The Worst ‘Alternative Facts’ About Abortion

The leaders and lawmakers of the anti-choice movement have created a cottage industry out of devising bogus claims and flawed research to advance their baseless policies.

Maternal-fetal medicine specialist Dr. Byron Calhoun claimed in 2013 that he saw people admitted for serious post-abortion complications at his West Virginia teaching hospital on a weekly basis. (After Calhoun initially made this claim, the administrator at the teaching hospital where Calhoun worked investigated and found no evidence to support it.) SymMaternalHealth / YouTube

To view the full False Witnesses gallery, click here.

During her first weekend as counselor to the 45th president of the United States, Kellyanne Conway introduced the country to a foreboding new catchphrase: “alternative facts.”

Many an editorial, even from conservative writers, expressed dismay that a top aide to the president appeared to be openly challenging the meaning of the word “fact.”

But longtime observers of Conway’s work and the anti-choice movement from which she rose to become the first woman to manage a successful presidential campaign should not be surprised. The leaders and lawmakers of this movement have been dealing in “alternative facts”—also known as lies—about abortion and other reproductive health issues for decades. They have created a cottage industry out of devising bogus claims and flawed research to advance anti-choice policy.

The administration of President Donald Trump promises to bring many challenges to accessing reproductive health care, helped by a GOP-controlled Congress eager to obliterate the Affordable Care Act and defund Planned Parenthood. Even more so, the administration promises to bring more challenges to facts about reproductive health, already demonstrated by the statements and past actions of Trump and some of his cabinet picks.

As an antidote to this misinformation campaign, Rewire is rebooting our False Witnesses gallery, which profiles a set of ideologically motivated scientists and doctors who have promoted falsehoods about reproductive health in state houses, Congress, and the courts (sometimes on the taxpayer’s dime).

We’ve given a fresh coat of paint to this series and added a half-dozen new “experts.”

While some of these new additions traffic in well-worn chestnuts about abortion, the sequel to our series also features newer falsehoods trending in the anti-choice movement in the last couple of years.

These are some of the key falsehoods likely to be repeated about reproductive care:

Myth: Abortion Is Dangerous for Women’s Health

If one is to believe the claims made collectively by these 20 individuals in courtrooms, legislatures, and across the internet, one has to picture abortion as one of the most dangerous procedures practiced in the United States.

Maternal-fetal medicine specialist Dr. Byron Calhoun claimed in 2013 that he saw people admitted for serious post-abortion complications at his West Virginia teaching hospital on a weekly basis. (After Calhoun initially made this claim, the administrator at the teaching hospital where Calhoun worked investigated and found no evidence to support it, only noting about five documented complications from abortion during the previous year.)

OB-GYN and lawyer Dr. Anthony Levatino muses that he probably rendered many women sterile when he provided abortions during the early 1980s. (A striking admission, though Levatino’s record indicates no disciplinary records or malpractice lawsuits. So, if he’s right, he hasn’t faced any consequences for his actions.)

In recent years, lawmakers have used similarly alarmist portrayals of abortion to justify extreme restrictions, such as requiring clinics to conform to ambulatory surgical standards and doctors performing abortions to obtain admitting privileges at hospitals within a specific distance.

The 1992 landmark U.S. Supreme Court case Planned Parenthood v. Casey paved the way for states to regulate abortion for the stated purpose of protecting the health and life of the pregnant person. And in the last few years, states like Alabama, Texas, and Wisconsin hired some of the doctors in the False Witnesses gallery—Dr. James Anderson, Dr. John Thorp, and Vincent Rue—to support the argument that surgical center standards and admitting privileges requirements are necessary to advance patient safety.

But in 2016, the Supreme Court ruled on the side of facts, striking down provisions of a Texas abortion law in Whole Woman’s Health v. Hellerstedt. The Court concluded that defendants had failed to show credible evidence that these requirements protected patient safety. While the Texas ruling also applied to similar laws in some other states, Missouri is currently litigating a similar law involving admitting privileges and ambulatory surgical requirements.

The Reality: Evidence suggests a much different world-view from the fake narrative that abortion is medically harmful. Data show that the overall complication rate of abortion is lower than the complication rate for wisdom tooth removals and tonsillectomies, according to Advancing New Standards in Reproductive Health, a research center at the University of California, San Francisco.

In 2013, Congress launched an investigation into disciplinary actions incurred by abortion providers nationwide. The investigation was sparked by the trial of Kermit Gosnell, an abortion doctor who in 2010 was charged with the murder of several babies born alive and the involuntary manslaughter of one of his patients. But the evidence gathered in this investigation did not in any way show that Gosnell is the typical abortion provider in the United States. Rather, the documents submitted by state attorneys general and health departments turned up a vast array of abortion-related regulations and very few complaints and investigations against abortion providers, particularly those serious enough to provoke disciplinary action.

And specific to the policies ruled unconstitutional in 2016, the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA) say there is “simply no medical basis to impose a local admitting privileges requirement on abortion providers.” Regarding ambulatory surgical centers, ACOG and AMA say, “the transfer of care from the abortion provider to an emergency room physician is consistent with the developments in medical practice dividing ambulatory and hospital care in the medical field more broadly.”

Dr. Pratima Gupta, an OB-GYN based in San Francisco who provides abortions and a full range of obstetric and gynecological services, including prenatal care and delivery, says the medical ethical standard of “informed consent” is not compatible with communicating risks to patients that are not supported by science.

“Patients are putting their trust in you at one of their most vulnerable times,” Gupta told Rewire in a phone interview. “For better or for worse, society has a level of trust and status that doctors are placed in. People don’t come to their doctor for inaccuracies. They’re putting their trust in our expertise and assuming that we’re going to provide them with accurate and appropriate care.”

Gupta says she communicates with her patients the risks involved in abortion—the main ones being infection, bleeding, and damage to the uterus—just as she communicates the risks of childbearing.

Myth: Abortion Causes Breast Cancer

For decades, opponents of abortion have used the abortion-breast cancer link as a scare tactic to dissuade women from obtaining abortions. Thanks to anti-choice lobbying and copycat legislation, five states (Alaska, Kansas, Mississippi, Oklahoma, and Texas) now require doctors falsely to tell patients they could get breast cancer as a direct result of their abortion. And Trump’s pick for secretary of the Department of Health and Human Services (HHS), Tom Price, belongs to a medical group, the Association of American Physicians and Surgeons (AAPS) that promotes the unfounded claim that abortion causes breast cancer.

As with the issue of climate change—where there is a only a small group of scientists who (frequently and publicly) disagree that the climate is changing due to human activity—there is a small group of scientists who disagree with underlying science that there is no causal relationship between abortion and breast cancer. The group includes Joel Brind, an endocrinologist with no medical training; Freda Bush, an OB-GYN; and Angela Lanfranchi, a breast-cancer surgeon. All three appear in the largely one-sided Canadian documentary Hush, a conspiracy theory film that argues abortion causes breast cancer, despite the rejection in the film itself of that theory by leading medical organizations in the United States, Britain, and Canada. The filmmakers cast that rejection as further evidence of their conspiracy theory.

Most scientists agree that a woman’s reproductive history is one of several risk factors for cancer. Anti-choice opponents have injected a plot twist in this theory that is not supported by most scientists and medical organizations. They argue that induced abortion (but not miscarriage) disrupts hormone cycles in a woman’s body, ultimately leaving behind immature breast tissue that is susceptible to cancerous growths.

The Reality: The major U.S. medical institutions agree that, based on available data, neither induced nor spontaneous abortions lead to an increased risk of breast cancer. Until the early 1990s, the research on this link was mixed. But in 2003, the National Cancer Institute held a workshop of leading experts on pregnancy and breast cancer risks to review existing medical literature. They concluded that having a miscarriage or an induced abortion does not increase one’s risk of developing breast cancer later in life. During this workshop, scientists attributed earlier findings showing a breast cancer link to methodological flaws, such as recall bias, where subjects do not accurately recall complete medical histories.

The most common risk factors of breast cancer, listed by the Centers for Disease Control and Prevention (CDC), are: age, sex, race, personal history of breast cancer, family history of breast cancer, genetic mutations, start date of menstruation, number of childbirths, whether breastfed (breastfeeding is said to reduce cancer risk), start date of menopause, physical activity, obesity, breast density, use of hormonal replacement therapy, use of oral hormonal contraceptives, previous radiation therapy, and alcohol use.

Myth: Abortion Causes Mental Illness

Nine states (Kansas, Louisiana, Michigan, Nebraska, North Carolina, South Dakota, Texas, Utah, and West Virginia) require doctors to tell women, falsely, that induced abortion can independently lead to long-term psychological effects.

Dr. Monique Chireau, an OB-GYN; Priscilla Coleman, a psychologist; David Reardon, an electrical engineer with a bogus degree in biomedical ethics; Vincent Rue, an independent legal consultant with degrees in sociology and family studies; and Dr. Martha Shuping, a psychiatrist, have all heavily contributed to the proliferation of these policies and the general narrative that abortion is an independent risk factor for psychological problems such as post-traumatic stress disorder, depression, and suicide ideation.

Together, Coleman, Rue, and Shuping co-authored a study published in 2009 in the well-regarded Journal of Psychiatric Research that claimed a causal relationship between abortion and mental illness. After serious methodological errors emerged, the study’s conclusions were debunked by other researchers and by the editors of the journal. Abortion opponents, however, continue to use the study’s flawed data to advance abortion regulations.

The Reality: The American Psychological Association (APA), after conducting an extensive literature review in 2008, found no evidence for the claim that, on its own, abortion leads to mental illness, particularly for adults who have one first-trimester abortion and do not already have mental health disorders.

APA did, however, find positive associations between multiple abortions and poorer mental health. But these associations, APA noted, may be linked to other risks and factors that predispose women to both multiple unwanted pregnancies and mental health problems. APA also found evidence that stigma and need for secrecy surrounding abortion can have a negative effect on a woman’s mental health.

Abortion providers, including Planned Parenthood, acknowledge that women who have abortions can and do experience negative reactions. Consistent with APA’s findings, Planned Parenthood states that there are predisposing factors that are linked to feelings of depression, guilt, or regret, such as “extreme ambivalence regarding the decision to terminate” and “feeling coerced into having an abortion.” APA emphasizes that, as with all stressful life events, “including childbirth,” the strongest predictor of mental health after abortion is mental health before an abortion.

Myth: Abortion Causes Premature Birth

Hinting at a misunderstanding between correlation and causation, OB-GYN Freda Bush blames high incidence of preterm birth rates among Black women on the disproportionately high rate of abortions among Black people. Bush helps to advance the narrative in the anti-choice movement that having an induced abortion can negatively impact subsequent pregnancies.

The Reality: According to the CDC, the most common list of factors that contribute to the risk of premature birth are: alcohol, drug, or tobacco use; being pregnant with multiples; being Black; low or high maternal age; low maternal income; and prior preterm births. Absent among these risk factors is induced abortion.

Some research has found a small increased risk in premature birth or low birth weight linked to having three or more abortions, but the Royal College of Obstetricians and Gynaecologists says “there is insufficient evidence to imply causality.”

Myth: Fetuses Can Feel Pain at 20 Weeks’ Gestation

Twenty states have banned abortion at 20 weeks on the unfounded basis that fetuses can feel pain at or before that point. Courts have blocked this law in three of these states; North Carolina’s law is currently being challenged in court, but is still in effect. New HHS Secretary Tom Price supports a national 20-week abortion ban.

Twelve states mandate that doctors tell women that a fetus can feel pain at or before 20 weeks’ gestation.

Lawmakers have also used this unfounded theory to try to ban specific second-trimester procedures, and to require that fetuses receive anesthesia before an abortion procedure. Some doctors have argued this latter mandate is risky to the woman and unnecessary.

Maureen Condic, a neurobiologist; Levatino, an OB-GYN and lawyer who claims to have performed abortions in the 1980s but not since; and David Prentice, a molecular geneticist and one of the heads of a leading anti-choice lobbying group, have all advanced this claim, which has the additional legal effect of promoting the concept of fetal rights in abortion-related laws.

Were the Supreme Court to someday rule in favor of 20-week bans, the result would upset the central premise of its 1973 decision in Roe v. Wade, which concluded that abortion is legal before a fetus is viable outside of the womb, generally believed to be around 24 weeks’ gestation. In 2014, the Supreme Court rejected Arizona’s request to review a lower court decision finding its 20-week ban unconstitutional, effectively passing up an opportunity to consider the arguments about fetal pain.

The Reality: According to ACOG, “a human fetus does not have the capacity to experience pain until after viability.” Researchers with expertise in anatomy, neuroscience, obstetrics and gynecology, and anesthesia published a multidisciplinary review in the Journal of the American Medical Association in 2005 concluding that “fetal perception of pain is unlikely before the third trimester,” because before then, the fetus’ nervous system is not fully functioning.

Myth: Medical Abortions Can Be Reversed

One of the newer falsehoods in the anti-choice movement is the claim that a medication abortion can be interrupted and “reversed.”

Dr. George Delgado, a family practitioner and the medical director of a Catholic health clinic, has advanced a protocol for reversing abortion. He has also convened a national network of doctors who claim to offer this service. His theory is based on a 2012 paper he co-authored, found to be seriously flawed by many scientists.

Nevertheless, Arizona, Arkansas, and South Dakota have enacted laws requiring doctors to inform abortion patients that abortion via medication can be reversed. The law also requires those doctors to direct patients to Delgado’s organization (Arizona’s law was repealed in 2016 after the state could not defend the science of the law in court, but Arkansas‘ and South Dakota‘s laws are still on the books.) Still, more and more states have been trying to pass similar laws, including California, Colorado, Georgia, Idaho, Indiana, North Carolina, and Utah.

The Reality: Major medical institutions, including ACOG, have denounced Delgado’s protocol, arguing that it is not evidence-based and carries potential health risks.

Medication abortions, which are typically provided up to 10 weeks’ gestation, involve taking two drugs: mifepristone, followed 24 to 48 hours later by misoprostol. The mifepristone blocks receptors for the hormone progesterone, causing the lining of the uterus to break down. Mifepristone also softens the cervix and promotes uterine contractions. The misoprostol causes the uterus to contract and expel the fetus.

Delgado’s theory is that if the patient only takes the mifepristone and is then injected with high doses of progesterone, this is likely to “reverse” the effects of the abortion. But ACOG says there is a 30 percent to 50 percent chance that the abortion won’t work anyway if the patient takes only the mifepristone but not the misoprostol, and that Delgado’s theory is not based on evidence. His initial paper outlines the case histories of six patients who underwent his protocol; their pregnancies continued in four of the cases. Delgado’s critics say Delgado failed to show conclusively that his treatment led to the continued pregnancies. They also derided the tiny number of women in his “sample.”