Peter Saunders

Abortion and premature birth – new Finnish study raises serious questions

Peter Saunders
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The link between abortion and premature birth is already well established but largely underplayed or denied by authorities in Britain.

However a new landmark study from Finland published last week in the journal ‘Human Reproduction’ has gained the attention of the British media with the Guardian, Daily Mail and even the BBC running the story. The matter can no longer be ignored.

These media reports are all worth reading but one really needs to read the original paper to grasp its full significance.

Data from all 300,858 first-time mothers in Finland between 1996 and 2008 were analysed. They showed that women were three times more likely to have a very premature baby, born before 28 weeks, if they had had three or more abortions.

All first-time mothers with a singleton birth were identified in the nationwide Finnish Medical Birth Register (MBR) for the period 1996– 2008 and linked to the data in the Abortion Register (AR) for the period 1983 –2008.

In total, 300,858 first-time mothers with singleton births in the period 1996–2008 were identified from the MBR. According to the AR, 31 083 (10.3%) had had one, 4417 (1.5%) two and 942 (0.3%) three or more IAs before the first birth.

Overall there would be three babies born before 28 weeks for every 1,000 women who had never had an abortion, four per 1,000 who had had one abortion, six in those who had had two abortions and 11 if the woman had had three or more abortions.

What can we make of this and what does it tell us about abortion-related prematurity in the UK? Here are my reflections:

1.This paper is very important

This is a very significant paper. However its findings are not new. Many previous studies and reviews have found a positive association between induced abortion (IA) and risk of preterm birth or a dose– response effect (ie. the risk of preterm birth increased with increasing number of IAs). As I have previously reported there are around 120 articles in the world literature already attesting to an association between abortion and premature birth, and very few indeed that contest the association.

But this Finnish study is very important because of the number of cases it evaluates and also because it controlled for all the major confounding factors which could detract from the strength of the conclusions (eg. adjustment was made for maternal age, marital status, socioeconomic position, urbanity, smoking during pregnancy, previous ectopic pregnancies and miscarriages).

2.UK research is rudimentary by comparison

This kind of research could not have been carried out in the UK because abortion authorisation forms here do not carry NHS patient numbers meaning that birth and abortion data cannot be matched (a story in itself!) This is really inexcusable given that abortion is one of the most common procedures carried out by doctors. Finland, with its quality of reporting, really puts the UK to shame in this area.

3.The problem of abortion related prematurity is much worse in the UK than in Finland

The number of abortion-related premature births is significant in Finland but will be much higher in the UK. This is because UK abortion rates are twice that in Finland (17 compared with 9 per 1,000 women aged 15 to 44) and because the UK population is twelve times greater (60 million cf 5 million). This means that there are many more women in Britain who are at risk of abortion-related premature births.

There were approximately 190,000 abortions in England and Wales in 2011: 122,000 of these women were having their first abortion, 52,000 their second and 16,000 had had three or more.

So if these women went on to have pregnancies we would expect them to have a total of 976 premature births under 28 weeks (122 x 4 + 52 x 6 + 16 x 11) of which 406 (122 x 1 + 52 x 3 + 16 x 8) would be abortion-related. When we consider that there are only about 4,000 babies under 28 weeks born in the UK each year (there were 4,150 in 2005/6) we can see that abortion related prematurity is a very significant problem indeed.

4.Abortion-related prematurity is a significant health problem in the UK

Being born too soon is linked to higher risks of infection, hypothermia and death and the risks are higher the younger the baby. Furthermore, premature births cost the UK an extra £939m a year, according to researchers at the Oxford Centre for Health Economics.

5.UK doctors are in denial about the reality of the problem

In most medical literature on prematurity abortion is not listed as a contributory factor. The Net Doctor information on ‘what causes prematurity?’ are a good example of this. But women have a right to know the facts and the government has a responsibility to address the problem given the cost implications of prematurity.

The Finnish study’s conclusions need to be taken on board here in the UK: ‘In terms of public health and practical implications, health education should contain information of the potential health hazards of repeat IAs, including very preterm birth and low birthweight in subsequent pregnancies. Health care professionals should be informed about the potential risks of repeat IAs on infant outcomes in subsequent pregnancy.’

This all raises significant questions. How many cases of extreme prematurity each year in the UK are abortion-related? What is the cost of this extra burden of care to the NHS? Why are doctors and the government not being honest about the extent of the problem? Why is so little relevant research being done?

I suspect the main reason there are so little answers forthcoming is because abortion is such a deeply political issue that different rules are applied whenever it is evaluated and discussed.

But I wonder how long it will be before the first mother with a prior abortion brings a case against a doctor or health authority for not being told that she was at increased risk of having a premature baby following abortion, especially if that baby suffers one of the more severe and expensive complications of prematurity.

The problem of abortion-related premature birth is very serious and demands answers.

Reprinted with permission from Dr. Saunders’ blog.

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Therapists to offer sex change drugs to nine-year-olds

Peter Saunders
Peter Saunders
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Children as young as nine are to be prescribed drugs which delay the onset of puberty as the first step towards a sex change operation (Mail on Sunday and Daily Telegraph).

Doctors at the Tavistock and Portman NHS Foundation Trust said a trial of the treatment on ‘gender dysphoria’ patients aged 12 to 14 had been successful and it could now be offered even earlier.

Monthly injections of the drugs, known as hypothalamic blockers, are used to slow the development of the children’s sexual organs by blocking the production of the hormones testosterone and oestrogen.

The rationale is that by delaying the onset of sexual maturation this gives more time for gender conflicted youngsters to decide whether they wish to embark on hormone treatment and surgery aimed at changing their gender. 

Most people will be shocked at this news but it is actually a logical consequence of accepting four prior ideological presuppositions – that gender is a social construct, that personal autonomy should trump other considerations, that emotional suffering should be avoided at all costs and that technology should be used to achieve these ends. 

There are obvious safety concerns - although the gender treatment is reversible, the long-term effects on brain development, bone growth and fertility have not yet been fully evaluated.

But safety considerations aside, using hormones to suppress puberty in transgender children is highly controversial, not least because of deep societal disagreements about the causes and nature of transsexuality and the effectiveness and appropriateness of transgender therapies per se.  This means that therapists remain strongly divided about the best way of handling the issue.

Transgender people are born with the anatomy and physiology of one sex but believe that they belong to the opposite sex.  Should therapy therefore be aimed at changing bodies (using hormones and surgery) to match a person’s beliefs or should it rather be aimed at helping people to adjust mentally to accepting the bodies they were born with? Even more fundamentally, is ‘gender dsyphoria’ a mental disorder or is it just a normal variant like eye or skin colour?

Up until recently ‘gender identity disorder’ was classified as a mental disorder (in the Psychiatric diagnostic inventory DSM-IV) but it has now been reclassified and renamed ‘gender dysphoria’ (in the DSM-V).  This change was strongly ideologically driven and many psychologists and psychiatrists dispute the reclassification. They still see ‘gender identity disorder’ as a kind of body dysphoria, whereby a person has an unshakeable false belief that they are one sex when in fact they are the other. It has been likened to anorexia nervosa, where the affected individual is convinced she is fat whilst being grossly underweight.

Those who supported the reclassification however, take the view that gender identity is biologically fixed and determined and that it is harmful to affected individuals to deny them sex change therapy or to 'force' them to live with the body they were born with. Some even hold to the strongly postmodern view that gender, regardless of what one’s genes or hormones suggest, is simply a social construct, even a matter of choice. If you wish to appreciate how passionately these views are held, then try expressing a traditional understanding on twitter using the hashtag #lgbt!  

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Is gender identity fixed as male or female or is it more of a spectrum or continuum? Can it change over time? How effective is therapy in changing the strength and orientation of one’s beliefs? How might suppression of puberty using hormonal treatment affect bone, brain and sexual development?

Research is still at an early stage with many of these questions and strong ideological convictions one way or the other mean that scientific objectivity about the real effects of sex change therapy may always be a matter of contention.  It is perhaps not surprising that both opinion and research in this whole area is often driven by powerful ideological vested interests.

Complicating this is the fact that gender identity may change in an individual over time, and that it may be very difficult to predict the outcome of for any particular person. Some children are much more appropriately described as ‘gender nonconforming’ or ‘gender-fluid’ rather than transgender. In many others gender identity may change with time.

Toronto specialist Ken Zucker, who opposes the use of sex change therapies, claims that only about 12% of boys and girls with gender dysphoria will still have persistent dysphoria as adults. This fact alone should lead even the most committed supporters of early intervention to err strongly on the side of caution.

The CMF File ‘Gender Identity Disorder’ goes into the issue in more detail and also looks at biblical principles which can be applied.

The Bible teaches that human beings are created in God's image and of two sexes – male and female (Genesis 1:27). Jesus drew on this when he commented, 'haven't you read, that at the beginning the Creator “made them male and female”, and said, “For this reason a man will leave his father and mother and be united to his wife, and the two will become one flesh” (Matthew 19:4-5).

The Old Testament command 'you shall not commit adultery' also indicates that sexual intercourse should only occur within the framework of marriage (Exodus 20:14). Sex outside the marriage bond is wrong, whether with someone of the same or opposite sex (Leviticus 18:22, 20:10).

The ideal pattern for existence was spoilt at the Fall when mankind rebelled against God's rules. One consequence of this is that moral values, sexual patterns and also biology (genes and hormones) have become distorted.

The good news at the centre of Christianity is that Jesus, through his death and resurrection, gives people new life and power to change. On top of this, there will be a time in the future when all rebellion against God's plans will come to an end and a perfect relationship with God can be fully restored. This brings the hope that transsexual people may find support as they seek to live in ways that are honest to the way God made them, and open to God's ideals.

It's worth noting that the Bible regards celibacy as a high calling. Jesus was fully human and male, but never married nor had sexual intercourse. He also taught that marriage is not for everyone (Matthew 19:12).  It is important to acknowledge this, as for some people, battling with gender conflict may be a life long process.

Reprinted with permission from PJ Saunders

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Why assisted suicide should not be legalised in Britain

Peter Saunders
Peter Saunders
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I have recently been published in a head to head with Sir Terence English in the Oxford Mail on whether assisted suicide should be legalised in Britain. My contribution to the debate is reproduced below. Perhaps not surprisingly I have said ‘no’.

Any change in the law to allow assisted suicide or euthanasia would inevitably place pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others.
 
The ‘right to die’ would so easily become the ‘duty to die’. This would especially affect people who are disabled, elderly, sick or depressed and would be greatly accentuated at this time of economic recession with families and health budgets under pressure.
 
Elder abuse and neglect by families, carers and institutions are already real and dangerous and would be made worse.
 
Any so-called ‘safeguards’ against abuse, such as limiting it to certain categories of people, will not work.
 
This is because exactly the same arguments – autonomy and compassion – would apply to people outside the categories decided upon and so any law allowing it for some would immediately be challenged under equality legislation.
 
If for terminally ill people, why not for those who have chronic illnesses but are ‘suffering unbearably’?
 
If for adults why not for ‘Gillick competent’ children? If for the mentally competent why not for people with dementia who ‘would have wanted it’?
 
The news coming from other jurisdictions which have gone down this route, particularly Belgium and the Netherlands, shows a pattern of incremental extension and pushing of the boundaries – an increase in cases year on year, a widening of categories of people to be included and people being killed without their consent.
 
Belgium has recently legalised euthanasia for children and in the Netherlands babies with spina bifida and people with dementia are already put to death.
 
This is why British parliaments have rightly rejected the legalisation of assisted suicide in Britain three times in the last seven years and why the vast majority of UK doctors, almost all medical groups including the British Medication Association (BMA), Royal College of Physicians (RCP) and Royal College of General Practitioners (RCGP), and all major disabled people’s advocacy groups are also opposed.
 
Persistent requests for euthanasia are extremely rare if people are properly cared for, so our real priority must be to ensure that good care addressing people’s physical, psychological, social and spiritual needs is accessible to all.
 
This issue is understandably an emotive one but hard cases make bad law and even in a free democratic society there are limits to human freedom. Our present law with its blanket prohibition on all medical killing does not need changing.
 
The penalties it holds in reserve act as a strong deterrent to exploitation and abuse whilst giving discretion to prosecutors and judges to temper justice with mercy.
 
Reprinted with permission from PJ Saunders

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Royal College of Ob/Gyn bars pro-life doctors from receiving its degrees and diplomas

Peter Saunders
Peter Saunders
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Doctors and nurses who have a moral objection to prescribing ‘contraceptives’ which act by killing human embryos are to be barred from receiving diplomas in sexual and reproductive health even if they undertake the necessary training according to new guidelines.

Under new rules issued by the Faculty of Sexual and Reproductive Health (FSRH) earlier this year these doctors and nurses are also to be barred from membership of the faculty and from specialty training.

The FSRH is a faculty of the Royal College of Obstetricians and Gynaecologists established on the 26th March 1993 as the Faculty of Family Planning and Reproductive Health Care. In 2007 it changed its name to the Faculty of Sexual and Reproductive Healthcare.

Whilst many contraceptives act by preventing the union of sperm and egg, some, including most IUCDs (intrauterine contraceptive devices) and the morning-after pill EllaOne (ulipristal acetate), also act by preventing the implantation of an early embryo. In other words they are embryocidal or abortifacient, rather than truly contra-ceptive.

Many doctors, of all faiths and none, have a moral objection to destroying human life and wish therefore to avoid using drugs or methods which act after fertilisation.

In fact this position was once held by the British Medical Association (BMA) when it adopted the Declaration of Geneva in 1948. This states, ‘I will maintain the utmost respect for human life from the time of conception even against threat’.

But in 1983 the words ‘from the time of conception’ were amended to ‘from its beginning’ due to sensitivities about increasing medical involvement in abortion. The word 'beginning' was left undefined, giving doctors the opportunity to argue, contrary to the biological reality, that early human life was not actually human life at all.

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Now it seems that doctors who wish to abide by the original wording of the Declaration of Geneva are to be barred from practising in certain medical specialties. This is an extraordinary about face.

The Faculty may argue that they are not barring doctors and nurses from practising, but simply from obtaining certain qualifications. But as many job appointments will be conditional on applicants having these qualifications this is effectively also a bar on practice.

Interestingly doctors who have a moral objection to abortion are still able to complete the Faculty’s qualifications because the Abortion Act 1967 contains a conscience clause which protects them. But there is no law protecting those who object to destroying human embryos.

Many Christians believe that every human life, regardless of age, sex, race, degree of disability or any other biological characteristic, is worthy of the utmost respect, wonder, empathy and protection.

This is based on the idea, taught in the Bible, that human beings are made in the image of God. In a society which is becoming more hostile to Christian faith and values it is perhaps not surprising that we are seeing institutional discrimination of this kind.

Perhaps it is time for Christian doctors and nurses, and others who share their prolife views, to set up an alternative training programme.

Reprinted with permission from PJ Saunders

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