ABORTION DOES NOT IMPROVE WOMEN'S REPRODUCTIVE HEALTH

By Denise Hunnell, MD

When the United States House of Representatives debated the Protect Life Act, a bill meant to ensure that no taxpayer money would fund abortions, former Speaker of the House Nancy Pelosi, proclaimed that passage of the bill would leave American women “dying on the floor” of American hospitals. Similarly expressing a concern for “women's health”, United Nations Secretary General Ban Ki-moon, recently called on the United Nations Commission on Population and Development to endorse unfettered access to abortion for teenagers and even younger adolescents. In Trinidad, Minister of Gender, Youth, and Child Development Verna St. Rose Greaves, called for the legalization of abortion in Trinidad because of public health concerns.

Clearly, there is a widespread perception that optimal reproductive health for women includes access to abortion. Yet, where is the data that supports this view? Is this just another manufactured claim by the abortion industry to justify the inclusion of abortion in health care?

The Guttmacher Institute, a pro-abortion research organization founded by Planned Parenthood, tried to bolster this position with a report on abortions in Colombia. This publication claimed that there were over 400,000 clandestine abortions annually in Colombia and at least one-third of these cases had significant medical complications. Their conclusions called for increased abortion 'services' in Colombia:

The study's findings make clear the need to remove institutional and bureaucratic obstacles for women seeking a legal procedure and ensure that health facilities with the capacity and mandate to provide safe and legal procedures do so,” says Cristina Villareal, director of Fundación Oriéntame and a coauthor of the report. “Six out of 10 health facilities in Colombia that have the capacity to provide postabortion care do not provide it, and about nine out of every 10 of these facilities do not offer legal abortion services.

While this study appears and claims to support the view that ready access to legal abortion improves women's health, a just released study by Dr. Elard Koch of Chile refutes this Guttmacher Institute report. Review of the methods for the calculation of clandestine abortions in Colombia reveal that the Guttmacher Institute relied on the opinions of health care workers to estimate the number of abortion procedures and complication rates.

In other words, there was no objective data. The translated abstract of Dr. Koch's article published in Ginecologia y Obstetricia de Mexico states:

There is no objective data based on real vital events, the whole estimate is based on imaginary numbers underlying mere opinions. Even as a public opinion survey, the sampling technique introduced serious selection bias in the gathering of information. Valid epidemiological methods using standardized rates, choosing the paradigmatic cases of Chile and Spain as standard populations, it was observed that Guttmacher Institute methodology overestimates more than 9 times the complications due to induced abortion in hospital discharges and more than 18 times the total number of induced abortions. In other Latin American countries where the same methodology was applied including Argentina, Brazil, Chile, Mexico, Peru, Guatemala, and Dominican Republic, the number of induced abortions was also largely overestimated. These results call for caution with this type of reports that alarm public opinion.

Instead of relying on guesses and subjective opinions, one can actually assess the effect of abortion on women's reproductive health by analyzing the maternal mortality ratio (MMR), a widely accepted indicator of women's health. If abortion were truly critical for the well-being of mothers, one would expect the maternal mortality rate to decrease with increased abortion availability and to increase as abortion is restricted.

Chile provides a natural laboratory for such an analysis. The country has kept extensive and detailed records of maternal morbidity and mortality for over fifty years. In addition, the country has implemented several distinct interventions including increasing skilled medical attendants for births, increasing the education of women, increasing the sanitation and overall level of care at medical facilities, and perhaps most significant for this discussion, the prohibition of abortion. The trends of the maternal mortality ratio can be evaluated both before and after each of these initiatives.

A recently published collaborative study by scientists from both the United States and Chile have used this objective data to demonstrate the effects of improved medical care, increased education of women, and abortion on maternal mortality. Their findings should provide the scientifically-based guidance needed to reduce maternal mortality in all developing countries.

The overall maternal mortality ratio in Chile from 1957 through 2007 decreased from 270 maternal deaths per 100,000 live births to 18.7 maternal deaths per 100,000 live births -. This is a decrease of 93.7%. The steepest declines were between the years 1965 and 1981. In 1965 Chile mandated a minimum of eight years of free education for all children. This resulted in the increase in the average years of schooling for women from 3.1 years in 1957 to 12 years in 2007. In addition, Chile markedly increased the percentage of deliveries that were aided by skilled medical attendants from 60.8% in 1957 to over 90% by 1980. By 1999, over 99% of births occurred in hospitals or maternity centers.

After 1981, the downward trend in maternal mortality continued, but the rate of decrease slowed. This is accounted for by the increasing number of women who delivered their first child over the age of 29. As Chilean women became more educated they delayed child bearing. This increased the number of maternal deaths due to underlying medical conditions such as diabetes and hypertension.

What happened to the maternal mortality trend after 1989 when Chile outlawed abortion? The Guttmacher Institute, UN Secretary General Ban Ki-moon, and Nancy Pelosi would like us to believe that this move sent the rate of maternal deaths soaring. Instead, we saw the opposite: The truth is there was absolutely no such effect.  In fact, the downward trend in maternal mortality continued with a decrease from 41.3 to 12.7 maternal deaths per 100,000 live births. That is a 69% decrease in maternal mortality after the ban on abortion took effect.

The Guttmacher Institute calls into question the validity of the Chilean study by speculating that there is underreporting of abortion-related morbidity and mortality, but provide no evidence of such reporting errors. The authors of the Chilean study, however, have already addressed these concerns in their published article:

Considering the strict protocol for active epidemiological surveillance on maternal and infant mortality registry implemented in the early 1930s, it is unlikely that the observed reduction could be explained by unobserved illegal abortion deaths or misclassification for other causes. Currently any maternal death occurring in Chile is audited by the sanitary authority revising the clinical registries, interviewing the relatives, and the medical personnel under strict confidentiality rules for determining the primary cause of death.

This analysis of the Chilean experience provides persuasive evidence that the key to improving women's reproductive health begins with improved education. Women must also have access to skilled birth attendants and well-equipped and sanitary birthing centers. The Chilean study raises serious questions about the claims by government officials and other abortion advocates who say that abortion is a critical component of quality medical care for women. Initiatives that promote abortion for the health and well-being of women increasingly appear to be motivated by ideology and based on something other than science.