 38 times.(23) This translates into one half of the neurological problems in children that includes severe or significant developmental delay.(23) These problems can be prevented by eliminating abortions. Given that one half of the neurological problems could be prevented, it is astonishing that there is not more call for limitations on abortion.

The liability crisis, fueled in part by the brain damaged infant, has become a major issue in obstetrical practice.(24) With the median damage award for medical negligence at birth of over $2 million in the years 1994-2000(25) and the cost for a "brain damaged" infant substantially higher, averaging over $1 million (with one recent case awarded $100 million), should make all obstetricians and abortion providers take notice.(26) A patient may now claim, that if they were not informed of the increased risk of preterm delivery by a physician performing an induced abortion, they may recover monetary damages for such negligence.(27)

Even a modest effect attributable to induced abortion leads to significant cost consequences in initial neonatal hospitalizations. Women, the public and public health officials must be made aware of the huge costs (some $1.2 billion a year in the United States) that even an increase of 31.5% of the risk of early preterm birth will have on initial neonatal care. A careful history of induced abortion must be part of every new pregnant patient encounter in any setting. Enhanced surveillance and counseling of increased risk for preterm birth ought to be discussed with women with a history of induced abortion, in preconception visits and/or early prenatal visits. Importantly, these precautions will provide the prudent obstetrical practitioner wish: 1) an opportunity to alter a woman's prenatal care, given their induced abortion history, 2) a malpractice defense for a subsequent preterm birth, since the increased risk came with the induced abortion, not in the obstetrical care, 3) allow for the compilation of national guidelines to manage pregnant women who have had a prior induced abortion, 4) allow for the construction and execution of new studies to improve the perinatal outcome of preterm birth specifically attributable to induced abortion.

Using the available information regarding induced abortion and initial hospital costs in the United States, over $1.3 billion in excess initial hospital costs due to preterm delivery are attributable to induced abortion.(1) The calculated initial neonatal hospital costs of over $1.3 billion do not reflect the subsequent significant lifetime costs of the increased morbidity of early preterm birth including: cerebral palsy, blindness, deafness, and learning disabilities. This discussion also does not address other maternal psychological, emotional, or medical costs associated with induced abortion. These costs are beyond the scope of this discussion. Further studies and analysis of the data relative to the attributable risk of preterm birth as a consequence of induced abortion and induced abortion's significant impact on public health costs will be required. Many women and their families, who experienced a previous crisis pregnancy ending in induced abortion, unnecessarily bear the burden for their lifetimes with the birth of a handicapped child. Armed with newer epidemiological studies demonstrating an association between prior induced abortion and preterm birth before 32 weeks, abortion and obstetrical providers necessarily need to carefully re-design informed consent forms (if not already done) for both induced abortion and prenatal care and delivery, and consider the medical and liability consequences of induced abortion more carefully than ever.

Table 2
Summary of early preterm births due to induced abortion from 24-28 weeks and 29-32 weeks gestation

*Gestational Age (weeks)	Life birth Rates (%)	Survival Rates (%)	#Survivors	#Non-survivors

24	0.087	43	1,504	1,994
25	0.137	53	2,920	2,590
26	0.152	67	4,096	2,017
27	0.221	73	6,488	2,400
28	0.209	81	6,808	1,597
29	0.245	91	8,966	887
30	0.364	94	13,761	878
31	0.394	96	15,212	633
Total			59,755	12,996

(Assumes 4,021,726 births from: Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: Final data for 2002. National Vital Statistics Reports, Vol 52 No 10. Hyattsville, MD: National Center for Health Statistics, 2003.) * After St John EB, Nelson KG, Cliver SP, Bishnoi RR, Goldenberg RL. Cost of neonatal care according to gestational age at birth and survival status. Am J Obstet Gynecol 2000; 182:170-175(8,5)

Table 3
Excess early preterm births and very low birth weight costs (dollars and human) due to prior induced abortions in the US per year in 2002 dollars


22,917	Excess Early Preterrn Births (birth less than 32 weeks gestation)
4,094	Excess Deaths of Newborns with Early Preterrn Births
18,495	Excess Cases of Newborns with Very Low Birth Weight
14,427	Excess Cases of Surviving Newborns with Very Low Birth Weights
1,096	Excess Cases of Newborns with Very Low Birth Weights with Cerebral Palsy
$1.2 Billion	Excess Initial Neonatal Hospital Costs for Early Preterm Births per year in US

Table 4
Summary of costs of induced abortion from 24-28 weeks and 29-32 weeks gestation)

*Gestational Age (weeks)	Live Birth %	Survival %	Cost per Infant Survivors	Cost per Infant Non-survivors	Population Cost (Millions $ (US) Survivors	Population Cost (Millions $ (US) Non-survivors	% both

24	0.087	43	$145,892	$20,597	$219	$41	2.8
25	0.137	53	$121,181	$22,683	$354	$59	4.2
26	0.152	67	$99,362	$24,770	$407	$50	4.4
27	0.221	73	$80,264	$26,856	$521	$64	6.0
28	0.209	81	$63,714	$28,942	$434	$46	4.5
Total Cost					$1.94 billion	$260
Inflation Adjusted (2001- 02)					$2.02 billion	$272
Abortion adjustment (31.5% of total)					$636	$86
29	0.245	91	$49,546	$31,028	$444	$27	4.7
30	0.364	94	$37,569	$33,114	$517	$29	5.5
31	0.394	96	$27,629	$35,200	$420	$22	4.3
Total Cost					$1.4 billion	$78
Inflation adjusted (2001-02)					$1.46 billion	$81
Abortion adjustment (31.5% of total					$460	$26

(Assumes 4,021,726 births from: Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: Final data for 2002. National Vital Statistics Reports; Vol 52, No 10. Hyattsville, MD: National Center for Health Statistics; 2003.(2)) * After St John EB, Nelson KG, Cliver SP, Bishnoi RR, Goldenberg RL. Cost of neonatal care according to gestational age at birth and survival status. Am J Obstet Gynecol 2000; 182: 170-175(5).

References

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