Posted on | November 29, 2012 by Rebecca Oas, Ph.D |
An editorial published in the November 24 issue of The Lancet claims that “women’s choice” is the key to reducing maternal deaths, and refers to abortion access as the “neglected taboo in discussions of reproductive health and family planning.” The author notes that we are fast approaching the 20-year anniversary of the Cairo International Conference on Population and Development (ICPD), and refers to this milestone as “the moment in time when we need to take stock.” This reference may seem an odd choice, given that the definition of “reproductive health” adopted at the Cairo conference was repeatedly clarified as excluding abortion.
Nevertheless, for a “neglected taboo”, abortion is the topic of a surprising number of studies and other articles, including several cited directly within the editorial. Unfortunately, much of the actual data given to support the editorial’s argument is inaccurate or misleading:
Every year, of an estimated 43·8 million abortions, 49% are classified as unsafe and nearly all (97%) in Africa are unsafe. The percentage of unsafe abortions has increased from 44% in 1995 […] and while maternal mortality overall has declined, mortality from unsafe abortions has remained the same at an estimated 47 000 women each year.
As discussed in a previous C-FAM Friday Fax, the estimates of “unsafe” abortions are inflated, largely because of the way the term is defined by the World Health Organization (WHO), which has an “operational definition” equating unsafe abortions with illegal ones, or ones which take place in countries with restrictive laws regarding abortion. As for the claim that mortality from unsafe abortions has remained steady, this is patently false: while The Lancet does not provide a time frame of reference, a paper published by WHO researchers Shah and Åhman reports:
Globally, the number of unsafe-abortion-related maternal deaths from all causes has declined by one-third since 1990, from 69,000 in 1990 to 58,000 in 1997 and 2000, 56,000 in 2003, and 47,000 in 2008. The data show an increased momentum between 2003 and 2008, which is partly attributable to improvements in maternal health services and possibly also to an increasing reliance on medical abortion.
Perhaps the editor at The Lancet meant to say that out of total maternal mortality, the relative percentage linked to abortions has remained largely steady at an estimated 13%. However, this would not help the argument; the editorial notes that mortality overall has declined, and mortality associated with abortion has declined along with it, in spite of the increased percentage of abortions classified as unsafe. Furthermore, abortion-related mortality has decreased dramatically in Latin America compared to Africa, although the two regions both account for the highest levels of “unsafe” abortion worldwide. In their article quoted above, Shah and Åhman attribute much of this discrepancy in mortality to improved medical infrastructure in Latin America, not liberalization of abortion laws.
Despite the admission that global estimates of maternal deaths in 2008 place less than 0.3% of them in the developed world, and despite the fact that Ireland has been a consistent leader in maternal safety even among developed countries, the editorial took the time to admonish the Irish Government to “thoroughly review and reassess its ambiguous abortion law” in light of the recent case of Savita Halappanavar, who died due to complications of a miscarriage. Given the scarcity of reliable and complete information, is unfortunate that a leading medical journal would be so quick to urge legislative action before the findings of investigations into the incident are known. Perhaps a review and reassessment of the global maternal mortality data by the editorial staff of The Lancet would be a better recommendation.