Wednesday, October 26, 2011

One way a local crisis pregnancy center misrepresents medical risks

The NARAL Pro-Choice North Carolina Foundation has recently conducted an audit study of crisis pregnancy centers in North Carolina. The study found that that the centers tend to give inaccurate and incomplete information, that few had medically-trained staff (though that didn't stop staff from dressing up like medical professionals), and that some encouraged women who might still be considering terminating their pregnancies to wait to see if a natural miscarriage occurred. The report has sparked a lively conversation at Ed Cone's blog.

To get some perspective on how these centers are presenting themselves, I thought that it would be worthwhile to look at the web-site that is run by the local Greensboro Pregnancy Care Center (GPCC). The web-site encourages women to "consider their choices" and says specifically to women considering abortion that "it is good you are taking the time to do some research before you make your final decision because there are risks, just as there are with any other medical procedure, and you are wise to weigh them."

Below is the information that the GPCC offers about the abortion pill, Mifepristone, and about drug-induced abortions.
This drug is only approved for women up to the 49th day after the start of their last menstrual period. Some doctors may prescribe this drug up to 63 days after the last menstrual period, but this is not an FDA approved method of use. The procedure usually requires three office visits. On the first visit, the woman is given pills to cause the death of the embryo. Two days later, if the abortion has not occurred, she is given a second drug which causes cramps to expel the embryo. The last visit is to determine if the procedure has been completed. The abortion pill will not work in the case of an ectopic pregnancy.

An ectopic pregnancy is a potentially life-threatening condition in which the embryo lodges outside of the uterus, usually in the fallopian tube. If not diagnosed early, the tube may burst, causing internal bleeding and in some cases, the death of the woman.

Women are being instructed to use the abortion pills in a manner not approved by the FDA. This includes using it beyond 49 days of pregnancy and using it vaginally. A number of women who have used the abortion pill have died due to sepsis (full body infection).
The information, while scary and intimidating, is factually accurate and is similar in a lot of respects to the more detailed cautions on the Food and Drug Administration's (FDA's) web-site.

The GPCC, however, omits one crucial bit of context--the risks are exceedingly rare. How rare? According to the FDA, the risk of any complications whatsoever is about 0.15% (about 150 in 100,000), and the risk of dying is about 0.001% (slightly less than 1 in 100,000). Put another way, about one woman per year dies shortly after taking Mifepristone.

Numbers like this can be hard to interpret, so let's compare them to some other risks.

For instance, what are the risks associated with popping an aspirin or another NSAID pain reliever? A 1998 study in the American Journal of Medicine reported
Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.
Without information on the number of people who take aspirin, it's hard to re-express this number as a rate. But even if we use the entire U.S. population as a base, the risk of death from taking aspirin is at least 5 times higher than taking Mifepristone.

A more relevant comparison is the risk of death from child birth, that is, maternal mortality. The independent and nonprofit health care accreditation and certification organization, the Joint Commission, reports
According to the National Center for Health Statistics of the Centers for Disease Control and Prevention, in 2006, the national maternal mortality rate was 13.3 deaths per 100,000 live births.

...“Maternal deaths are the tip of the iceberg for they are a signal that there are likely bigger problems beneath – some of which are preventable,” says Dr. Callaghan. “It is important to consider the women who get very, very sick and do not die, because for every woman who dies, there are 50 who are very ill, suffering significant complications of pregnancy, labor and delivery.” For 1991 through 2003, the severe morbidity rate in the U.S. for severe complications and conditions associated with pregnancy was 50 times more common than maternal death. Understanding these experiences could affect how care is delivered as well as health policy.
Women who continue their pregnancies to term are 13 times more likely to die than women who take Mifepristone.

What does the GPCC say about pregnancy?
During pregnancy, your body goes through many changes. Some common symptoms of early pregnancy include a missed period, nausea, breast tenderness, frequent urination, tiredness and mood swings.
Other than listing some questions women might have, the GPCC mentions no other medical complications or risks with pregnancy. Medically, it all sounds like a refreshing walk through the park.

Readers can decide with the GPCC's highly selective reporting, which lists but does not quantify the mortality risks of Mifepristone but which omits the risks of pregnancy, is misleading.

If the GPCC really wants women to "weigh" the risk, why does it only put information on one side of the scale?