Abortion Ban Does Not Mean More Maternal Deaths, Chilean Study Finds
“This study provides evidence that the legal status of the therapeutic abortion is not related with maternal mortality reduction. Moreover, after abortion was prohibited, an additional reduction in maternal and abortion mortality was observed in Chile,” Dr. Elard Koch, an epidemiologist on the faculty of medicine at the University of Chile, said in an e-mail to CNSNews.com.
Illegal abortions do not necessarily correlate with unsafe abortions, Koch continued.
“Although (it) is frequently considered that illegal abortion is related with ‘unsafe abortion’—especially in developing countries with restrictive abortion laws, our preliminary findings suggest that although in Chile abortion is fully clandestine, it occurs in very low-risk sanitary conditions,” Koch explained.
Koch said that education and improved health care access appear to fuel the decrease in maternal deaths in Chile.
“The increasing education level appears as the most important factor predicting maternal mortality reduction in this developing country, likely influencing other factors such as reproductive behavior (fertility rate) and maternal health facilities,” Koch said.
To assess if legal abortion is associated with lower rates of maternal deaths in Chile, Koch examined vital statistics data for maternal deaths from 1960 to 2007.
“Historically, an active epidemiological surveillance in maternal mortality has been carried out in Chile, including deaths by abortion,” Koch said.
Abortion was legal in this Latin American country until 1989 when it was completely outlawed. Abortion was legal from 1931 to 1988.
Koch observed that maternal mortality peaked in 1961, abortion causing 34% of maternal deaths. From 1960 to 2007, total reduction in maternal mortality rates equaled 97.9% - regardless of whether or not abortion was legal.
“The present study provides preliminary evidence that indicates that in Chile, the elimination of therapeutic abortion did not translate into increases in maternal mortality. Thus, access to legal abortion does not appear to be necessary to achieve low rates of maternal deaths,” Koch said.
Koch added that the association between poor education and high maternal mortality should be studied further.
Dr. Susan Yoshihara, vice president for research at Catholic Family and Human Rights Institute (C-FAM), told CNSNews.com that Koch’s study is significant because global abortion lobbyists equate illegal abortion with unsafe abortion and claim maternal deaths would decline with liberal abortion laws.
“(Global abortion lobbyists claim) illegal abortion, or unsafe abortion, is causing a certain number of deaths—anywhere between 13,000 and 80,000 a year in the world—and therefore, abortion has to be legalized in order to make it safe. And (they claim) that will save women’s lives,” Yoshihara said.
Yoshihara called the data which abortion supporters cite to make that claim “unsubstantiated” and “unverifiable.”
Yoshihara called the Chilean study “very exciting” because though preliminary, its data is “outstanding,” setting it apart from other studies on maternal mortality rates in developing countries.
“This study is remarkable because Chile, although it is considered a developing country, has outstanding maternal health data dating all the way back to the beginning of the 1900s,” Yoshihara said.
Because this study shows a steady decline in abortion after 1961, it undercuts the abortion lobbyists’ claim that liberal abortion laws are needed to protect women’s health, Yoshihara said.
“And it’s pretty clear that maternal mortality decreased whether or not abortion was legal in that country,” she added.
Yoshihara said both sides of the abortion debate agree that there is a dearth of reliable data on maternal mortality rates in developing countries.
“The reason for that is that the developing world doesn’t keep good records,” she said, explaining, “It’s very rural, (and) they don’t have good health infrastructures.”
Yoshihara said that to make claims based on weak data is unreasonable because “we all know you just can’t get that kind of good data in the developing world.”
She predicted that Koch’s study will be published this year.
Last September, Guttmacher Institute, which supports abortion access, said in a report titled “Estimates of Health Care System Costs of Unsafe Abortion in Africa and Latin America” that 19 million unsafe abortions occur each year in developing countries, resulting in approximately 5 million women treated for “serious medical complications.”
The study concludes that the costs of treating medical complications from unsafe abortions significantly burden the public health care systems of the developing world and that post-abortion injuries “are a significant cause of maternal morbidity.”
In a report from last October, Guttmacher Institute President Dr. Sharon Camp states, “Legal restrictions do not stop abortion from happening, they just make the procedure dangerous. Too many women are maimed or killed each year because they lack legal abortion access.”
The report, titled “Abortion and Unintended Pregnancy Decline Worldwide as Contraceptive Use Increases, But Progress Over Past Decade Has Been Uneven, and Unsafe Abortion Remains a Key Challenge to Women’s Health,” also states, “Unsafe abortion causes an estimated 70,000 deaths each year, and an additional five million women are treated annually for complications resulting from unsafe abortion. Approximately three million women who experience serious complications from unsafe procedures go untreated.”
Guttmacher Institute Communications Associate Rebecca Wind declined to comment on the initial findings of Koch’s study.
“(Chile) is not a country we have expertise in, so it’s not something we would comment on,” Wind said.
Koch presented his preliminary findings at the inaugural meeting of Women and Children First: International Working Group for Global Women’s Health Research last January in Washington, D.C.
A consortium of region specific working groups, Women and Children First brings together maternal health researchers from the United States, Peru, Chile, Mexico, Jamaica, Kenya, Nigeria, Lithuania, France and several other nations to address the critical need for evidence-based research on maternal mortality causality and methods to decrease maternal mortality.
ABSTRACT FROM KOCH’S STUDY
Is there an association between maternal mortality reduction and abortion legalization? Preliminary data from time series analyses in Chile, 1960 - 2007.
Elard Koch1 on behalf of The Chilean Maternal Mortality Group
1Department of Family Medicine, Faculty of Medicine, University of Chile, Santiago, Chile.
Background: Nowadays, the impact of abortion prohibition on maternal mortality trends in developing countries is unknown. Chile offers the opportunity for assessing the impact of different factors related with maternal mortality reduction, including two periods before and after abortion was prohibited in this Latin American country.
Methods: Time series of maternal mortality ratio (MMR) and abortion mortality ratio (AMR) from 1960 to 2007 were analyzed using multiple autoregressive moving average (ARIMA) models. Therapeutic abortion was legal until 1989 and was considered as a dummy variable in statistical analyses along time series of social and demographic factors and maternal health facilities.
Results: During the study period, MMR decreased from 293.7 to 18.2 per 100,000 live births (-93.8%); AMR decreased form 92.5 to 1.7 per 100,000 live births (-98.1%). No significant effect of legal and illegal abortion periods on these decreasing trends was observed in ARIMA models. After abortion was fully prohibited, MMR and AMR decreased from 41.3 to 18.2 (-44.1%) and 16.5 to 1.7 (-10.3%) per 100,000 live births respectively. The average of education years, illiteracy rate, GDP per-capita, and the percentage of delivery by skilled attendants were all significant predictors of MMR. The same factors along decreasing fertility rate were significant predictors of AMR trends.
Conclusions: Reductions in MMR and AMR are not related with legal/illegal therapeutic abortion periods in Chile. The increasing education level appears as the most important factor predicting maternal mortality reduction in this developing country, likely influencing other factors such as fertility and maternal health facilities.