Women must be informed of the overwhelming evidence linking abortion and later preterm birth

The link between abortion and premature birth is already well established but largely underplayed or denied by British authorities including the Royal College of Obstetricians and Gynaecologists (RCOG).

Most doctors and women are therefore not aware of it.

I have previously summarised the medical evidence on this blog and have recently highlighted major Finnish, Danish and Scottish studies confirming the link.

Now a new paper from North Carolina has reviewed all the available data on the association between abortion and subsequent increased risk for preterm and very preterm birth. 

The author, Martin McCaffrey, is a clinical professor of paediatrics at the UNC-Chapel Hill School of Medicine, director of the Perinatal Quality Collaborative of North Carolina, and member of the NC General Assembly Child Fatality Task Force.

He highlights findings from two recent Systematic Review and Meta-analysis articles.

The two standout conclusions are as follows:

1. The risk of prematurity increases, in a ‘dose effect’ with one or more induced abortions (ie. The more abortions, the higher the risk of prematurity)

2. Abortion is linked with increased risk of ‘preterm’ birth (33-36 weeks), but it is linked with an even higher risk of ‘very preterm birth’ (VPTB) (< 32 weeks) where babies are at much higher risk of morbidities like cerebral palsy.

There are currently 137 scientific articles reporting on the link between abortion and preterm birth in the subsequent pregnancy.

Two well-designed meta-analyses now demonstrate that just one prior abortion increases by 36% the risk for a future ‘preterm’ birth and by 64% for a ‘very preterm’ birth.

Two or more abortions increase the risk for a future ‘preterm’ birth by 93%.

It is long overdue, based on the scientifically proven risk abortion poses for future preterm birth, that we educate sexually active women and men of the serious risk abortion poses for the health of babies born subsequent to abortion.

The article contains two very helpful graphic demonstrations highlighting the inordinate shift of higher risk of VPTB for infants born subsequent to the mother having had an abortion. 

It is a travesty that this information is not disseminated by medical and other organisations dealing with reducing the incidence of preterm birth.

I am grateful to AAPLOG for drawing this report to my attention.

The question that the police have not asked and Nitschke has not answered

Australia's ‘Dr Death’ Philip Nitschke (pictured left) visited the UK this week and held a ‘workshop’ at Dragon Hall in London providing instruction in how to commit suicide. About 150 people attended.

Not understandably the event evoked protests (see picture below) and some publicity.

In the week before Nitschke arrived I wrote to both the Home Secretary Theresa May and the London Metropolitan Police Commissioner Sir Bernard Hogan-Howe to advise them about his visit and to inform them that I believed his workshop would be in breach of the Suicide Act 1961, under which it is an offence to ‘encourage or assist’ suicide.

The Act does not require that a suicide is actually carried out in order to for a prosecution to take place.

Quite possibly as a result Nitschke was briefly detained at Gatwick airport but was eventually let in, presumably with the permission of the Home Secretary.

The police did not attend the workshop but referred the matter to the Crown Prosecution Service who decided that an investigation was not necessary.

At his workshop last Tuesday Nitschke, who is on public record as supporting suicide for ‘the depressed, the elderly bereaved, (and) the troubled teen’, gave advice on the sourcing, supply and use of barbiturates, nitrogen and other means that people could use to kill themselves.

A 2010 report demonstrated that coroners were aware of 51 Australians who had died from an overdose of Nembutal, a lethal barbiturate that Nitschke has promoted since the late 1990’s as ‘a peaceful way to die’.

But this fact seems to leave Nistchke unperturbed.

When previously confronted with the fact that 14 of the 51 were Australians in their 20’s and 30’s and only 11 of 38 investigated were known to have suffered chronic physical pain or a terminal illness he responded that ‘there will be some casualties’.

Currently Nitschke is the subject of an inquiry by the Australian Health Practitioners Agency (AHPA) in connection with an entity called 'Max Dog Brewing' which he has set up in order to sell nitrogen cylinders via his ‘Exit International’ website to people who wish to end their lives.

‘Max Dog Brewing’ is a business name for the company Northern Analytics Pty Ltd which has ‘Philip Haig Nitschke’ as its sole director.

Its website claims that nitrogen cylinders can be used for home brewing (nitrogen produces the bubbles in stout) but Nitschke has admitted on Australian national media that they can equally be used to commit suicide and there are much cheaper sources of the gas available for brewers.

I asked Nitschke on twitter this week how many nitrogen cylinders he has so far sold to members of the British public but thus far he has not responded.

However according to the Newstalk ZB in New Zealand 'Max Dog Brewing' has already sent shipments to both New Zealand and the UK.

So here we have a man who travels the world running ‘workshops’ in order to give information to people in order that they can commit suicide.

He tells them where they can obtain barbiturate drugs and sells kits for storage of the drugs and for measuring their concentration.

And he sells nitrogen cylinders via a company he has set up for the purpose along with the necessary kit to deliver the gas.

Quite why this does not amount to ‘encouraging and assisting’ suicide is a mystery to me.

What will it take, I wonder for the authorities - including the Home Secretary, the police and the Crown Prosecution Service - to do something about it?

I hope it is not the first barbiturate or nitrogen suicide of someone in the UK making use of his information and equipment. But I am not holding my breath. 

Three parent embryos for mitochondrial disease – unsafe, unethical and unnecessary

Britain is planning to become the first country in the world to offer controversial ‘three-parent’ fertility treatments to families who want to avoid passing on mitochondrial diseases to their children.

The BBC reports this morning on the new techniques which it is claimed will children born through 'three-person IVF' who would carry genetic material from each of three different people.

There are about 50 known mitochondrial diseases (MCDs), which are passed on in genes coded by mitochondrial (as opposed to nuclear) DNA. They range hugely in severity, but for most there is presently no cure and little other than supportive treatment.

It is therefore understandable that scientists and affected families want research into these two related ‘three-parent embryo’ techniques (pronuclear transfer and maternal spindle transfer) to go ahead. But there are good reasons for caution.

This is not about finding a cure. It is about preventing people with MCD being born. We need first to be clear that these new technologies, even if they are eventually shown to work, will do nothing for the thousands of people already suffering from mitochondrial disease or for those who will be born with it in the future.

There are also already some alternative solutions available for affected couples including adoption and egg donation.

But apart from this I’m left with four big questions.

Is it safe? This is far from established. Each technique involves experimental reproductive cloning techniques and germline genetic engineering, both highly controversial and potentially very dangerous. Cloning by nuclear transfer has so far proved ineffective in humans and unsafe in other mammals with a large number of cloned individuals spontaneously aborting and many others suffering from physical abnormalities or limited lifespans. Also, any changes, or unpredicted genetic problems (mutations) will be passed to future generations. In general, the more manipulation needed, the higher the severity and frequency of problems in resulting embryos and fetuses.

Will it work? I am sceptical. This technology uses similar ‘nuclear transfer’ techniques to those used in ‘therapeutic cloning’ for embryonic stem cells (which has thus far failed to deliver) and animal-human cytoplasmic hybrids (‘cybrids’). The wild claims made about the therapeutic properties of ‘cybrids’ by the biotechnology industry, research scientists, patient interest groups and science journalists duped parliament into legalising and licensing animal human hybrid research in 2008. Few now will remember Gordon Brown’s empty promises in the Guardian on 18 May that year of ‘cybrids’ offering 'a profound opportunity to save and transform millions of lives' and his commitment to this research as 'an inherently moral endeavour that can save and improve the lives of thousands and over time millions of people'. That measure was supported in a heavily whipped vote as part of the Human Fertilisation and Embryology Bill, now the HFE Act. But ‘cybrids’ are now a farcical footnote in history. They have not worked and investors have voted with their feet. Ironically, it was in that same Act of Parliament, that provision for this new research was also made.

Is it ethical? No, there are huge ethical issues. A large number of human eggs will be needed for the research, involving ‘harvesting’ that is both risky and invasive for women donors. How many debt-laden students or desperate infertile women will be exploited and incentivised by being offered money or free IVF treatment in return for their eggs? How many thousands of human embryos will be destroyed? If it ever works, what issues of identity confusion will arise in children with effectively three biological parents? What does preventing those with mitochondrial disease being born say about how we value people already living with the condition? Where will this selection end? Some mitochondrial diseases are much less serious than others. Once we have judged some affected babies not worthy of being conceived, where do we draw the line, and who should draw it?

Is the debate being handled responsibly? No. The research scientists involved have huge financial and research-based vested interests and getting the regulatory changes and research grants to continue and extend their work is dependent on them being able to sell their case to funders, the public and decision-makers. Hence their desire for attention-grabbing media headlines and heart rending (but highly extreme and unusual) human interest stories that are often selective about what facts they present.

It must be tempting for politicians to make promises of ‘miracle cures’ in years to come which no one may remember. But I suspect it is much more about media hype than real hope.

This new push is being driven as much by prestige for government, research grants for scientists and profits for biotechnology company shareholders as anything else.

Let’s keep a cool head and instead concentrate on finding real treatments and providing better support for affected individuals and their families rather than spending limited health resources on unethical, risky and highly uncertain high tech solutions that will most likely never deliver. 

 (See BBC, Guardian, Times(£), Independent, Daily Mail and Telegraph).

Three-parent embryos for mitochondrial disease? Twelve reasons for caution

The media is buzzing today with the news that Britain is planning to become the first country in the world to offer controversial ‘three-parent’ fertility treatments to families who want to avoid passing on mitochondrial diseases to their children (See BBC, Guardian, Times (£), Independent, Daily Mail and Telegraph).

The Department of Health announced yesterday that it would draw up draft guidelines to allow fertility clinics to offer the technique. The proposed guidelines would be released for public comment later this year, and Parliament would vote on a final version in 2014.

Scientists are currently researching two main three-parent IVF techniques. The first, being developed at Britain's Newcastle University and known as pronuclear transfer (PNT), swaps DNA between two fertilised human eggs. Another, called maternal spindle transfer (MST), swaps material between the mother's egg and a donor egg before fertilisation.

The BBC is heralding it as a ‘ground-breaking technique for preventing serious genetic disease’ and a ‘bold step for science and society’. Media reports are full today of reassurances that that mitochondrial DNA only accounts for 37 out of our 20,000 human genes and that this therefore is a small step that will be undertaken only under ‘strict safeguards’.

Most people accessing broadcast media will hear heart-rending accounts of affected families and will get the message that those opposing the move are Luddites and religious fundamentalists on the lunatic fringe.

But there are actually very good reasons we should not be going down this route. Here are just twelve for starters:

1. Even were this new technology to work (and there are huge questions about that) it would help only a very small handful of families and only a tiny fraction of those with mitochondrial disorders. One in 6,500 babies is born with mitochondrial disorder, about 200 per year in Britain. But only five to ten of these have conditions serious enough to merit this intervention.  The technology will not help the other 190 or the 12,000 people in the UK already living with mitochondrial disease.

2. Babies with serious mitochondrial disease will still be born as many families are not aware they are even carrying the abnormal genes until after the birth of at least one affected child. So this will largely be relevant only in preventing the birth of subsequent affected children to these families.

3. There are already alternative routes for these families to have unaffected children either through adoption or egg donation (although I personally have serious ethical misgivings about the latter).

4. Both techniques above involve cell nuclear replacement ‘cloning’ technology which has not yet been shown to work in humans. Whilst it appears to be effective in lower mammals like mice (see here) use of cloning techniques in higher mammals has resulted in huge numbers of miscarriages and the birth of large numbers of abnormal offspring. It took 273 attempts to produce Dolly the Sheep and she herself was abnormal dying early. There is a strong possibility that we may simply be trading mitochondrial disease for other abnormalities if babies are ever born after use of the technique.

5. It is likely that thousands of embryos will need to be produced and experimented upon in developing these techniques. Many, like me, who believe that human embryos are worthy of the utmost respect and protection as early individual human lives will argue that the end of producing an unaffected baby does not justify these means.

6. Tens of thousands of eggs will be required for this research. It is virtually certain that donated excess eggs from those undergoing fertility treatment will not be adequate to meet this demand and that egg harvesting from paid donors will be necessary leading to exploitation of  vulnerable women and exposure to  at times high-risk egg-harvesting procedures.

7. If successful, this research will cross an ethical and safety rubicon by allowing human germline genetic therapy for the first time in human history. The genes from the third parent will be passed on down the generations and will be impossible to remove from the family.

8. Any babies resulting from this therapy will have a third genetic parent whose details will not be on the birth certificate. This raises issues of personal and family identity for children born as a result of the technique and will inevitably lead to litigation involving parents wanting to assert maternity rights and children wanting information about all their genetic parents. Behind these cases will be the hugely emotive issues of custody and inheritance.

9. Allowing the technique will lead to further demands for extension in two ways. It will be argued that if we have accepted germ line therapy for mitochondrial disease then we should also accept it for genetic disorders transmitted by nuclear DNA and for less serious mitochondrial disorders. This will lead to pressure to extend the use of these techniques to other diseases. By backing germ line therapy even in these limited circumstances the UK is crossing a line that every other country which has considered the matter has concluded is too dangerous.

10. These techniques do not offer support or treatment to people affected with mitochondrial disease but rather are aimed at identifying these individuals at the embryo stage and genetically engineering them. There is more than an element of eugenic thinking here. Is it right for us to decide that lives with serious disability are not worth living to the extent that such people must be prevented being born or genetically altered to make them acceptable? This is a very dangerous slippery slope indeed.

11. In addition to genuine compassionate concerns about affected families there are very powerful ideological and financial vested interests in this field including research grants for scientists, profits for biotechnology companies and prestige for the British government. 

12. Hard cases do not necessarily make good law or policy. I remain deeply suspicious of the way this 'breakthrough' that will potentially help only a tiny number of people with a very limited number of conditions is being  foisted on the British public using emotive personal stories by an incredibly well-organised coalition of politicians, biotechnology companies, journalists, research scientists and patient interest groups without full consideration of the concerns like those above which many have expressed. I suspect there are much bigger agendas here that are not yet being fully disclosed. Are we, for example, seeing reproductive cloning and germ line therapy being deliberately smuggled in under the back door under the guise of compassion? The moving boundaries and mission creep we have seen with other IVF-related technologies should sound a huge note of caution for us. 

I have written previously on mitochondrial disease here, here, here and here. Also see CMF’s official submissions to the HFEA and Nuffield consultations on this issue and  a recent blog post where we argue that these techniques are unsafe, unnecessary and unethical.  

Update on Gay marriage Bill in House of Lords - what happens next?

Colin Hart, Campaign Director of the Coalition for Marriage (C4M), has this week issued a very useful summary on the current status of the Marriage (Same Sex Couples) Bill, which is now moving to Report Stage in the House of Lords.  

It outlines the main concerns with the bill and the way it undermines civil liberties and changes the meaningsof words like ‘husband’ and ‘wife’.

I have reproduced it below:

The Bill has now completed its Committee Stage. As is usual, there have been no votes during Committee Stage. The Bill now moves to Report Stage, scheduled to take place on 8 and 10 July, when we expect there will be votes on key amendments.

During Committee Stage, many Peers have been pressing for a long list of protections for people who believe in traditional marriage, including:

• Protecting people at work from being disciplined just because they voice support for traditional marriage.

• Stopping local authorities using the Public Sector Equality Duty to ban a church from hiring public facilities just because the church disagrees with same-sex marriage.

• Protecting foster carers from being blacklisted by social workers just because they believe marriage is the union of a man and woman.

• Giving couples the option of marrying according to the real definition of marriage, rather than being forced to marry according to the new genderless definition.

• Protecting the right of teachers to express support for traditional marriage without risking their careers.

• Making clear that freedom of speech about marriage should not be restricted by equality laws.

There have been some passionate and excellent speeches from Peers who support these protections, including from a number of the country’s top legal experts. A former Lord Chancellor and two former senior judges lent their voices to the call for civil liberty safeguards.

The Government has promised to change the criminal law so that criticism of same-sex marriage won’t be, of itself, a hate-crime. We welcome that reassurance, but our primary concern lies with civil, not criminal, law. For example, employment law and discrimination law – where the problems are most likely to arise – are part of civil law. Here, the Government has stubbornly refused to give an inch on safeguarding the freedom of people who believe in traditional marriage.

They even went as far as saying people who work in the private sector – let alone public sector – should be fired if they refuse to provide services for a same-sex wedding. As far as the Government is concerned, there should be no liberty of conscience in those circumstances.

That shows what we’re up against, but we have no intention of backing down. We will be working hard to call for safeguards for people – like you – who support traditional marriage.

This is important work, but we haven’t stopped defending the principle of real marriage. We always said the Government would tie itself in knots trying to redefine marriage, and here is just one example: in the official Explanatory Notes which accompany the Bill, the Government says:

The terms “husband” and “wife” here refer to a person who is married for the purposes of paragraph 1(2)(c) of Schedule 3. This means that “husband” here will include a man or a woman in a same sex marriage, as well as a man married to a woman. In a similar way, “wife” will include a woman married to another woman or a man married to a man. The result is that this section is to be construed as including both male and female same sex marriage. 

In other words, under this Bill, a woman can be a “husband” and a man can be “wife”. It just shows that words lose all meaning when politicians meddle with marriage.

21st century Britain - a dying rose severed from its cultural roots

The 20th Century was defined by economic and class-based divisions between socialists and capitalists. But, with the main political parties now increasingly embracing free market capitalism, it is culture rather than economics which has now become the defining political divide. The 21st Century is characterised by cultural, social and ethical fault lines between liberals and conservatives.

                         

The main vehicles of British culture - parliament, the institutions, judiciary, universities, media, arts and entertainment- are increasingly now populated and dominated by a liberal elite which embraces an atheist worldview and the ethics of secular humanism. People who were in their teens and twenties in the 1960s are now running the country, 150 years after the start of decline of British Christendom in 1860.

Liberal elite values are characterised by sexual permissiveness, easy divorce, cohabitation, liberal abortion, drug legalisation, government interference, higher taxes, increased welfare spending and more recently by political correctness, embryo research, same sex marriage, euthanasia and the marginalisation of, and discrimination against, those with conservative values.

Social conservative values I see as including sexual purity, marital faithfulness, family and community loyalty, upholding the sanctity of life, respect for king and country, accountability, responsibility, integrity, stewardship, simplicity, sacrificial service, self-control, a strong work ethic and both charitable provision and legal protection for the most vulnerable.

In Britain these social conservative values are essentially Christian values – which have their roots in the Bible and were revived by the 16^th century reformation, by the 17^th century puritanism that drove the Pilgrim fathers and the non-conformist movement, and by the 18^th century evangelical revival under Wesley and Whitefield (and  parallel Great Awakening in America) which led both to the 19^th century social reform catalysed by the likes of Wilberforce and the Clapham sect and also to the 19^th missionary movement, beginning with Carey in 1793, which profoundly shaped the Christian culture of the British Empire.

Christian social conservative values are a strange mixture of right and left wing political concerns – combining traditionally left wing concerns for the poor, disabled people, ethnic minorities and concerns about developing world trade, aid and debt with a more traditionally right wing opposition to abortion, euthanasia, divorce, sexual immorality and substance abuse.

David Cameron fails to understand this because he understands Christianity primarily in terms of its influence on Britain’s architecture, language, constitutional monarchy and parliamentary democracy but without really grasping Christianity’s fundamental world view and ethics except in very vague terms.

His recent speech on the 400^th anniversary of the KJV illustrates this well – where he talked about ‘responsibility, hard work, charity, compassion, humility, self-sacrifice, love…pride in working for the common good and honouring the social obligations we have to one another, to our families and our communities…’ but tellingly left out any reference to the sanctity of life, sexual purity, respect for conscience or most importantly any reference to the mission of Christ or his incarnation, crucifixion, resurrection, ascension or return in judgement – concepts which by contrast the Queen does actually seem to understand.

Iain Duncan Smith in his 2006 analysis of ‘Breakdown Britain’ I believe attributed accurately the decline to the ‘five pathways to poverty’: family breakdown, educational failure, economic dependence, indebtedness, and addiction which he calculated costs us £102 billion per annum.  He listed 191 policies aimed at reversing the breakdown, with which I have much sympathy, but I see the underlying solutions as predominantly spiritual rather than political.

This is because at a deeper level I see the breakdown of Britain and its five 'drivers' as symptoms of a more general spiritual malaise – a loss of Christian faith and values – of Christian belief and behaviour. What is missing is the sense of accountability, responsibility, human dignity and empathy that has its roots in a Christian world view.

The problem with Britain is that like a dying rose it has been severed from the very roots which were responsible for its, now fading, bloom. 

Scottish government committee recommends making free leather gloves available to teenage burglars

Colin McGregor (not his real name) is unlikely to forget his 15th birthday.

‘The night I cut my hand, I was celebrating my birthday,’ he says. ‘I told my friend I was going to burgle a house down the street because I wanted a television set. He said I should be careful that I didn’t cut myself smashing a window but I didn’t take proper precautions and came back bleeding. I was scared about people’s reactions but a bit excited at the same time. But then when I told my parents they didn’t take it well at all. All hell broke loose.’

‘Anyway this big cut in my hand needed suturing and then got infected which meant that I was grounded and couldn’t go out with my mates until it was properly healed. I missed out on a lot of fun having to stay at home when they were all out having a good time. And it stopped me playing tennis too.’

Unplanned lacerations are inevitably traumatic for the individuals concerned but they also have a negative impact on wider society. A report from Holyrood’s health and sport committee, published last week, calls for a national strategy to reduce injuries from burglaries.

Controversially, it recommends starting burglary education ‘as early as possible - pre-school even’ and making free protective leather gloves widely available to teenagers as young as 13.

Scotland has one of the highest teenage burglary rates in Western Europe and while teenage burglary levels are lower in Scotland than for Britain as a whole, Scottish government targets on reducing teenage burglary have yet to be met.

Dundee has the highest rate of teenage burglaries and those in the most deprived areas are almost five times more likely to suffer injuries than those in the least deprived.

While the report took care not to stigmatise teenage burglary, it highlighted the danger of injury and the cost to the general public. Teenagers who burgle are less likely to complete their education, more likely to live on benefits or in poverty and more likely to experience family conflict.

Andrew Houston, chief executive of Teenagers 1st, a charity which is broadly in favour of the report’s recommendations, says that injured burglars fall into three groups.

‘Some injuries are completely accidental and there is an issue with knowledge and information and access to leather gloves but there is also an issue with doing burglaries when they are drunk and which they regret afterwards,’ says Houston. ‘The second group are proactive and want to injure themselves or are ambivalent but wouldn’t mind if it happened.’

‘Often those are teenagers who live in poverty and deprivation. They don’t have aspirations and ambitions and they don’t feel part of anything. A scar following injury while carrying out a burglary is often seen as something desirable. It gives them an identity. Then there is a third group where they get injured after being led on by abusive people.’

‘It has ever been that teenagers will experiment with burglary,’ says Houston. ‘It is unlikely we will ever be able to stop that entirely. We then have a choice. If young people are going to burgle is it our preference to say, “You must not,” or do we talk about it, explain it is not the best time to do this, support them and help them to protect themselves?’

Note: This report was adapted from a Sunday Times report (£). This was not originally about burglary and injuries but another illegal activity, having sex with someone under sixteen, which runs the risk of an unplanned pregnancy.  The names have been changed but the same government committee did actually recommend making free protective condoms available to teenagers as young as 13.