Abortion and Maternal Death

Study: Education is key to reduced mortality

SANTIAGO, Chile — Women die in greater numbers when they have to resort to illegal abortions. So, to save lives, it’s imperative to decriminalize abortion in countries around the world. That’s been the argument of international pro-abortion groups for years.

But there’s one problem: The numbers behind their claim turn out to be gross exaggerations. So says an American-Chilean research team using statistics from Chile covering the years 1957-2007. They claim the numbers are far more reliable than those touted by pro-abortion activists and refute their argument and the less-than-reliable research it is based on.

The new study shows a steady decline in maternal mortality from abortion throughout the 50-year study period — a decline that continued unabated after abortion was made illegal in 1989.

“This is a pretty powerful statement that you can really push maternal mortality rates down without changing access to abortion,” said Dr. John Thorp of the University of North Carolina, co-author of the Chilean study.

Improvement in education levels was the key factor in reduced maternal mortality, concluded the Chilean researchers, giving the country the second-lowest rate in the Americas, 16.5 maternal deaths per 100,000 live births, behind only Canada.

Asked about the evidence to the contrary cited by abortion-access advocates, such as Planned Parenthood and the Guttmacher Institute, Thorp said, “If the Guttmacher view of the world were correct, you would expect to find abortion mortality at least plateauing in Chile, if not going up. In fact, it went down.”

The study’s co-author, Dr. Elard Koch, an epidemiologist at the University of Chile, told the Register that the marked decline in maternal mortality both generally and attributable to abortion was due to “public policies leading to higher education levels and better maternal-health facilities.” How can education reduce maternal mortality? Thorp offers an example: “In Malawi, it is the mother-in-law who decides what health care the mother gets; but if she is uneducated, she may hold to the cultural belief that a difficult labor is a sign of infidelity and reject hospital care for her daughter-in-law.”

Reviewing research on the issue from African and Latin American countries where abortion has been legalized, the Chilean researchers found none of the evidence claimed by the Guttmacher Institute and others: that legalization of abortion reduced maternal mortality in these regions. The Guttmacher Institute, originally created as Planned Parenthood’s research arm but now independent in governance, remains committed as ever, according to its website, to advancing “sexual and reproductive health and rights.”

Its position is clearly made in the January issue of Lancet, where its researchers, led by Gilda Sedgh, report, “Abortion mortality fell greatly after the liberalization of the abortion law in South Africa. In Nepal, where abortion was made legal on broad grounds in 2002, abortion-related complications fell from 54% to 28% of all maternal morbidities treated at relevant facilities between 1998 and 2009.”

The same study reported that the world abortion rate declined from 35 per 1,000 women per year in 1995 to 29 in 2003, but then stalled, while the proportion of “unsafe” to “safe” abortions had increased. Koch responded that his team “completely ruled out … the methodology described by Sedgh,” which extrapolates national totals from numbers gathered from different types of sources, such as hospitals, surveys and other academic studies.  

Major Overestimation

“Such methodology leads to a major overestimation in the number of clandestine abortions,” Koch told the Register. Moreover, such overestimations then become ammunition for political campaigns for abortion legalization.

In Mexico in 2006, said Koch, “Guttmacher researchers employing the same methodology estimated between 700,000 and 1 million clandestine abortions per year. This study was pivotal for the legalization of abortion in Mexico” in April 2007.

But in the four years following legalization, abortions have totaled only 75,176. Another example of the shaky nature of Third World data came on May 16, in the World Health Organization’s annual report, “WHO Health Statistics.” In 2008, WHO suddenly reduced its annual, global maternal mortality estimate from 542,000 to 358,000. Now it has dropped it further to 290,000.

As for Guttmacher’s attribution of the decline in maternal death in countries such as Nepal to decriminalization of abortion there, Koch said Guttmacher has failed to factor in other likely causes of reductions in maternal death, especially increased literacy and education.

And in South Africa, said Koch, the maternal death rate has increased, not decreased, since decriminalization. But Guttmacher’s analysts responded that it was the Koch-Thorp study’s methodology that was lacking.

According to the Guttmacher Institute’s team, Chile’s abortion laws before criminalization in 1989 were already very restrictive and permitted abortion only to save a woman’s life, which is rarely necessary. Therefore, criminalization would have little impact on maternal mortality or abortion mortality.

As well, the Chilean study’s reliance on vital statistics is unreliable, say the Guttmacher analysts, because women generally underreport illegal abortions for fear of criminal charges. It is just this problem with underreporting that has led to the development of the methodology used by Guttmacher, relying on women’s surveys and data from sample hospitals and published in peer-reviewed journals.

Koch said he was aware his team’s conclusions are “controversial with regards to the real impact of the illegal status of abortion on maternal health, but they are supported by actual and objective data.”

He denied the Guttmacher Institute’s claim that Chile’s law was not severely restrictive before 1989 but allowed “therapeutic” abortions. In fact, for three-quarters of the period under review, it was the single most common cause of maternal mortality by far, hovering around one-third of all maternal deaths and only shrinking far below that mark to 6% after it was made completely illegal.

He also points out that the study shows Chile gradually progressing to one of the lowest rates of maternal mortality without liberalizing its abortion law. “This 50-year natural experiment provides strong evidence,” he said, “for the first time, that a liberal law of abortion is unnecessary to improve maternal health: It is a matter of scientific fact in our study.”

Steve Weatherbe writes from Victoria, British Columbia.