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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African denounces Western elites pushing population control in his country

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By Ben Johnson

An op-ed in one of the leading publications in Uganda has denounced the promotion of IUD use and other long-acting reversible contraceptives (LARCs) in the nation as a colonialist form of population control.

An article published in New Vision, which bills itself as “Uganda's leading daily,” and which was posted online after being translated into broken English, contradicts the frequent claim that there is a desperate cry from Africans and brown people generally to provide the “unmet need” for contraception in the Third World.

Programs to convince African women to use the IUD or other forms of contraception “are projects of multibillion international agencies distributing them under the guise of helping the poor countries to control birth rates,” Stephen Wabomba wrote.

The use of the IUD leads to an increase in “the spread of STIs/HIV/AIDS, infections or increased rates of Pelvic Infection Diseases (PID),” and other maladies, he said. The IUD, which is inserted into the uterus and may work for years at a time, offers no protection against sexually transmitted diseases and often does not prevent fertilization.

Western governments and NGOs are very much “aware of the side effect[s] but still force them on us through sensational marketing strategies by claiming that there is unmet need” for contraception “in Uganda,” he wrote.

He instead suggested the use of Natural Family Planning methods as the “best alternative” for married couples, as well as increased “funding of chastity and abstinence education in Uganda.”

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He called on every citizen of Uganda “to stand up and be counted as a lover of life” and become a “protector of the voiceless and defenseless unborn children being aborted every day.”

Wabomba is heeding his own advice by acting as director of the Pregnancy Help Center in Jinja, the second largest city in Uganda. The town of 87,000 is perched on the shores of Lake Victoria.


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UN tells Chile and Peru to legalize abortion

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By Guilherme Ferreira Araújo

On July 7 and 8, the United Nations Human Rights Commission (UNHCR) discussed Chile’s abortion laws and issued a report asking for liberalization of those laws.

According to the report, Chile “should establish exceptions to the general prohibition of abortion, contemplating therapeutic abortion and in those cases in which the pregnancy is a consequence of a rape or incest.”

Chile is one of the few countries that prohibits abortion in all cases.  So far, the country has managed to stand against internal and external pressure to legalize abortion.

But during her campaign, President Michele Bachelet promised to make the legalization of abortion a priority.  Indeed, last May she stated that her intention was to reopen the debate so that the government could approve therapeutic abortion before the end of this year.  The U.N. report also said that Chile “should make sure that reproductive health services are accessible to all women and adolescents."

One of the reasons the UN is using to pressure Chile’s government to change their abortion laws is the high number of clandestine abortions allegedly taking place in Chile. The UNHRC points to “official data” showing 150,000 annual clandestine abortions. However, not only is it impossible to corroborate that figure, but other sources show that this number could be exaggerated by a factor of 10.  According to an article published in the Chilean news publication, Chile B, the annual number of clandestine abortions in Chile may vary between 8,270 and 20,675.

Inflating the number of illegal abortions and maternal mortality is a common tactic of the pro-abortion movement’s effort to legalize the deadly practice. Dr. Bernard Nathanson, founder of the National Abortion Rights Action League (NARAL), famously admitted the tactic after becoming pro-life.

“We claimed that between five and ten thousand women a year died of botched abortions,” he said. "The actual figure was closer to 200 to 300 and we also claimed that there were a million illegal abortions a year in the United States and the actual figure was close to 200,000. So, we were guilty of massive deception."

Chile has also been used as a prime example that legalized abortion does not reduce maternal mortality.

A study published in 2012 by Plos One Institute found that since 1989 when Chile banned abortion, there has been an annual decrease in maternal death. That study, and others compiled and published by the Chilean MELISA Institute strongly challenge the myth that abortion is safe or even necessary to increase maternal health.

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Notwithstanding the empirical data, the United Nations is also hard at work to pressure Chile’s neighbor to the North, Peru, to liberalize its own abortion laws.  In the case of Peru it is the Committee on the Elimination of Discrimination Against Women (CEDAW) that has issued the report, not the UNHRC.  CEDAW representatives examined Peru’s case on July 1 and suggested that Peru should legalize abortion in case of rape and severe abnormalities of the unborn child.

The organism suggested that the government eliminate all laws that punish women who abort and asked that Peru “urgently” adopt a law to fight violence against women, a notion often used as a euphemism for legalizing abortion.  

The CEDAW commission presented the conclusions of the report on July 22 and put special emphasis on the abortion issue. This happens despite the strong opposition to abortion in Peru. A recent survey showed that 79 percent of Peruvians support the Catholic Church’s position on abortion.

The CEDAW pressure on Peru is not new. In 2011, after the UN sanctioned Peru for denying an abortion to a teenager, Carlos Polo, Director of the Population Research Institute’s Latin American office, stated that the UN organism doesn’t have the right to force Peru to approve abortion.


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People ask me all the time, “How do you live with your past?” My answer is silly, but it is a true story. Youtube screenshot
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I helped so many women abort their babies. Now how do I live with that?

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By Abby Johnson
Abby Johnson business card Planned Parenthood

I have many memories of my time with Planned Parenthood. I spent eight years of my life there. Some memories are good, some are not. But they are contained in my mind. It’s easy to forget them. I have forgotten so much about my time there in just four and a half short years. 

I found my old business card the other day. That is a tangible memory for me. It made me think of the day that I heard I had been promoted to direct the clinic. I was so happy…hugging and jumping up and down with my supervisor. She was so proud of me.

I thought about the day I moved everything into my new, big office. I put pro-choice stickers all over my file cabinet. I called my parents to share the news. They were, of course, proud of me, but hated my work. I can’t imagine how conflicted they were in their minds and hearts. Human resources sent me my new paperwork. There was my new title, my new and amazing salary. 

A few days later, my new business cards came. I remember putting them in my new business card holder on my desk. I filled up the business card holder that I kept in my purse. I had already become used to hearing myself say my new title.

I was proud of myself. I was proud of the hard work I had put in to earn that new title. I worked so many hours, sacrificed so much time from my family. But I knew it would be worth it. And now I had the job title to prove it.

I remember proudly passing out my new business cards to anyone that would take one. Being pro-choice was not just a movement to me; it was a lifestyle. I wholeheartedly embraced that lifestyle and loved being a part of it. 

These tangible reminders that I occasionally find are sometimes hard to work through. I remember receiving the records from my medication abortion. That tangible reminder of my past was difficult to manage. I look at my “Employee of the Year” award that I received from Planned Parenthood and think back to the night I received it. I ended up putting that old award on my desk as a reminder of where I came from and how much my life has changed. Seeing that plaque no longer brings back those tangible memories. 

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One of the reasons I was so taken aback when finding my old business card was not just because it was a reminder of how proud I had been to run an abortion clinic…something I find deplorable now. It was because of the things I took part in while I had that big title.

The memories of handing women small monetary checks in order to pay for their silence after we had left them with a serious infection after their abortion. The memories of watching women bleed out on our abortion table and being instructed not to call the ambulance because we didn’t want to let the pro-lifers know that we had a medical emergency. The memories I have of “joking” about the babies that died in our facility by abortion. The memories I have of training our abortion facility employees on the “normalcy” of abortion and how to convince women that abortion is the best choice for them.

Part of being a former abortion clinic worker is learning how to deal with your past sin. It may be the lady who came to your clinic for an abortion that you bump into at the store. It could be standing in front of your former abortion facility and remembering all of the damage your words and actions did to so many women. It could be finding that old business card that reminds you of the pride you felt when you became the director of an abortion facility. 

People ask me all the time, “How do you live with your past?” My answer is silly, but it is a true story. 

One day I was watching the kid’s movie “Kung Fu Panda” with my daughter. In the film there is a wise, old tortoise named Oogway. He is talking to one of his students who is frustrated with his current situation. Oogway asks his student, “Do you know why today is called the present? Because it is a gift.”

That little line by an animated tortoise hit me like a ton of bricks. Today is a gift. There is absolutely nothing we can do with our past. And there is very little we can do to control our future. We live NOW. We serve NOW. We choose to move on from our past NOW. 

I don’t know what your past sins are. And I don’t know how frequently you are reminded of them. But as someone who has to face their past sins on pretty much a daily basis, I can tell you that you can be free from their burden. Being reminded of your past doesn’t mean that you have to live with constant grief. It simply means that you have been given the opportunity to transform your past into something positive…maybe you can help others make different choices than you did, maybe you can help others heal from the same struggles that you lived through. I don’t know what you are being called to do, but as the saying goes, “God can turn our mess into a message.” 

Carrying around past burdens doesn’t help us in any way. Know that you can be forgiven. Accept that forgiveness. Use your life to help others. The present is indeed a gift.

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