There are inherent dangers to pregnancy. There are also inherent dangers to induced abortions. Debates concerning abortions often have at least a minor focus on situations in which they may be necessary to save the mothers’ lives. How frequent are such situations in the United States? How do these compare to the number of women who die annually from complications which follow legally-induced abortions?
Before proceeding with the discussion, it is important to establish a clear definition for what encompasses a legally-induced abortion. The Centers for Disease Control and Prevention defines it as
“an intervention performed by a licensed clinician… within the limits of state regulations that is intended to terminate a suspected or known ongoing intrauterine pregnancy and does not result in a live birth.” 
Since the definition specifically states “intrauterine,” it excludes treatment for ectopic pregnancies. It also specifies “ongoing,” so that would exclude any treatments for or after miscarriage (e.g. dilation and curettage, prostaglandin-induced labor, etc.). The CDC does specifically include both surgical and medical abortions.
The focus is only legally-induced abortions, so we will exclude illegal ones. We will also exclude the more-encompassing general terms “fetal homicide” and “feticide” to focus only on actions performed or consented by the mother.
Deaths from legal abortions
The CDC website reports on “Abortion Surveillance” , which consists of voluntarily-provided statistics for each of the fifty states, the District of Columbia, and New York City. Near the bottom of the main webpage, Table 23  lists the annual case-fatalities for 1973-2015, subdivided into legal, illegal, and unknown legality abortions. Focusing on the raw counts in the most recent block of years (2008-2015), the total maternal fatalities for legally induced abortions in column two was forty-eight, or six per year.
Since only about half of states have legal requirements to report abortion complications , there are major deficiencies in these statistics. At a minimum, California, New Hampshire, Maryland, and the District of Columbia, never contribute to these numbers.  California alone is estimated to account for one-quarter to one-third of all induced abortions in the United States. 
Another caveat is that the count most likely includes only women who were immediately admitted into hospitals after serious injuries at abortion clinics. Most commonly, either someone at the clinics phoned in the emergencies, or the clinics had physicians on staff with admitting privileges to nearby hospitals for clear chains-of-custody in treating post-abortive injuries. Situations outside these scenarios may never be counted because abortion providers and advocates may specifically instruct women to tell hospitals that they had natural miscarriages  (Figure 1), or the physicians completing the death certificates may simply be unaware that the deaths were post-abortive for any number of reasons (i.e. patient unresponsive upon arrival, embarrassed to tell the truth, had the abortion in secret, etc.). 
How commonly are abortion fatalities incorrectly counted as deaths from miscarriage complications? Due to incomplete and incorrect data tabulation, that is unclear. Still, it does taint the numbers. As at-home medical abortions continue to increase, the lack of direct oversight by a physician will only further add to that.
So, how many women actually die per year from legally induced abortions? We only know that it is at least six per year, on average, over the past eight years of records.
Lives saved from legal abortions
Now, let us look at the other side: women whose lives are saved by induced abortions each year.
For states which track and report detailed numbers, they combine everything that is “life endangering” into a single statistic, such as in Florida’s 2018 “Reported Induced Terminations of Pregnancy by Reason, by Trimester.”  There are numerous situations deemed “life endangering” which can actually be treated as high-risk pregnancies and safely carried to term. Thus, the count of 194 provided in this table (Figure 2) could consist of nothing but preemptively induced abortions for conditions which could still be treated and result in live births.
So, let us say that a health situation arises with the mother. She needs to immediately be treated for it, and her unborn child may not survive. A few scenarios come to mind:
- She has cancer, and the particular form of chemotherapy she needs is known to sometimes cause miscarriage. Under her physician’s advice, she proceeds with the treatment. The CDC definition of an induced abortion specifically states that the procedure must be “intended to terminate.” A triage or emergency medical situation does not apply here.
- She has preeclampsia, causing extreme hypertension around twenty weeks of gestation (when the earliest symptoms generally arise) . After a week of attempting to reduce the symptoms, she requires an immediate induction of labor or a Caesarian section. For this scenario, the infant will be born at the threshold of viability with a slim to zero chance of survival under current medical technology. As with the previous scenario, the intent it not to kill the infant but to produce a live birth, so this is also not an induced abortion.
In essence, the CDC definition of an induced abortion is limited to the preemptive, intentional killing of unborn children before performing any lifesaving treatments on the mothers. Are there any such instances in which this would be needed to save the mother’s life?
Avoiding legal liability
In March 1996, Dr. Thomas Murphy Goodwin, MD, Professor of Obstetrics and Gynecology and Pediatrics Chief at the University of Southern California , wrote of his experiences as director of maternal-fetal medicine at the Hospital of the Good Samaritan in Los Angeles.  At the time, this institution was the largest obstetrics service in the United States for fifteen years running, facilitating fifteen thousand to sixteen thousand deliveries per year. They would often be the go-to place in the Los Angeles area for high-risk pregnancies. Of these pregnancies, Goodwin states that only one to two cases per year involved risks of maternal mortality greater than 20 percent. 
He presents a series of cases in which other area physicians or their patients contacted his institution for second opinions, after recommendations for immediate abortions. For the cases his institution received, none of the mothers died during or as the results of the pregnancies. Additionally, all infants survived the births, only one dying soon afterwards from an unrelated infection.
In multiple of the cases, physicians feared legal liabilities of high-risk pregnancies involving heart dysfunction, chemotherapy, or other issues, and either ended up not referring their patients for treatment or only referring them if the Hospital of the Good Samaritan would assume full legal liability for anything that could happen to the patients.
Goodwin explains that by skipping informed consent regarding pregnancy risks and immediately suggesting women to induce abortions, physicians can remove all legal liabilities from themselves and their practices.  This is also why many urge tests to screen for fetal anomalies that could lead to “wrongful birth” or “wrongful life” lawsuits. 
According to the American Medical Association’s 2016 Benchmark Survey, obstetrics and gynecology has one of the highest rates of lawsuits of all medical specialties with 63.6 percent of physicians having been sued at least once in their careers and 6.7 percent sued in just the past year.  By catching maternal risks or fetal anomalies early, physicians can legally protect themselves by pushing to induce abortions that then end up getting reported as medical emergencies on state tallies. Now, obviously, this is not an indictment of all OB/GYNs. In fact, only 14% actually perform induced abortions. 
Aside from Goodwin, what do other physicians say about the necessity of inducing abortions to save women’s lives?
Severe Medical Conditions
Dr. Ingrid Skop, MD, of The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) wrote a paper in 2018 on Top 10 Myths About Abortion in which “Myth 04” discusses reasons for inducing abortions, particularly focusing on the claim that abortions are necessary for life-endangering pregnancies:
“It is clearly the standard of care for any physician to intervene in a pregnancy that presents a risk to the mother’s life, as long as no direct action is taken to terminate the life of the unborn child. However, these life-threatening situations occur far less commonly than one may assume.” 
The paper continues with a discussion on several life-threatening situations, including ectopic pregnancies, infections from membrane rupture, severe hypertension, cardiac conditions, and treatment for cancers that include chemotherapy or surgery, and dismantles the belief that induced abortions are valid practice for any of them. How do physicians handle life-threatening conditions late in pregnancy? She states that
“With modern surgical techniques, a C-section delivery is usually very safe, even in an extremely sick woman. (One out of three pregnancies in our country are delivered this way.) By comparison, a dilation and evacuation abortion usually necessitates between one and three days of cervical ripening in order for the surgeon to enter the uterus. If a woman were truly sick enough to need emergent delivery, this much of a delay would only worsen her condition.” 
Even outside the United States, numerous physicians affirm that induced abortions are never needed to save the mothers’ lives. The Dublin Declaration on Maternal Healthcare, which has been signed by 244 OB/GYNS & nearly 800 other medical professionals around the world, declares the following:
“As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman.
We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child.
We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.” 
Over the last several decades in the United States, several physicians from broad backgrounds have given consistent statements that induced abortions are not needed to save mothers’ lives.
Dr. Alan Guttmacher, MD, and former president of Planned Parenthood and vice-president of the American Eugenics Society, said in 1967 (emphasis added),
“Today it is possible for almost any patient to be brought through pregnancy alive, unless she suffers from a fatal illness such as cancer or leukemia, and, if so, abortion would be unlikely to prolong, much less save, life.” 
In 1972, Dr. Rose Middleman, MD, former medical director of Pittsburgh Planned Parenthood stated:
“It’s extremely rare, if nonexistent, for a physician to have a medical reason to abort a woman in the 7th or 8th month.” 
Former Surgeon General and pediatric surgeon Dr. C. Everett Koop, MD, said in 1980 (emphasis added):
“Protection of the life of the mother as an excuse for an abortion is a smoke screen. In my 36 years in pediatric surgery I have never known of one instance where the child had to be aborted to save the mother’s life… If, toward the end of the pregnancy complications arise that threaten the mother’s health, he will take the child by inducing labor or performing a Caesarean section. His intention is still to save the life of both the mother and the baby. The baby will be premature and perhaps immature depending on the length of gestation. Because it has suddenly been taken out of the protective womb, it may encounter threats to its survival. The baby is never willfully destroyed because the mother’s life is in danger.” 
Dr. Bernard Nathanson, MD, co-founder of NARAL Pro-Choice America (originally the National Association for the Repeal of Abortion Laws) that later became a pro-life activist, wrote in his 1996 book The Hand of God:
“As early as the 1960s, progress in technology had led to the point where abortion was no longer needed to save women’s lives, if it ever was.” 
In the 2002 book A Doctor’s Experience with the Abortion Dilemma, Dr. Don Sloan, MD, an OB/GYN with over 57 years of experience, stated:
“If a woman with a serious illness… gets pregnant, the abortion procedure may be as dangerous for her as going through the pregnancy… The idea of abortion to save the mother’s life is something that people cling to because it sounds noble and pure—but medically speaking, it probably doesn’t exist.” 
Dr. Ron Paul, former Congressman from Texas, had a three decade career as an OB/GYN during which he delivered over 4000 babies.  In November 28, 2007, at the CNN/YouTube Republican presidential debate, Paul made this statement on the medical necessity of induced abortions:
“I’m an OB doctor, and I practiced medicine for 30 years, and I of course never saw one time when a medically necessary abortion had to be done.” 
In 2015, former abortionist Dr. Anthony Levatino, MD, said (emphasis added),
“During my time at Albany Medical Center I managed hundreds of such cases by “terminating” pregnancies to save mother’s lives. In all those cases, the number of unborn children that I had to deliberately kill was zero.” 
Doe v Bolton’s Influence
If cases are so rare to non-existent that a mother’s life could be in such danger to necessitate an induced abortion to survive, why are abortion laws written with that exception?
Before the advent of modern medicine — such as the use of antibiotics and blood transfusions — maternal mortality rates were forty to fifty times higher than they are now in much of the developed world.  Conditions may have once existed for which induced abortions were needed to save the mothers’ lives that are resolved through other means today. Thus, exceptions in criminal abortion laws for saving the mothers’ lives were very common over a century ago. In fact, only Illinois  and Nebraska  lacked such exemptions in their “Crimes Against the Person” laws by the mid-nineteenth century.
The modern precedent for overly broad “health” exemptions in abortion laws came from the 1973 US Supreme Court decision for Doe. v. Bolton , not due to medical science. State legislatures now preemptively include Doe-compliant provisions in their abortion bills to prevent potential lawsuits, not for hypothetical emergency scenarios.
Based on the overwhelming evidence from numerous medical professionals, the number of women’s lives saved by legally-induced abortions is statistically negligible, if not outright zero. Since at least six women died per recent year from legally-induced abortions within the United States, it is clear abortions kill more women per year than they save.
- “CDCs Abortion Surveillance System FAQs.” Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm
- “CDCs Abortion Surveillance System FAQs.” Ibid.
- Jatlaoui TC, Eckhaus L, Mandel MG, et al. “Abortion Surveillance — United States, 2016”. MMWR Surveill Summ 2019; 68 (No. SS-11) pp.1-41. https://www.cdc.gov/mmwr/volumes/68/ss/ss6811a1.htm
- Skop, Ingrid, MD. “Top 10 Myths About Abortion,” American Association of Pro-Life Obstetricians and Gynecologists. https://aaplog.org/wp-content/uploads/2019/02/MFL-FRC-Top-Ten-Myths.pdf
- Jatlaoui TC, Eckhaus L, Mandel MG, et al. Ibid.
- Skop, Ingrid, MD. Ibid.
- “Signs of a complication” Women on Waves. Accessed August, 20, 2020. https://www.womenonwaves.org/en/page/6104/how-to-do-an-abortion-with-pills
- Skop, Ingrid, MD. Ibid.
- “Reported Induced Terminations of Pregnancy (ITOP) by Reason, by Trimester,” Agency for Health Care Administration.(Fla., 2018) https://ahca.myflorida.com/MCHQ/Central_Services/Training_Support/docs/TrimesterByReason_2018.pdf
- Al-Jameil, Noura, et al. “A Brief Overview of Preeclampsia,” Journal of Clinical Medicine Research. Dec 13, 2013. Accessed Aug 28, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881982/
- Goodwin, Thomas Murphy, MD. Professor of Obstetrics and Gynecology and Pediatrics Chief, Division of Maternal Fetal Medicine Director, USC Perinatal Group, Keck School of Medicine of USC. https://pressroom.usc.edu/thomas-murphy-goodwin/
- Good Samaritan Hospital, The Davajan-Cabal Center for Perinatal Medicine. https://www.goodsam.org/Centers-of-Excellence/Davajan-Cabal-Center-for-Perinatal-Medicine.aspx
- Goodwin, Thomas Murphy, MD. “Medicalizing Abortion Decisions” First Things, March 1996. Archived at https://www.firstthings.com/article/1996/03/003-medicalizing-abortion-decisions
- Goodwin. Ibid.
- Goodwin. Ibid.
- Guardado, José R., PhD. “Medical Liability Claim Frequency Among U.S. Physicians,” American Medical Association. 2017, accessed Sept 17, 2020. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/government/advocacy/policy-research-perspective-medical-liability-claim-frequency.pdf
- Stuhlberg, Debra B., et al., “Abortion Provision Among Practicing Obstetrician-Gyne- cologists,” Obstetrics & Gynecology 118 (2011): 609, accessed Sept 17, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170127/.
- Skop, Ingrid, MD. Ibid.
- Skop, Ingrid, MD. Ibid.
- Dublin Declaration on Maternal Healthcare. https://www.dublindeclaration.com
- Guttmacher, Alan F., MD. “Abortion — Yesterday, Today and Tomorrow,” The Case for Legalized Abortion Now. Diablo Press, 1967. Berkeley, Calif. Archived at https://www.nrlc.org/archive/abortion/pba/HowOftenAbortionNecessarySaveMother.pdf
- “Doctor Refutes Abortion Claim,” Reading Eagle, June 14, 1972. (Quoting Dr. Rose Middleman)
- Koop, Everett, MD. Moody Monthly. May 1980. https://www.nrlc.org/archive/abortion/pba/HowOftenAbortionNecessarySaveMother.pdf
- Nathanson, Bernard. The Hand of God: A Journey from Death to Life by the Abortion Doctor Who Changed His Mind. Regnery. Washington D.C., 1996.
- Sloan, Don and Paula Hartz, Choice: A Doctor’s Experience with the Abortion Dilemma, pp.45-46. International Publishers, New York City, 2002.
- White, Steve. The American Prospect, “Ron Paul’s Abortion Rhetoric.” August 16, 2007. https://prospect.org/article/ron-paul-s-abortion-rhetoric/
- Paul, Ron, MD. The CNN/YouTube Republican Debate. St. Petersburg, Fla. November 28, 2007. https://www.cnn.com/2007/POLITICS/11/28/debate.transcript/index.html (transcription)
- Levatino, Anthony. Testimony before the Kansas Senate Health & Human Services Committee. February 2, 2015. http://kslegislature.org/li_2016/b2015_16/committees/ctte_s_phw_1/documents/testimony/20150202_08.pdf
- Louon, Irvine. “Maternal mortality in the past and its relevance to developing countries today,” The American Journal of Clinical Nutrition, Vol 72, Issue 1, pp241S-246S. July 1, 2000. https://academic.oup.com/ajcn/article/72/1/241S/4729611
- Illinois Revised Code, Div 5, §46. “Offenses Against the Persons of Individuals, Poisoning” (Ill., 1833)
- Territory of Nebraska Revised Statutes, Criminal Code, §42. “Offenses Against Persons, Abortions” (Neb., 1858)
- Doe v. Bolton (410 US 179; 1973) https://supreme.justia.com/cases/federal/us/410/179/