Talk:Abortion

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Milestones of prenatal development having purported moral relevance

This article is heavy on debunking notions that abortion has adverse effects on women, but is light on the effects that abortion has on the embryo or fetus. I think this article should say more about what abortion does, and not just what it doesn't do. It's not enough to just say that an abortion causes the death of an embryo or fetus. It would be much more informative to say, for example, that an abortion after X weeks stops a beating heart, an abortion after Y weeks stops a fetus that has started to move its head and limbs, an abortion after Z weeks ends a life that stood a better than even chance of surviving to birth, an abortion after P weeks ends the life of a being in which all major human organs exist, et cetera. These are some of the developmental milestones that various legislatures, civilizations, ethicists, and/or pregnant women have deemed to be possibly significant with regard to the morality of abortion.

Now, one could respond by saying that a reader of Wikipedia could easily just go to the articles about the fetus or embryo to find out about these characteristics, but that's incorrect. Those articles do not attempt to single out characteristics relevant to abortion, and indeed there are many aspects of prenatal development that have significance for reasons completely unrelated to abortion. Any thoughts about whether this article should try to do better in this regard? There is a vast literature about the possible moral implications of aborting at various different times in pregnancy, and yet this Wikipedia article mentions none of it.Anythingyouwant (talk) 22:39, 21 February 2011 (UTC)

This is a joke, right? Roscelese (talk ⋅ contribs) 22:54, 21 February 2011 (UTC)

Does it seem funny to you? No, it's not a joke.

Giving zero weight to these matters seems inconsistent with WP:Weight, especially when you consider that the prominence of the abortion issue is mainly due to the effects on the person/ thing that is aborted. I've got some other things to do today, but will be interested to read the replies tomorrow.Anythingyouwant (talk) 22:59, 21 February 2011 (UTC)

It might be useful at Abortion debate, but it absolutely, absolutely does not belong here. "Abortion stops a beating heart" is propaganda, not encyclopedic content. Roscelese (talk ⋅ contribs) 23:02, 21 February 2011 (UTC)

Abortion does not always stop a beating heart. Some do and some don't. That's biology, just like the biological fact that abortion doesn't cause breast cancer. The latter could be considered pro-choice propaganda to the same extent that the former can be considered pro-life propaganda.Anythingyouwant (talk) 23:07, 21 February 2011 (UTC)

Why does this Wikipedia article discuss when fetal pain becomes possible, and when viability occurs, but not any other abortion-related milestones of development? Is it because the others occur months earlier, perhaps?Anythingyouwant (talk) 00:29, 22 February 2011 (UTC)

I don't see anything about fetal pain or viability in this article. Could you clarify what you're pointing out? Roscelese (talk ⋅ contribs) 00:59, 22 February 2011 (UTC)

The fetal pain stuff was removed a few months ago, so now the article is even more focused on the woman, while NPOV would seem to suggest a few more words about impacts on the embryo/fetus, as I suggested at the start of this thread.Anythingyouwant (talk) 01:42, 22 February 2011 (UTC)

The article states in its very first sentence, without mincing words, that abortion involves the death of the fetus. I don't see how one could possibly be more blunt, or upfront, about the impact of abortion on the fetus. MastCell ^Talk 05:12, 22 February 2011 (UTC)

Indeed, I addressed that sentence in my initial comment in this thread. How about if we also say in the lead without mincing words that competently performed abortion has negligible adverse health effects on women --- and then delete all that subsequent stuff about mental health, breast cancer, et cetera? Seriously, the idea that the concept of "viability" would not be mentioned in a Wikipedia article about abortion is bizarre, and why not mention other abortion-related developmental milestones? For example, why not say which abortions stop a heartbeat, and which ones don't? That's simply a biological fact, like the fact that abortion is safer than childbirth when performed competently.Anythingyouwant (talk) 05:38, 22 February 2011 (UTC)

I understand that these concepts are very important to you personally. Unfortunately, on Wikipedia, we follow sources. And if the majority of our clearly reliable sources (and WP:RSMED) seem to be biased against the fetal POV, then we should not give undue weight to those positions, even if they are The Truth and facts. It may be important for one side to focus on the fetus in the abortion debate. In court, I know the concept of viability has come up. These are all places where such content could be presented, given sources. But the content you are proposing doesn't seem to follow any known source. Such a presentation, and the language below, are simply original synthesis, seemingly strung together to present a novel POV.-Andrew c ^[talk] 17:17, 22 February 2011 (UTC)

The notion that "viability" is extremely relevant to abortion is not my POV, but rather is a well-known fact to anyone passingly familiar with the subject. When I get a chance, I'll list some sources for you. Although you may wish to portray any facts that are the slightest bit descriptive of what abortion entails as POV-pushing, actually suppressing such facts fits that description perfectly.Anythingyouwant (talk) 23:21, 22 February 2011 (UTC)

Some proposed language

For starters, can we insert the following into this article?

“ The death of an embryo or fetus has different aspects depending on when during pregnancy it occurs, and these developmental milestones sometimes influence the decision whether to perform, permit, or obtain an abortion.  For example, an abortion after about five months of pregnancy destroys a "viable" fetus that possibly could have survived a premature birth with modern medical technology. ”

This would be a good start. An article like this ought to mention viability.Anythingyouwant (talk) 13:41, 22 February 2011 (UTC)

I think it would be reasonable to mention viability, since this is a significant legal (and conceivably an ethical) milestone in some countries. In contrast, I'm not convinced that "abortion stops a beating heart" has any significance outside the realm of partisan pro-life rhetoric. MastCell ^Talk 05:22, 23 February 2011 (UTC)

Like viability, the start of heart beats is a biological milestone. Just as the law recognizes viability in some jurisdictions, so too it recognizes other biological milestones (e.g. in informed consent laws). Andrew c has correctly pointed out that it all boils down to sourcing. When I get around to closely examining the sources, it may become apparent that viability is not the only significant developmental milestone that this article ought to address. (Of course, I don't agree with the part of Andrew c's comment that dismissed this entire matter as POV-pushing.)Anythingyouwant (talk) 05:27, 23 February 2011 (UTC)

I think the thing is that this article basically discusses abortion from a medical point of view. The societal stuff is mostly split into separate articles. You aren't going to find MEDRS-compliant sources talking about how "abortion stops a beating heart!!!1!!one!" because the MEDRS sources on prenatal development don't tend to make it all about abortion. That's why I think this sort of thing belongs in the Abortion debate article. Roscelese (talk ⋅ contribs) 06:40, 23 February 2011 (UTC)

One of the problems with this article has been consistent attempts to treat it as strictly a medical article, when in fact abortion has many other dimensions, and its prominence in the public mind is just as much due to those other dimensions. This article has a section on history, so reliable historians should be adequate as sources. It also has a section on society and culture, so reliable sources on those subjects should not be excluded either. Excluding all sources except MEDRS sources would skew this article, and make abortion seem like just another run-of-the-mill medical procedure, when in fact it's much more than that. There are other articles that have a mixture of medical and other dimensions, and we don't limit the sources to only MEDRS sources (e.g. see eugenics, pollution, overpopulation, et cetera).Anythingyouwant (talk) 14:08, 23 February 2011 (UTC)

Comment: I agree that the subject resists being reduced to the merely medical/surgical aspect. Discourse on the topic frequently shifts between medical, legal, philosophical, theological, moral, sociological and psychological matters. It would therefore be incorrect to try and separate out these different aspects too much. That's not to say that the main article has to deal with each in depth. With regard to viability it needs to be recognised that when the debate shifts into the moral sphere, the term is more controversial and that it may be used more by one side in the debate than the other, I think we need to remember undue weight and NPOV and not over-use any term which expresses a particular POV. Note, I said over-use. The moral debate is centred on personhood and the various milestones of foetal development are brought into the discussion with reference to that and are generally not discussed in isolation from it. DMSBel (talk) 19:53, 1 March 2011 (UTC)

The public moral debate about whether abortion should be legal/illegal is distinct from the private decision that women make based on whatever info they find relevant. Pro-choice people ostensibly support giving info to women about the embryo/fetus so that the private choice is informed and intelligent, and they ostensibly support the woman's choice even if that choice is to not get an abortion due to ethical concerns. Classifying all ethical concerns about the embryo/fetus as "pro-life propaganda" would therefore be incorrect, and would deny women the "choice" to base a decision on ethical grounds.Anythingyouwant (talk) 20:26, 1 March 2011 (UTC)

Taking Anythingyouwant's suggested text, and modifying it a little, how about: "Milestones in fetal development represent an important aspect in the ethical discussion regarding the beginning of personhood and thus influence the decision whether to permit, perform, or obtain an abortion." Followed by brief description of the milestones with regard to brain function, heart function, and ability to survive if born prematurely?DMSBel (talk) 20:58, 1 March 2011 (UTC)

Just been looking back through the thread and reading it again (I just glanced over it first time). I realise I may have been a bit quick to offer a modified version of the paragraph Anythingyouwant suggested for inclusion, and hope I did not jump in prematurely with my own version which was based around it. Question to Anythingyouwant: Whereabouts in the article were you thinking of with regards to the proposed insert? I should say that I see no reason why we should not cover this aspect at some place in the article. 62.254.133.139 (talk) 14:20, 2 March 2011 (UTC) DMSBel (talk) 14:25, 2 March 2011 (UTC)

I haven't thought about where exactly it would go. When time permits, I'll look at what reliable sources have to say on this subject, and then report back here.Anythingyouwant (talk) 12:26, 3 March 2011 (UTC)

Does anyone object to the addition of a tag:

per current discussion? DMSBel (talk) 13:15, 4 March 2011 (UTC)

General sanctions

According to the very top of this talk page, it appears the rules at this article have just changed considerably. One would have thought that the relevant discussion would have been mentioned here before the decision was made.Anythingyouwant (talk) 22:49, 26 February 2011 (UTC)

Shouldn't really be a problem, since the article history doesn't show any sign of the editing patterns that led to the sanctions being imposed in the first place. --SarekOfVulcan (talk) 16:37, 28 February 2011 (UTC)

I actually prefer general sanctions. They're far preferable to only shutting up one side. If I had known about the discussion at ANI, my main concern would have been to limit the general sanctions to the article itself, so that discussion at the talk page continues to be as free as possible (subject to the usual rules about civility).Anythingyouwant (talk) 20:28, 1 March 2011 (UTC)

On second thought, it seems that general sanctions can be easily abused, so I oppose them.[1]Anythingyouwant (talk) 03:48, 18 March 2011 (UTC)

Misuse of the words "elective" and "therapeutic"

1. Wikipedia Elective surgery states: "Elective surgery is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patient's life, but does not need to be performed immediately."

2. Medicinenet.com defines the term Elective surgery as follows: "Surgery that is subject to choice (election)...As opposed to urgent or emergency surgery." [[2]]

3. Medicinenet.com defines the term Elective as follows: "In medicine, something chosen (elected). An elective procedure is one that is chosen (elected) by the patient or physician that is advantageous to the patient but is not urgent. Elective surgery is decided by the patient or their doctor. The procedure is seen as beneficial but not absolutely essential at that time." [[3]]

4. Wikipedia Surgery states: "Types of surgery: Surgical procedures are the commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation. Based on timing: Elective surgery is done to correct a non-life-threatening condition, and is carried out at the patient's request, subject to the surgeon's and the surgical facility's availability. Emergency surgery is surgery which must be done promptly to save life, limb, or functional capacity. A semi-elective surgery is one that must be done to avoid permanent disability or death, but can be postponed for a short time. Based on purpose: Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition."

Thus a reasonable person would conclude that non-emergency therapeutic surgery is a subcategory of elective surgery. Nearly all surgical abortions are NOT emergency procedures (in other words, they are scheduled procedures and are not medical emergencies).

It seems that this Abortion article's inartful use of the terms "elective" and "therapeutic" confuses the reader rather than clarifying important distinctions. One would use "elective" to describe a procedure based on the timing of the surgery. One would use the term "therapeutic" to describe a procedure based on whether there has been a diagnosis. The 2 terms are not mutually exclusive.

If the terms "elective" and "therapeutic" are to be applied consistently (with no politically correct definitions for procedures performed on pregnant women), then virtually all therapeutic abortions are also elective procedures. Practically speaking, in nearly all modern situataions the 2 terms will be mutually inclusive because modern medicine considers the satisfaction of any woman's desire to no longer be pregnant (regardless of the reason why she no longer wants to be pregnant) as "therapeutic", and abortion is virtually NEVER performed under emergency conditions (in other words: there are virtually no occurences in which an abortion must be done immediately to avoid a serious health risk).

The current section of this article called "Induced" [[4]] contains a false dichotomy when it states: "Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic abortion when it is performed to: ... An abortion is referred to as elective when it is performed at the request of the woman "for reasons other than maternal health or fetal disease.".

This false dichotomy should be corrected by helping the reader understand that the 2 terms therapeutic and elective are virtually synonymous, rather than leading the reader to incorrectly think that an abortion is EITHER elective OR therapeutic. Rarely will any therapeutic abortion not also be elective.

Finally, using the term "therapeutic" also implies that the condition of being pregnant is a disease or a health defect, when in reality, absent any political use of medical terminology, pregnancy is a sign of a healthy reproductive system and is never a disease. There are extremely rare occassions when organs of or near the reproductive tract are diseased and an abortion could thus be therepeutic to the gravid woman (though fatal to the fetus).

Perhaps this wording would address these concerns:

An induced abortion is almost always both elective and therapeutic, meaning that it is a non-emergency surgery performed based on a prior diagnosis. Induced abortions are performed for various reasons, including:

• birth control (postpone or stop childbearing); ^
• socioeconomic concerns; ^
• health risk to pregnant woman;
• health risk to fetal siblings;
• prevent further development and birth of disabled or diseased fetus;

^ source: [[5]] (Findings from 32 studies in 27 countries were used to examine the reasons that women give for having an abortion... Worldwide, the most commonly reported reason women cite for having an abortion is to postpone or stop childbearing. The second most common reason—socioeconomic concerns—includes disruption of education or employment; lack of support from the father; desire to provide schooling for existing children; and poverty, unemployment or inability to afford additional children. In addition, relationship problems with a husband or partner and a woman's perception that she is too young constitute other important categories of reasons.) —Preceding unsigned comment added by 67.233.18.28 (talk) 21:37, 28 February 2011 (UTC)

I am not saying this section is ok as it stands or that there should be no discussion what terms to use, there could certainly be improvement, however your suggestion to describe all induced abortions as both elective and therapeutic would I think confuse things further because while any elective abortion requires consent and intention, not every elective abortion is "therapeutic" as that term is defined in the article (being to preserve the life or health of the mother etc.)

I strongly agree that pregnancy in itself is the sign of a healthy reproductive system and that we should preserve that understanding and avoid language which "implies that the condition of being pregnant is a disease or a health defect". However your proposed change does not actually address all your own objections regarding the use of the term "therapeutic", and introduces the word "diagnosis" which might actually re-inforce the impression of pregnancy being a disease. DMSBel (talk) 00:22, 2 March 2011 (UTC)

You are missing a very key thing here. Sourcing. I see you cite AGI, but that article says nothing about "elective" or "therapeutic", and find original synthesis in your proposed wording. That said, the source we are currently citing says this "Most providers consider all terminations to be elective", so I think we are presenting a false dichotomy. The point that emedicine article is making is abortions performed for medical reasons are called "therapeutic abortion". You may personally disagree with this, or find it somehow confusing, but without further sourcing, we have to accept this usage of the term, and not try to redefine it based on how other fields use similar terminology. It appears perhaps the Encyclopedia Britannica is the source using the dichotomy (which may or may not actually be 'false'). I don't have the full text, so I cannot judge. I do think we need to consider our other source which says Most providers consider all terminations to be elective, or a voluntary decision made by the patient herself. There are medical factors both maternal and fetal that contribute to the decision. These factors have been termed therapeutic abortion, defined as the termination of pregnancy for medical indications, including the following.. and see if we are misrepresenting it, and what we can do to bring out text more in line with the meaning of our source. -Andrew c ^[talk] 00:53, 2 March 2011 (UTC)

I expect you'll find different sources that define the terms differently. "Elective" can be contrasted with "therapeutic," which would presumably mean abortions performed due to health threats or not, but it can also be contrasted with "spontaneous," ie. even "therapeutic" abortions are "elective" because they are not miscarriages. Roscelese (talk ⋅ contribs) 01:15, 2 March 2011 (UTC)

You have both possibly not carefully digested my entire original comments. Item #4 in the original comment quotes wikipedia's own general explanation for when a surgical procedure is called "therapeutic". I am simply advocating that the use of terminology in the abortion article be consistent with the terminology used in the surgery article (which accurateluy uses the term therapeutic). The term therapeutic" does NOT mean "to preserve the life or health of the mother", and the abortion article should not use it or define it in such a way.

With regard to pregnancy, a "diagnosis" is actually a determiniation of the cause of a deviation from homeostasis [see: http://en.wikipedia.org/wiki/Medical_diagnosis#Diagnosis_in_medical_practice] or of a "medical condition" [see: http://en.wikipedia.org/wiki/Disease#Medical_condition], so I wouldn't avoid that word "diagnosis".

I do not think the word "therapeutic" is helpful to the abortion article, but I have presumed that people will not want to eliminate the word from the article. My proposed language is certainly sourced and is not original research.

Also, there is no need for the AGI source article to mention the two words (elective or therapeutic) as the article is referenced for the REASONS women choose to have an INDUCED abortion, which is the very subheading (Induced) of the abortion article content we are discussing.

The main reality that the article should elucidate is that virtually all induced abortions are "elective" (meaning they can be scheduled a day or a week out without any harm to the gravid female's health), and virtually all induced abortions are therapeutic (meaning they come after a diagnosis). Barring the very rare (almost unheard of) exception, induced abortions are always elective and therapeutic.

The article as it appears now contains a confusing and imprecise and inaccurate discussion of the terms "elective" and "therepeutic". The artcle as it appears now contains an inaccurate conflation of the term "therapeutic" (inaccurately defined as non-elective) with a list of reasons a woman might have an elective abortion, and a false conclusion that other reasons would make it a non-therapeutic elective abortion. The article contains false information now that appears geared toward convincing the reader that abortions are most often "therapeutic" (with accompanying langauge that implies a therapeutic abortion is medically necessary) and that abortions are not very often elective. But the research (the most comprehensive of which was commissioned by and is propagated by abortion advocacy group AGI) comes hands down against that conclusion.

I have revised the suggested NEW wording:

An induced abortion is almost always both elective (a non-emergency procedure) and therapeutic (scheduled after a diagnosis of pregnancy). Induced abortions are performed for various reasons, including:

• birth control (postpone or stop childbearing); ^
• socioeconomic concerns; ^
• health risk to pregnant woman;
• health risk to fetal siblings;
• avoid birth of a disabled or diseased neonate;

67.233.18.28 (talk) 18:32, 3 March 2011 (UTC)

The problem is that the term therapeutic abortion is not uniformly used in the sense of "scheduled after a diagnosis of pregancy" but quite often with reference to medical indications other than the pregnancy, or in addition to the pregnancy, or in the unborn baby. That seems to be the sense in which it is being used here viz the last three reasons on the list. Elective is being used in the sense of voluntary but without medical indications. Is this not generally the usage in the literature? We should go by more general sources rather than political advocacy groups. While it is not in wikipedia's scope to advance any new nomenclature, we should make sure there is necessary clarification when there is the potential for confusion. DMSBel (talk) 23:27, 3 March 2011 (UTC)

The MedTerms.com definition for "therapeutic abortion" at [6] is "An abortion that is brought about intentionally," which comports with the general definition of the word "therapeutic" (related to a treatment after diagnosis of a medical condition).

The American Heritage dictonary [7] defines "therapeutic abortion" as

• 1. Any of various procedures resulting in the termination of a pregnancy by a qualified physician.
• 2. Any of various procedures resulting in the termination of a pregnancy in order to save the life or preserve the health of the mother.

The Gale Encyclopedia of Medicine [8] defines therapeutic abortion as "the intentional termination of a pregnancy before the fetus can live independently". This definition comports with the language I am suggesting because the term is independent of any serious medical threat to the mother's health (although this definition is also problematic because in practice there are medical doctors in good standing who will induce fetal demise of a fetus that is capable of living independently, and there are laws that protect such abortions).

The wikipedia article for therapeutic abortion is likewise poorly written and inaccurate in that it ascribes a colloquial meaning to a medical term, when there is no evidence that the term "therapeutic abortion" is even used colloquially. That article avoids any mention of the actual medical term of art, when that is the most common and rational starting point for an article about that term. "Therapeutic abortion" seems to be a term that is most often used incorrectly by abortion advocates in an effort to paint most abortions as medically neccessary, when the bulk of research and testimony confirms that abortion is almost never medically necessary. But wikipedia should not propagate such usage when the definition for the medical term can so easily and readily be confirmed.

In any event, the scholarly article at this link [9] asserts that "Most providers consider all terminations to be elective, or a voluntary decision made by the patient herself." This assertion supports my suggestion that the wikpedia main article convey to the reader that most typically, an abortion is elective, and that because the termination of any unwanted pregnancy is de facto deemed to be "therapeutic", therefore all abortions are both elective and therapeutic. The only exceptions are the very rare cases when a pregnancy actually threatens a woman's life.

Here is yet another revision of the suggested NEW wording:

An induced abortion is almost always both elective (a non-emergency procedure) and therapeutic (scheduled after a diagnosis). Induced abortions are performed for various reasons, including:

• birth control (postpone or stop childbearing); ^
• socioeconomic concerns; ^
• health risk to pregnant woman;
• health risk to fetal siblings;
• avoid birth of a disabled or diseased neonate;

76.2.124.88 (talk) 18:21, 4 March 2011 (UTC)

I still don't support your original synthesis: "An induced abortion is almost always both elective (a non-emergency procedure) and therapeutic (scheduled after a diagnosis)." The term "therapeutic abortion" has never once been associated with "scheduled after a diagnosis". This is some novel idea you are promoting, not supported by a single source (but instead, you are mixing definition A with definition B to come up with C, something original, not found anywhere else). The exact same thing applies to "elective abortion" and "non-emergency procedure". The term and the meaning are not found in conjunction with each other in any one source. You are changing the meanings of terms based on your own understanding of how similar terms are used in completely unrelated fields. It's not OK. Sorry.-Andrew c ^[talk] 02:06, 5 March 2011 (UTC)

What is there now in this "Induced" section of the article is terrible. As it stands, it is a mish-mash admixture conflation that needs to be fixed if readers are to actually benefit from the section. —Preceding unsigned comment added by 71.3.237.145 (talk) 01:33, 6 March 2011 (UTC)

I can't figure out from the last comment what the IP thinks needs fixed and what doesn't! I find the term "therapeutic" something of a misnomer when it is not being used to distinguish between abortions performed because of medical indications and those for other reasons, and don't object to it being changed or removed. All abortions that are not coerced are elective whether or not they are done to preserve the life of the mother or unborn fetal siblings. The term was useful when it differentiated between therapeutic reasons (ie when there are medical indications) and non-therpeutic. I agree that the birth control and socio-economic concerns constitute the reasons for the majority of abortions. DMSBel (talk) 22:10, 6 March 2011 (UTC)

Source not represented correctly

Under unsafe abortion there is currently this sentence, sourced to a NY Times article:

"however, generally equating "safe" abortion to "legal" abortion is controversial."

But the NY Times article doesn't say this. It makes it clear that the study's findings were conclusive, not ambiguous, when it comes to the connection between legal status and safety:

"Moreover, the researchers found that abortion was safe in countries where it is legal, but dangerous in countries where it was outlawed and performed clandestinely."

"But the legal status of abortion did greatly affect the dangers involved, researchers said. 'Generally, where abortion is legal it will be provided in a safe manner,' Dr. Van Look said. 'And the opposite is also true: where it is illegal, it is likely to be unsafe, performed under unsafe conditions by poorly trained providers.'"

The only mention of any kind of dispute over the study's findings is this:

"Anti-abortion groups criticized the research, saying that the scientists had jumped to conclusions from imperfect tallies, often estimates of abortion rates in countries where abortion is illegal. 'These numbers are not definitive and very susceptible to interpretation according to the agenda of the people who are organizing the data,' said Randall K. O'Bannon, director of education and research at the National Right to Life Educational Trust Fund in Washington.

He said that the major reason women die in the developing world is that hospitals and health systems lack good doctors and medicines. 'They have equated the word 'safe' with 'legal' and 'unsafe' with 'illegal,' which gives you the illusion that to deal with serious medical system problems you just make abortion illegal,' he said."

This isn't a "controversy." It's one person's unqualifed personal assessment of a World Health Organization study. This personal assessment certainly shouldn't be given the kind of weight it's being given in the article now. Reddestrose (talk) 07:07, 6 March 2011 (UTC)

Thanks for your comment Reddestrose. You quoted the NYT: "the researchers found that abortion was safe in countries where it is legal, but dangerous in countries where it was outlawed and performed clandestinely." Then the NYT quoted a pro-life source. So, the NYT didn't take a position one way or the other, but rather cited two different sources. So for us to say that there's controversy is faithful to what the NYT reported. If you will examine the other two sources that are cited for the sentence in this Wikipedia article, you will find that in an advanced country like the United States, making abortion illegal does not result in the unsafety that would occur if lots of illegal abortions were self-induced or done without access to antibiotics. In contrast, making abortion illegal in third world countries may result in much greater unsafety for women, because clandestine surgical abortions may be self-induced or lack antibiotics. I tried to write the sentence in our article to capture all of this, so please consider all three sources. Also, if you carefully analyze what the two "sides" were saying as reported by the NYT, I think you'll find that they were not necessarily disagreeing with each other about the facts surrounding unsafe abortion, but rather were emphasizing different things. Thanks.Anythingyouwant (talk) 18:22, 6 March 2011 (UTC)

I disagree. The abortion opponent that the NYT quoted is not a scientist or a medical doctor, and it would be wrong to treat his (personal and obviously biased) opinion of a medical study as authoritative. The NYT doesn't do so, and we shouldn't either. Roscelese (talk ⋅ contribs) 19:36, 6 March 2011 (UTC)

I agree we shouldn't treat it as authoritative, and we don't. This Wikipedia article clearly says that making abortion illegal can make it unsafe for women if that causes more self-induced abortions or more abortions without antibiotics to prevent sepsis. That is a 100% correct statement that is true regardless of geographic location, and it is not based on anything that the non-authoritative source said in the NYT.Anythingyouwant (talk) 20:17, 6 March 2011 (UTC)

I don't think we should say that it's controversial unless a source attests controversy. Any new scientific study that finds that denying rights to women or gay people might not be a very productive idea is going to draw criticism from groups who oppose those rights - that's not really controversy, and our NYT source doesn't say there's controversy. Alternately, we could just make it clear that it was anti-abortion groups rather than actual scientists or doctors who criticized the study, since saying there is controversy without any other information suggests that there is scientific controversy. Roscelese (talk ⋅ contribs) 20:31, 6 March 2011 (UTC)

Okay, it might be possible to make it clearer, and I'll try. But it's significant that the NYT article didn't exactly say that researchers equate safe and legal. It just said that a pro-life spokesman asserts otherwise.Anythingyouwant (talk) 20:48, 6 March 2011 (UTC)

I think your addition of "politically" is an improvement. Roscelese (talk ⋅ contribs) 21:11, 6 March 2011 (UTC)

I looked at the two sources mentioned, and now I see the problem runs deeper. The first is over 50 years old, the second nearly 20. Both focus on the impact of illegal abortion in the US (the first mainly, the second exclusively). Why rely on outdated and localized sources when the 2007 Lancet study is recent and global? Reddestrose (talk) 20:23, 6 March 2011 (UTC)

AFAIK, nothing in the two cited sources has ever been contradicted. The issue of what happens when abortion is banned in a developed country is largely a matter of history, and the 2007 Lancet study does not address it. This Wikipedia article says: "An abortion is more likely to be unsafe where abortion is illegal, at least if the illegality results in more self-induced abortions or more abortions without antibiotics to manage sepsis;[75][76] however, generally equating 'safe' abortion to 'legal' abortion is politically controversial.[77]" What's inaccurate about that? Is there a WP:RS that contradicts it?Anythingyouwant (talk) 20:39, 6 March 2011 (

The 2007 Lancet study found abortion is more likely to be safe in regions where it is legal and more likely to be unsafe in regions where it is illegal. It did not suggest that this connection depends on self-induction or antibiotic availability. So the 1960 and 1992 sources are contradicted by a more recent source. Moreover, the 1960 and 1992 sources focus on the US, but their findings are being presented as though they apply on a global level. It's not safe to assume that what may hold true for one country holds true for all others. In short, it would be better to present the findings of a recent, global study instead of stitching together two outdated, localized sources to present a novel conclusion not found elsewhere. Reddestrose (talk) 22:12, 6 March 2011 (UTC)

Looking at the article history I see the first sentence of unsafe abortion was changed yesterday. The first sentence originally read:

"One of the main determinants of the availability of safe abortions is the legality of the procedure."

This sentence should be restored, sourced to the 2007 Lancet study. It reflects current scientific understanding. The sentence in the article now is based on outdated sources - one of them over half a century old. Reddestrose (talk) 22:59, 6 March 2011 (UTC)

The 2007 Lancet study did not address the effects of illegality in developed countries, and the 2007 Lancet study does not contradict any of the other cited sources. Therefore, deleting the other cited sources would present an incomplete and slanted POV. As I explained above, the 2007 Lancet study addressed current policy, and not historical data. I asked above and will ask again, what's inaccurate about what the article now says? Is there a WP:RS that contradicts it?[[Anythingyouwant (talk) 00:39, 7 March 2011 (UTC)

Neither the 1960 nor 1992 sources address the impact of illegality in developed countries. Both focus on the impact of illegality in a specific country, the US. The US is a developed country, but that doesn't mean what holds true for it holds true for the rest of the developed world. It's original research to take data specific to one developed country and present it as if it represents all developed countries. Moreover, neither the first sentence as it stands now nor as it stood yesterday makes any mention of developed country vs developing country, only legal vs illegal.

As to accuracy, a 51 year old source doesn't give an accurate picture of the state of things today. That this article currently relies on a source from 1960 when there is a source from 2007 available is confusing. It doesn't seem logical to present outdated data over current data. Reddestrose (talk) 02:30, 7 March 2011 (UTC)

The 2007 study is summarized by the NYT article, which we cite. So, we are not excluding the 2007 study. I would have no objection if someone wants to add a footnote directly citing the 2007 study, if you want, but we are already making readers aware of it. No single one of the cited sources looks comprehensively at the effects of illegality now and in the past, in both developed and undeveloped countries. But, in combination, they provide readers with a fuller picture than any one of them alone would. You haven't pointed to anything factually incorrect about what this Wikipedia article now says. The cited sources are consistent with each other. Because this is partly a historical issue, there's nothing wrong with citing a source that is old but accurate. We should not give the impression that banning abortion tomorrow in a developed country would have the same effect that banning abortion in an undeveloped country would have; the 2007 study does not address that issue, and we should not give the impression that it does. Moreover, there are various possible ways that abortion could hypothetically be made illegal that are not addressed or encompassed by the 2007 study, so we should be careful about making overly broad statements in reliance on the 2007 study. I think the present language in thus article strikes that balance.Anythingyouwant (talk) 02:43, 7 March 2011 (UTC)

The NY Times article (and thus the 2007 Lancet study) is not being used to support the part about the impact of legal status on safety, rather it's being used to support the part about "controversy." The part about the impact of legal status on safety is based on two outdated sources, one 51 years old. Not to mention that it's original research to present data specific to one country (America) as representative of the entire world. So the current sentence in the article presents outdated data as current and localized data as global. This is an inaccurate and needs to be changed. Reddestrose (talk) 03:16, 7 March 2011 (UTC)

The NYT article is footnoted at the end of the Wikipedia sentence, and it supports more than the statement about controversy in that sentence. Accurate historical data is not outdated if it is not disputed. Reddestrose, so that we don't keep going in circles here, may I inquire whether you believe the 2007 study indicates that the legality of abortion is what prevents unsafe abortion even in developed countries? How could such a conclusion possibly be drawn without examining a developed country where abortion is or was illegal? Such data is necessarily old, but calling it outdated would make the whole inquiry impossible. No source says that the old historical data is incorrect or outdated. As I recall, the sentence before I added sources did not assert that it was based only on contemporaneous analysis without historical context, and the sentence still doesn't say so.Anythingyouwant (talk) 03:51, 7 March 2011 (UTC)

Historical data is appropriate to use when writing about the past, but when making a present tense statement like either version of the first sentence, we need to go by the most recent sources available. Some sources use sets of historical data to analyze trends over time. But data from a particular year and location, in isolation, can only tell us about that particular time and place.

If the goal is to add information on how legal status differently effects developed and developing countries, the place to start would be to look for sources that compare data from many countries and draw conclusions about it. A case study of Ireland could tell us about Ireland, but it couldn't be used to form a generalization about illegality in developed countries. There's many factors that need to be considered, which vary from country to country. Reddestrose (talk) 19:22, 7 March 2011 (UTC)

The sentence is currently unsourced, and I also believe it is inaccurate with respect to the effect of illegality in developed countries. As far as I can tell, the only way to make a statement about the effect of illegality in developed countries is to analyze old data from when abortion was illegal, and compare that accurate old data to more recent data from the era when it's been legal. Without doing that, I don't see how any accurate statement can be made about the effect of illegality in developed countries.Anythingyouwant (talk) 19:37, 7 March 2011 (UTC)

The Lancet study supports the first sentence, so it can be added. I mentioned this above. Reddestrose (talk) 20:02, 7 March 2011 (UTC)

"Weighted too heavily toward only one aspect of its subject"

At the top of the article there is currently a notice which says:

"This article is weighted too heavily toward only one aspect of its subject."

All the major aspects are covered: medicine, law, history, debate, culture. Some areas may need to be expanded, but I don't think any particular aspect's coverage is disproportionate enough to warrant this notice. Reddestrose (talk) 23:32, 6 March 2011 (UTC)

Because whoever put that there didn't post anything on the talk page, or make his issues known, I've removed the notice.--Patton123 (talk) 00:03, 7 March 2011 (UTC)

Actually, another editor did post here at the talk page about it. See the end of this section.Anythingyouwant (talk) 00:42, 7 March 2011 (UTC)

I added the tag. I asked if there were any objections before doing so. Reason for adding was as per discussion here [[10]]DMSBel (talk) 18:53, 8 March 2011 (UTC)

I do not see justification in that section for this tag. We have a whole section here on society and culture. Seems to be reasonably weighted. Doc James (talk · contribs · email) 19:24, 8 March 2011 (UTC)

I see User:MastCell removed the tag and I am not going to put it back, however I can't see the point of having tags if we can't use them when appropriate. I was discussing possible changes with another editor with regard to cleaning up the article and addressing the issue. I didn't see anything wrong with putting the tag in until those issues are resolved. User:DMSBel 62.254.133.139 (talk) 18:38, 9 March 2011 (UTC)

Can you explain here briefly the concerns? Doc James (talk · contribs · email) 18:59, 9 March 2011 (UTC)

There is already a discussion above - Anythingyouwant felt the article was too weighted towards a medical perspective and towards stating that the woman's health was unaffected, he said "I think this article should say more about what abortion does, and not just what it doesn't do." I tend to agree that more coverage needs to be given to abortion in regard to fetal development.DMSBel (talk) 21:33, 9 March 2011 (UTC)

We state what it does in the first line "Abortion is the termination of a pregnancy by the removal or expulsion of a fetus or embryo from the uterus, resulting in or caused by its death" I am not sure what you mean thus you will need to explain more fully before I can assess the need for this tag.Doc James (talk · contribs · email) 06:11, 10 March 2011 (UTC)

What sort of sources do you think we can use to write such coverage? I think there are ample sources on the issue of viability, which has substantial legal (and arguably ethical) significance in many countries. Beyond that, I'm not sure how much coverage is warranted. MastCell ^Talk 22:05, 9 March 2011 (UTC)

(Undent) Just a brief note about the recent tagging of the article. While I do believe that this article is slanted, biased, and incomplete for various reasons that I've mentioned above and previously, I have tried to tackle the issues one by one, which is time-consuming because a lot of research is necessarily involved. My time is limited. As I said above, "When time permits, I'll look at what reliable sources have to say on this subject, and then report back here." While I think tagging this article would be helpful to readers, tagging would probably not be successful without ongoing attempts to hash out the problems. I don't have time to do that at the moment, and that's why I haven't tried to tag the article.Anythingyouwant (talk) 15:32, 10 March 2011 (UTC)

No mention of forced abortion

There has been considerable coverage in the news over recent years on the issue of forced abortion. The article does not refer to this at all. See [11], [12], [13], [14], [15].DMSBel (talk) 19:04, 9 March 2011 (UTC)

Since all of these are from China, it would seem to belong in Abortion in China. Roscelese (talk ⋅ contribs) 19:06, 9 March 2011 (UTC)

Thanks, yes it might be better there - I did not know that there was that article. Those were the links that came up in the first two pages of search results, I know China is particularly under scrutiny I don't know if it happens anywhere else.DMSBel (talk) 19:14, 9 March 2011 (UTC)

Unsafe abortion

I overhauled this section. It seems best to start out with a definition.Anythingyouwant (talk) 03:46, 18 March 2011 (UTC)

I think that starting with a definition is a very good idea. However, I don't think the remainder of the overhaul is an improvement. It seems like virtually all reputable public-health sources agree that the safety of abortion is most strongly tied to its legality, but your overhaul seems to go out of its way to avoid saying this. It introduces qualifications that seem largely editorial, rather than representative of the best available sources. I don't think that a factcheck.org piece on the assertions of various U.S. politicians is the best source for medical and epidemiologic information; better sources are obviously available in the scholarly literature, and we should use them. MastCell ^Talk 04:03, 18 March 2011 (UTC)

You completely removed about a dozen solid sources without giving any reason. If you think that I mischaracterized one of them, how about suggesting a better characterization, instead of completely removing so many sources and footnotes from the article? Regarding the FactCheck piece, do you disagree with any of its conclusions? Do you agree that penicillin and birth control pills have made illegality less of a contributor to maternal morbidity?Anythingyouwant (talk) 04:11, 18 March 2011 (UTC)

I gave you a reason: I think that your edits improperly obscure the content of reliable expert sources. I think the pre-existing characterization was superior (that's why I edited to restore it). I don't really see what problems your edit is intended to fix; your comments focus solely on starting out with a definition, and I agree as far as that goes. I don't think that adding more sources automatically makes the article better, nor does removing sources automatically make it worse. If we add a bunch of technically acceptable sources but, in the process, make it harder for the reader to discern the current state of expert knowledge on the topic, then we've failed. For exampe, we already have top-quality, peer-reviewed, global, up-to-date sources on the epidemiology of unsafe abortion, so I'm still not sure why you want to downplay those in favor of factcheck.org. MastCell ^Talk 04:20, 18 March 2011 (UTC)

Several of the sources I added say explicitly that it is a mistake to conflate illegal and unsafe abortion. Can we please have a source-based discussion? Also, I don't think addition of FactCheck downplays anything; which sources contradict FactCheck?Anythingyouwant (talk) 04:22, 18 March 2011 (UTC)

Several of the sources you added say that while criminalizing abortion makes it much more likely to be unsafe, there is not a 100% correlation between the two. Your sources caution against equating safe abortion with legal abortion - and we don't. On the other hand, your sources note a clear and strong correlation between safety and legality, and your edits don't adequately convey that, IMO. According to your sources, in countries with restrictive abortion laws, wealthy or socioeconomically advantaged women may still be able to access relatively safe abortion services, although poor women are pretty much screwed. Similarly, in some countries where abortion is nominally legal, unsafe abortions still occur because of extralegal barriers to safe abortion. Your edits make it sound like the legal status of abortion isn't really a big deal, but that's at odds even with the sources you've selected.

More to the point, these are sources that you've selected. It's not clear why you've selected these, in preference to the existing high-quality, up-to-date sources that you've downplayed. You're using these new sources to replace conclusions from the previously existing sources, but that's not an appropriate use of these sources. They don't "rebut" the existing sources, and it's an artificial editorialization to use them that way. We should be synthesizing these sources, if anything, rather than cherry-picking them. MastCell ^Talk 05:01, 18 March 2011 (UTC)

You say you don't know how I picked the sources, and then you jump to the bad-faith assertion of cherry-picking. The fact is, all the sources I inserted are high-quality reliable sources, but if you want to name ones you don't like then go ahead.

The article now says: "Most unsafe abortions occur where abortion is illegal, or in developing countries where affordable well-trained medical practitioners are not readily available, or where modern contraceptives are unavailable....The illegality of abortion contributes to maternal mortality...." Only someone with very strangely colored glasses could read that as an assertion that legality is no big deal. More generally, it is important that this article NOT give the impression that legalizing abortion will magically make unsafe abortion disappear, as your preferred language did, and it is important that this article NOT give the impression that the only way to drastically reduce the number of unsafe abortions is to legalize, as your preferred language did. Reliable sources flatly contradict both notions.Anythingyouwant (talk) 05:06, 18 March 2011 (UTC)

I'm not sure I see a big shift in the meaning of the article between the versions, but I must comment that the tone above seems rather more heated than necessary. The rush of wp:BOLD edits by Anythingyouwant was perhaps precipitous, but the breadth of MastCell's reversion was not helpful either. May I suggest that we agree to go back to the version prior to MastCell's reversion then look one at a time at the preceding edits (in reverse time order) to discuss if they should stand or be reverted? Then when that's finished, we can get on with the fixing details in the resultant mix (such as the citation formats). At the moment fixing those would only complicate matters.LeadSongDog come howl! 15:55, 18 March 2011 (UTC)

I am ready and willing to discuss things here at the talk page, but I oppose a blanket revert that would remove reliable sources and restore blatant misinformation. I begged for a blanket revert when this misinformation was inserted en masse by Doc James, and my request was not only rejected here but was also the basis for criticism of me from members of ArbCom. I don't think en masse reverts should be fine for one POV but not another. WP:BRD should apply to everyone, and if it did then the stuff I removed wouldn't have been there in the first place.

I would like to hear MastCell explain why it is important that this article give the impression that legalizing abortion will magically make unsafe abortion disappear, as his preferred language did, and why it is important that this article give the impression that the only way to drastically reduce the number of unsafe abortions is to legalize, as his preferred language did. Reliable sources flatly contradict both lies.Anythingyouwant (talk) 16:19, 18 March 2011 (UTC)

@LeadSongDog: I think your suggestion would be fine; I would welcome a bold, revert, discuss cycle, or even a bold-revert-revert-discuss cycle. I would certainly welcome more outside input, regardless of whether it agrees with me.

To the extent that undue frustration has seeped into my comments, it springs from my perception of a focused, long-standing effort to minimize or downplay the link between abortion's legality and its safety, a link that (whatever one's personal opinions on the subject) is acknowledged as central and uncontroversial by all reputable medical and public-health sources. I perceive a long-term effort to obscure the content of these sources where their findings are ideologically objectionable to individual editors; hence the frustration. The best solution is the involvement of additional outside editors; in the meantime, I will endeavor to improve my tone, starting by ignoring the immediately preceding comment. MastCell ^Talk 16:25, 18 March 2011 (UTC)

And I perceive a long-term systematic effort to slant this article toward one POV, and apply Wikipedia rules selectively to only one side of the dispute.Anythingyouwant (talk) 16:31, 18 March 2011 (UTC)

Not an excuse to avoid WP:BRD. It would be nice if EVERYONE played by the rules.-Andrew c ^[talk] 21:05, 18 March 2011 (UTC)

Well, let's all try to avoid commenting on editors and their supposed intentions and focus instead on the edits. Shall we begin? LeadSongDog come howl! 17:13, 18 March 2011 (UTC)

1. Ok, so this was the last edit. It clearly is in error, attributing present tense to a 2005 document. Ultimately this would better have read "as of ... was". If we can agree on that, I'll revert for now and add that to a list of changes to make later. LeadSongDog come howl! 17:34, 18 March 2011 (UTC)

Sure. MastCell ^Talk 17:48, 18 March 2011 (UTC)

I would not support that revert. Before I touched this section, it already cited the one in eight figure (as 13%). It's a very well-known statistic, and if you give me an hour so I can give you about twenty more recent cites for it. This whole article would have to be in past tense if we demand March 2011 sources for present tense.Anythingyouwant (talk) 18:41, 18 March 2011 (UTC)

That may be mooted by the next point, but be aware that past tense is the normal choice for encyclopedic language anyhow. Otherwise the burden of evidence extends to demonstrating the numbers can't have changed since the cited work. But Chaudhuri's words clearly used the past tense, citing (WHO 2003) in text, but not listing a 2003 publication on p.265. LeadSongDog come howl! 19:04, 18 March 2011 (UTC)

If you look generally at the footnotes for this article, you'll see that dozens are earlier than 2005. If an editor does not show any source contradicting a 1997 source, for example, I don't see the problem using the 1997 source in present tense. As of March 9 (i.e. before my recent edits), this article said: "Complications of unsafe abortion are said to account, globally, for approximately 13% of all maternal mortalities...." That's basically equivalent to the "one in eight" currently in this article, the only difference being that the old source was eight years older: "Salter, C., Johnson, H.B., and Hengen, N. (1997). Care for post abortion complications: saving women's lives. Population Reports, 25 (1) Retrieved 2006-02-22." I provided a source that is eight years more recent, which seems perfectly okay to me.Anythingyouwant (talk) 19:18, 18 March 2011 (UTC)

I don't really have a strong preference here; I think either wording is reasonable. MastCell ^Talk 20:38, 18 March 2011 (UTC)

Actually, it appears the (WHO 2003) mention is of ISBN 9789241590341 which, at its p.3 cites those same 13%/67,000 annually figures to an older paper: 1998. "Global and Regional Estimates of Incidence of Mortality Due to Unsafe Abortion with a Listing of Available Country Data" (WHO/RHT/MSM/97.16). Geneva: World Health Organization. That was almost an entire generation ago now, and much has changed in the intervening years, one hopes for the better, but do we have such a newer source to cite? LeadSongDog come howl! 21:04, 18 March 2011 (UTC)

2. The edit before that was this one. It did two things. Naming a reference to Blas p.182 for an existing statement that cites it would be uncontentious, but also citing it while replacing "where health care is at a generally low level" with "where affordable well-trained medical practitioners are not readily available" when neither statement is truly supported by the reference here, at least not on the cited page 259. Perhaps a more judicious reading of the source(s) would help with this edit. LeadSongDog come howl! 19:04, 18 March 2011 (UTC)

This article says in pertinent part that some unsafe abortions may occur, "in developing countries where affordable well-trained medical practitioners are not readily available." Two sources are cited: Chaudhuri and Blas. The first of these two sources (Chaudhuri) says: "95% of [unsafe abortions] occur in developing countries". No one has disputed this statement of Chaudhuri, and no one has supplied a contradictory source. The other cited source (Blas) says: "Legal abortions – like any other medical procedure – may be unsafe where clinicians are poorly trained or facilities are inadequate. Some countries in which abortion is legal for most indications continue to have high rates of unsafe abortion. India and South Africa are countries where high rates of unsafe abortion persist despite changes in the law that should make abortion readily available. Contributing factors include cost, procedural and bureaucratic delays, inadequate number of trained practitioners to meet demand and concerns about confidentiality for women below the age of majority." I think these two sources adequately support what's in this Wikipedia article, but if someone wants to suggest a rephrase then I'm all ears. LSD acknowledges that the phrase I removed ("where health care is at a generally low level") is not truly supported by the reference. But the stuff I replaced it with is supported by Blas, IMO. Blas repeatedly talks about poor training, inadequate numbers of trained practitioners, and also talks about cost, in countries like India. No one has disagreed that this info from Blas is correct, and no one has suggested any contradictory source. Maybe change "not readily available" to "not readily and confidentially available"?Anythingyouwant (talk) 19:37, 18 March 2011 (UTC)

This is an example of the problem I see in our use of sources. Blas states on p. 182:

The principal social determinant of recourse to unsafe abortion is real or perceived legal restriction on safe abortion. Developing countries are much more likely to restrict access to legal abortion than developed countries, and the restrictions disproportionately affect poorer women. [16]

This source clearly identifies legality as fundamentally linked to safety (as does essentially every other reputable source). I don't have a problem with stating that the availability of well-trained providers contributes to unsafe abortion, even where it is legal. I do have a problem with selectively quoting this source to minimize the impact of legality, when the authors clearly address it as the principal determinant of unsafe abortion. What this source actually says is that legalization is essential, but not sufficient, to prevent unsafe abortion; sufficient infrastructure is also necessary to eliminate unsafe abortion. This is a subtle but, I think, important problem in how we use these sources.

As to the edit in question, I have a weak preference for the version favored by LeadSongDog, but overall I don't feel strongly that one version is better than the other. Mostly, I think the overall way we present these sources is misleading, but presumably we can address that as we unwind the stack of recent edit a bit further. MastCell ^Talk 20:36, 18 March 2011 (UTC)

The issue is partly one of wp:SYNTH. We should keep the statements to what each cite can support distinct, or else we should find a statement that both support. Neither of those two cited pages even mention confidentiality. Blas doesn't mention India until page 183, is that not what we should cite for the cost impact? The ref on p.182 was re the principal social determinant without, afaikt, any comparison between the social and other (esp. cost) determinants. LeadSongDog come howl! 21:04, 18 March 2011 (UTC)