LEGAL ABORTION DEATHS, PART II: MISREPORTED, UNREPORTED & COVERED
by James A. Miller
Beginning in 1979, the Centers for Disease Control undertook a new surveillance of
ectopic pregnancy-related mortality, and published its first ectopic pregnancy
surveillance report in 1982. As a result all deaths associated with ectopic pregnancy,
whatever connection they might have with induced abortion, were excluded from the
abortion death totals and the Annual Abortion Surveillance Reports.1
The CDC's new rule had a most pernicious effect: ectopic pregnancy deaths subsequent
to induced abortions would no longer be counted in the abortion death totals but now
all such deaths automatically would be dumped into the pregnancy/childbirth
maternal mortality statistics. The relation of such deaths to legal abortion would never
be known, it at least by the general public. And once again the invidious comparisons
between the alleged safety of legal abortion and the supposedly greater danger
associated with child-bearing could be more easily made.
The CDC also went back over all the older Abortion Surveillance Reports and removed
all the ectopic/induced abortion deaths which had been counted previously; at least 10
such deaths were removed in this fashion.
In a 1990 article regarding the incidence of ectopic pregnancy concurrent with induced
abortion, CDC researchers disclosed that from 1972 through 1985 a total of "24 women
who underwent an induced abortion died as a result of a concurrent ectopic
pregnancy" Of course, under the 1979 CDC guidelines, none of these deaths would be
counted as abortion-related, not even the three cases reported in which the deaths
occurred "during [the] abortion."2
New York City alert: A smoking gun?
In June 1987, Dr. Stephen Joseph, New York City's then-Commissioner of Health,
issued an "ANESTHESIA ALERT" to all "Gynecologists, Anesthesiologists,
Administrators, and Others Concerned With the Provision of Abortion Services,"
warning of the risks to abortion patients from the routine "use of general anesthesia for
The "Alert" noted that general anesthesia was "more commonly used in New York City
than other places for performing abortions" and that the Alan Guttmacher Institute,
Planned Parenthood's research arm, had "estimate[d] that in 1982, 66.1 percent of all
abortions in New York were done under general anesthesia, or a combination of heavy
sedation and local anesthesia." This compared with just "21.8 percent in other parts of
the United States."3
The real eye-opener in the "Alert" was found in several statistics cited in the third
paragraph of the short document:
"During the period between 1981 and 1984, there were 30 legal abortion-related deaths
in New York City ..." These 30 deaths constituted "17.0 percent of all legal abortion-
related deaths in the United States during that period, although only 12.3 percent of all
induced abortions were performed in New York City." "One third of these 130 deaths,
namely] 10 were due to general anesthesia." "...in the rest of the United States less than
10 percent of abortion related deaths were due to general aesthesia (12/ 146)."
Several observations are in order:
1) During the 1981-1984 time period during which Commissioner Joseph said New
York City had suffered "30 legal abortion-related deaths," the CDC reported a total of
"just" 42 legal abortion deaths throughout the entire United States. If the CDC death
total is correct, New York City would have accounted for 71.4 percent of all U.S.
abortion deaths while performing "only 12.3 percent of all [the] induced abortions" in
the United States during that four-year period.
2) But Commissioner Joseph was quite explicit in stating that New York
City's "30 legal abortion-related deaths" constituted "17.0 percent of all legal abortion-
related deaths in the United States during that period." Following Commissioner
Joseph, simple division (30 divided by 0.17) yields a total of 176 legal abortion-related
deaths throughout the United States during the years 1981-1984! (Yet the CDC reports
"just" 42 abortion deaths in that period, less than 25 percent of the total derived from
Commissioner Joseph's figures).
3) Commissioner Joseph's figures regarding the ratio of U.S. abortion deaths outside of
New York City which were due to general anesthesia- 12 of 146-provides some
confirmation of his total abortion death figure for 1981-1984: 146 deaths in the United
States exclusive of New York City, plus 30 abortion deaths in New York City, adds to
176 total abortion deaths throughout the country, the very figure previously derived
from Joseph's "17.0 percent" statistic. At the very least, the document's abortion figures
are internally consistent. But are they correct?
Most of the 10 New York City abortion-anesthesia deaths in that time period can be
verified. An article in the CDC's own MMWR report substantiates seven of those
anesthesia deaths and lists four more abortion deaths from "other causes," all occurring
between January 1980 and June 1985.4
Another report states that of the "ten abortion related deaths occurring 1980-84, in eight
the cause of death was anesthesia-related."5 Combining the data from these two
reports, it is seen that eight of the 10 anesthesia deaths (80 percent) which
Commissioner Joseph cited have been accounted for as well as 12 of the 30 abortion
deaths (40 percent). It's not a perfect match, but it's all there is, and the figures are
definitely well in the ballpark.
A call was made in early August 1995 to the New York City Health Department to see
if Joseph's figures were still accepted, or if a correction had been made subsequently. A
statistician for the health department stated that as far as he knew the numbers "were
correct" and, moreover, he knew former Commissioner Joseph and was confident he
would not make an error in his statistics. Unfortunately, when the health department
employee realized why I was interested in the dichotomy between Joseph's statistics
and the ones issued by the CDC, he became quite belligerent, started an argument, and
Obviously, further investigation must be done. If Commissioner Joseph's numbers are
correct, over 130 abortion deaths between 19801984 would have been misreported or
Maryland abortion deaths
The year 1989, for which the CDC has yet to report abortion death figures, was a very
unlucky one for women undergoing abortion in the state of Maryland. There were at
least three abortion deaths that year, all clustered in just one of the states's 23 counties,
Prince George's. A fourth woman who also underwent an abortion in Prince George's
County in 1989 finally expired in late 1992 as a result of the overwhelming injuries she
suffered in her abortion.
None of the deaths is listed as an induced abortion-related death by the Maryland
Department of Health. Indeed, only one of the deaths is listed as a maternal death; that
one was an ectopic pregnancy death subsequent to an induced suction abortion. When
this writer queried the CDC about this cluster of abortion deaths, it was discovered that
they only knew of the ectopic death. Of course, as previously discussed, ectopic deaths
are now never linked by the CDC with an earlier abortion, no matter how proximate a
cause of death the abortion might have been.
In two of the death cases, however, the CDC will never be able to learn about the
connection with abortion, or even pregnancy for that matter, since the autopsy reports
have been deliberately miscoded by the Office of the Chief Medical Examiner of the
State of Maryland!
Consider the facts:
In one case a 16-year-old girl, who underwent an abortion without her parents
knowledge or consent, died from severe internal hemorrhage and an air embolism, the
result of her abortionist's carelessness in causing a "laceration [that] extended into the
vagina, cervix and the [uterus]." Although the medical examiner stated on the front
page of the autopsy report that the injury occurred as a result of a "therapeutic
misadventure," and termed the death an "accident," he did note, on the next-to-the-last
line of the last page, that the injury occurred during an "evacuation procedure which
resulted in perforation of the uterus."9
Back on the front page, however, the death was incorrectly coded under the
International Classification of Diseases, 9th Revision, the system used throughout the
world to accurately record the cause of deaths. Instead of using the specific codes
pertaining to abortion injuries 635.1: a legally induced abortion complicated by ...
excessive hemorrhage, and 635.2: complicated by damage to pelvic organs, and 635.6:
complicated by embolism, the medical examiner hid the truth of what really had
occurred by utilizing codes N867 and E870.
An "N code" describes the nature of the injury while an "E code" designates the external
cause of the injury. N867 simply indicates that the injury was to the "pelvic organs" and
E870 designates an "accidental cut, puncture, perforation, or hemorrhage during
medical care." Note that in using these particular codes the medical examiner has
managed to completely hide the fact that the injury occurred during an abortion, and
was in fact, caused by the abortion. Indeed, with the codes chosen, there is no way that
the death can even be identified as pregnancy-related.
No one searching death records for abortion or pregnancy-related cases would ever
think of pulling up for examination a female death coded in the upper 800's-abortion
and pregnancy death code numbers range between 630-676.
A second case involved a woman who went "into general cardiac arrest while under
general anesthesia" during her abortion, as a result of which her "brain was deprived of
oxygen for at least 12 minutes." After three days of "no brain activity," doctors at the
hospital to which she had been removed -discontinued life support systems."'
Once again the same Chief Medical Examiner of Maryland signed the autopsy report,
and once again one had to go to the very last page of the autopsy report, this time to the
third from last line, to discover that an abortion was involved.8 This time around the
death codes utilized were N977 and E980, the former indicating that the death resulted
from -poisoning by other and unspecified drugs and medicinal substances," while the
latter designated a "poisoning" in which it cannot be determined -whether [it was]
accidentally or purposely inflicted."
Again, no researcher would think of looking for an abortion-related death among codes
numbered in the upper 900's. The medical examiner has again managed to code a death
so as to completely omit any connection with abortion. An accurate coding would have
been 635.7: legally induced abortion with specified complication-in this case, an
anesthesia overdose-along with the appropriate E code for the two anesthetic agents
administered, E933 (Chlorpheniramine) and E937 (Phenobarbital). These E codes
correctly identify the anesthesia as being administered for "therapeutic use"; the E
codes utilized by the medical examiner are more appropriate for a suicide or an
Another 1989 case-the woman who eventually died more than three years after the
abortion-involved the same clinic as the anesthesia case (above). In this instance an
anesthesia overdose was also administered, resulting in massive brain damage from the
deprivation of oxygen. The patient, rendered a paraplegic and mentally impaired,
eventually died of pneumonia. Although this victim's life basically ended a few
minutes after her abortion began, the death will never be classified as abortion-related
due to the time interval involved.
With the CDC currently reporting 10 or fewer abortion deaths per year throughout the
entire nation, one cannot help but wonder how, in just six months, one Maryland
county of some 750,000 population (.3 percent of the nation's population) could have
four (or three) abortion deaths within its boundaries.
Another New York report In 1988 the New York State Department of Health issued a
report on Maternal Mortality in the state during the years 1980- 1986.9 The study
examined all upstate New York "deaths assigned a cause of death in the ICD-9 range of
codes 630-676." (Note: codes numbering in the 800's and 900's were not even
considered, but those were the ones utilized in the Maryland cases previously
Through such record-matching, -27 deaths were identified... [as] associated with
induced abortions in upstate New York." The researchers estimated that "at least 47
additional [abortion-related! deaths may have occurred in New York City" but, due to
different record keeping systems in the City, a similar search could not be undertaken.
(Former Health Commissioner Joseph's numbers are looking
better all the time.)
Of the newly found 27 upstate abortion-related deaths, three were recorded as
"indirect" maternal deaths, nine as non-maternal deaths, and 15 were not reviewed.
Thus at least 25 percent of the newly discovered abortion deaths were "missed" and not
properly recorded in the State's statistics.
The three new upstate "indirect" maternal abortion deaths represented 150 percent (!) of
the two that were previously known (both in 1980). And who knows how many more
such instances might be found among the 15 cases -not reviewed" or even among the
nine which were labeled -non-maternal"?
James A. Miller is HLI's director of research.
Taken from the December 1995 issue of "HLI Reports."
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1 CDC Abortion Surveillance Report, Annual Summary 1978, November 1980 (issued),
p. 7; Annual Summary 1979-1980, issued May 1983, p. 9; and Annual Summary 1981,
issued November 1985, p. 9, respectively.
2 "Ectopic pregnancy concurrent with induced abortion: Incidence and mortality,"
, Vol 162. March 1990, pp. 726-30.
3 "Anesthesia Alert," Stephen C. Joseph, M.D., M.P.H., Commissioner of Health, The
City of New York. June 5, 1987.
4 Morbidity and Mortality Weekly Report (MMWR), Vol. 35, No. 37, 19 September
1986, CDC, p. 579
5 "Changing patterns of maternal mortality in New York City during the past 20 years
(1965-1984), undated, New York City Department of Health, p. 4.
6 Maryland Autopsy Report No. 89593, (Erica Richardson).
7 , 13 August 1990, pp A1, 6 AT 6.
8 Maryland Autopsy Report No. 89-1873, (Debra Gray)
9 "Maternal Mortality in New York State: 1980-1986, New York State Department of
Health, November 1988, pp. 3-4.