Regarding the "manipulated statistics" section and the maternal mortality calculation used in the Raymond/Grimes study - the study claims to have only included pregnancies that ended in live birth in its maternal mortality stats. The journal article states: "We estimated mortality rates associated with live births and legal induced abortions in the United States in 1998–2005 by combining published data from several national data sets. For mortality related to live birth, we divided the number of pregnancy-related deaths among women delivering live neonates as reported by the Centers for Disease Control and Prevention's (CDC) Pregnancy Mortality Surveillance System by the number of live births as reported on birth certificates." They say that they divided mothers who died following live births by the number of live births, not all mothers who died - as is described in Gonzalez vs. Planned Parenthood. Am I missing something?
Below is the reply from Dr. Ferrer, author of this article:
Greetings SJ!
Thank you for reading my article and for having the courage to offer some critical feedback. When I first saw the question, it made me rethink things a bit. I had to go back and re-check my sources, reread my notes, and so on. While I think the general thrust of the article, and the "Manipulated Statistics" section, are still strong, I think you do have a point.
You are right to ask for some clarification. I don't think my article made clear how the RG study was using a subset of the CDC maternal mortality figures, namely, those with "live births." The Gonzalez v Planned Parenthood amicus brief is addressing more than just the RG study, so it makes sense for that report to speak in broader terms, addressing maternal mortality figures regardless of live births. The CDC maternal mortality figure is correctly described (and cited) in the Gonzalez brief, and in the ERI article, whereas the RG study used only a portion of that CDC data in calculating a different maternal mortality figure, one regarding only live births. So, you're right in one sense, by pointing out that the RG study is working with a subset of the CDC data. I can probably edit the article to clarify this point for future readers.
In another sense, you might have missed how the RG study still used the CDC maternal mortality data – with all the methodological drawbacks it carries – before extracting a subset of that data for their specific purposes. The CDC maternal mortality rate still informed the RG study, RG just focused on a subset of that data, namely the live-birth cases. You may recall that the CDC method for compiling that data was to "identify all deaths occurring during pregnancy or within 1 year of pregnancy" (CDC, para. 9). This means there were women who died of heart attack, cancer, and car accidents – all unrelated to child-birth – but were included as "maternal deaths," and some of them had had live births. The RG study includes these cases, thus artificially inflating the maternal mortality rate for childbirth. RG took pains to weed out false positives for abortion-related deaths but were not so careful with childbirth-related deaths.
Moreover, using only the CDC data for live birth cases (of maternal death), the RG study excludes hundreds of thousands of women who survived miscarriage, stillbirth, ectopic pregnancy, molar pregnancy, etc. – since those are not live-birth cases. This effectively suppresses reporting on the relative safety of child-birth.
What about cases where the woman and child both die in delivery? The RG study omits these too though they would be included in the CDC maternal mortality rate. While this omission would seem to make childbirth look safer than it is, remember that the RG study also omits the hundreds of thousands of cases where women survive after losing a child by miscarriage, stillbirth, ectopic pregnancy, etc. As the RG study omits all but the live-birth cases, they overall suppress data on the relative maternal safety of child-birth.
In summary, the commentator is correct to point out that the RG study had a different calculation for their maternal mortality figures. But, since RG still incorporated the CDC maternal mortality figures, as reflected in the description and chart in the ERI article, and did so without correcting for inflationary factors (false positives and survival rates with non-live births) the end result is the RG study still suppresses the relative safety of child-birth. The ERI article can benefit from some clarifying edits yet the key points of emphasis stand intact.
Thank you for the great question. I found your observation insightful. I hope my response helps resolve your concern.
Off topic, but I love how Mr. Ferrer signs his own name as "Dr. John D. Ferrer".
When I think of "Doctors", immediately a dude with a degree in apologetics at a Bible College springs to mind. Not, you know, scientists or doctors of medicine.
Interesting how those scientists and doctors of medicine often don't refer to themselves "Doctors", yet these apologetics types do.
Thank you for your thoughtful question! I reached out to Dr. Ferrer, and he is making some time to address your question personally. I just wanted to let you know that we have indeed seen your question and will have an answer for you very soon!
Very good and analytical article. One more way in which permissive abortion laws may increase maternal deaths is because, sadly, some women become less motivated to use the most effective contraceptive methods when abortion is seen as a "backup" birth control measure. https://www.guttmacher.org/journals/psrh/2015/05/state-abortion-context-and-us-womens-contraceptive-choices-1995-2010 "Women who lived in a state where abortion access was low were more likely than women living in a state with greater access to use highly effective contraceptives rather than no method (relative risk ratio, 1.4). Similarly, women in states characterized by high abortion hostility (i.e., states with four or more types of restrictive policies in place) were more likely to use highly effective methods than were women in states with less hostility (1.3)."
It has a good meaning. If you always live positively, someday good things will happen.Greetings SJ!
Thank you for reading my article and for having the courage to offer some critical feedback. When I first saw the question, it made me rethink things a bit. I had to go back and re-check my sources, reread my notes, and so on. While I think the general thrust of the article, and the "Manipulated Statistics" section, are still strong, I think you do have a point.
You are right to ask for some clarification. I don't think my article made clear how the RG study was using a subset of the CDC maternal mortality figures, namely, those with "live births." The Gonzalez v Planned Parenthood amicus brief is addressing more than just the RG study, so it makes sense for that report to speak in broader terms, addressing maternal mortality figures regardless of live births. The CDC maternal mortality figure is correctly described (and cited) in the Gonzalez brief, and in the ERI article, whereas the RG study used only a portion of that CDC data in calculating a different maternal mortality figure, one regarding only live births. So, you're right in one sense, by pointing out that the RG study is working with a subset of the CDC data. I can probably edit the article to clarify this point for future readers.
In another sense, you might have missed how the RG study still used the CDC maternal mortality data – with all the methodological drawbacks it carries – before extracting a subset of that data for their specific purposes. The CDC maternal mortality rate still informed the RG study, RG just focused on a subset of that data, namely the live-birth cases. You may recall that the CDC method for compiling that data was to "identify all deaths occurring during pregnancy or within 1 year of pregnancy" (CDC, para. 9). This means there were women who died of heart attack, cancer, and car accidents – all unrelated to child-birth – but were included as "maternal deaths," and some of them had had live births. The RG study includes these cases, thus artificially inflating the maternal mortality rate for childbirth. RG took pains to weed out false positives for abortion-related deaths but were not so careful with childbirth-related deaths.
Moreover, using only the CDC data for live birth cases (of maternal death), the RG study excludes hundreds of thousands of women who survived miscarriage, stillbirth, ectopic pregnancy, molar pregnancy, etc. – since those are not live-birth cases. This effectively suppresses reporting on the relative safety of child-birth.
What about cases where the woman and child both die in delivery? The RG study omits these too though they would be included in the CDC maternal mortality rate. While this omission would seem to make childbirth look safer than it is, remember that the RG study also omits the hundreds of thousands of cases where women survive after losing a child by miscarriage, stillbirth, ectopic pregnancy, etc. As the RG study omits all but the live-birth cases, they overall suppress data on the relative maternal safety of child-birth.
In summary, the commentator is correct to point out that the RG study had a different calculation for their maternal mortality figures. But, since RG still incorporated the CDC maternal mortality figures, as reflected in the description and chart in the ERI article, and did so without correcting for inflationary factors (false positives and survival rates with non-live births) the end result is the RG study still suppresses the relative safety of child-birth. The ERI article can benefit from some clarifying edits yet the key points of emphasis stand intact.
Thank you for the great question. I found your observation insightful. I hope my response helps resolve your concern.
Sincerely,
Dr. John D. Ferrer
When I think of "Doctors", immediately a dude with a degree in apologetics at a Bible College springs to mind. Not, you know, scientists or doctors of medicine.
Interesting how those scientists and doctors of medicine often don't refer to themselves "Doctors", yet these apologetics types do.
One more way in which permissive abortion laws may increase maternal deaths is because, sadly, some women become less motivated to use the most effective contraceptive methods when abortion is seen as a "backup" birth control measure.
https://www.guttmacher.org/journals/psrh/2015/05/state-abortion-context-and-us-womens-contraceptive-choices-1995-2010
"Women who lived in a state where abortion access was low were more likely than women living in a state with greater access to use highly effective contraceptives rather than no method (relative risk ratio, 1.4).
Similarly, women in states characterized by high abortion hostility (i.e., states with four or more types of restrictive policies in place) were more likely to use highly effective methods than were women in states with less hostility (1.3)."