Carolyn Moynihan

New Chile study challenges the ‘safe abortion’ myth

Carolyn Moynihan
By Carolyn Moynihan
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May 8, 2012 (Mercatornet.com) - One of the great scandals of today’s global village is the deaths of hundreds of thousands of mothers each year simply because they are carrying or giving birth to a child. The last reliable estimate, from 2008, indicated nearly 343,000 of these maternal deaths. The scandal lies in the fact that most of them are easily preventible with basic health care, as the West discovered more than a century ago.

The West, as we know from many statements from the World Health Organisation and reproductive health groups, is anxious to reduce this awful statistic, which is an important aim of the Millennium Development Goals. Unfortunately, this altogether worthy goal is entangled with another: the reduction of fertility in the developing countries, by the quickest means possible. This means that, often before other basic medical and social improvements are in place, there must be universal access to birth control technology—not only contraception but abortion.

Abortion, however, must be safe for the woman—that is, provided by medically qualified people or by medically certified means—and to be safe it must be legal. Where it is illegal it will happen anyway but it will be unsafe, and often lethal. States which persist in keeping abortion illegal or severely restricted (and not the agents who are pushing this form of birth control) are thus contributing to the dire maternal mortality statistics. And states which ban abortion after it has been legal are similarly putting women’s lives at risk. That, as they say, is the narrative.

There’s just one problem with the drift of this story: there is no proof that it is true. The only hard evidence that we have on the subject of restrictive abortion laws and maternal mortality rates (MMR) is very new and it points in the opposite direction.

Research from Chile published a few days ago shows that, when therapeutic abortion was banned in 1989 after a long period when it had been legal in that country, there was no increase in maternal mortality. None at all. On the contrary, maternal deaths continued to decline. Chile today has one of the lowest maternal mortality rates in the world (16 per 100,000 live births), outstripping the United States (18) and, within the Americas, second only to Canada (9). Rather than the rogue violator of women’s reproductive health that the UN makes it out to be, Chile is looking this week like a model for countries that really want to save the lives of mothers.

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It’s important to note here what the study, Women’s Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007, does not claim. It does not say that making abortion illegal caused a decline in maternal deaths. But it shows, importantly, that the 1989 law did not increase mortality. It continued to decline substantially, although other factors were at work in the decline—notably, the education of women and their ability to shape their own reproductive behaviour. (The latter does not mean quite what birth control fundamentalists mean, as we shall see.)

The study, published in the open access online journal PLoS One, is the work of Chilean and American researchers led by Dr Elard Koch, epidemiologist and a professor at the University of Chile and Universidad Católica de la Santísima Concepción (UCSC). The group, who formed the Chilean Maternal Mortality Research Initiative (CMMRI) for the purpose of the study, had access to exceptionally good data: 50 years of official records from Chile’s National Institute of Statistics, 1957 to 2007. These provide the basis of what the authors call a “natural experiment” in fertility and abortion policy.

What these records show is a dramatic decline in MMR from 1965, when abortions were numerous and abortion was the main cause of mortality, through to 1981; a continuing but slower reduction from 1981 to 2003; and a steady state from 2003 to 2007. To explain this pattern the researchers analysed social policies and trends likely to influence maternal mortality. Here are the key ones, especially for the first phase:

* Delivery by skilled birth attendants. For each 1 per cent increase in the number of deliveries performed by skilled attendants there was an estimated decrease of 4.58 maternal deaths per 100,000 live births. Clean water and other sanitary improvements also played a part.

* Access to maternal healthcare services. Nutrition programmes for mother and child, coupled with the distribution of fortified milk at primary care clinics created new opportunities for pregnancy and birth care for both mother and child. This strategy practically eradicated malnutrition, increased birth weight and contributed to the noteworthy reduction in infant mortality observed in Chile, 3.1/1000 live births for infants 28 days to 1 year of age.

* Women’s educational level. This, says Koch, is the most important factor, and the one which increased the effect of all other factors. Educating women enhances a woman’s ability to access existing health care resources and directly leads to a reduction in her risk of dying during pregnancy and childbirth. Data showed that for every additional year of maternal education in Chile there was a corresponding decrease in the MMR of 29.3/100,000 live births.

Boosting female education did something else: it brought down the fertility rate (currently the TFR is 1.87). To return to a point mentioned earlier, the authors point out that “education promotes higher autonomy in women, allowing them to take control of their own fertility” using the method they prefer. Interestingly, a majority of Chilean women do not prefer artificial contraceptives. The authors note:

“Although the primary care system currently provides universal access to a variety of contraceptives methods, actual use of hormonal contraceptives and intrauterine devices in Chile reaches approximately 36% of women of reproductive age. Therefore, as in developed nations, other factors not limited to the use of artificial contraceptives seem to be contributing to the reduction in TFR in Chile. One such factor could be women’s increasing level of education.”

And here the news stops being good. At this point Chilean woman meets North American and European and Antipodean woman in a pattern of delayed motherhood—and pathologies associated with that delay. Koch and colleagues describe this “fertility paradox” as follows:

Although a strong correlation did exist between the decline on the MMR and the reduction on total fertility rate (i.e. the average number of children that would have been born to a woman over her reproductive lifetime), the increase in the number of first pregnancies at advanced ages was directly associated with an increase on maternal deaths. For every 1% increment in primiparous women giving birth older than 30 years of age, an increase of 30 maternal deaths per 100,000 live births was estimated. Thus, when the total fertility decreases and produces a delayed motherhood it can also provoke a deleterious effect on maternal health via an increase of the obstetric risk associated with childbearing at advanced ages.

Before 1980 the causes of MMR in Chile were on the whole directly related to pregnancy and birth. From then on the underlying health problems of “aging pregnancy” began to take over in the mortality stakes: hypertension, diabetes and obesity among others. The problem now, there and here in the developed world, “is not a matter of how many children a mother has, but a matter of when.”

Did the reproductive health brigade get that? Delayed motherhood can be literally deadly. At a certain point, the gains of education and good health and social services are taken too far and recoil upon the modern woman. With the greater part of the world, including many developing countries, now below replacement TFR, maternal mortality from social progress is set to climb before deaths from deprivation have been thoroughly, and one could say properly, addressed.

Koch’s study shows that the custodians of reproductive health profoundly misunderstand the remedy for maternal mortality in developing countries. Will they do any better when they try to come to grips with the fertility paradox?

Carolyn Moynihan is deputy editor of MercatorNet. This article is reprinted under a Creative Commons License.


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Thaddeus Baklinski Thaddeus Baklinski Follow Thaddeus

African researchers warn early sexual activity increases risk of cancers

Thaddeus Baklinski Thaddeus Baklinski Follow Thaddeus
By Thaddeus Baklinski

A report on rising cancer rates in Africa delivered at a conference in Namibia last week warned that oral contraceptives and engaging in sexual activity from a young age lead to an increased risk of breast and reproductive system cancers.

Researchers presented the "2014 Integrated Africa Cancer Fact Sheet & Summary Score Card" during the 8th Stop Cervical, Breast and Prostate Cancer in Africa (SCCA) conference, held in Windhoek, Namibia from July 20 to 22, noted that cancer is a growing health problem in many developing countries and that breast and cervical cancer are the most common forms affecting African women.

The report said that sexually transmitted diseases (STDs) play a major role in reproductive system cancers and that young girls who engage in sexual activity risk getting, among other STDs, the human papilloma virus (HPV), some strains of which are linked to cervical cancer.

The report said although HPV infections are common in healthy women, they are usually fought off by the body’s immune system, with no discernible symptoms or health consequences.

The Cancer Association of South Africa points out that of the scores of HPV types, 14 of the more than 40 sexually transmitted varieties are considered "high risk" for causing serious illness, while two, HPV-16 and HPV-18, are linked to cervical cancer.

“Long-term use of oral contraceptives is also associated with increased risk [of cancer], and women living with HIV-AIDS are at increased risk of cervical cancer,” the report said.

Dr. Thandeka Mazibuko, a South African oncologist, told the conference attendees that when an 18-year-old is diagnosed with cervical cancer, “this means sex is an important activity in her life and she indulged from a young age.”

Mazibuko said the standard treatment for cancer of the cervix is seven weeks of radiation therapy.

“After the treatment they cannot have sex with their husbands or partners. They cannot bear children because everything has been closed up. Some may still have the womb but radiation makes them infertile,” Mazibuko said, according to a report in The Namibian.

Statistics from the Cancer Association of Namibia show that cases of cervical cancer have risen from 129 in 2005 to 266 in 2012.

The SCCA Conference theme was, "Moving forward to end Cervical Cancer by 2030: Universal Access to Cervical Cancer Prevention."

In his keynote address, host and Namibian President Hifikepunye Lucas Pohamba urged African countries to help each other to expand and modernize health care delivery in the continent.

"Within the context of the post-2015 Development Agenda and sustainable development goals, the provision of adequate health care to African women and children must be re-emphasized," said the president, according to AllAfrica.

The Namibian leader urged mothers to breastfeed their children for at least six months as a measure to prevent breast cancer.


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Hilary White Hilary White Follow Hilary

Allow ‘lethal injection’ for poor to save on palliative care: Lithuanian health minister

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By Hilary White

Euthanasia is a solution for terminally ill poor people who cannot afford palliative care and who do not want to “see their families agonize” over their suffering, Lithuania’s health minister said last week.

In an interview on national television, Minister Rimantė Šalaševičiūtė added that the Belgian law on child euthanasia ought to be “taken into account” as well. 

Šalaševičiūtė told TV3 News that Lithuania, a country whose population is 77 percent Catholic, is not a welfare state and cannot guarantee quality palliative care for all those in need of it. The solution, therefore, would be “lethal injection.”

“It is time to think through euthanasia in these patients and allow them to make a decision: to live or die,” she said.

Direct euthanasia remains illegal in the Balkan state, but activists tried to bring it to the table in 2012. A motion to drop the planned bill was passed in the Parliament in March that year in a vote of 75 to 14. Since then the country has undergone a change in government in which the far-left Social Democrats have formed the largest voting bloc.

Šalaševičiūtė is a member of Parliament for the Social Democrats, the party originally established in the late 19th century – re-formed in the late 1980s – from Marxist principles and now affiliated with the international Party of European Socialists and Socialist International.

Fr. Andrius Narbekovas, a prominent priest, lecturer, physician, bioethicist, and member of the government’s bioethics committee, called the suggestion “satanic,” according to Delfi.lt. He issued a statement saying it is the purpose of the Ministry of Health to “protect the health and life, instead of looking for ways to take away life.”

“We understand that people who are sick are in need of funds. But a society that declares itself democratic, should very clearly understand that we have to take care of the sick, not kill them,” he said.


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Islamists in Mosul mark Christian homes with an Arabic "N" for Nazarene.
Gualberto Garcia Jones, J.D.

We must open wide our doors to Iraq’s Christians

Gualberto Garcia Jones, J.D.
By Gualberto Garcia Jones J.D.

On July 18, the largest Christian community in Iraq, the Chaldean Catholics of Mosul, were given a grotesque ultimatum: leave your ancestral home, convert to Islam, or die.

All but forgotten by the 1.2 billion Catholics of the world, these last Christians who still speak Jesus’ native tongue of Aramaic and live in the land of Abraham and Jonah are being wiped out before our very eyes.

As a way of issuing a thinly-veiled threat, reminiscent of the Nazi persecution of the Jews, the Arabic letter “N” (for Nazarean) has been painted on the outside of the homes of all known Christians in Mosul.

These threats, issued by the fanatical Islamic State of Iraq and Syria (ISIS) known for its bloodthirsty rampage of executions, have been taken very seriously by the several hundred thousand Christians in Mosul who have left with little more than the clothes they were wearing. 

At least most of these Christians were able to flee and find temporary protection among the Kurds in their semi-autonomous region.  However the Kurds do not have the resources to defend or shelter the Chaldean Christians for much longer.

On Monday, during an interview on Fox News, Republican U.S. Rep. Frank Wolf, who recently joined with 54 other members of the House of Representatives in a letter to President Obama asking him to act to protect these communities, stated that while Iraqi President Maliki had sent military flights to Mosul to evacuate Shiite Muslims, the US has done nothing to protect the Chaldean Christians.  Rep. Wolf also stated emphatically that President Obama has done “almost nothing” about the genocide taking place.

The silence from the White House is deafening.  But the lack of leadership from the hierarchy of the Catholic Church in America has been shocking as well.

Nevertheless, the plight of these Iraqi Christians is beginning to be taken seriously.   This is due in large part to the heroic efforts of local Iraqi religious leaders like Chaldean Patriarch Sako, who has gone on a whirlwind tour of the world to alert us all of the plight of these Iraqi Christians.  In a statement demonstrating his character, he told the Christians of Iraq last week, “We are your shepherds, and with our full responsibility towards you we will stay with you to the end, will not leave you, whatever the sacrifices.”

Before the U.S.-led invasion of Iraq was launched there were approximately 1.5 to 2 million Christians living in Iraq.  Today, there are believed to be less than 200,000.  The numbers speak for themselves.

Now that the world is beginning to be aware of the genocide in Northern Iraq, many of us ask ourselves: what can we do?  As citizens and as Christians blessed to live in nations with relative peace and security, what can we do?

The answer is quite simple and unexpected.  Demand that our government and church pull its head out of the sand and follow France. Yes, France.  

Yesterday, in a heroic gesture of Christian solidarity that would make Joan of Arc proud, the government of France opened wide its doors to the persecuted Iraqi Christians.  

”France is outraged by these abuses that it condemns with the utmost firmness," Laurent Fabius, France's foreign minister, and Bernard Cazeneuve, France's interior minister, said in a joint statement on Monday.

"The ultimatum given to these communities in Mosul by ISIS is the latest tragic example of the terrible threat that jihadist groups in Iraq, but also in Syria and elsewhere, pose to these populations that are historically an integral part of this region," they added. "We are ready, if they wish, to facilitate their asylum on our soil.  We are in constant contact with local and national authorities to ensure everything is done to protect them.”

The French statement drives home three crucial elements that every government, especially the United States, should communicate immediately:

  1. Recognize the genocide and name the perpetrators and victims.

  2. Officially condemn what is happening in the strongest terms.

  3. Offer a solution that includes cooperation with local authorities but which leads by making solid commitments such as offering asylum or other forms of protection.

With regard to the Church, we should look to the Chaldean Patriarch and the Iraqi bishops who shared their expectations explicitly in an open letter to “all people of conscience in Iraq and around the world” to take “practical actions to assure our people, not merely expressions of condemnation.”  Noticeably, the last section of the letter from the Iraqi bishops, before a final prayer to God, is an expression of thanks to the Kurdish government, which has welcomed them not just with “expressions” of goodwill but, like France, with a sacrificial hospitality.

On Friday, July 25, the United States Conference of Catholic Bishops did issue a statement, but unfortunately it lacked much in terms of leadership or solutions.  We should encourage our bishops to do better than that, be bolder and stronger for our persecuted brothers and sisters, name names and offer concrete sacrificial aid. In a word, be more like the French.

In 1553, Rome welcomed the Chaldean church into the fold of the Catholic Church.  Nearly 500 years later, Catholic Americans must find ways to welcome these persecuted people into our country, into our churches, and into our own homes if need be.

I say, I am with you St. Joan of Arc.   I am with you, France.  I am with you, Chaldeans!

Gualberto Garcia Jones is the Executive Director of the International Human Rights Group, a non-profit organization based in Washington, DC, that seeks to advance the fundamental rights to life, the natural family, and religious liberty through international law and international relations. 


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