Posted by: Ken Brown | May 12, 2008

Abortion and Miscarriage

I just stumbled upon an interesting post by Timothy Mills (HT: James McGrath), which claims the pro-life movement is inconsistent to argue so vehemently against abortion, while ignoring that more (far more, according to him) conceived embryos die of miscarriage than are aborted intentionally:

About 10-20% of pregnancies that the mother knows about miscarry. In studies that use detailed detection techniques, about 30% of clinically-recognized pregnancies end in miscarriage. (In this case, “clinically-recognized” means “exhibiting the hormone produced on uterine implantation of the embryo”.) Extrapolating to those fertilized eggs that never get implanted and so are currently impossible to medically detect, 75% of conceptions may fail to carry to term.

So three quarters of conceived (and thus fully-human, by the anti-abortionists’ lights) embryos miscarry – die without anyone setting out to kill them. And of those that survive this natural winnowing, 25% are then aborted intentionally (about 6% of total conceptions).

The vast majority of pre-birth deaths are miscarriages – twelve times as many as are aborted. If abortion is genocide, miscarriage is a plague unparalleled in human history, claiming 75% of all human lives.

So if [pro-life advocate] Matthew and his colleagues are indeed pro-life, and not simply anti-abortion, what obligation does this knowledge place on them? Isn’t miscarriage a more immediate and profound problem than the relatively minuscule one of abortion?

I have to admit that this is not an aspect of the abortion debate that I had ever considered before, but I have serious problems with his argument. First, notice how he introduces the 75% figure as a possibility (“may”) but then immediately employs it as a certainty. More basically, however, I fail to see how he justifies this number at all. How exactly can he “extrapolate” from a clinically established 31% rate of miscarriage (based on a small trial at that – the study he links only involved 221 women) to a 75% rate based on a variable that no one even knows?! The link he provides gives no source or justification for this figure of 75%, and I’ve been unable to find anything like it through Google (most sites I’ve seen suggest that somewhere between 20-30% of pregnancies end in miscarriage).

If we instead accept the 31% figure given by the study he cites, that still means that nearly a third of all pregnancies end in miscarriage. I’ll be the first to admit that this is indeed a terrible thing; my wife and I have lived through two of them ourselves and I wouldn’t wish it on anyone. But this figure certainly does not dwarf the number of abortions. His 6% figure (which he does not explain) seems to be based on the assumption that 75% of conceptions miscarry, which allows him to divide the actual ratio of abortions to live births (23.5% in North America) by four, but as he has given no proof that we should accept this 75% figure, I don’t see why we should accept this calculation either.

The truth is, we simply do not know what percentage of conceptions miscarry before they are detectable. What we do know is that today in North America, more pregnancies that are detected are aborted as miscarry on their own. Timothy himself notes that only 10-20% of known pregnancies miscarry, whereas in the USA and Canada about 23.5% of known pregnancies end in legal abortions (and other developed nations have much higher abortion rates; Russia’s is over 50% relative to live births). Miscarriage is a tragedy, so how much worse is abortion, which despite Timothy’s claims, appears to take many more lives, and unlike miscarriage, is almost entirely preventable?

But for sake of argument, let’s assume he’s right and far more fetal deaths are “natural” than intentional, I truly don’t understand what he thinks this proves. Consider an illustration: If murder were suddenly to become legal (but no more prevalent than it is today), would we be unjustified in loudly condemning the practice despite the fact that far more people die of natural causes? Would a group that sought to publicize the evil of murder be suspect for not spending a greater amount of their time advocating better safety regulations or health care? If not, why should abortion be any different for those who believe that no innocent human being should be killed for the benefit of another?

Timothy, however, does not accept that human beings have innate dignity:

To me, human rights derive from those properties of human existence that we most value: consciousness, sentience, free will.

Personally, I have some sympathy for this view. After all, human dignity is not arbitrary nor unrelated to these features of our nature, but I’ve never understood why people think this should make abortion acceptable. Unless he is suggesting that only those who currently possess these properties deserve to live, what difference does it make that an unborn child is not yet conscious, sentient, etc, when if left alone it will naturally become so? Don’t all of us lack these properties from time to time (while asleep or under anesthesia), yet killing a person is still murder even if they are asleep. What’s the difference?

Yet once again, let’s assume he is right and, since a fetus lacks these properties, it cannot be murdered. Even in that case should it not still concern us that literally millions of people every year now choose – often for no better reason than convenience – to actively deny one of their already conceived children from attaining those capacities, that is, from living the life they would otherwise have enjoyed? This was not always so, and quite apart from any inherent human dignity, this seems a profoundly tragic state of affairs.


Responses

  1. (Here’s a re-try at a response I composed a week ago that got lost in the ether.)

    I am grateful that you are trying, as I am, to see the other side. Although I think the arguments for a ban on or further restriction of abortion are insufficient, I certainly don’t think abortion is a pleasant or “good” alternative. I think it is unfortunate that such a large number of people see it as the best option when they find themselves pregnant, and I hope that efforts to (for example) educate young people (the portion of the population with the highest abortion rate) about the consequences of and alternatives to unprotected sex will help us reduce the number of abortions sought.

    So, here are my responses to a couple of the points you make in your post.

    “First, notice how he introduces the 75% figure as a possibility (“may”) but then immediately employs it as a certainty. More basically, however, I fail to see how he justifies this number at all.”

    Fair enough. I came across the 75% figure on a website providing advice for women, and I confess that I accepted it uncritically. The 31% rate of miscarriage is based on a scientific study that used chemical markers of uterine implantation to determine conception rates. It is reasonable to assume that the actual miscarriage rate is higher than this, because not all fertilized eggs will implant in the uturus. I have no basis on which to estimate how many fail to implant, so I should have stuck to the more conservative figure of 31%.

    I would like to clarify and defend my further derivation of a 6% abortion rate, though. The miscarriage figures are given as a portion of (detected) conceptions. The abortion rate is (typically) given as a portion of the total of live births + abortions (ie, all fetuses that would probably have resulted in live births if none were aborted). Thus, the abortion rate is based on the number of conceptions that didn’t miscarry. To obtain the 6% figure for the “true” abortion rate (as a portion of conceptions), I first inferred from the 75% miscarriage rate a 25% non-miscarriage rate. The reported abortion rate is a portion of the conceptions that didn’t miscarry. That is, 25% (reported abortion rate) of 25% (non-miscarriage rate), or about 6%, which is what I reported. Now, as Ken pointed out, 75% is unreasonably high, given the empirical evidence. Let’s take the safely conservative rate of 31% given by the study I linked to. In that case, the proportion of conceptions that are aborted is 25% (reported abortion rate) of 69% (non-miscarriage rate), or about 17.25%. This is just over half the established miscarriage rate of 31%.

    I think this still justifies my suggestion that, if abortion is akin to genocide, then miscarriage is akin to a devastating plague. (Of course, I reject the notion that abortion is like genocide, and you have not tried to defend this extreme rhetoric of the Genocide Awareness Project, so we need not dwell on this fact.)

    “After all, human dignity is not arbitrary nor unrelated to these features of our nature, but I’ve never understood why people think this should make abortion acceptable. Unless he is suggesting that only those who currently possess these properties deserve to live, what difference does it make that an unborn child is not yet conscious, sentient, etc, when if left alone it will naturally become so? Don’t all of us lack these properties from time to time (while asleep or under anesthesia), yet killing a person is still murder even if they are asleep. What’s the difference?”

    Matthew made the same suggestion to me about a sleeping person lacking consciousness. I would say that the crucial difference is that the early-stage embryo does not yet possess consciousness or sentience, while the sleeping person already does (but perhaps does not exhibit them all at this moment).

    For me, the right to existence of the early embryo, which lacks certain morally-relevant human properties, are outweighed by the right to choice of the mother, who possesses such properties. I think it is a shame when these rights conflict with one another, and we should do what we can to help prevent such conflicts of interest. But when the conflict arises, I think our society has chosen well in adopting the solution we have.

  2. Timothy,
    Thanks very much for your thoughtful response. I’ll just offer a couple further thoughts:

    First, I admit that there are larger complexities involved when one moves from addressing the moral status of abortion to speaking of it legal status, which is why I focused on the former, rather than the latter. Personally, I don’t see the moral distinction between “not yet” and “not currently” when it comes to consciousness, etc., so I can see very few circumstances where the needs of the mother can morally justify the killing of her fetus, but that doesn’t necessarily mean that abortion should be outlawed – that’s a topic for another day.

    Second, I’m still not quite comfortable with calling miscarriage is a plague, because that seems to reduce it to an abstraction, disregarding the different reasons that individual miscarriages occur. Many are caused by chromosomal errors that render the fetus non-viable from the start, while others are caused by environmental factors or health problems of the mother (such as hormonal deficiencies). Some of these can already be solved with adequate medical care, while others may remain beyond our control no matter what. But lumping them all together to contrast with abortion is rather like lumping all non-murders together (including accidents, health problems, and natural disasters) to imply that murder is relatively uncommon, and (therefore?) an acceptable sacrifice for the sake of freedom of choice. I note that you passed over that illustration in your comment.

  3. Timothy,
    Thanks very much for your thoughtful response. I’ll just offer a couple further thoughts:

    First, I admit that there are larger complexities involved when one moves from addressing the moral status of abortion to speaking of it legal status, which is why I focused on the former, rather than the latter. Personally, I don’t see the moral distinction between “not yet” and “not currently” when it comes to consciousness, etc., so I can see very few circumstances where the needs of the mother can morally justify the killing of her fetus, but that doesn’t necessarily mean that abortion should be outlawed – that’s a topic for another day.

    Second, I’m still not quite comfortable with calling miscarriage is a plague, because that seems to reduce it to an abstraction, disregarding the different reasons that individual miscarriages occur. Many are caused by chromosomal errors that render the fetus non-viable from the start, while others are caused by environmental factors or health problems of the mother (such as hormonal deficiencies). Some of these can already be solved with adequate medical care, while others may remain beyond our control no matter what. But lumping them all together to contrast with abortion is rather like lumping all non-murders together (including accidents, health problems, and natural disasters) to imply that murder is relatively uncommon, and (therefore?) an acceptable sacrifice for the sake of freedom of choice. I note that you passed over that illustration in your comment.

  4. You do force me to think, Ken. Thankyou!

    I recognise the distinction between a strictly moral debate and a legal debate – though of course legal discussions are dangerous if they have no moral anchor, and moral discussions are pointless if they never lead to how we ought to act in society.

    For the distinction between not yet and not currently, I understand that you may not feel the same way as I do. But let me put it another way. I could meaningfully say that each of my sperm, or each of my wife’s eggs, is not yet conscious – it only needs the right ingredients and it may become a conscious being. Just like a fertilised egg; just like a blastocyst or an early-term embryo.

    When talking to Matthew (who I mentioned in my original blog entry), one of his key points was that conception is a clear boundary – any other boundary seems arbitrary to him. To me, there is no meaningful boundary between any of the stages in which an entity is not yet conscious – separate germ cells, fertilised egg, bundle of undifferentiated cells, etc – that would justify calling it human on one side and not human on the other. The least arbitrary boundary, in my mind, is the first acquisition of consciousness (and sentience, and if it could be identified in any objective way I’d add free will).

    But I understand how personal that perspective may be.

    Your point on my use of the word plague is legitimate: a plague is one thing, but miscarriages are due to a multitude of reasons.

    I would, however, counter that using “plague” for miscarriage is no worse than using “genocide” for abortion. Genocide suggests a systematic hatred or disregard for the lives taken. Is that true of all abortions? Is the teenager fearing the loss of her future potential the same as the woman who casually has an abortion so she can keep her perfect waistline? What about the late abortion where baby and mother are both at risk if the pregnancy continues? I don’t know what proportion of abortions fall in each of these (and probably other) categories – though I know teenagers have a higher abortion rate than other women. But surely it is an unfair condemnation of many to call abortion as a whole “genocide”. The word suggests much more evil than “murder”.

    Having said that, I recognise of course that, from your perspective, abortion is still murder, so it is unacceptable to you simply on that ground.

    Again, thanks for making me think deeper into this. I’m enjoying our exchange.

  5. You do force me to think, Ken. Thankyou!

    I recognise the distinction between a strictly moral debate and a legal debate – though of course legal discussions are dangerous if they have no moral anchor, and moral discussions are pointless if they never lead to how we ought to act in society.

    For the distinction between not yet and not currently, I understand that you may not feel the same way as I do. But let me put it another way. I could meaningfully say that each of my sperm, or each of my wife’s eggs, is not yet conscious – it only needs the right ingredients and it may become a conscious being. Just like a fertilised egg; just like a blastocyst or an early-term embryo.

    When talking to Matthew (who I mentioned in my original blog entry), one of his key points was that conception is a clear boundary – any other boundary seems arbitrary to him. To me, there is no meaningful boundary between any of the stages in which an entity is not yet conscious – separate germ cells, fertilised egg, bundle of undifferentiated cells, etc – that would justify calling it human on one side and not human on the other. The least arbitrary boundary, in my mind, is the first acquisition of consciousness (and sentience, and if it could be identified in any objective way I’d add free will).

    But I understand how personal that perspective may be.

    Your point on my use of the word plague is legitimate: a plague is one thing, but miscarriages are due to a multitude of reasons.

    I would, however, counter that using “plague” for miscarriage is no worse than using “genocide” for abortion. Genocide suggests a systematic hatred or disregard for the lives taken. Is that true of all abortions? Is the teenager fearing the loss of her future potential the same as the woman who casually has an abortion so she can keep her perfect waistline? What about the late abortion where baby and mother are both at risk if the pregnancy continues? I don’t know what proportion of abortions fall in each of these (and probably other) categories – though I know teenagers have a higher abortion rate than other women. But surely it is an unfair condemnation of many to call abortion as a whole “genocide”. The word suggests much more evil than “murder”.

    Having said that, I recognise of course that, from your perspective, abortion is still murder, so it is unacceptable to you simply on that ground.

    Again, thanks for making me think deeper into this. I’m enjoying our exchange.

  6. Timothy,
    I’m glad you returned to continue the conversation; you too have helped to stimulate my thinking in a number of ways. In fact, I suspect we are closer to agreeing than we might have guessed at the beginning. Let me just clarify a few points:

    “legal discussions are dangerous if they have no moral anchor, and moral discussions are pointless if they never lead to how we ought to act in society.”

    I completely agree, but too often the issues are confused and morality equated with legality. Thus, some “conservatives” speak as though every moral failing should be prosecutable, and some “liberals” imply that the right to free choice makes moral judgment illegitimate. Just because something is legal doesn’t make it moral, nor vice versa (an obvious example is lying, which is and should be legal in most cases, but can have profoundly negative consequences on those around us and should, in almost all cases, be morally condemned).

    “For the distinction between not yet and not currently…To me, there is no meaningful boundary between any of the stages in which an entity is not yet conscious”

    I have to disagree; “consciousness” is only observable “from the inside” (so to speak), so determining when it begins or ends for another person seems inherently arbitrary. On the other hand, conception does provide a clear line, for once it occurs the embryo needs only nourishment and protection to develop into a full human being. These are the same requirements any grown adult has, and nothing more, so the fact that it does not yet possess full consciousness, etc. seems no more relevant to its moral status than the fact that a sleeping adult lacks these properties. On the other hand, this is assuredly not the case of a sperm or an egg, which by themselves, even if nourished and protected indefinitely, will never develop into a human being. Indeed, unless fertilized, mature sperm and eggs will naturally die in a matter of days even if protected and nourished.

    As for your comments on plague and genocide, I actually agree: I think it is just as problematic to refer to abortion as genocide as to refer to miscarriage as plague. Though such terms have rhetorical value in reminding that we are, in fact, referring to the death of a (proto)human being (they got us talking, anyway!), they obscure the fact that many women who choose abortion do not perceive it as a choice to kill a human being. Even if, as I believe, they are in fact killing a person, this ignorance renders problematic the label “murder” – perhaps manslaughter would be a better description.

    The result is the same, and equally tragic, but the moral culpability of the woman would seem to be different (and, lets not forget, any who may have pressured her into having the abortion; too often the father disappears from these discussions as though abortion were merely a “women’s problem”). What, if anything, this should have to do with legalization, I’m not sure, but I for one would be very reticent to call any particular woman who chose an abortion a “murderer,” for that presupposes a knowledge of her deepest motives that I could not presume to know.

    That said, even judging by self-reported reasons, only a minority of abortions are medically or financially necessary (see here for discussion of the relevant studies). It would also seem to be significant that fully a third of all US abortions are performed on 20-25 year olds (the highest rate of any age-group; see here for US stats, and here for comparable figures in Canada), a demographic that, frankly, has little legitimate grounds for claiming they are not mature or financially secure enough to raise a child.

    And again, thanks for continuing the conversation; if these issues were debated with this level of respect and civility more often, we’d all be better off!

  7. I don’t have much to add. I think we’ve done a fair job here of mapping out the places we can agree (for example, that abortion is an unpleasant alternative) and the places we cannot agree (principally, where does the value of human life come from, and when do non-person cells become a person).

    I would like to expand a little on something I said in my last post, for clarity and completeness.

    I said,

    For the distinction between not yet and not currently…To me, there is no meaningful boundary between any of the stages in which an entity is not yet conscious

    You (Ken) replied,

    I have to disagree; “consciousness” is only observable “from the inside” (so to speak), so determining when it begins or ends for another person seems inherently arbitrary. On the other hand, conception does provide a clear line, for once it occurs the embryo needs only nourishment and protection to develop into a full human being.

    I should have emphasised meaningful. As I’ve said before, I think that human rights and value are based on certain capacities we have – mental capacities such as free will, sentience (ability to feel pain and pleasure). The fertilization of an egg by a sperm is an identifiable event, but it does not instantly confer these capacities; therefore, in my view, fertilization does not confer human rights. It is not an event that meaningfully distinguishes a non-human from a human.

    The fact that it is more difficult to identify the “beginning of consciousness” is unfortunate. But we can identify physical correlates of consciousness (brain activity, say), and identify the point in gestation where these physical correlates appear.

    This approach is not easy or ideal. People will not all agree on the appropriate correlates, nor on what exactly the evidence says about them. This is why I disagree with the doctor I heard on the radio recently, who said that this debate was over decades ago. It is not over. No question whose answer depends on empirical facts can ever responsibly be closed forever.

    Despite its difficulties, I prefer to try this approach, rather falling back on a solution that ignores the gradual nature of human development in favour of an easy-to-spot boundary.


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