Is legal induced abortion significantly more safe than childbirth?

Question

When it is said that abortion is significantly safer for women compared to childbirth in mainstream media articles, it is often followed by a reference to a scientific study called The Comparative Safety of Legal Induced Abortion and Childbirth in the United States by Elizabeth Raymond and David Grimes.

The study does claim:

The risk of death associated with child-birth is approximately 14 times higher than that with abortion.

However, people who are anti-abortion claim that the Raymond and Grimes study is seriously flawed.

The National Institute of Family and Life Advocates' article Abortion is Not Safer for Women Than Childbirth strongly criticizes the study:

...the data reported by abortion clinics to state health departments and ultimately to the CDC significantly under-represents abortion morbidity and mortality for several reasons

The article then lists these reasons:

1. Abortion reporting is not required by federal law and many states do not report abortion-related deaths to the CDC

2. Deaths due to medical and surgical treatments are reported under the complication of the procedure (e.g., infection) rather than the treatment (induced abortion)

3. Most women leave abortion clinics within hours of the procedure and go to hospital emergency rooms if there are complications that may result in death

4. Suicide deaths are rarely, if ever, linked back to abortion in states reporting of death rates

5. An abortion experience can lead to physical and/or psychological disturbances that increase the likelihood of dying years after abortion, and these indirect abortion-related deaths are not captured at all

The article cites the Guttmacher Institute's article Abortion Reporting Requirements as evidence that abortion is under-reported.

Funnily enough, some of what the Guttmacher article says shows that one previous point is false and misleading. For example, in the article it says:

States are not required to submit abortion data to the CDC, but the overwhelming majority do.

This shows that point 1) is false and misleading. Yes, it is not required, but that gives the impression that there’s no good reason to trust the CDC’s reporting.

Secondly, as per the Guttmacher article, it is not true that many states do not report abortion-related deaths to the CDC.

In one of the highlights in the Guttmacher article, it also states that

46 states and the District of Columbia require hospitals, facilities and physicians providing abortions to submit regular and confidential reports to the state.

That means only four states do not.

What about the other four points?

The website gives a source for these claims, but whenever I try to access the link I get a timeout. The anti-abortion website makes other claims related to the first point, but they have the same problems, and so are grossly misleading and inaccurate. Points 4 and 5 and extremely dubious, and the psychological hypothesis, if I'm not mistaken, is rejected by the scientific consensus on the matter.

I would be very pleased if someone could give me a source that backs up the other four claims, or provide a good argument or study that showed that abortion is significantly unsafe compared to childbirth, or a study that shows the opposite.

Answer 1

Regarding claims of under-reporting

The implications of points 1-3 are that deaths due to abortion are being unreported because some states do not require certain types of reporting.

But most do...

1. 46 states + DC require abortions to be reported to the state.
2. 28 states require providers to report post-abortion complications.
3. Covered by 2.

One can rely on the reporting in those states. Since they don't raise any issues with the reported data, their points are moot.

Restricting abortion access harms women and children

Let's restate the question for what it really is: Is restricting abortion access and having an unwanted child safer than having an abortion?

The American Psychological Association writes in The facts about abortion and mental health concludes that restricting access to abortion does harm.

More than 50 years of international psychological research shows that having an abortion is not linked to mental health problems, but restricting access to safe, legal abortions does cause harm. Research shows people who are denied abortions have worse physical and mental health, as well as worse economic outcomes than those who seek and receive them.

Meanwhile, the same research shows getting a wanted abortion does not cause significant psychological problems, despite beliefs to the contrary. In a landmark study of more than 1,000 women across 21 states, those who were allowed to obtain an abortion were no more likely to report negative emotions, mental health symptoms, or suicidal thoughts than women who were denied an abortion.

One of the studies they cite is "The mental health impact of receiving vs. being denied a wanted abortion". It's key points are [italics mine]...

• Having a wanted abortion was not associated with mental health harms.
• Compared to receiving an abortion, being denied a wanted abortion was associated with experiencing more symptoms of anxiety and low self- esteem one week after denial.
• Both women who received and women who were denied an abortion experienced improvements in their mental health and well-being from the time they sought an abortion to five years later.
• Prior history of mental health conditions, history of child abuse and neglect, sexual assault, and intimate partner violence were the factors most strongly associated with experiencing adverse mental health outcomes after abortion.
• Laws that require women to be warned about negative psychological consequences of abortion are not based in evidence

This answers point 5: once you control for confounding conditions, the increased suicide risk goes away.

They also cite The Turnaway Study examines "the effects of unwanted pregnancy on women’s lives".

The main finding of The Turnaway Study is that receiving an abortion does not harm the health and wellbeing of women, but in fact, being denied an abortion results in worse financial, health and family outcomes

The Turnaway Study concludes that "women denied abortion are..."

• More likely to experience serious complications from the end of pregnancy including eclampsia and death.
• More likely to stay tethered to abusive partners.
• More likely to suffer anxiety and loss of self-esteem in the short term after being denied abortion.
• Less likely to have aspirational life plans for the coming year.
• More likely to experience poor physical health for years after the pregnancy, including chronic pain and gestational hypertension.
• The study also finds that being denied abortion has serious implications for the children born of unwanted pregnancy, as well as for the existing children in the family.