DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service



Office of the Assistant Secretary
for Health
Washington DC 20201

                      July 13, 1981

MEMORANDUM


TO:      The Under Secretary

FROM:    Deputy Assistant Secretary for Health

SUBJECT:  Abortion Surveillance by Center for Disease Control

The Center for Disease Control has an abortion surveillance unit
which periodically publishes in their "Morbidity and Mortality
Weekly Report (MMWR).  To the best of my knowledge, statistics
reported by the unit in MMWR have always been on the number of
abortions performed and/or on the mortality of legal and illegal
abortions.  The CDC unit is under the direction of Willard (Ward)
Cates, M.D.,  a member of the Commissioned Corps of the Public
Health Service.

Pro-life groups across the board have been very critical of
Cates and the CDC for two reasons:  first,  the pro-abortion
editorializing by Cates in the MMWR, and secondly, because of
his frequent writings from a pro-abortion point of view in
medical journals and other publications such as "Family Planning
Perspectives."

Shortly after my arrival in Washington when I went to CDC, I
discussed with Bill Foege, the Director of CDC, the concern of
pro-life groups mentioned above and pointed out to him that
such criticism did not do CDC any good.  Also,  from a purely
scientific and editorial point of view Cates frequently stepped
out of line.  Foege agreed with this and subsequently told Cates
that he must cease editorializing in the manner to which he had
become accustomed and that any pro-abortion scientific publica-
tions could not note his affiliation with CDC.   I considered
both of these steps to be progress.  In addition,  Bill Foege has
sent me the last two reports by the abortion surveillance unit
for approval before they were published in MMWR.   The first of
these which I approved with two word-changes several months ago
was merely a report on the numbers of abortions.   The second
one was a report on mortality of abortion, both legal and
illegal,  and was the report that triggered this memorandum.

In the attached memorandum, note on page 2 that there is an
unnecessary comparison of deaths from several procedures.
Many do not consider abortion to be a surgical procedure. To
compare abortion which is not used in the treatment of a


Page 2 - The Secretary

disease with operations which are used in the treatment of dis-
ease such as tonsillectomy and appendectomy is both unscientific
and irrelevant.  In addition,
unfair.                 the comparison of statistics is
    The figures for tonsillectomy and appendectomy were

accumulated before 1973 while the abortion figures were com-
piled seven years later with the benefit of additional
scientific advancement.

On Page 3 at the top, while the statistics concerning the risk
of death from pregnancy are accurate, the average woman in the
United States who knows she is pregnant, gets good prenatal care,
and has good obstetrical services is nowhere near at the risk of
death of 8.9 per 100,000 live births.,
from a small,                   These figures are derived


care.      frequently mobile group of women with no prenatal

At the bottom of page 3, the association of deaths from illegal
abortion with lack of availability of public funds is probably
not provable.  If it were,  it seems likely that in the heated
debates over the language of the Hyde Amendment on more than
thirty occasions in Congress would have brought these deaths
to public attention.

It seems legitimate to question the necessity of editorializing
at all on abortion statistics,
PHS policy.               especially as this is seen as
        Perhaps most important of all, however, is the fact

that it is not so much the mortality from abortion that is of
concern but rather its morbidity.  The mortality of abortion
insignificant (ll-17/year) compared to the morbidity which is is

more than lOO,OOO/year.
morbidity and mortality, Inasmuch as MMWR is reporting both
                a legitimate question would seem to

be why has there never been a study'of morbidity following
abortion.

The Supreme Court decision of Doe vs Bolton giving preferential
treatment to free-standing abortion clinics in reference to
record keeping makes statistics from such installations meaning-
less.  In addition to that,  the morbidity associated with abortion
performed in free-standing clinics is cared for subsequently not
at those clinics but in hospitals or obstetrician's offices.
Nevertheless, limited studies from hospitals would give a sub-
stantial clue to the incidence of morbidity following abortion.

It is my personal opinion that when the morbidity story is
eventually written,  it will be a serious blot on the contribu-
tion of the medical profession in this past decade.   I believe
it is impreative that a morbidity.study be undertaken and that
Cates be replaced by a scientist concerned with the morbidity
of women in reference to reproduction.

       . .   ;_ -7
              . -CT Jc--' ,
C; Everett`Koop, L.D.
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