分娩vs流产，哪种选择的负面影响更大？｜科学60秒

2023-02-11 14:02

生育与堕胎

美国最高法院于当地时间2022年6月24日作出决定，推翻具有里程碑意义的“罗诉韦德案”（Roe v. Wade），一项1973年堕胎合法化的裁决。尽管专家对这一结果已有预料，最终的裁决仍震动了全美乃至全球。

美国加州大学旧金山分校（University of California, San Francisco）的妇产科与生殖科学教授黛安娜·格林·福斯特（Diana Greene Foster）说：“这一决定的冷酷也令人唏嘘：宪法竟不保护人们关于像生育这样基本的事情做出决定的权利，而这些决定对他们的健康和养活自己和孩子的能力会产生巨大的影响。”

福斯特领导了Turnaway研究，这是一项纵向研究，对近1000名寻求堕胎的妇女进行了调查，这些妇女要么成功堕胎，要么因为刚刚超过妊娠截止日期而被“拒之门外”（turned away）。

与一些反堕胎积极分子所说的相反，堕胎并没有伤害妇女。研究发现，实际的情况是：无法进行人工流产的妇女受到了负面影响。

福斯特：“调查中我们看到了非常大的健康负担，对于足月妊娠的人来说，健康风险更大，这与医学文献的结果一致。我们发现分娩并发症多于流产并发症，事实上，研究中有两名妇女在分娩后死亡。”

但影响不仅限于健康。被拒绝堕胎也会对家庭财务产生长期的负面影响。

福斯特：“在一组受试者分娩后，那些成功堕胎和被拒绝堕胎的人，你可以在她们的信用记录和公共财务记录中看到，被拒绝堕胎的受试者比成功按自己意愿堕胎的受试者经历了更多的破产、驱逐，背负了更多的债务。”

无法进行堕胎并被迫足月怀孕的情况下，受试妇女的结局更为糟糕。这里须要指出的是，Turnaway研究仅涉及妇女，但实际上并非所有怀孕或寻求堕胎的人都是妇女。

堕胎的人与想要孩子的人并没有根本的不同。福斯特和同事发现，许多寻求堕胎的妇女后来在准备好时生了宝宝，这些孩子过得更好，也更有安全感。

福斯特：“当她们堕胎后又继续生活一段时间再生孩子时，我们看到这些孩子的处境比被拒绝堕胎的母亲生出的孩子更好，他们与母亲的情感联结更深，经济状况更好，也就是这些孩子所处的家庭更能负担得起他们的食物和健康。”

裁决正式生效时，各州将通过法律彻底限制或禁止堕胎。美国已有13个州制定了所谓的触发法规，一旦“罗诉韦德案”被推翻，新法案就会立即生效。这些州的孕妇为了堕胎将不得不出国，前提是她们能负担得起这笔费用。

对于那些无法获得所需要的护理的人来说，后果将极为严重。

福斯特：“对于那些因为美国最高法院允许各州禁止堕胎而无法堕胎的人来说，我们将看到身体健康状况更差、经济困难更大、理想计划的实现率更低、孩子在更不稳定的经济环境中长大的各种处境，人们的生活被颠覆了。”

推翻“罗诉韦德案”的另一个影响是，将会有更少的医疗从业人员接受堕胎培训。在2022年4月发表在《妇产科》（Obstetrics & Gynecology）杂志上的一篇论文中，研究人员发现，如果最高法院否决“罗诉韦德案”，大约45%的妇产科住院医师项目所在的州肯定或可能禁止堕胎，这意味着类似比例的妇产科医生将无法接受……[查看全文]

The Harmful Effects of Overturning Roe v. Wade

Tanya Lewis: This is Scientific American’s 60-Second Science. I'm Tanya Lewis.

On Monday a Supreme Court draft opinion was leaked, causing shockwaves. The opinion—if it’s officially adopted—will overturn Roe v. Wade, the landmark 1973 ruling that guarantees the right to an abortion. Even though experts were expecting this outcome, the leaked opinion still came as something of a surprise.

Diana Greene Foster: The callousness of the decision is kind of shocking, too..., the idea that the Constitution doesn’t protect people’s decision-making around something so fundamental as childbearing, when it has such huge impacts on their health and their ability to support themselves and their children.

Lewis: That’s Diana Greene Foster, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. She led the Turnaway Study, a longitudinal study of nearly 1,000 women seeking abortions who either got them or were “turned away” because they were just past the gestational cutoff.

Contrary to what some antiabortion activists say, getting an abortion did not harm women. In fact, women who were unable to access abortions were the ones who saw negative impacts, the study found.

Foster: What we see is very large health burdens, greater health risks for people who carry pregnancies to term. That's consistent with the medical literature. We see greater complications from childbirth than from abortion, and in fact, two women died after giving birth.

Lewis: But the impacts were not limited to health. Being denied an abortion also had long-lasting negative effects on families’ finances.

Foster: After one group gave birth, the people who received abortions and were denied abortions there, you can see in their credit records, you can see in their public financial records, that one group experienced greater bankruptcies, evictions, greater debt than other people who received their wanted abortion.

Lewis: Not being able to access an abortion and being forced to carry a pregnancy to term resulted in worse outcomes for these women. I should note that the Turnaway Study specifically involved women, but of course not all people who get pregnant or seek abortions are women.

And it’s not as though people who get abortions are fundamentally different from those who want kids. In fact, many of the women who sought abortions later had children when they were ready, and those children fared better and were more secure, Foster and her colleagues found.

Foster: When they go on and get an abortion and they go on and have a baby, we see those babies do better than children born because their mom was denied an abortion in terms of the mom’s emotional bond with the child, the kids’ economic well-being—the chance that they live in a house with just enough money to pay for food and health.

Lewis: If the draft opinion becomes official, it will immediately open the door for states to pass laws to restrict or ban abortion outright. And in fact, 13 states already have so-called trigger laws that will take effect as soon as Roe is struck down. To get an abortion, pregnant people in these states will then have to travel out of state if they can afford to do so—or they will not be able to one.

And the consequences for those who can’t get the care they want will be serious.

Foster: For people who are unable to get their abortion because the Supreme Court just lets states ban abortions, we’re going to see worse physical health, greater economic hardship, lower achievement of aspirational plans, kids raised in more precarious economic circumstances, and people’s lives upended.

Lewis: Another effect of overturning Roe is that fewer medical providers will be trained in providing abortions. In a study published in the journal Obstetrics & Gynecology in April, researchers found that about 45% of ob-gyn residency programs are in states that are certain or likely to ban abortion if the Supreme Court strikes down Roe. This means a similar percentage of ob-gyn residents wouldn’t be able to...[full transcript]

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