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Mortality after induced abortion

      To the Editor: I was most interested to read Gissler et al
      • Gissler M.
      • Berg C.
      • Bouvier-Colle M.H.
      • Buekens P.
      Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000.
      research on pregnancy-associated mortality. I was, however, surprised that there was no discussion of the fact that the age-adjusted mortality after induced abortion was 3 times that of those who gave birth and 1.5 times that of women who were nonpregnant. Further, these women were 6 times as likely to die from violent causes as women who gave birth, and more than 2 times as likely to die from violent causes as nonpregnant women.
      For unclear reasons, the authors excluded deaths from unintentional accidental injuries and intentional injuries in their analysis of pregnancy-associated mortality. The lead author's own prior work
      • Gissler M.
      • Hemminski E.
      • Lonnqvist J.
      Suicides after pregnancy in Finland, 1987-94: register linkage study.
      demonstrated that a woman obtaining an induced abortion is 6 times more likely to die from suicide (intentional injury) than women who give birth, and 3 times more likely to commit suicide than the general population, within a year of the delivery or the abortion. If these additional deaths were added to the current analysis, it is expected that there would be an even greater differential in the number of deaths after induced abortion compared with women who give birth or who are nonpregnant.
      Whether this association of induced abortion and subsequent increased mortality is due to common underlying risk factors or from a causative effect of induced abortion on an individual's subsequent behavior, the association itself cannot be ignored. A woman obtaining an induced abortion appears to be at increased risk for dying from violent causes in the near future, including suicide. The stark reality underlying these statistics would seem to represent a significant public health concern that warrants further investigation.

      References

        • Gissler M.
        • Berg C.
        • Bouvier-Colle M.H.
        • Buekens P.
        Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000.
        Am J Obstet Gynecol. 2004; 190: 422-427
        • Gissler M.
        • Hemminski E.
        • Lonnqvist J.
        Suicides after pregnancy in Finland, 1987-94: register linkage study.
        BMJ. 1996; 313: 1431-1434

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        American Journal of Obstetrics & GynecologyVol. 191Issue 6
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          To the Editors: Hoeldtke points out a very important aspect of pregnancy-associated deaths. Even though the risk of pregnancy-associated death from external causes is lower than the corresponding mortality among nonpregnant women of reproductive age,1 the risk differs by the cause of death, age, and the outcome of pregnancy.2,3
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