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"Before Roe v. Wade, thousands of women died every year - and because of extreme attacks on safe, legal abortion care, this could happen again right here in America." - Wen, in a tweet , April 24, 2019
"We're not going to go back in time to a time before Roe when thousands of women died every year because they didn't have access to essential health care." - Wen, interview on MSNBC's "Morning Joe, " May 22.
A reader asked us to investigate this repeated claim by the president of Planned Parenthood - that "thousands of women" died every year from botched abortions before the Supreme Court in 1973 nullified antiabortion laws across the United States in Roe v. Wade.
This turned out to be an interesting inquiry, taking The Fact Checker through a tour of decades of musty academic literature. Statisticians had tried to parse data on what was, for the most part, an illegal act. Unplanned pregnancy and abortions were deeply shameful at the time, so the official statistics were not necessarily reliable indicators of mortality rates from abortion.
Still, by the time Roe was issued, 17 states had liberalized their abortion laws, and the Centers for Disease Control was collecting solid data on abortion mortality. If Roe is overturned, a significant number of states, such as California and New York, are expected to still permit abortions, so the situation would be more akin to the period immediately before Roe.
The problem with Wen's claim is that is derived from data that is decades old. Let's explore.
Erica Sankin, a Planned Parenthood spokeswoman, directed us to a 2014 policy statement issued by the American College of Obstetricians and Gynecologists (ACOG): "It is estimated that before 1973, 1.2 million U.S. women resorted to illegal abortion each year and that unsafe abortions caused as many as 5,000 annual deaths."
There is no citation in the statement for the estimate of "as many as 5,000 annual deaths," even though many of the other sentences are carefully documented. None of the citations around this sentence supports the figure, and there is no explanation about how it was calculated.
Kate Connors, an ACOG spokeswoman, initially referred us to a 1958 report that said "a plausible estimate of the frequency of induced abortion in the United States could be as low as 200,000 and as high as 1,200,000 per year," adding that "there is no objective basis for the selection of a particular figure between these two estimates."
That's quite a range for the number of illegal abortions, indicating how fuzzy the numbers are. The ACOG took the high-end estimate for its statement. But this report contained no mortality rates or an explanation of the 5,000-death estimate, nor did any of the other material sent by Connors.
Meanwhile, Sankin also sent a variety of reports, many of which were referenced in a footnote in a document published by NARAL Pro-Choice America. One of the citations especially caught our eye: Frederick Taussig, "Abortion Spontaneous and Induced: Medical and Social Aspects," (1936).
Why was a study from 1936 being referenced?
Taussig, who died in 1943, was a gynecologist and influential advocate of legalized abortion. In his book, he calculated that the number of deaths from abortion was between 8,000 and 10,000 a year. But it was not a very rigorous calculation, based on a mix of theory and data from the United States and Germany. Just 13 states recorded such data in 1927 and 15 in 1928. That added up to 912 deaths from abortion a year. Because the states represented 26 percent of the birth registration of the United States, Taussig multiplied it to come up with 3,508 a year. He then rounded it up to 4,000 to account for oversampling of rural areas. Then he assumed half of the deaths were concealed, so he doubled it to 8,000 and concluded it was no more than 10,000.
But he admitted that just five years earlier, he had estimated 15,000 deaths in another paper. "I am convinced my previous estimates were too high," he wrote. A few years later, in 1942, he revised the figure yet again, down to 5,000.
The advent of antibiotics such as penicillin and improved medical procedures suddenly made abortion less risky. Another prominent researcher, Christopher Tietze, argued in a 1948 paper that the number of deaths from abortion was rapidly declining because of three reasons: contraceptive methods had improved so fewer women were getting pregnant, abortion providers were getting better at avoiding infections, and many lives had been saved because of the introduction of sulfa drugs and penicillin.
"It is felt, however, that the official statistics include the great majority of all deaths from abortion," he wrote. "The outstanding fact about mortality from abortion is the steady and sometimes precipitous decline which has been observed almost everywhere. The reality of this decline cannot be doubted, and the extent of the fall is in all likelihood understated by the official statistics."
The data collected by Tietze showed 2,677 deaths from abortion in 1933, compared with 888 in 1945, with much of the decline in septic cases associated with illegal abortions. (The numbers also include deaths from "therapeutic abortions," permitted by law, and "spontaneous abortions.")
By 1959, a leading researcher wrote: "Abortion is no longer a dangerous procedure. This applies not just to therapeutic abortions as performed in hospitals but also to so-called illegal abortions as done by physicians. In 1957, there were only 260 deaths in the whole country attributed to abortions of any kind. In New York City in 1921, there were 144 abortion deaths, in 1951 there were only 15."
The writer was Mary Steichen Calderone, at the time medical director of Planned Parenthood. She attributed the decline in the mortality rate to antibiotics and the fact that 90 percent of illegal abortions were done by trained physicians.
The stigma associated with abortion does mean the numbers must be treated with caution. Misreporting on death certificates was possible, but the problem is said to have improved during the 1960s as public debate about abortion intensified.
"Some 30 years ago it was judged that such deaths might number 5,000 to 10,000 per year, but this rate, even if it was approximately correct at the time, cannot be anywhere near the true rate now," Tietze and Sarah Lewit wrote in Scientific American magazine in 1969. "The total number of deaths from all causes among women of reproductive age in the U.S. is not more than about 50,000 per year. The National Center for Health Statistics listed 235 deaths from abortion in 1965. Total mortality from illegal abortions was undoubtedly larger than that figure, but in all likelihood it was under 1,000."
Tietze and Lewit, his spouse, were honored by Planned Parenthood in 1973 with the Margaret Sanger award, the organization's highest honor, for their research, including "identifying the effects of abortion policy on maternal health." He died in 1984.
A 1978 study found that deaths from abortion declined even more rapidly after 1965 because of more effective forms of contraception and increased availability of legal abortion.
The CDC began collecting data on abortion mortality in 1972, the year before Roe was decided. In 1972, the number of deaths in the United States from legal abortions was 24 and from illegal abortions 39, according to the CDC.
Stanley Henshaw, who from 1979 to 2013 researched abortion statistics at the Guttmacher Institute, which favors abortion rights, said he agreed with Tietze's assessment in 1969.
"In the 1960s, the officially recorded number of deaths from illegal induced abortion was under 300 per year. While there were undoubtedly other unreported abortion deaths, it is unlikely that the actual number was over 1,000. The figure of 5,000 to 10,000 is reasonable for the 1930s, when there were probably more abortions and less effective treatment of complications," he said. "In my opinion, if Roe v. Wade were overturned, women would turn to relatively safe medications that can be purchased over the Internet. There would be some deaths but probably not as many as there were in the 1960s."
"While stigma, fear, and poor tracking mean we can never know the exact number who suffered before Roe v Wade was decided, what we do know is that even one woman's death from abortion before it was legal is one too many," Sankin, of Planned Parenthood, said in a statement. "Abortion is health care, and it is one of the safest medical procedures there is -- there is no reason anyone's health or life should be endangered by politicians hell-bent on keeping people from accessing this basic health care. Yet far too many politicians seem determined to take us back to the days before Roe was decided -- where abortion was virtually inaccessible and all those who could become pregnant paid the price."
The ACOG's Connors urged The Fact Checker to contact David Grimes, a retired abortion doctor and researcher at the University of North Carolina's medical school. "Tietze, whom I knew, readily acknowledged that his mortality estimates were just that: crude estimates. There is no way to confirm or refute them. Stated alternatively, there are no facts to be checked, only estimates, the usefulness of which can be debated," Grimes said. "Whether the numbers of deaths pre-Roe were in the hundreds or in the thousands per year, the message for your readers is that nearly all of these deaths were entirely preventable."
Wen is a doctor, and the ACOG is made up of doctors. They should know better than to peddle statistics based on data that predates the advent of antibiotics. Even given the fuzzy nature of the data and estimates, there is no evidence that in the years immediately preceding the Supreme Court's decision, thousands of women died every year in the United States from illegal abortions.
Wen's repeated use of this number reminds us of the shoddy data used by human trafficking opponents. Unsafe abortion is certainly a serious issue, especially in countries with inadequate medical facilities. But advocates hurt their cause when they use figures that do not withstand scrutiny. These numbers were debunked in 1969 - 50 years ago - by a statistician celebrated by Planned Parenthood. There's no reason to use them today.
Four Pinocchios
An award-winning journalism career spanning nearly three decades, Glenn Kessler has covered foreign policy, economic policy, the White House, Congress, politics, airline safety and Wall Street. He was The Washington Post's chief State Department reporter for nine years, traveling around the world with three different Secretaries of State. Before that, he covered tax and budget policy for The Washington Post and also served as the newspaper's national business editor. Kessler has long specialized in digging beyond the conventional wisdom, such as when he earned a "laurel" from the Columbia Journalism Review