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Frequently asked questions (FAQ)
  1. Should we add or expand coverage of a particular aspect of abortion?
    It is likely that we have already done so. There was so much information on abortion that we decided to split it all into separate articles. This article is concise because we've tried to create an overview of the entire topic here by summarizing many of these more-detailed articles. The goal is to give readers the ability to pick the level of detail that best suits their needs. If you're looking for more detail, check out some of the other articles related to abortion.
  2. This article seems to be on the long side. Should we shorten it?
    See above. The guidelines on article length contain exceptions for articles which act as "starting points" for "broad subjects." Please see the archived discussion "Article Length."
  3. Should we include expert medical or legal advice about abortions?
    No. Wikipedia does not give legal or medical advice. Please see Wikipedia:Medical disclaimer and Wikipedia:Legal disclaimer for more information.
  4. Should we include or link to pictures of fetuses and/or the end products of abortion?
    No consensus. See the huge discussion on this topic in 2009 here. Consistently, there has been little support for graphic "shock images"; while images were added in 2009 the topic remains contentious, and some images have been removed.
  5. Should we include an image in the lead?
    No consensus. Numerous images have been proposed for the article lead. However, no image achieved consensus and the proposal that garnered a majority of support is to explicitly have no image in the lead.
Abortion was one of the Natural sciences good articles, but it has been removed from the list. There are suggestions below for improving the article to meet the good article criteria. Once these issues have been addressed, the article can be renominated. Editors may also seek a reassessment of the decision if they believe there was a mistake.
Article milestones
DateProcessResult
December 26, 2006Good article nomineeListed
January 14, 2008Good article reassessmentDelisted
February 21, 2015Good article nomineeNot listed
Current status: Delisted good article

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Notable precedents in discussion

live birth section with inaccuraciesEdit

Hello. I would like to make some edits to the Live Birth section under complications. The changes and references are in my sandbox: https://en.wikipedia.org/wiki/User:NastywomanMD/sandbox Thank you in advance. NastywomanMD (talk) 01:04, 14 July 2019 (UTC)NastywomanMD


Hello again. Given that there is so much inflammatory rhetoric at the moment about live birth, I think it is important to add something addressing the inaccuracies of the rhetoric to this section. My preference would actually be to delete the section, since it disproportionately draws attention to this issue under "Safety" of abortion, when it is quite uncommon. However, since it is already there, I'd like to add some information that provides nuance. This subject has resurfaced due to the proposal of the Born Alive Survivors Protection Act. This article discusses the history around that bill as well as statistics: https://www.factcheck.org/2019/03/the-facts-on-the-born-alive-debate/ Another reference that describes the propaganda: https://www.nytimes.com/2019/02/26/health/abortion-bill-trump.html Thanks! NastywomanMD (talk) 17:17, 30 July 2019 (UTC)NastyWomanMD

live-birth long-term surviving examplesEdit

I think they deserve some coverage in the section Abortion#Live_birth.
--SmokeyJoe (talk) 01:42, 15 July 2019 (UTC)
It seems to me there's already too much coverage of an extremely rare phenomenon that occurs in only about one out of twenty-five thousand abortions. We don't need more coverage; see WP:UNDUE. NightHeron (talk) 07:09, 15 July 2019 (UTC)
Agree. NastywomanMD (talk) 17:07, 30 July 2019 (UTC)NastyWomanMD

Second paragraph updatesEdit

I'd like to edit the second paragraph of this article to reflect updated citations and language that's consistent with those citations. See below for my suggested changes. DataNerdMPH (talk) 19:45, 17 July 2019 (UTC)

Abortion is one of the safest procedures in medicine.[1][2] It is safer than carrying a pregnancy to term, which has a 14 times higher risk of death in the United States.[3][4] Modern methods use medication or surgery for abortions.[5] The drug mifepristone in combination with prostaglandin, often misoprostol, is as safe and effective as surgery during the first and second trimester of pregnancy.[5][6] The most common surgical technique involves dilating the cervix and using a suction device.[7] Contraception, such as the pill or intrauterine devices, can be used immediately following abortion.[6] When performed safely on a person who desires it, abortions do not increase the risk of long-term mental or physical problems.[8] In contrast, unsafe abortions (defined by the World Health Organization as a procedure done by a person lacking the necessary skills or in an environment that does not meet medical standards, or both) cause 47,000 deaths and 5 million hospital admissions each year.[8][9] The World Health Organization recommends safe and legal abortions be available to all.[10]

References

  1. ^ Grimes, DA; Benson, J; Singh, S; Romero, M; Ganatra, B; Okonofua, FE; Shah, IH (2006). "Unsafe abortion: The preventable pandemic" (PDF). The Lancet. 368 (9550): 1908–19. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724. Archived (PDF) from the original on 29 June 2011. Cite uses deprecated parameter |deadurl= (help)
  2. ^ Raymond, EG; Grossman, D; Weaver, MA; Toti, S; Winikoff, B (November 2014). "Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States". Contraception. 90 (5): 476–79. doi:10.1016/j.contraception.2014.07.012. PMID 25152259.
  3. ^ Darney, Blair G.; Henderson, Jillian T. (May 2018). "Claims about abortion and clinical implications lack evidence". Paediatric and Perinatal Epidemiology. 32 (3): 305. doi:10.1111/ppe.12442. ISSN 1365-3016. PMID 29319905.
  4. ^ Raymond, E.G.; Grimes, D.A. (2012). "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". Obstetrics & Gynecology. 119 (2, Part 1): 215–19. doi:10.1097/AOG.0b013e31823fe923. PMID 22270271.
  5. ^ a b Kulier, R; Kapp, N; Gülmezoglu, AM; Hofmeyr, GJ; Cheng, L; Campana, A (9 November 2011). "Medical methods for first trimester abortion". The Cochrane Database of Systematic Reviews (11): CD002855. doi:10.1002/14651858.CD002855.pub4. PMID 22071804.
  6. ^ a b Kapp, N; Whyte, P; Tang, J; Jackson, E; Brahmi, D (September 2013). "A review of evidence for safe abortion care". Contraception. 88 (3): 350–63. doi:10.1016/j.contraception.2012.10.027. PMID 23261233.
  7. ^ "Abortion – Women's Health Issues". Merck Manuals Consumer Version. Archived from the original on 13 July 2018. Retrieved 12 July 2018. Cite uses deprecated parameter |dead-url= (help)
  8. ^ a b Lohr, PA; Fjerstad, M; Desilva, U; Lyus, R (2014). "Abortion". BMJ. 348: f7553. doi:10.1136/bmj.f7553.
  9. ^ Shah, I; Ahman, E (December 2009). "Unsafe abortion: global and regional incidence, trends, consequences, and challenges" (PDF). Journal of Obstetrics and Gynaecology Canada. 31 (12): 1149–58. doi:10.1016/s1701-2163(16)34376-6. PMID 20085681. Archived from the original (PDF) on 16 July 2011. Cite uses deprecated parameter |deadurl= (help)
  10. ^ World Health Organization (2012). Safe abortion: technical and policy guidance for health systems (PDF) (2nd ed.). Geneva: World Health Organization. p. 8. ISBN 978-92-4-154843-4. Archived (PDF) from the original on 16 January 2015. Cite uses deprecated parameter |deadurl= (help)
This bit "Properly done, abortion is one of the safest procedures in medicine." As poorly done it kills 10s of thousands of women a year.
Also why did you duplicate all the reference meta data and give all the references new names? It makes it unclear what you have changed.
Have restored to how it was before. Doc James (talk · contribs · email) 22:00, 29 July 2019 (UTC)

Safer than carrying a pregnancy to termEdit

I have concerns about the "safer than carrying a pregnancy to term" sentence. Even if true, this makes the second paragraph overtly POV and encourages to perform abortion instead of carrying to term. Per WP:IMPARTIAL and WP:MEDICAL suggest removing that sentence. Brandmeistertalk 07:19, 30 July 2019 (UTC)

Your concern is extremely hypothetical, since there is no evidence that women who have normal pregnancies (when the woman does not suffer from a condition that makes the pregnancy dangerous for her) would choose to have an abortion because of fear of the health consequences of childbirth (and there has been much written about the actual reasons why women choose abortion). The sentence in question, which is true, is necessary because much misinformation about this has been spread by the anti-abortion movement. NightHeron (talk) 10:49, 30 July 2019 (UTC)
Verifiability does not guarantee inclusion. Such additions, particularly in a debated topic, should be balanced against WP:NPOV in general. The sentence makes the paragraph overtly biased and partisan which is against policy. The straightforward implication of this sentence is having abortion rather than full-term pregnancy which is unhelpful to say the least. Brandmeistertalk 14:06, 30 July 2019 (UTC)
@JzG: You're welcome to join the discussion if you have concerns. Note that per WP:IMPARTIAL, "Even where a topic is presented in terms of facts rather than opinions, inappropriate tone can be introduced through the way in which facts are selected, presented, or organized". So it's not about liking, but neutrality and balanced tone. Brandmeistertalk 09:07, 1 August 2019 (UTC)
Safety is clearly relevant in the context of the current political debate, since anti-abortion activist States in the US cite safety as a reason for erecting ever higher barriers to licensing of clinics providing abortion services. The same States have the highest rates of maternal and neonatal mortality in the developed world, and, probably not coincidentally, the lowest rates of medical coverage for pregnant women. Guy (Help!) 10:01, 1 August 2019 (UTC)
Wikipedia shouldn't take a side in this debate which is clearly prescribed by WP:NPOV. Such statements may be ok for medical publications themselves (where authors express their own opinions), but Wikipedia has its own policies. Effectively claiming that abortion is better than full-term pregnancy is an explicit POV and encouragement to have it instead of pregnancy. The sentence opens a can of worms and is prone to faulty interpretation because "safer" = "better". Brandmeistertalk 13:02, 1 August 2019 (UTC)
There is a misconception that abortion is unsafe. When looking at the safety of options one must compare them. When one is pregnant there are really only two options and thus this comparison is perfectly reasonable. This has nothing to do with "taking sides", this is simple stating facts. Doc James (talk · contribs · email) 15:29, 1 August 2019 (UTC)
The paragraph already explains safe and unsafe abortions with statistics. We should not compare healthy pregnancy and abortion at the expense of the former. "Looking at the safety of options" and "compare them" is explicitly against both NPOV and WP:MEDICAL when it comes to abortion vs pregnancy. Other than that, this effectively amounts to a statement that people should stay at home rather than outside because being outside is more hazardous. All facts in this contentious topic should be checked against NPOV policy and the sentence is question does not pass it. The lead has been relatively stable without that problematic sentence which seems to be a recent addition. Brandmeistertalk 17:16, 1 August 2019 (UTC)
That's not a valid analogy, because there's no active movement spreading false claims that staying at home is dangerous and should be discouraged. When there's a movement that's spreading misinformation designed to discourage people from making a decision that would be in the interest of health (physical or mental) -- such as getting one's children vaccinated or getting an abortion for reasons of the physical or mental health of the woman -- then it becomes important for Wikipedia to include the correct information from RS. NightHeron (talk) 22:37, 1 August 2019 (UTC)
That sentence adds intelligent context concerning RELATIVE RISKS. (I came back to this article because it dawned on me that if that comparison wasn't in the lead, I would add it.) As Doc James says, a woman who finds herself pregnant has two options; this states the relative risk of the choice.
I propose adding more context to that, by some concise part of the statement for the lead: In the US from 2000 to 2009, abortion had a a similar or lower mortality rate than running a marathon. [80] (Already in the "Safety" section.) Putting risk in context to activities people routinely engage in helps people understand risk. Many women CHOOSE to get pregnant and have a child, this puts the risk of abortion in perspective relative to that choice. ---Avatar317(talk) 22:32, 1 August 2019 (UTC)
Such statements could be ok to make for a medical professional or for a Wikipedia editor with medical background, but, as explained above, in encyclopedic terms it is an evident bias and a violation of neutrality (being an explicit promotion of one view to an average reader) in the abortion debate. It's not Wikipedia's mission to advise a woman what choice to make by comparing a healthy pregnancy and abortion. By doing so we effectively engage in an abortion debate which violates NPOV in general and WP:IMPARTIAL in particular. Further expansion would be a larger POV and I'm mildly shocked that this basic isssue of neutrality persists. Brandmeistertalk 22:59, 1 August 2019 (UTC)
Stating reality is not a POV issue simply because there is a political movement to deny it. Just as it's not a POV issue to lay out the basic evidence for Evolution in the article's lede, or to state unequivocally that Vaccination has proved effective in that own article's lede. Someguy1221 (talk) 01:57, 2 August 2019 (UTC)
Brandmeister is correct that this line appears to lack an impartial character, based on my impression when reading it. For reference, one could also see the older, related issue above on this talk page when I pointed out that a related line was inconsistent with the cited sources, other users repeatedly tried to turn the discussion into a political one and talked past me with boiler-plate style reponses, not once addressing the statement/source inconsistency within the subsection. As goes the talk page, so goes the article. One difficulty is that information a medically-trained person reads in a scholarly article is liable to be perceived differently when reproduced in summary form and read by the average lay reader. For example, any expert reader will add in the background knowledge that marathons don't cause Asherman's syndrome, but many abortions can and do. Most non-expert readers will not consider the risk of significant and potentially life-altering though non-lethal side effects.--Epiphyllumlover (talk) 05:26, 2 August 2019 (UTC)
Exactly. Also, due to different national abortion laws and accessibility of safe abortions this comparison and relative risks are globally inappropriate (and potentially dangerous). In some countries abortion is not safer than pregnancy simply because a woman would get into conflict with the law. Brandmeistertalk 06:53, 2 August 2019 (UTC)
Nope. Abortion carried out by qualified doctors is safer than childbirth. You're basically saying this is not true because a back street abortion in Kenya is more dangerous than childbirth in a country with universal healthcare. Back in the real world, reliable sources reflect what we say right now, and the only sources I can find that say the opposite are anti-abortion activists (I can find one source that disputes the size of the difference in risk, which appears also to be written by someone opposed to abortion).
Here's an interesting source on risks of abortion: [1]. Spoiler: claimed risks are illusory, but that doesn't stop anti-abortionists from continuing to assert them. Interestingly, the risks of abortion in the US specifically appear to have declined dramatically from the mid-1970s. Guy (Help!) 08:49, 2 August 2019 (UTC)
The source you quoted is related to legal abortions ("Getting a legal abortion is much safer than giving birth, suggests a new U.S. study published Monday"). And the source for the disputed sentence in the article is titled "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". In other words, the statement is true only for countries where abortion is legal and is not true in absolute terms. The same paragraph already says that "When performed legally and safely on a woman..." So stating that "It is safer than carrying a pregnancy to term" does not account for all the complexities of this debate and is redundant to what the paragraph already says. Brandmeistertalk 09:45, 2 August 2019 (UTC)
By the way, it is not the case that "the statement is true only for countries where abortion is legal." Indonesia is the largest country in the world (264 million population) that outlaws abortion except in extreme cases. It's estimated that in Indonesia 16% of maternal mortality is due to abortion, and also that there are about 2 million abortions (almost all illegal) each year, and 5 million childbirths. That means that of the women who undergo one of the two procedures about 30% have abortions and 70% give birth. But of those who die from the procedure about 16% die from abortion and 84% from childbirth. I'm not proposing this information for the article, but just citing it to provide context and make the point that there's no evidence that the U.S. and U.K. are atypical in abortion being safer than childbirth. NightHeron (talk) 21:10, 2 August 2019 (UTC)
What I mean is that when an abortion is legal it's typically safe, as legalization also normally entails medical safety. So from that perspective it's redundant to state that an abortion is safe in a given country where it's legal. For countries where it's illegal abortion is obviously not safe both from legal and medical point of view (due to underground practices). Brandmeistertalk 21:28, 2 August 2019 (UTC)
In the "It is safer..." sentence, "it" refers to the previous sentence "Properly done, abortion..." and so the sentence you're disputing is supported by the source. NightHeron (talk) 10:04, 2 August 2019 (UTC) only
I don't dispute that. I wrote that the source is related only to a single country with legal abortion and associated access to safe abortions. That's one of the issues, as in addition to NPOV, country bias comes into play. So the sentence is problematic in multiple ways. Brandmeistertalk 13:39, 2 August 2019 (UTC)
It's not just a single country; from the Royal College of Obstetricians and Gynaecologists in the U.K. see [2]. NightHeron (talk) 15:53, 2 August 2019 (UTC)
I think I've clarified all the issues with that sentence by now. The sentence better suits Abortion in the United States and indeed it's already there. All other country-specific statements of abortion safety should be in relevant subarticles, not in the general article. Brandmeistertalk 16:11, 2 August 2019 (UTC)
No, you're not clarifying issues. You're making a fallacious claim, namely, that a sentence must be omitted from the abortion article because the available studies that we've found described in RS to support it come from two countries (the U.S. and U.K.). Are you going to go through the article now and call for the removal of all material that's sourced from those same two countries? NightHeron (talk) 19:23, 2 August 2019 (UTC)
The sentence is better ommitted because of all concerns I and User:Epiphyllumlover mentioned above in this thread, not merely because it comes from two countries. And that's why I'm proposing to leave such statements in relevant country-specific articles instead of this article as a solution to this dispute. Brandmeistertalk 19:55, 2 August 2019 (UTC)
In your opinion. Others differ. That includes me. Guy (Help!) 22:51, 2 August 2019 (UTC)
Just because you can endlessly generate ever-changing "reasons/concerns/arguments" why you believe that some content should be suppressed from inclusion in Wikipedia, even when validly sourced, does not mean that you will get consensus for it.
As I've stated previously, I STRONGLY support having that statement in the LEAD, which by the way in the Abortion in the United States article, the safety of abortions is not discussed at all in the lead, so your claim that it is "already in that article" is false/misleading. The article on Abortion should provide an overview of the whole subject, while the AitUS article concentrates on specifically US issues. ---Avatar317(talk) 00:12, 3 August 2019 (UTC)

─────────────────────────I have no idea why this question has been asked, since the cited sources are as clear as they can possibly be. According to this large-scale US government study, childbirth killed 8.8 women out of 100,000 while legal abortion killed 0.6 out of 100,000. The difference is HUGE, that is, 14 or 15 times more women die in childbirth than they do in legal abortion. We should most definitely emphasize this fact in the article body and in the lead section. Binksternet (talk) 01:19, 3 August 2019 (UTC)

And in response to editor @Epiphyllumlover: who stated that we are only listing "mortality" and ignoring "morbidity" from the above study (which is also the one used as a reference for the statement in the article - Raymond & Grimes 2012): from the abstract: In the one recent comparative study of pregnancy morbidity in the United States, pregnancy-related complications were more common with childbirth than with abortion. And from the text: Common maternal morbidities were defined as conditions either unique to pregnancy or potentially exacerbated by pregnancy that occurred in at least 5% of all pregnancies. Every complication was more common among women having live births than among those having abortions (Fig. 1). The relative risks of morbidity with live birth compared with abortion were 1.3 for mental health conditions, 1.8 for urinary tract infection, 4.4 for postpartum hemorrhage, 5.2 for obstetric infections, 24 for hypertensive disorders of pregnancy, 25 for antepartum hemorrhage, and 26 for anemia.
We could also include the statement: "Pregnancy-related complications are always more common with childbirth than with abortion."
(I almost always include quotes with references, so that editors can easily see specifically which statements in the reference MOST support the statements in the article, and so readers can have some confidence that the references are being reasonably summarized/paraphrased. Maybe these quotes should be added to the reference.) ---Avatar317(talk) 04:45, 3 August 2019 (UTC)
The safety and legality of abortion varies by country. Picking one country where abortion is legal and safe to state that it's safer than pregnancy introduces POV. We already state that "When performed legally and safely on a woman who desires it, induced abortions do not increase the risk of long-term mental or physical problems". There is no need in repeating the same in POV language related to one country. Brandmeistertalk 05:52, 3 August 2019 (UTC)
This is an article about a medical procedure. It makes sense that the content will be about the medical procedure. The fact that there are commonly used unsafe versions of the procedure is a reason to discuss them, but not a reason to dilute the main article. In fact, reliable sources on unsafe and illegal abortions are virtually always discussing them in the context of safe and legal abortions in the same or other countries for the sake of comparison - it is most certainly not treated as a separable subject. So actually, this article is currently presenting content in the same viewpoint as most reliable sources, and thus is already using the neutral point of view. Overall, I think you are confusing "NPOV" with "non-partisan". The goal here is obviously not to pick a side in a partisan debate, but it's definitely not to seek some mystical balance between partisan viewpoints. And that's because NPOV doesn't care about partisan viewpoints - it cares about the viewpoints in reliable sources. I'm not saying that this article was written in a partisan way, but it is simply true that one side of the partisan debate happens to line up very well with the viewpoint of reliable sources. That is not a problem for NPOV. The prevailing viewpoint of medical authorities doesn't become unacceptably biased just because a lot of people are upset about it. "in determining proper weight, we consider a viewpoint's prevalence in reliable sources, not its prevalence among Wikipedia editors or the general public." Someguy1221 (talk) 06:33, 3 August 2019 (UTC)
The safety and legality of abortion are strongly correlated. Around the world, the inescapable conclusion is that the only alternative to safe, legal abortions, is unsafe, illegal abortions. But as always you're ignoring the point. Abortion is safer than pregnancy because in most cases it's done early. In fact most abortions are spontaneous, a fact that is often missed. The claims of "morbidity" from abortion derive almost exclusively from people opposed to the procedure, and in some cases, such as the claim of a breast cancer link, they turn out to be pure invention. You're arguing "I know X" versus sources. That rarely works on Wikipedia. Guy (Help!) 09:14, 3 August 2019 (UTC)
I'm glad you acknowledge that the the goal here is obviously not to pick a side in a partisan debate. But there's no false balance because, unlike evolution or flat Earth, abortion still has different legal, scientific and ethno-cultural interpretations around the world. If you look at the map, roughly half of all countries worldwide have various legal restrictions on abortion. Furthermore, I'd encourage to have a look at Fetal rights#Modern regulations. So it's not that only "one side of the partisan debate happens to line up very well with the viewpoint of reliable sources". The opposite side also happens to line up well with multiple reliable sources, including medical authors. That's basically why the abortion debate still persists. With that in mind, to state that NPOV "cares about the viewpoints in reliable sources" is an oversimplified misinterpretation. Per WP:IMPARTIAL, "Wikipedia does not engage in disputes. A neutral characterization of disputes requires presenting viewpoints with a consistently impartial tone; otherwise articles end up as partisan commentaries even while presenting all relevant points of view. Even where a topic is presented in terms of facts rather than opinions, inappropriate tone can be introduced through the way in which facts are selected, presented, or organized".
Considering the above, unsafe, illegal abortions are not "the only alternative to safe, legal abortions", as claimed by Guy (JzG). That's merely the opinion of the opposing camp. So let's leave the "It is safer than carrying a pregnancy" sentence to country-specific abortion articles only. Hope that helps. Brandmeistertalk 21:29, 3 August 2019 (UTC)
If that's the best argument you have then you're done here. Binksternet (talk) 21:54, 3 August 2019 (UTC)
Stating that abortion is safer than childbirth is impartial because it is true, as established by sources. Wikipedia is concerned with the real world, not an idealised one in which women deprived of autonomy become happy to carry every pregnancy to term. You may be looking for Conservapedia, where reality takes second place to ideological consonance.  Guy (Help!) 22:11, 3 August 2019 (UTC)
@Brandmeister: It is clear from the commenters here that the consensus is clearly against you. You are free to open an RfC if you like. ---Avatar317(talk) 22:21, 3 August 2019 (UTC)
Brand, if you think there is another side to "safe and legal abortions are safer than childbirth" that is supported by reliable medical sources, then it's clear you're just deep into fringe territory, so I won't bother further. Someguy1221 (talk) 02:16, 4 August 2019 (UTC)
I see we agreed to disagree by now, so it will be the community's turn to decide. Brandmeistertalk 07:23, 4 August 2019 (UTC)
They already did. Consensus here is very clear. Guy (Help!) 07:34, 4 August 2019 (UTC)
It's sad that you once again removed the disputed tag, considering that Epiphyllumlover also provided their opinion, so it's not 1AM. And even if it is, it's not a policy and is against established process. Brandmeistertalk 07:41, 4 August 2019 (UTC)
I removed it exactly once, I have no idea if anyone else has done so. The statement itself is not in dispute, your only issue is whether it's generalisable, so addition of the tag is disruptive, especially in the context of a rather clear consensus here that inclusion is warranted. You have been wanred about the discretionary sanctions, I suggested two ways forward. I think that is an end of it. Guy (Help!) 07:50, 4 August 2019 (UTC)
Sorry, the first time it was Avatar317. End by now. Brandmeistertalk 07:54, 4 August 2019 (UTC)

RfC about the neutrality of the abortion's leadEdit

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.
I'll provide more comments in the next section, where different options were discussed in greater detail, but briefly, some of the concerns here were around the specific 14x description based on a US source, and favoured broadening the scope of the sentence to discuss other studies about the safety of abortion. I don't find a consensus here that the sentence breaches any neutrality policies and should be removed. I will close the subsequent RFC below as well (but briefly here, version 2 was the preferred version). Steven Crossin Help resolve disputes! 03:18, 22 September 2019 (UTC)


Does the sentence "It is safer than carrying a pregnancy to term, which has a 14 times higher risk of death in the United States" in the article's lead constitute a breach of WP:NPOV and WP:IMPARTIAL specifically? Brandmeistertalk 08:23, 4 August 2019 (UTC)

  • No. It's an accurate reflection of a reliable source, and the claim itself is entirely unsurprising. Guy (Help!) 08:31, 4 August 2019 (UTC)
  • No. Wikipedia:Neutral point of view specifies: "All encyclopedic content on Wikipedia must be written from a neutral point of view (NPOV), which means representing fairly, proportionately, and, as far as possible, without editorial bias, all of the significant views that have been published by reliable sources on a topic." Omitting it would be a violation. Dimadick (talk) 08:33, 4 August 2019 (UTC)
The key phrase there is "without editorial bias". And further below the policy says: "Prefer nonjudgmental language. A neutral point of view neither sympathizes with nor disparages its subject (or what reliable sources say about the subject)... Present opinions and conflicting findings in a disinterested tone. Do not editorialize. When editorial bias towards one particular point of view can be detected the article needs to be fixed". Also, this talkpage's FAQ clearly says we should not include expert medical advice about abortions per WP:MEDICAL. Brandmeistertalk 08:49, 4 August 2019 (UTC)
Re: Medical advice: This is in NO WAY including "expert medical advice." Expert medical advice is "Should *I* take this drug/have this treatment/surgery?" Current statement is presenting facts of averaged risks across all persons; your individualized risk may be greater or lesser. ---Avatar317(talk) 20:01, 4 August 2019 (UTC)
  • Comment. This is kind of an unsurprising factoid, but the source is not-great being old, primary and American-specific. From a quick look on PUBMED I don't see that much (any?) secondary literature couches discussion of safety in an "abortion vs full-term" manner. It might be better just to say that abortion is generally very safe and adverse events rare (which is easily sourced from strong WP:MEDRS). Alexbrn (talk) 09:33, 4 August 2019 (UTC)
This is a long-standing area of research - this form 1982, for example, this looking at legal aspects, HuffPo repeating the 14x number in 2015, this from the UK (independent data) - and virtually all pushback is form anti-abortion groups. I can't find any medical sources that contradict this claim. Note also that when sources discuss the "contentious" risks of abortion to mental health, the actual science shows that these purported effects are not a risk. Whatever we say - whether we include relative risk or not - it is clear that we should be stating that abortion is a very safe procedure. That 2016 study notes that "Induced abortion is among the safest outpatient procedures performed in the United States" and, in conclusion, "This study describes the physical health experiences of women after birth and abortion. Our results reinforce the existing data on the safety of induced abortion when compared with childbirth, and highlight the risk of serious morbidity and mortality associated with childbirth after an unwanted pregnancy."
A Grauniad article in August 2017 notes that the US has the highest maternal mortality rates in the developed world, and it disproportionately affects black women. It's an important topic, and there are a lot of sources discussing abortion and pregnancy which make this point - that for me is the compelling fact, Wikipedia would be following a significant number of other sources in noting that the risks of abortion are lower than those of pregnancy. Limiting Access to Abortion Could Cause Maternal Deaths to Rise, May 31 2019, for example, or USA Today making the same statement of fact we do based on the same source in June 2018, or the NYT in May 2019 saying "Pregnancy Kills. Abortion Saves Lives." Guy (Help!) 09:52, 4 August 2019 (UTC)
The developed world is not the entire world. Maternal death rates vary significantly in the world and per CIA factbook, as of 2015, 94 out of 184 countries had a maternal mortality rate for 100,000 live births at around 50 or lower, which is small. And Poland, where abortion is notably restricted, had one of the lowest rates, merely 3 (three) per 100,000 live births (alongside Finland, Iceland and Greece). So choosing one country from a developed world to argue that abortion is better than full-term pregnancy in the lead is a cherry-picking of sources under biased criterion which is explicitly discouraged. That's also why I proposed to leave it to Abortion in the United States. Brandmeistertalk 10:25, 4 August 2019 (UTC)
Are you intending to hector every dissenting voice? If so, we can save time and go straight tio WP:AE. You tried that argument above, it failed. Guy (Help!) 10:30, 4 August 2019 (UTC)
No, those are just two important remarks to make things clearer. I will not discuss in this RfC further. Brandmeistertalk 10:47, 4 August 2019 (UTC)
Why we SHOULD include the comparison: What does "safe" mean for a medical procedure? everything involves risks and trade-offs. Are opiates "safe"? Would the medical profession say that automobile usage is "safe"? In my opinion, to not include the comparison of abortion risk vs. pregnancy-to-term risk would be to hide facts from the reader by over-simplifying the article. Without meaningful and easily understandable numbers and relevant comparisons, a "safe medical procedure" doesn't convey much information, other than an argument from authority that someone has deemed it safe. ---Avatar317(talk) 20:11, 4 August 2019 (UTC)
  • No. This fact is an important one to note in the lead, especially since opponents of abortion have spread misinformation about the safety of abortion. The safety of abortion, even compared to childbirth, is quite general and is not restricted to the U.S. The Royal College of Obstetricians and Gynaecologists in the U.K. has come to a similar conclusion, and the greater likelihood of death from childbirth than from an abortion is even true in Indonesia, a developing country that severely restricts legal abortion. NightHeron (talk) 11:44, 4 August 2019 (UTC)
  • Yes, but . . . the article should say that abortion is generally safer for the mother than carrying a child to term. My objection is not to the inclusion of the concept; it's to the overly specific nature of the sentence. Why are we limiting it to the United States? What if a different study found a different ratio? Additionally, I have no opinion about whether or not the less specific statement should be in the lead. Adoring nanny (talk) 12:53, 4 August 2019 (UTC)
  • Yes The figure is coming from a single 2012 study based on 1998–2005 data in the US only. It's a very selective figure. It would be fine to include "according to a 2012 study on US birth data" to "neutralize" the statement. --Masem (t) 13:57, 4 August 2019 (UTC)
    • Also from what others have said, it would better to summarize the other studies than focus on the 14x number, which is what throws this off. "Multiple studies have shown abortion to be from 6 to 14 times safer than childbirth" (Assuming that's the number range). But using one study based on 1st world data and an older set to boot is a problem. --Masem (t) 14:00, 4 August 2019 (UTC)
I'm fine with leaving the 14x out and citing a wider range of sources, e.g. from the UK. Guy (Help!) 20:11, 4 August 2019 (UTC)
  • No. A widely cited statistic from a large-scale study can never be "a breach" of neutrality. Brandmeister is wasting the community's time. Binksternet (talk) 14:27, 4 August 2019 (UTC)
    Statistics can breach neutrality. "Lies, damn lies, and statistics." Levivich 17:03, 5 August 2019 (UTC)
  • No.Presenting all facts as we know them (published in reliable sources) is not a breach of neutrality, and the statement neither endorses nor rejects any particular point of view. The statement has no "Point of View"; it is about facts found in a medical study. As I stated in a reply earlier in this RfC section, to claim "safety" without stating relative risks amounts to nothing other than an argument from authority that X procedure is "safe." By stating hard numbers we allow the reader to think for themselves, and better understand the risks. Also, there are many statements in Wikipedia sourced by only one medical study, because that is the current state of human knowledge. ---Avatar317(talk) 00:02, 5 August 2019 (UTC)
  • Yes per Adoring nanny and Masem. The current sentence is cherrypicking from a single study; it's actually factually incorrect. Abortion isn't exactly 14x safer than pregnancy; it's misleading to claim that sort of accuracy. I'm not opposed to the general sentiment, but it needs to be broadened in scope, beyond just one study in the US, as suggested above. Levivich 16:57, 5 August 2019 (UTC)
    Yup, so we drop 14x and include the other sources that show it to be safer, and that fixes the problem, right? Guy (Help!) 07:20, 6 August 2019 (UTC)
    Yup, more or less. Levivich 06:08, 7 August 2019 (UTC)
  • Yes as abortion is a medical procedure this needs a secondary source and needs to explain the study rather than stating it as factual per WP:MEDRS --[E.3][chat2][me] 04:40, 6 August 2019 (UTC)
  • Comment. If you wanted a global figure, as of 2015 the global abortion death rate is 63 per 100,000 abortions, while the maternal death rate is 213 per 100,000 live births [3]. However, citing the situation in the United States to compare safe abortion to no abortion is actually pretty common (see, for example, [4]. The death rate from unsafe abortion varies pretty wildly around the world, from as low as 20 to as high as 540 per 100,000 abortions [5], and the total death rate from pregnancy also varies significantly (first reference). There is some difficulty in that the papers presenting death rates are rarely the same ones presenting abortion rates, the very act of gathering this data is extremely difficult in many countries, and some of the best datasets aggregate information in a way that prevents this type of comparison [6]. Someguy1221 (talk) 06:19, 6 August 2019 (UTC)
  • Yes In particular, safety is left vague, as the individual risks to life, complications, and mental health are left ambiguous. In particular, the last is controversial in the current academic literature as linked to in an earlier discussion and the article should reflect this fact.--Epiphyllumlover (talk) 04:20, 9 August 2019 (UTC)
  • No - Especially as clarifying that the "14x safer" figure is from the U.S. seems to have fixed the issue. - CorbieV 22:49, 12 August 2019 (UTC)
  • As others have suggested, one solution is simply to say that abortion, when performed by trained personnel in settings where it is legal, is substantially safer than childbirth. This is a) true, and b) gets away from the US-specific "14x safer" number. The arguments that is it somehow "POV" to present well-sourced, accurate medical information about the safety of abortion—or that such information should be suppressed because it may lead women to make choices that individual editors disagree with—are inappropriate and, frankly, should disqualify the people making such arguments from editing this article. MastCell Talk 15:49, 14 August 2019 (UTC)
  • No - it is a neutral statement of fact. Doc James (talk · contribs · email) 08:48, 20 August 2019 (UTC)
  • Wrong question The question, as E.3 notes, should be about sourcing. This is a single paper from 2012 and is not sufficient for the claim being made. petrarchan47คุ 04:42, 21 August 2019 (UTC)
  • No. Setting aside discussion on the best wording, the comparative safety of abortion vs continued pregnancy is abundantly supported by sources, and it is clearly pertinent and noteworthy in relation to this article/topic. An accurate summary of pertinent and noteworthy information does not become advocacy just it is inconvenient for a subset of advocates who believe fraud or FUD on some particular point might benefit their cause. The text is not a violation of WP:NPOV, WP:IMPARTIAL, or any other policy or guideline I can think of. Alsee (talk) 13:04, 31 August 2019 (UTC)

The above discussion is preserved as an archive of the debate. Please do not modify it. No further edits should be made to this discussion.

RfC v2Edit

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.
An overall consensus here exists for version 2. Some editors here have suggested tweaks to the proposed text here, such as the removal of the word especially, and noting the change in option 2 (where "carrying a pregnancy to term" has been replaced with "carrying a baby to term."), and I would recommend these finer points be discussed in more detail. But overall, for now, a consensus exists for option 2. The finer refinements can continue to be discussed. Steven Crossin Help resolve disputes! 03:21, 22 September 2019 (UTC)

In the above discussion, some are opposed to the current lede sentence on the basis that the precise number is specific to the USA and thus invalid.

There would seem to be three possibilities, not the two listed above.

  1. It is safer than carrying a pregnancy to term, which has a 14 times higher risk of death in the United States. (current version)
  2. Modern abortion procedures are safer than carrying a baby to term,[7], [8], [9], [10], especially in the US, where maternal mortality rates are among the highest in the developed world.[11]
  3. Omit the statement.

Guy (Help!) 08:34, 6 August 2019 (UTC)

DiscussionEdit

  • I favour 2 (obviously). I note especially [12] and [13]. There is a well documented consensus that legal abortion carried out by properly trained people, especially medical rather than surgical abortion, is remarkably safe, and that all efforts to deny this either through rhetoric or through law are designed to control women, not make them safer. Guy (Help!) 08:34, 6 August 2019 (UTC)
  • As an alternative to omission, I'm ok with retaining that sentence in the Abortion#Safety only. Per other users' concerns in this RfC and per MOS:INTRO (which advocates a general summary, saying that "editors should avoid... overly specific descriptions"), the sentence should be removed from the lead. Brandmeistertalk   10:04, 6 August 2019 (UTC)
    OK, so for all your protests about it being overly specific, you're really concerned that people shouldn't know that abortion is safer than childbirth, especially in the US (because we know that most people don't read beyond the lede). Good to know, thanks. Guy (Help!) 13:06, 6 August 2019 (UTC)
    I don't see a net benefit in such generalized statements. If abortion is safer than a normal childbirth, if "making safe abortion legal and accessible reduces maternal death", should a woman have an abortion instead of carrying a healthy pregnancy to term? Simply wow. Brandmeistertalk 14:59, 6 August 2019 (UTC)
    People should also fly everywhere because it's safer than driving. >rolling eyes< Having a baby is not about deciding what's safer, it's about love and the drive to reproduce. Brandmeister, you have become disruptive to this discussion. Binksternet (talk) 16:05, 6 August 2019 (UTC)
    Exactly, it is not about deciding what's safer. So no need to compare it generally with a normal pregnancy and it's not only my opinion in this discussion. Brandmeistertalk 19:47, 6 August 2019 (UTC)
    This is Wikipedia, we deal with reality. In the UK, for example, medical professionals include advice on termination as part of the discussion with pregnant women, explicitly including the fact that abortion is safer. [14]. Guy (Help!) 19:53, 6 August 2019 (UTC)
    2 is problematic. "Modern abortion procedures are safer than carrying a baby to term" is still an unqualified generalization and oversimplification. It depends on a country and on whether abortion is safe or unsafe. For that matter we already state that "When performed legally and safely..." Also, there are conflicting studies on this issue: [15], [16]. Brandmeistertalk 22:37, 6 August 2019 (UTC)
    Your first link shows a study that combines abortion mortality with miscarriage mortality – not relevant. Your second link shows a report that is an outlier, one that is swamped by many other studies showing abortion to be safer than childbirth. The lead section is for stating major trends, not outliers. Binksternet (talk) 03:14, 7 August 2019 (UTC)
    Based on relevant research and RS articles posted in this thread, and in previous sections, I have to agree that saying something like "Modern abortion procedures are safer than carrying a baby to term..." is accurate and a useful sentence (or phrase) for the lead. I appreciate the effort by fellow editors posting relevant studies and RS articles, reflecting research from the nineteen seventies all the way to recent studies in the twenty-teens. That research and this discussion has given me a clear picture of what is accurate. ---Steve Quinn (talk) 17:30, 7 August 2019 (UTC)
  • 2 seems perfectly fine, addressing the single study's relevance while noting lesser studies that are still relevant broadly to the world population. --Masem (t) 20:22, 6 August 2019 (UTC)
  • 2 seems fine to me, except that the wording of the "especially" clause is ambiguous and could be read as suggesting doubt about the validity of the first part of the sentence outside the US, which is not the way it should be read. Would either of the following changes in wording be agreeable? (a) change "especially in the US" to "by a factor that is especially large in the US..."; or (b) start a new sentence after the four references "Abortion is safer than childbirth by a particularly large margin in the US..." Thanks. NightHeron (talk) 22:49, 6 August 2019 (UTC)
  • 3 In addition to the above, the sentence is flawed in another ways. The CDC itself notes: "Errors in reported pregnancy status on death certificates have been described, potentially leading to overestimation of the number of pregnancy-related deaths. Whether the actual risk of a woman dying from pregnancy-related causes has increased in unclear, and in recent years the pregnancy-related mortality ratios have been relatively stable". That's probably why for 2015 we have conflicting figures - 17.2 (CDC) or 14 deaths (CIA Factbook). But even if 17.2 is considered, that's actually is not high for standard 100,000 live births - merely 0.01% meaning 99,99% of all other pregnant women do survive. Even CDC's own website does not consider 17.2 a high number, only talking about an increase. Also, per Maternal mortality in the United States, up to 50% of these deaths are due to preventable causes. This means (and I think many medical professionals would agree) that reducing those preventable causes is the primary solution to maternal deaths, not the abortion. Brandmeistertalk 01:12, 7 August 2019 (UTC)
  • 2 works fine, and can be augmented with mortality ratios from a few large countries for comparison. Binksternet (talk) 03:15, 7 August 2019 (UTC)
  • 2 looks good, and would be an improvement. Alexbrn (talk) 07:50, 7 August 2019 (UTC)
  • 2 would be more factual KFvdL (talk) 13:40, 7 August 2019 (UTC)
  • None of these choices, either – Sorry, I'm not trying to be difficult, but we can't go with any of these choices and stay in line with policy. 1 is not good for the reasons given in the previous RfC, above. 3 would be omitting vital information from this article, so that's right out. 2 is absolutely better than 1, but it does not comply with WP:MEDRS and I think is still (unintentionally) inaccurate in a potentially misleading way. First, I don't see how we can use popular press like Popular Science, The Telegraph, and NPR, to back up a medical statement, per WP:MEDPOP. Second, the first PDF link shows up as an "invalid token" error for me, so I'm not sure what that PDF is, and so AFAICS, the only scientific/medical journal source in #2 as drafted is the 2012 US "14x" study (text). #2 as drafted doesn't say exactly what that the study says, which is Legal abortion in the United States remains much safer than childbirth. It's "legal abortion in the United States", not "modern abortion procedures", and it's specifically childbirth, not "carrying a baby to term". What the study does is compare the pregnancy-associated mortality rate among women who delivered live neonates with mortality rate related to induced [legal] abortion (in the US in 1998–2005). (The study also looks at literature on morbidity rates and concludes that the overall morbidity associated with childbirth exceeds that with abortion.) The study itself notes one of its weaknesses is that it doesn't account for other risks involved with pregnancy/carrying a baby to term, either before or after childbirth, nor the risks associated with abortions that can arise after the abortion procedure (long-term risks). Of course, some pregnancies who are carried to term nevertheless result in abortions, and those aren't accounted for, either. The authors say they don't think any of these affect the validity of the study, but it's still just one study–we should include others. I suggest what needs to be done is not an RfC, but a pre-RfC discussion to workshop language and sources. I know there are other academic sources we could use (not popular press), in addition to the 2012 US 14x study, and I'm sure we can come up with accurate consensus language. Levivich 16:11, 7 August 2019 (UTC)
  • 2 seems to solve this issue. It speaks in broader and more generalized terms, while also noting the findings in the USA. It also debunks the myths that say the opposite is true or that say abortion is shown to be an across-the-board, unhealthy alternative. ---Steve Quinn (talk) 18:43, 7 August 2019 (UTC)
  • None per Levivich (talk · contribs)Manabimasu (talk) 23:48, 7 August 2019 (UTC)
  • 2 It is very important to have this summary of safety in the lead (per WP:Lead: "...summarize the most important points,") Safety is a VERY important point, especially when many are propagating myths about abortion safety. But I agree with editor NightHeron about the "especially" sounding somewhat clumsy and confusing....this can be improved later. ---Avatar317(talk) 17:19, 8 August 2019 (UTC)
  • Vote to prefer the first RfC, however, should that RfC fail, my preference is first for 3, to omit. I would go with 2, but it should read "have a lower risk of death than carrying" instead of "are safer than carrying" because of the issue of conflating multiple risks of safety--such as long-term complications vs. mortality vs. mental heath. Any mention of safety should refer to the type of safety involved. Non-medical professionals should not be expected to know which kind of safety the references are dealing with without explicit clarification.--Epiphyllumlover (talk) 04:28, 9 August 2019 (UTC)
    Some of those sources (and indeed others cited in the article) look in depth at the very questions you raise, and find that there is little to no risk of any of these outcomes that anti-abortionists assert to be common. There is, however, a very strong correlation between those risks and being denied abortion. Guy (Help!) 12:46, 9 August 2019 (UTC)
    Each assertion of safety must be narrowly described and reflect the ref tag at the end of it. Broad strokes of "it is safe" in general expect the reader to know an unreasonable amount of background information. Generalized statements that are difficult to either substantiate or refute reflect the big lie fallacy, which is often used in political rhetoric. If safety is about maternal death, mention maternal death, if mental health, state what type(s) of mental health, if fertility, describe the likelihood of future chronic fertility complications, etc.--Epiphyllumlover (talk) 04:08, 10 August 2019 (UTC)
    The WHO and other sources describe abortion as very safe, and the only sources portraying it as risky are either anti-abortion sites (many of which discuss "risks" that have been analysed and found to be spurious) or are cearly discussing the developing world and other places where abortion is not conducted wihtin a well-regulated medical environment. In other words, it's only dangerous when your medical system isis broken or when it's illegal. And we make that point, with sources, already. Guy (Help!) 10:49, 10 August 2019 (UTC)
    The individual reader cannot be expected to know the medical background of what constitutes "safety". Choosing this vague description is a logical fallacy.--Epiphyllumlover (talk) 04:06, 11 August 2019 (UTC)
    Please re-read my previous response to you. (I added a "reply to" at that location.) The lead should summarize; "safer in ALL respects" is supported by the sources. The relative safety of each complication could be detailed in the safety section. ---Avatar317(talk) 19:45, 11 August 2019 (UTC)
    Not with respect to fertility--abortion is a risk factor for infertility while birth is not. Correlations with suicide is also stronger with abortion than birth, but this is controversial because maybe woman who choose abortion were already more likely to choose suicide even prior to the abortion. There is no way to know--possibly the suicide risk factors are also abortion risk factors.--Epiphyllumlover (talk) 03:20, 14 August 2019 (UTC)
    Late abortions (which are a very small proportion in countries where abortion is legal) and incompetent abortions (which are not being discussed here) are a risk factor for infertility. Birth by Caesarian section, which in 50 countries constitutes over 27% of births, is a risk factor for infertility. NightHeron (talk) 10:52, 14 August 2019 (UTC)
    This study found no connection between suicide and abortion. [17] Gandydancer (talk) 15:21, 14 August 2019 (UTC)
    Basically, every medical assertion made by Epiphyllumlover is false. (Safely performed) abortion is not associated with subsequent infertility (see RCOG guidelines); unsafe abortion (in settings where abortion is illegal or access is restricted) can lead to infertility, but that's a different issue. Nor does abortion cause mental-health problems or suicide (see the same guideline, along with the findings of every other relevant expert group). Epiphyllumlover, ultimately it is disruptive for you to continue to use this page to propagate misinformation and false medical claims about abortion; please stop. MastCell Talk 16:15, 14 August 2019 (UTC)
    For proof of the fertility assertion, see Cleveland Clinic: Asherman's Syndrome. There are eight scholarly references backing this up. I explained how the suicide correlation, though it exists, is controversial due to cause/effect considerations; do not misrepresent me.--Epiphyllumlover (talk) 17:43, 16 August 2019 (UTC)
    The problem is that you have an agenda, but you don't know what you're talking about. The biggest risk factor for Asherman syndrome is pregnancy itself, not abortion. Asherman syndrome can occur after any surgical procedure involving the uterus, and is most commonly associated with D&C performed after live delivery or after a miscarriage. There is no indication that Asherman syndrome is more common after induced abortion than it is after live birth or miscarriage. Separately, many abortions use medication and don't even involve instrumentation of the uterus, and thus pose no risk of Asherman syndrome. That reference doesn't prove your assertion in any way. Expert bodies are quite clear on this: "Published studies strongly suggest that infertility is not a consequence of uncomplicated induced abortion." (RCOG guideline). You're tying yourself into logical knots to avoid recognizing the actual state of human knowledge on this subject, which we have a responsibility to convey accurately to readers. MastCell Talk 22:18, 16 August 2019 (UTC)
  • 2 is good although I agree with NightHeron about using the word "especially." To quote him, "...except that the wording of the "especially" clause is ambiguous and could be read as suggesting doubt about the validity of the first part of the sentence outside the US, which is not the way it should be read." Gandydancer (talk) 14:13, 10 August 2019 (UTC)
  • 2 Looks good. 1 is fine, but 2 is clearer. The bit after it in the current version, about "unsafe abortions", however... It's true, but "unsafe" needs to be more clear. - CorbieV 22:55, 12 August 2019 (UTC)
  • 2 is fine, although I guess I worry that it's original synthesis to link the 14x number to the US maternal mortality rate. (Although at least one or two of the cited sources allude to this connection, so it's probably fine). I'd favor simply saying that "Modern abortion procedures are safer than carrying a baby to term." This avoids country-specific estimates, and a general statement like this is appropriate for the lead (with more detail in the body of the article). I would also favor modifying the lead to something like: "Modern abortion procedures, when performed by trained personnel in settings where abortion is legal, are safer than carrying a baby to term." After all, "modern procedures" are not the sole determinant of safety—the legality of abortion and the personnel performing it also impact its safety. But in the interest of compromise, I'm OK with choice #2. MastCell Talk 15:57, 14 August 2019 (UTC)
    "Modern abortion procedures, when performed by trained personnel in settings where abortion is legal, are safer than carrying a baby to term childbirth." I think that's a fine way to put it. Levivich 16:07, 14 August 2019 (UTC)
    After doing a little more reading, I have some concerns about option #2. According to the Royal College of Obstetricians and Gynaecologists, in the U.K. the risk of death from abortion was 0.00032%, whereas the risk of maternal death after live birth was 0.01139% (see "The Care Of Women Requesting Induced Abortion", pp 37–38). So based on those numbers, in the U.K., abortion is actually about 35 times safer than childbirth. That suggests that the relative safety of abortion in the US is not an outlier, and is not driven primarily by the US's relatively high risk of maternal mortality. Therefore, I'd favor simply saying that abortion (with the above caveats about legality/training) is substatially safer than childbirth, but would not include the idea that the US is an outlier, because it doesn't seem to be true. Levivich's suggestion is fine with me. MastCell Talk 16:09, 14 August 2019 (UTC)
    Support Levivich's new wording, per MastCell's additional research. We can go into figures for the individual countries further down. Sorry, I hadn't looked at the current version of the lede. I think what we have there is good now. Though adding in the UK figure might be good, as well. - CorbieV 19:56, 14 August 2019 (UTC)
    The high mortality rate in the US stated by some sources is actually dubious. In the CDC graph for 1987-2015 the peak rate per 100,000 births for all those years was 18.0 in around 2014. These Pubmed articles also support a lower recent rate in the US: [18], [19] (16.0 for 2006-2010 and 17.0 in 2011-2013). The 18 per 100,000 births rate means merely 0.01% giving a maternal survival rate of 99.99%. Brandmeistertalk 08:31, 15 August 2019 (UTC)
    And as Brandmeister stated above, there is some dispute over the figures. I would like it to be discussed in the article an efn note.--Epiphyllumlover (talk) 16:14, 17 August 2019 (UTC)
    18 per 100,000 is close to 0.02%, not 0.01%. And it's not "merely". It's the highest maternal mortality rate in the industrialized world, and the US is one of very few countries where the rate has been increasing in recent decades. Nothing to be proud of. NightHeron (talk) 11:02, 15 August 2019 (UTC)
    That's still a purely subjective claim on a global scale, the world is not made just of the industrialized part. Chad or Central African Republic have that rate at around 800 per 100,000 deaths for comparison. Even if the US had the lowest rate of all countries, at 3 per 100,000 births, that will still be within the remarkable 99.99% maternal survival rate (specifically, 99.997%). Brandmeistertalk 13:21, 15 August 2019 (UTC)
  • 2 is reasonable. 3 is reasonable only if other details are moved from the lede to the main body of the article, not just the one sentence. Shmuel (Seymour J.) Metz Username:Chatul (talk) 16:28, 15 August 2019 (UTC)
  • 2 though certainly factual, could be improved in the light of objections to what some participants represent as partisan presentation, by adding a little more perspective. How about:
    Modern abortion procedures are safer than carrying a baby to term,[20], [21], [22], [23], especially in the US, where maternal mortality rates are among the highest in the developed world.[24] Mortality rates from medically unsupervised abortion however, is far higher still. (Exact wording and citation open to adjustment) JonRichfield (talk) 12:21, 25 August 2019 (UTC)
    As far as I'm aware, the implication that the US is atypical ("especially") is not supported by sources; rather, there seem to be many countries where maternal mortality is much greater than abortion mortality. Similarly, the last sentence (if I'm reading it correctly -- do you mean "far higher" than maternal mortality?) is not consistent with sources. Earlier in this discussion I gave the example of Indonesia, where abortion, even though it's illegal, has a substantially lower mortality rate than childbirth. NightHeron (talk) 14:18, 25 August 2019 (UTC)
  • Comment The source currently used for 2 is related only to the US. But even when it comes to the US, the Louisiana Department of Health, for example, after making a risk comparison of abortion vs pregnancy, states there's no absolute safety in abortion vs a healthy pregnancy, as both have their disadvantages (complications) and advantages. The RCOG source itself, cited by MastCell above, says: "Genital tract infection, including pelvic inflammatory disease, occurs in up to 10% of women undergoing induced abortion. Post-abortion infection not only causes immediate morbidity but may also lead to tubal subfertility and an increased risk of ectopic pregnancy". A study from BMC Women's Health arrived to similar conclusion on complications in Sweden. So a generalized statement like "abortion is safer than pregnancy" is unhelpful and shallow. It makes sense only in a limited number of situations. Brandmeistertalk 22:01, 15 August 2019 (UTC)
    • Again, you are trying to diminish the major theme by citing minor and outlier cases, which is a not something we should do in the lead section. Binksternet (talk) 23:38, 15 August 2019 (UTC)
      I do not think the editor is; if you read the above posts, the problem is making a vague generalized assertion of "safety" when reality is more complicated. To avoid cluttering up the lead, just listing mortality instead of "safety" solves your concern. But an assertion of safety is necessarily inclusive of the details, which is why they are being mentioned here.--Epiphyllumlover (talk) 17:46, 16 August 2019 (UTC)
      Brandmeister is reading the RCOG guideline incorrectly. It states that post-infection abortion occurs in up to 10% of women if preventive antibiotics are not given. (That's what they mean when they cite "control groups in trials of prophylactic antibiotics"—the control group is the group which did not receive antibiotics). In modern practice, with antibiotic prophylaxis, infection rates are 0.92% to 1.7% ([25], p.42), which is comparable to or lower than the incidence of post-partum infection. As is the case with many of the efforts here to obscure or suppress expert knowledge on the safety of abortion, Brandmeister has either misunderstood or is misrepresenting the source on this point. MastCell Talk 22:27, 16 August 2019 (UTC)
      The effort is not to obscure or suppress the knowledge, but to convey a balanced view on abortion vs pregnancy safety and not to cherry-pick. As noted above, the situation is more complex rather than procedural safety, so it could be hard to summarize in one sentence. To quote the same Dept of Health source: "Women who have had a first full-term pregnancy at an early age have reduced risks of breast, ovarian and endometrial cancer. Furthermore, the risks of these cancers decline with each additional full-term pregnancy. Pregnancies that are terminated afford no protection; thus, a woman who chooses abortion over continuing her pregnancy would lose the protective benefit". Such factors also fall under comparative safety of abortion and pregnancy. Brandmeistertalk 11:22, 17 August 2019 (UTC)
      Vast cohort studies have shown absolutely no detrimental effect form abortion. The only people pushing these "risks" are anti-abortionists. Zoom right out to top level sources like the WHO: safel, legal abortion saves lives and is less risky than childbirth. This is not even remotely surprising. Most abortions are achieved using drugs and exactly as risky as miscarriage, which is to say, not very provided the woman has healthcare and is not cowering in fear of being prosecuted for murder. Guy (Help!) 11:45, 17 August 2019 (UTC)
      This is another reason why blanket generalizations of "safer" are inappropriate---not all classes of pregnancies are the same in terms of safety.--Epiphyllumlover (talk) 16:14, 17 August 2019 (UTC)
      Travelling by train is safer than travelling by car. Train crashes do not invalidate that fact. Guy (Help!) 10:15, 21 August 2019 (UTC)
      Many places are reachable by car and some by train only. Same here, the safety factor is not the only one to consider and single it out. Brandmeistertalk 12:56, 22 August 2019 (UTC)
      But one mode of transportation isn't more likely to leave you with a chronic health condition and the other one more likely to kill you. This is the situation with abortion vs. birth. Birth is more likely to kill you, but abortion more likely to leave you with infertility (such as Asherman's). This fact has never been addressed by people arguing for the blanket designation of safety. Because of this issue of talking-past-each-other, I feel like I am talking to someone coming to my door looking for me to join their group.--Epiphyllumlover (talk) 19:59, 22 August 2019 (UTC)
      On the contrary, this has been addressed earlier in this thread. Your point about infertility is wrong, because of the high rate of C-section internationally. As I said above (you seem not to have read it the first time): Late abortions (which are a very small proportion in countries where abortion is legal) and incompetent abortions (which are not being discussed here) are a risk factor for infertility. Birth by Caesarian section, which in 50 countries constitutes over 27% of births, is a risk factor for infertility. NightHeron (talk) 22:59, 22 August 2019 (UTC)
      You are correct that I had missed that part of the discussion. Thank you for correcting me. As for C-sections, the risk for infertility after C-section is lower (statistically hard to detect at all in this study) than the risk of infertility with D&C (see this article). As the international rate of D&C varies greatly (here is a map), again making a broad brush of "safety" an inappropriate generalization.

────────────────────────────── Thank you for responding to my point. I assume that in your last sentence you meant to write "C-section" rather than D&C, since that's what the map and article (from CNN) is about. Your other article about the supposedly low risk of infertility from C-section is a good example of why Wikipedia editors, in accordance with WP:MEDRS, are not supposed to jump to conclusions based on a single primary source. The article's introduction refers to earlier studies (two of which are cited) that showed a significant risk of infertility from C-section, but the article claims that this was not the case for the C-sections they studied, all of which took place in Scotland in 1980-1984. Even if this one study is correct about Scottish abortions performed in 1980-1984, does that apply to a later period when vastly more elective (not medically necessary) C-sections are performed? Do you think it applies to the list of 5 countries in the CNN article -- Brazil, Egypt, Turkey, Venezuela, and the Dominican Republic -- in which more than half of births are now by C-section? And what about the other dangers of C-section (mentioned in the CNN article), which explain why experts see the high incidence of C-section as "alarming"?

Concerning D&C, according to the Wikipedia article on the subject, "Because medicinal and non-invasive methods of abortion now exist, and because D&C requires heavy sedation or general anesthesia and has higher risks of complication, the procedure has been declining as a method of abortion.[8] The World Health Organization recommends D&C as a method of surgical abortion only when manual vacuum aspiration is unavailable.[9] Most D&Cs are now carried out for miscarriage management and other indications..." Miscarriage management is for patients attempting to carry a pregnancy to term.

The main point, which several editors have made repeatedly, is that the consensus of secondary sources is that legal abortion is safer than childbirth. We could go on forever debating what different primary sources say, but that's not what we're supposed to be doing here. NightHeron (talk) 03:12, 23 August 2019 (UTC)

  • 2 is reasonable for now. If people wish to edit it in future improvements, let them justify their proposals according to the same criteria of accuracy and support at that time. We can't wait forever for perfection, and version 2 isn't going to mislead any readers. JonRichfield (talk) 09:30, 17 August 2019 (UTC)
  • 2. It doesn't really need to single out the US but I guess it's useful to clarify that the statement applies to the developed world. ─ ReconditeRodent « talk · contribs » 13:05, 17 August 2019 (UTC)
  • Happy with 1 2 is also okay but could use some simplification / summarization. Doc James (talk · contribs · email) 08:52, 20 August 2019 (UTC)
    Doc James, how do you like MastCell's suggestion "Modern abortion procedures, when performed by trained personnel in settings where abortion is legal, are substantially safer than carrying a baby to term." Gandydancer (talk) 12:59, 21 August 2019 (UTC)
    Would shorten 2 to "Modern abortions are safer than carrying a baby to term." Doc James (talk · contribs · email) 01:32, 22 August 2019 (UTC)
  • 2 or one of the equivalent variations discussed above is a well-supported summary of Reliable Sources, but drop the US-centric second half and avoid ref-bombing the lead. Maybe keep one ref, but the rest should either be moved to the body of the article or deleted if redundant to refs in the body. Alsee (talk) 10:16, 31 August 2019 (UTC)
  • 1 is the best choice of those offered. The problem with 2 is that it is a violation of WP:SYNTH, so it's impossible to implement despite the fine people here who would rather see 2. And 3 is wrong-headed, taking away from the reader a valid, widely reported fact. Binksternet (talk) 15:17, 31 August 2019 (UTC)
    • Had to merge my edit with yours! When you say WP:SYNTH, do you mean the stuff I elaborated on below, about how the 14 times isn't necessarily especially high in the US, or necessarily just due to the high maternal mortality rate? Triacylglyceride (talk) 15:31, 31 August 2019 (UTC)
  • 1 -- although it's good to be open about America-centrism, I have a couple of problems with 2. There's a sneaky edit put in there where "carrying a pregnancy to term" has been replaced with "carrying a baby to term." That's non-neutral language and I'd favor "continuing a pregnancy to term." I also think the "especially" is misleading because it implies that the safety ratio might be dramatically smaller in other countries, or is high in the US mainly due to the US's poor maternal mortality rate. The US's poor maternal mortality rate is in part due to the high rate of undertreated comorbid conditions and poverty -- and abortion sees the same issues. From this source I've estimated an abortion mortality rate of just over 1/500K in England Wales, compared to a maternal mortality rate of 8.9/100K (ProPublica) in the UK, so that's 45 times safer or so (unless Scotland and Northern Ireland are throwing us way off). Can we really say that abortion is "especially" safer in the US? Triacylglyceride (talk) 15:28, 31 August 2019 (UTC)
    One should be careful with the C-section statistics in China as C-sections have been used for late-term abortions to enforce population control measures, similar to (or perhaps the same procedure as Hysterotomy abortion).--Epiphyllumlover (talk) 03:54, 16 September 2019 (UTC)
Epiphyllumlover, can you cite any RS that say that late term abortions are being misreported as C-sections (in China or anywhere else) on a significant scale, that is, enough to significantly affect C-section statistics? Thanks. NightHeron (talk) 14:44, 16 September 2019 (UTC)
The abortion in China page says "not all abortions are registered..Family Planning statistics are usually considered state secrets." As China is a large portion of the globe, if you are going to figure out the safety of abortion, this should be a factor. I was unclear in my above statement, I am referring to the "c-section abortion"--which is used as a more-or-less punitive measure on late term women. What I was saying is that any c-section mortality figures from china could be expected to include abortions as well as births. Forced abortions in China have no official statistics because officially it is illegal to force abortions in China. There appears to be overlap between the categories of "forced abortion" and "c-section abortion." This was especially done under the one-child policy, which ended in 2015, but is still within the timeframe of statistics as reported in papers. The best not-dead link I've found for Chinese abortion statistics is here. What we are looking at is an issue of under or non-reporting. I know this is dated because it comes from 2002, but this text it says "In the past 45 years there have been only seven studies on failed abortion suggesting that there has probably been systemic underreporting of its effects on women and their children."--Epiphyllumlover (talk) 00:22, 19 September 2019 (UTC)
Epiphyllumlover, I'm afraid you didn't answer my question, since none of what you write cites a source to support your claim in your previous comment that "One should be careful with the C-section statistics in China" because late term abortions misreported as C-sections occur on a significant scale. As of 2017 the C-section rate in China was estimated at 35% (see[26]), which translates to over 5 million C-sections per year. The World Health Organization (see [27]) has expressed alarm over the number of C-sections in many countries, including China, because of all the health risks. As far as I've seen, the WHO does not mention anything about late abortions disguised as C-sections. From what I can tell from the RS, that seems to be a rare occurrence, statistically speaking. In other words, C-sections are a risk of pregnancy/childbirth, not (to any statistically significant extent) a risk of abortion. You have not given any sourced evidence to the contrary. NightHeron (talk) 01:04, 19 September 2019 (UTC)
As stated before, I used unclear terminology in the post some days back... you are reading too much into this.--Epiphyllumlover (talk) 02:25, 19 September 2019 (UTC)
  • 2 works well, 1 is my second choice. 3 is terrible as it removes vital information from most readers. I support 2 in spite of the argument referring to WP:MEDPOP because the greater safety of the modern abortion procedure is so obviously true that it becomes a sky-is-blue statement, not a matter for debate. The medical aspect is not in question; it's the socio-political aspect that drives the issue. Binksternet (talk) 15:02, 16 September 2019 (UTC)
  • 2 and then try to work towards a better version, per Levivich. KillerChihuahua 15:40, 16 September 2019 (UTC)
  • Comment Prior abortions change the safety of subsequent birth, just as c-sections do: Prior surgical abortion linked to subsequent preterm birth. Comparing the safety of abortion to birth becomes inappropriate if abortion changes the safety of birth.--Epiphyllumlover (talk) 00:35, 19 September 2019 (UTC)
    What? Comparing abortion and live birth is inappropriate if there is a difference? that made exactly no sense. Also, Thomas Jefferson U? Not without other sources, no. KillerChihuahua 00:23, 20 September 2019 (UTC)

The above discussion is preserved as an archive of the debate. Please do not modify it. No further edits should be made to this discussion.

Suggestions for Methods section, surgical abortionEdit

Hello,

I suggest substantial revisions to paragraphs 3 and 4 of the surgical abortion methods section.

The paragraph begins with a range of gestational ages "from 15th to 26th weeks" that do not reflect clinical practice. Surgeons can use D&E as early as 12 weeks and can use EVA alone up to 16 weeks; there are no hard and fast rules as the clinical situation will determine the approach. Instead, I use a range when clinicians start the D&E approach, from 12 to 16 weeks. D&E and D&X techniques can be used flexibly later in pregnancy; there is no gestational age to suggest as a cut-off.

The section on intact D&E needed substantial revision. The technique is not used until the 18th or 20th week; I have revised accordingly. Intact D&E is not referred to as "intrauterine cranial decompression". That procedure can, but does not always occur, and is part of the whole procedure not descriptive of the entire procedure. I deleted that description since describing the individual parts of the operation are beyond the scope of this article which includes a more broad overview. The correct acronym is D&X, not IDX, I have changed this as well.

I revised to delete the reference to "partial birth abortion" which is a non-medical term. This section is about methods, not bans. The banned procedure described in that statute doe snot map to a distinct medical procedure. Further, the law that bans "partial birth abortion" is only relevant in the U.S.

To support these changes I cite a standard textbook on abortion for medical professionals previously cited in this section (ref 63, Hammond and Chasen chapter on D&E, in Management of Unintended and Abnormal Pregnancy).

You can review my proposed changes in my sandboxRach1997 (talk) 20:35, 9 August 2019 (UTC)

I support the changes you've enacted and the ones you propose. However, I think that the political phrase "partial birth abortion" may have relevance in this encyclopedic article due to its political significance. Triacylglyceride (talk) 01:32, 2 September 2019 (UTC)

Thank you for the comment. I suggest adding "Partial birth abortion, banned in the United States, does not map to a standard surgical technique." Rach1997 (talk) 19:50, 6 September 2019 (UTC)

@Rach1997: Could you make the wording a little easier to understand? I'm not sure what "maps to a...technique" means. Do you mean something like "...is not a medical term, and does not refer to any particular surgical procedure"? Thanks. NightHeron (talk) 22:11, 6 September 2019 (UTC)
It means that there are multiple ways to do it, such as the method I discussed above.--Epiphyllumlover (talk) 00:45, 19 September 2019 (UTC)

Numbers in sources in safety sectionEdit

I've looked a little closer at that sentence in the safety section that says that abortion is 14 times safer than childbirth. The citation given backs that up, with 8.8 vs. 0.6 deaths per 100,000 equals 14 times. However, the very next sentence in the article states that the number of deaths from childbirth is 17.2 per 100,000, with the source backing that up too. That would make abortion 24 times safer. Which number is right, or am I missing something?Yhdwww (talk) 17:06, 11 September 2019 (UTC)

The 14 times is specifically in the United States for the time frame 2012. The other data is for 2019. Doc James (talk · contribs · email) 17:04, 22 September 2019 (UTC)
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