By Joyce Arthur, Abortion Rights Coalition of Canada

March 4, 2010

This article has been adapted and slightly expanded from Joyce Arthur’s op-ed published in the Saskatoon Star Phoenix on March 4, 2010: MPs Use Harmful Information. A few updates to statistics and several new sources were added in January 2013. A complete list of data sources for this article is available below.

A new favorite pastime of the anti-choice movement is to try and cast doubt on the overwhelming evidence that legal abortion saves women’s lives and health. Anti-choice groups (here and here), news sites (here and here), and even elected government officials in Canada have been making the bizarre claims that legalizing abortion does not improve maternal health and may even harm it, and that countries with strict anti-abortion laws have better maternal health records. Nothing could be further from the truth.

Without exception, every country that has legalized abortion has seen dramatic decreases in deaths and serious complications due to unsafe abortion. In western industrialized countries, death from unsafe abortion has been virtually eliminated. Legalizing abortion has improved the overall health and survival of women, and that of their children and families.

In order to support the opposite contention, anti-choice writers commit a serious logical error by equating a country’s overall maternal mortality rate with the legal status of abortion. But a wide variety of medical and social factors impact maternal health – unsafe abortion is only one cause of maternal mortality, although it’s a major one that is entirely preventable. 13% of deaths from pregnancy-related causes are due to unsafe, usually illegal abortion. 47,000 women die every year from unsafe abortion and 8.5 million are injured, mostly in heavily poverty-stricken regions in Africa, Latin America, and Asia.

In developed countries, healthcare systems are advanced enough to prevent most maternal mortality and morbidity, but if abortion is illegal, women still die. During the first half of the 20th century, maternal deaths in western countries dropped sharply because of antibiotics and modern medicine, despite abortion still being widely illegal. In Canada alone, 4,000 to 6,000 women died from unsafe abortion between 1926 and 1947.

Even where abortion is legal, there may be many barriers to safe abortion, including cost, accessibility, few providers, stigma, and lack of confidentiality. For example, India has liberal abortion laws, but two out of every five abortions performed are still unsafe because of poverty and inadequate healthcare systems in rural areas. Cambodia, Zambia, and South Africa are other countries with legal abortion but insufficient access to safe services.

Anti-choicers are fond of citing Ireland and Poland as examples of countries with low maternal mortality and illegal abortion. They fail to mention that both countries export their abortion demand. Irish women travel mostly to the UK to have safe legal abortions, but also to other European countries. Between 1980 and 2008, over 137,000 Irish women went to the UK alone. The practice is so common that “taking the boat to England” has become familiar Irish parlance for having an abortion. Polish women have an estimated 80,000 to 200,000 illegal abortions every year. They travel all over Europe, particularly to nearby countries where abortion is cheaper, such as Ukraine. Safe underground abortion services are also well-developed in Poland, because abortion was legal up until 1993. Many doctors who used to perform abortions continue to provide safe (but clandestine and costly) procedures in their clinics. Gynecological ads with cloaked references to abortion services are abundant in the press and on the Internet.

Polish and Irish women are frequently denied abortions even when they have medical reasons that would qualify them for a legal abortion in their own countries. Three Irish women who were forced to travel to Britain to end pregnancies that were threatening their health are currently challenging the Irish abortion ban in the European Court of Human Rights. In 2007, Poland lost a case at the same court for denying a medically-approved abortion for a woman who went blind after carrying her pregnancy to term.

In spite of the abortion bans that violate their right to life and health, both Polish and Irish women are assured of free, high-quality, post-abortion care in their own countries (unlike women in Africa), which helps contribute to the low maternal mortality rates in both nations.

Illegal self-abortions have become much safer in the last few years for women able to access the Internet, which has played a major role in overcoming restrictions to information and access to abortion. To induce a miscarriage, women can now obtain mifepristone (RU-486) online, and/or misoprostol from a pharmacy or online (www.womenonweb.org and www.misoprostol.org). Even when used without medical supervision, these drugs are far safer than traditional self-abortion methods, which include inserting sharp sticks into the uterus, drinking turpentine, or jumping off a roof. The expanded use of drugs for self-abortion appears to be significantly reducing maternal mortality rates in many developing countries (although that is no excuse to continue criminalizing women’s healthcare).

Anti-choicers cite Guyana (in South America) as an example of a country with high maternal death rates and liberal abortion laws. But before Guyana legalized abortion in 1995, septic abortion was the third highest cause (19%) of hospital admissions. Six months after the new law, there was a 41% reduction in hospital admissions for septic abortions. Maternal mortality remains high in Guyana for various pregnancy-related causes, and is attributed to factors such as extreme poverty and political instability.

Chile, El Salvador, and Nicaragua are examples of countries with strict abortion laws and low or decreasing maternal death rates. But in all three countries, reductions in maternal deaths reflect other causes, while maternal mortality from unsafe abortion still occurs. In Chile, the government has supported family planning measures since the 1960’s, which reduced maternal mortality significantly, along with allowing midwives to deliver most babies. But abortion (induced and spontaneous combined) still accounted for up to 12% of maternal deaths between 2000 and 2004. In El Salvador, maternal mortality remains unacceptably high, with moderate reductions in the last few years attributed to improvements in healthcare delivery and the use of misoprostol for self-abortions. A reported 6% of maternal mortality in El Salvador is still due to unsafe abortion.

In Nicaragua, the government passed an abortion ban in 2008 that eliminated all exceptions, including for rape, incest, and the life or health of the woman. As a result, in the first 19 weeks of 2009, Amnesty International found that 16% of all maternal deaths were from unsafe abortion, compared to none in the same period in 2008. Recent small improvements in Nicaragua’s high overall maternal mortality rate are being threatened under the country’s oppressive abortion law. Doctors now routinely refuse or delay treatment for women suffering from an obstetric emergency, because they fear prosecution if treatment leads to fetal death. As a result, Amnesty International documented 33 unnecessary maternal deaths the year after the abortion ban.

All of the foregoing data are easily available from reputable sources on the Web. Nevertheless, anti-choicers don’t hesitate to ignore the evidence and distort facts in order to support their ideology. By doing so, they are devaluing the lives and health of women and undermining the urgent need to reduce maternal mortality around the world.

Sources

Global statistics and information on unsafe abortion / maternal mortality:

Guttmacher Institute. 2012. In Brief Fact Sheet: Facts on Induced Abortion Worldwide. http://www.guttmacher.org/pubs/fb_IAW.html

Guttmacher Institute (Singh S. et al). Abortion Worldwide: A Decade of Uneven Progress. 2009. http://www.guttmacher.org/pubs/AWWfullreport.pdf

U Högberg, I Joelsson. The Decline in Maternal Mortality in Sweden. Acta Obstetricia et Gynecologica Scandinavica. 1985, Vol. 64, No. 7, pp 583-592. 1931–1980. http://informahealthcare.com/doi/abs/10.3109/00016348509156367

International Planned Parenthood Federation. Unsafe abortions: eight maternal deaths every hour. Oct. 19, 2009. http://tiny.cc/tOhFZ [India]

S Jayachandran et al. Modern Medicine and the 20th Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs. National Bureau of Economic Research, NBER Working Paper No. 15089. June 2009. http://www.stanford.edu/~jayachan/sulfa.pdf

Angus McLaren, Arlene Tigar McLaren. The bedroom and the state: the changing practices and politics of contraception and abortion in Canada, 1880-1980. 1986. MClelland & Stewart, Toronto. (Secondary source: http://tiny.cc/KqO3c)

KO Rogo et al. Maternal Mortality. National Center for Biotechnology Information (NCBI). 2006. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=dmssa&part=A1437

World Health Organization. Fact Sheet No. 438. Maternal mortality. May 2012. http://www.who.int/mediacentre/factsheets/fs348/en/index.html

World Health Organization (DA Grimes et al). Unsafe Abortion: The Preventable Pandemic. October 2006. http://www.who.int/reproductivehealth/topics/unsafe_abortion/article_unsafe_abortion.pdf

World Health Organization (I. Shah et al). Unsafe abortion: global and regional incidence, trends, consequences, and challenges. December 2009. http://www.sogc.org/jogc/abstracts/full/200912_womenshealth_1.pdf

World Health Organization, Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2003, Fifth edition. 2007. http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf

Ireland and Poland / Abortion Tourism:

Irish Family Planning Association. IFPA Responds to Latest UK Abortion Stats. May 21 2009. http://tiny.cc/scmBp

Safe and Legal In Ireland. Abortion in Context. http://tiny.cc/A56sF

Ian Traynor. Women challenge Irish abortion ban in European court. The Guardian. Dec. 9, 2009. http://tiny.cc/zxQ7a

Polish Federation for Women and Family Planning. The Effects of the Anti-Abortion Law in Force in Poland since March 16, 1993. Report No 2, February 1996. http://www.federa.org.pl/english/report96/rap96_1.htm

Poland Point. Dawn of the Abortion Tourism. Nov 19, 2008. http://www.polandpoint.com/news/society/dawn-of-the-abortion-tourism/

Center for Reproductive Rights. Tysiac v. Poland (European Court of Human Rights). March 20, 2007. http://reproductiverights.org/en/press-room/tysiac-v-poland-european-court-of-human-rights

Marcy Bloom. “Abortion Tourism” Sheds Light on the Need for Health Care Access. Feb. 25, 2008. http://www.alternet.org/reproductivejustice/77790/

Chile, Guyana, El Salvador, Nicaragua:

Donoso S., Enrique Mortalidad Materna en Chile, 2000-2004. Revista chilena de obstetricia y ginecología. 71(4):246-251. 2006. http://tiny.cc/soMGD

World Health Organization. Making abortions safe: a matter of good public health policy and practice. Bulletin of the WHO. Vol.78, No.5. 2000. http://tiny.cc/zFcX8 [Guyana]

Pan American Health Organization. Maternal and Child Health [in Guyana]. N.d. http://www.guy.paho.org/maternal.html

UNICEF. Statistics for Guyana. 2009. http://www.unicef.org/infobycountry/guyana_statistics.html#70

International Women’s Health Program. Guyana at a Glance. 2009. http://iwhp.sogc.org/index.php?page=profile-9&hl=en_US

Ministerio de Salud Pública y Asistencia Social. Linea de Base de Mortalidad Materna en El Salvador: Junio 2005 – Mayo 2006 (Grafico No. 12, pg 47). http://www.mspas.gob.sv/pdf/documento_LBMM/CONTENIDO_PARTE4.pdf

UNICEF. At a glance: El Salvador. 2009. http://www.unicef.org/infobycountry/elsalvador_statistics.html

José Adán Silva. RIGHTS: Nicaragua Refuses to Discuss Therapeutic Abortion. Inter Press Service News Agency. Feb. 15, 2010. http://ipsnews.net/news.asp?idnews=50335

Amnesty International. Shocking abortion ban denies life-saving treatment to girls and women in Nicaragua. 27 July 2009. http://tiny.cc/YTPYy

Amnesty International. Governments urged to condemn Nicaragua abortion ban. Feb. 4, 2010. http://tiny.cc/9VcCJ

Misoprostol / Mifepristone:

IPAS. 2010. Misoprostol and medical abortion in Latin America and the Caribbean. http://www.ipas.org/~/media/Files/Ipas%20Publications/MISOLAC2E10.ashx

RJ Gomperts et al. Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services. BJOG. Vol.115, Issue 9, pp 1171-1178. http://www.ncbi.nlm.nih.gov/pubmed/18637010

S. Miller et al. Misoprostol and declining abortion-related morbidity in Santo Domingo, Dominican Republic: a temporal association. BJOG. 29 Jun 2005. Vol. 112 Issue 9, pp 1291 – 1296.http://www3.interscience.wiley.com/journal/118670815/abstract

A. Faúndes et al. Post-abortion complications after interruption of pregnancy with misoprostol. Advances in Contraception. March, 1996. Vol.12, No.1. http://www.springerlink.com/content/g363533371g13t85/