Recent classifications of "abortion safety" by the WHO and Guttmacher Institute fail to address the real harms to women and infants in the developing world. Abortion always means one dead, one wounded.

The assumption that legalized abortion is safe abortion has become so commonplace that few will question it. The reality, however, is that legalized abortion increases the maternal mortality rate in virtually every country where it is practiced.  Abortion also affects subsequent pregnancies and increases the risk of premature birth.

Researchers at the deVeber Institute for Bioethics and Social Research reviewed several studies on the statistics of maternal death after abortion in the developed world where healthcare is most advanced.  What they found should sound the alarm for those who wish to promote abortion in countries where health care is less than optimal.

Eastern European countries, where abortion has been legal for decades, has some of the highest abortion mortality rates in the world. Overall, maternal mortality remains “unacceptably high” in these countries, but induced abortion makes up 20 to 35% of all maternal deaths.

By contrast, the two countries with the world’s lowest over-all maternal mortality are Poland and Ireland. Ireland has never had legalized abortion and Poland restored its laws prohibiting abortion in 1989, after the fall of Communism.  

The World Health Organization admits that “a woman’s lifetime risk of maternal death is 1 in 7300 in developed countries versus 1 in 75 in developing countries.” But in Ireland it is 1 in 48 000.[1]

In Poland, since abortion laws were reinstated, maternal mortality has plunged by more than 75%.  In an article in the National Post (February 5, 2010), Dr. Ian Gentles, researcher for the deVeber Institute, wrote, “Infant mortality is down by almost two-thirds, and the rate of premature births has dropped by well over a half.” He notes that the reduction in premature births is especially important because premature babies are prone to all kinds of medical complications, the most serious being cerebral palsy.

“In fact,” he writes, “since the late 1980s, around a hundred children per year were dying before the age of five from cerebral palsy in Poland. By 2006, the number was down to five or ten per year -- a greater than 90% drop.”

Just how dangerous is abortion compared to childbirth?

Recent, massive studies from Scandinavia, Britain and the US have established that abortion in the developed world carries a risk of death that is four times greater for women than childbirth. These are developed countries where some of the most advanced healthcare in the world is available. The studies also found that in addition to the healthcare risk, the suicide rate was six times greater for women who have aborted than for women who have given birth.

In Finland, a country known for its impeccable birth, death and abortion registries, a study of all the women who had died between 1987 and 1994 showed the following maternal mortality for every 100,000 deaths:

Finland: Maternal deaths within twelve months of end of pregnancy per 100,000 women

Births                                                                              26.7

Miscarriages or ectopic pregnancies                47.8

Induced abortion                                                       100.5

(Source: Gissler, 1997)

Maternal mortality following abortion was four times higher than following childbirth. This does not include the incidence of suicide following abortion which the Finnish study found to be six times higher compared to childbirth.

Another Finnish study (Gissler and colleagues, 1996) had virtually identical findings. They found that per 100,000 women in the twelve months following the end of a pregnancy the death rate was 28.2 after birth, 51.9 after miscarriage, and 83.1 following abortion.

A British study looked at the incidence of suicide in 408,000 women between 1991 and 1995 and found that the suicide attempts related to pregnancy were less likely to be due to mental illness, and more likely to be associated with the outcome of the pregnancy itself (Morgan et al., British Medical Journal, 1997). Furthermore they found that the risk of suicide went down following childbirth and miscarriage, but for women who aborted the risk increased 3.25 times or 225%.

There are many reasons that account for the higher risk of mortality in woman who abort. But a study by Atrash and colleagues reported that anesthesia-related deaths have not decreased with legalized abortion because “pregnancy increases the sensitivity to the respiratory depressant effects of all these [anesthetic] agents.”

Given these findings it would be irresponsible at best to promote abortion in countries where maternal healthcare is severely lacking. Instead of promoting abortion in the developing world, attention should be focused on providing good healthcare for already pregnant women, and education on the hazards of abortion for women who are not. Researchers from the deVeber Institute note that “Refusal to recognize that induced abortion is more dangerous to a woman's life than giving birth is inexcusable.”

Under-reporting of Abortion-Related Deaths

But, objectors may comment that both Canada and the United States report very low abortion mortality.  In Chapter 6 of the book Women's Health After Abortion, the The deVeber Institute sheds light on the  serious problem of underreporting of maternal deaths following abortion.

The most immediate reason is simply that the protocol for reporting only includes the presenting cause of death and not the underlying cause. For example, if a woman is rushed to emergency because she is hemorrhaging from an abortion, the hospital in-take personnel will only code for the presenting symptoms, namely the fact that she is hemorrhaging. There actually is no code for the underlying reason, which is the abortion.

The reluctance of medical practitioners to report abortion-related deaths is so widespread throughout Canada and the US that death certificates where there has been some relation to pregnancy and maternal mortality are often inaccurately completed.

Further to this, the abortion providers themselves fail not only to report abortion related deaths, but they fail to report any negative findings at all. This is partly due to the fact that abortion is a politically charged issue.  Clearly, it is in the interest of the providers and advocates that it be seen as a “safe” procedure. Those providing abortion are also at risk for legal repercussions and could face discipline from their colleges if either injury or death is associated with them. 

Researchers found that there was a general underreporting of maternal deaths for both delivery and abortion in Canada, the US and with the World Health Organization. In fact, analysis of mortality stats using linkage studies shows that “more than half of such deaths... are probably still unreported.”

In Canada, for instance, Statistics Canada notes that “if complications ensue after a patient has been discharged from hospital, the condition is treated as a separate case and does not appear in the original abortion record.” So upon a woman's return visit to hospital with a complication arising from an abortion, the complication will be treated and reported independently.

In the United States the Centre for Disease Control's (CDC) Pregnancy-Related Mortality Surveillance System identifies maternal deaths working backwards from a recorded birth. But in the case of abortion, there is no birth, thus abortion related deaths are not included in the numbers. Since only the numbers of pregnancy-related deaths are reported, the numbers are inflated, making pregnancy and delivery seem more dangerous than abortion.

The WHO also under-reports. Their claim that legal abortion is safe is based upon self-reporting by physicians who are under no obligation to report the specifics of an incidence of maternal death, such as a complication during delivery or an abortion. 

Further to this, eighteen American states and four Canadian provinces do not permit deaths to be classified as abortion mortality if they occur 42 days after the procedure. A woman who dies on the 43rd day because of an abortion-related injury will not have the abortion named on the death certificate.

The implications for women in Developing Nations

National and international policy based on faulty statistics has serious repercussions for women around the world. It is well known that primary health care averts maternal death in developing countries while abortion causes it. Despite this knowledge, reproductive health and family planning programs insist on promoting abortion even where it is not welcome. 

Every country in the world that has ever legalized or promoted abortion has seen the numbers of abortions go up exponentially. More abortions means more risk to women's lives, and that is unacceptable when such poor choices could so easily be averted. 

 

 


[1] Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www. who.int/reproductive-health/publications/maternal_mortality_2005/index.html, accessed 14 August 2008).

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