By Lucia Muchova
Washington DC (C-FAM) – A widely publicized report in The Lancet
medical journal calling for the legalization of abortion contained
inflated numbers, flawed data collection and highly misleading language.
The recent article on “Induced Abortion: incidence and trends
worldwide from 1995 to 2008” updates abortion estimates to show progress
on improving maternal health. The Alan Guttmacher Institute and
staffers with the World Health Organization claim the number of unsafe
abortions per 1,000 women has risen from 44% to 49% between 1995 and
2008 while the global abortion rate has declined from 29 to 28 abortions
per 1,000 women of childbearing age. “Unsafe abortions” are
concentrated in developing countries. In Middle and Western Africa 100%
of abortions are deemed “unsafe.” Presenting various statistics, the
authors call for increased efforts to legalize abortion and expand
investment in contraception in developing countries.
However, the paper suffers from three main faults. First, the authors
use quasi-legal rather than medical definitions. Second, the authors
use problematic data collection. Third, the authors have manipulated the
data non-transparently. These recurring problems in World Health
Organization (WHO) data on maternal mortality have been well documented
by Donna J. Harrison, M.D.
Though not a WHO paper per se, much of the Lancet
article draws on previous WHO studies, with the estimation of unsafe
abortions “developed and commissioned by WHO.” The WHO defines “unsafe”
abortion as “a procedure for terminating an unintended pregnancy
carried out either by persons lacking the necessary skills or in an
environment that does not conform to minimal medical standards, or
both.”
However, in academic papers written by WHO staff members, like the Lancet
article, this definition becomes interchangeable with a quasi-legal
one: “As elaborated by WHO, abortions done outside the bounds of law are
likely to be unsafe even if they are done by people with medical
training… Thus, as in previous efforts to estimate abortion incidence
and consistent with WHO practice, we used the operational definition of
unsafe abortions, which is abortions done in countries with highly
restrictive abortion laws, and those that do not meet legal
requirements, in countries with less restrictive laws. Safe abortions
were defined as those that meet legal requirements, in countries with
liberal laws, or where the laws are liberally interpreted such that safe
abortions are generally available.” No mention is made of medical
standards or skills of those performing abortion.
What this means is that abortions performed in countries with liberal
laws, like the U.S., which result in serious complications or death
would be classified “safe” abortions. Abortions in restricted countries,
sometimes facilitated by activist groups funded by progressive
governments and foundations, fit in the “unsafe” category.
WHO researchers acknowledge the difficulty in obtaining good data on
abortion. Records of hospital admissions cannot distinguish between
spontaneous and induced abortions; surveys underreport the number of
abortions; ambiguous language prevents clear classifications of
pregnancy outcomes; and in countries where abortion is illegal or hardly
accessible, information is limited. Unsafe abortion in particular is,
according to the WHO, “one of the most difficult indicators to measure.”
Even for “safe” abortion, only 66% (2/3) of the countries with liberal
abortion laws have a mechanism to collect relevant data. Nevertheless,
statistics are reproduced, referenced and relied upon as if their
validity was set in stone.
The most recent WHO Unsafe Abortion
report asserts that 13% of maternal deaths are due to unsafe abortion,
identified as one of the three main causes of maternal deaths globally,
together with haemorrage and sepsis due to childbirth. This statistic is
relied upon in the Lancet article. Given the ambiguity of the
term “unsafe” and the unreliability of the data, one is left wondering
why more money should be spent on increasing access to abortion instead
of measures to improve antenatal and post-partum care.
The Lancet article indicates that “on the whole,” chemical
abortion procedures are classified as unsafe. Crucially, this includes
misoprostol, regarded as unsafe due to the risks of heavy bleeding
associated with incorrect usage. This means that organizations, such as
the International Consortium on Medical Abortion,
that encourage and actively distribute misoprostol for abortions are in
fact raising the numbers of unsafe abortions, which they claim to be
preventing.
Lucia Muchova writes for C-FAM. This article first appeared in the Friday Fax, an
internet report published weekly by C-FAM (Catholic Family & Human
Rights Institute), a New York and Washington DC-based research institute
(http://www.c-fam.org/). This article appears with permission.
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