A Texas health commission pamphlet falsely links abortion to breast cancer, depression, and other health risks, medical experts warn.
The “A Woman’s Right to Know,” pamphlet, released in a new edition on Monday, is required by law to be distributed to women considering an abortion in Texas.
“My concern is presenting information we know to be scientifically inaccurate,” Lisa Hollier, a professor of obstetrics and gynecology at Texas Children’s Hospital, told BuzzFeed News. “That is in direct conflict with my practice as a physician of presenting accurate, unbiased information to my patients.”
The new pamphlet replaces the original, which has been handed out to abortion patients since 2003, after a review by health officials in Texas, a state among the leaders in efforts to restrict abortion. Texas has seen 60% of its abortion clinics close in the last three years, and has seen its abortion rate drop 14% in that time. The changes to the health pamphlet are seen by abortion providers as harbingers of bad science arguments made against abortion refuted more than decade ago, but resurrected by abortion opponents in the long political fight over Roe v. Wade.
A recent change to state law, for example, requires that fetal remains from abortions receive handling from funeral home personnel, rather than disposal as medical waste.
Texas law also mandates that doctors perform a sonogram, showing the woman the fetus, and requiring her to listen to a heartbeat if it can be heard. The doctor must then wait 24 hours before being allowed to perform the abortion so that the women, according to the pamphlet, “can consider all the facts.”
Carrie Williams, a spokesman for the state’s Health & Human Services Commission, said that nearly 13,000 comments were received over the summer during their feedback period.
"We took great care to make sure this booklet is medically accurate and can be used as a resource to help women make the best personal decisions for themselves," John Hellerstedt, the Texas State Health Commissioner, said in a statement to BuzzFeed News. "We carefully reviewed every detail as we finalized it."
But the information included in the pamphlet, particularly concerning whether or not abortions carry health risks to women, is hotly contested among medical experts. The pamphlet includes a section called “Breast Cancer Risk,” despite numerous studies refuting any links. A 2003 National Cancer Institute review found “no evidence” of a link between miscarriage or abortion and breast cancer.
The pamphlet also suggests that women who have abortions carry higher risk of infertility and depression than women who carry their pregnancies to term.
In July, the Texas District of the American Congress of Obstetricians and Gynecologists (ACOG) sent a letter to the Department of State Health Services claiming that the information in the soon-to-be published pamphlet was “biased” and incorrectly represented the health risks of abortion.
Daniel Grossman, professor of obstetrics and gynecology at UC San Francisco, cited which data the state chose to include to make its breast cancer claims, and complained of more rigorous studies that the commission chose to leave out.
With regards to breast cancer, for example, the Texas pamphlet cited two Chinese papers, Hollier noted. So-called case-control studies, they collected medical records of women who developed breast cancer, and then combed them to find links to a risk.
In more rigorous prospective studies excluded from the pamphlet, however, women who have or have not had abortions are followed throughout the course of their lives to see whether or not they develop breast cancer. These studies, including a recent Danish study of over 25,000 women, have repeatedly shown no link between abortion and breast cancer.
“The booklet makes it sound like the issue of a link to abortion is unsettled and the topic of ongoing research,” Walter Willett, a professor of epidemiology at Harvard’s School of Public Health, told BuzzFeed News. One of Willett’s papers on breast cancer risk was cited in the pamphlet. “This has been looked at in detail and there is no evidence that abortion itself causes breast cancer. It is not really an active research area any more.”
While the Texas pamphlet does not explicitly state that abortions cause breast cancer, it instead suggests that women who carry their pregnancies to term — presumably having pregnancies earlier in life — have a decreased chance of getting breast cancer.
“I think they’re trying to twist that data and say that if you end the pregnancy you don’t get that benefit,” Hollier said. “But we have actual data looking at the issue in question. Does having an abortion increase your risk of breast cancer? No.”
Similarly, a section on mental health risks suggests that women who have abortions carry higher risk of depression or suicide. In a recent large study of 1,000 women comparing mental health outcomes among those who had an abortion and those who wanted abortions but were turned away because they presented too late to their physicians, both groups fared roughly equally in terms of depression scores and substance abuse risk.
“There’s now a great deal of evidence — rigorous evidence — indicating that there are no increased risk of negative mental health outcomes associated with abortion,” Grossman said. “Their information is really quite inaccurate and misleading.”
The Texas pamphlet also drew a connection between abortions and the chance of death. While the pamphlet correctly cites that the risk of death is 0.73 deaths per 100,000 reported abortions, Hollier called the numbers downplaying risk of death from childbirth, which can be much higher than abortion risks, deceptive.
Hollier, who is currently leading a task force in Texas looking at the massive spike in deaths among mothers in Texas within a year of giving birth, pointed out that those numbers are staggeringly higher, a point that is not made clear in the information pamphlet. “These aren’t small numbers. For African-American women it could be as high as 60 deaths per 100,000 births, which is 100 times higher than the risk associated with the abortion procedure,” she said.
“I think we in the medical community should really be outraged that the state is misleading women with inaccurate information around a healthcare service,” Grossman said. “It’s not just misleading information, it’s misleading information that leads to increased stigma.”