Elard Koch

A ground-breaking abortion study from Chile

Elard Koch
By Elard Koch
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A groundbreaking study of abortion in Chile published last week in the scientific journal PLoS One found that illegal abortion is not associated with maternal mortality. At a time when access to legal abortion is deemed absolutely necessary for women’s health, this shatters long-standing assumptions. In this exclusive interview, Dr Elard S. Koch (pictured below), the lead author of the study, defends his findings.


MercatorNet: Chile is not alone in restricting abortion. Poland, Malta and Ireland also have very restrictive rules and a low maternal mortality rates. But this has been known for years. Has no one studied it before?

Elard Koch: The Chilean study is the first in-depth analysis of a large time series, year by year, of maternal deaths and their determinants, including years of education, per capita income, total fertility rate, birth order, clean water supply, sanitation, and childbirth delivery by skilled attendants, and including simultaneously different historical policies.

In this sense, it is a unique natural experiment conducted in a developing country. Thus, a first difference between the data from Chile and data from Poland, Malta and Ireland is that, in the case of Chile, there is a rigorous analysis controlled by multiple confounders. It is not a matter of circumstantial or anecdotal evidence, but a matter of scientific data representing real, vital events whose methodology has been published for the first time in a peer-reviewed scientific journal.

A second consideration relates to the degree of abortion prohibition in the different countries. Taking into account the countries in your question: in Chile, all types of abortion were prohibited in 1989. In Malta, abortion is banned in all cases but it is not prosecuted when pregnancy threatens the life of the mother. In Ireland, abortion is illegal except in cases of substantial risk to the mother, including the threat of suicide. Finally, in Poland, abortion is prohibited except in the case of danger to the mother’s health, when the pregnancy is the result of a criminal act, or when the foetus is seriously malformed.

It is worth noting that since most European countries allow elective abortion, it may be easier for women from Malta, Ireland, and Poland to travel for an abortion and this may be acting as a confounder which is difficult to control.

In contrast, due to abortion prohibitions in most Latin American countries, it is unlikely that a significant number of abortions can be performed by Chilean women abroad.

In addition, for Poland maternal mortality rates were already low at the time of passing restrictive abortion laws, possibly due to public policies similar to those promoting the decrease of maternal mortality in Chile. To test this hypothesis, analysis of maternal mortality data from this country is required, possibly in a similar manner to the one published for Chilean data.

Finally, the evolution of maternal mortality in Poland, Malta, and Ireland is yet to be analyzed in depth in the formal biomedical literature. In fact, such analysis was also lacking for Chile before our publication.

MercatorNet: Chile’s National Women’s Service (Sernam), estimates that at least 10 percent of maternal deaths are caused by complications from attempted abortions. Abortion is the fourth most common cause of maternal death in Chile. Your comment?

Elard Koch: This constitutes a harmful misinformation spread by Sernam. Indeed, according to the tenth revision of the International Codes of Disease (ICD), in 2008 5 deaths were attributed to codes O00-O07 out of 41 total maternal deaths (codes O00-O99)—12% of maternal deaths. Knowledge of and familiarity with the ICD-10 revision quickly orientates interpretation and correct translation. Maternal mortality comprises codes O00 to O99. Codes O00-O08 are labelled “pregnancy with abortive outcome”. In Spanish this should be translated as “Embarazo con desenlace abortivo”, and not “Embarazo terminado en aborto” (literally: pregnancy ended in abortion) as the Chilean Ministry of Health depicts.

To declare that abortion is present in all these pregnancies is misleading, because it is then interpreted as induced abortion and actually means that “10 percent of maternal deaths are caused by complications from attempted abortions”.

In fact, of the 5 cases that took place in 2008, 3 were ectopic pregnancies and 2 were actually unspecified abortions, presumably attributable to clandestine abortion. Thus, a more precise statement should be that 2 out of 41 cases were attributable to complications of abortion. This means 4.87% and not more than 10% of the total maternal deaths registered that year.

Moreover, due to the very low maternal mortality exhibited by Chile, it is inappropriate to use percentages to refer those causes that only have 1 or 2 cases. The risk of maternal death by abortion in Chile was 1 in 2,000,000 women at fertile age in 2008 and 1 in 4,000,000 women at fertile age in 2009.

In other words and from an epidemiological perspective, when the numerators are very low, the proportions and rates are very unstable for comparison purposes because 1 or 2 cases make a big change in the proportion or rates.

As discussed in our article, according to the most recent report published by Chilean National Institute of Statistics, the maternal mortality ratio for 2009 was 16.9 per 100,000 live births (43 deaths) and the figures for indirect causes (codes O99, O98), gestational hypertension and eclampsia (codes O14, O15), abortion (code O06), and other direct obstetric causes were 18 (41.9%), 11 (25.6%), 1 (2.3%) and 13 (30.2%) respectively.

MercatorNet: Some critics argue that the decline is mostly attributed to women’s increasing use of misoprostol and mifepristone, which are far safer than other clandestine methods. What will eventually be the effect of widespread use of RU-486 and other do-it-yourself abortion drugs?

Elard Koch: Explaining the decrease of maternal mortality ratio in Chile as a result of using drugs such as misoprostol, mifepristone or RU-486 is speculation unsupported by our epidemiological data. As a scientist, I am concerned about actual empirical data supporting any causal assumption. It is a matter of scientific facts supported by real vital data. Clearly, no study currently exists which seriously supports a decline in maternal mortality associated with the use of abortifacient drugs such as misoprostol or mifeprestone in Chile.

Therefore, this is just a speculative assumption. Indeed, our study shows that global maternal mortality ratio—as well as mortality by abortion—steadily decreased from 1965-1967. This was before the development and commercialization of the abovementioned drugs with abortifacient effects.

In fact, these drugs were introduced in the Chilean black market in the late 1990s, making it extremely unlikely that their introduction had any important influence on overall rates of maternal mortality, which were already significantly reduced at that time.

In addition, and as discussed in our article, the methods used to conduct clandestine abortions at present may have lower rates of severe complications than the methods used in the 1960s, mainly based on highly invasive self-conducted procedures. Therefore, the practically null abortion mortality observed in Chile nowadays can be explained by both a reduced number of clandestine abortions and a lower rate of severe abortion-related complications. This phenomenon also seems to be related to joint-effects between increasing educational levels and changes in the reproductive behaviour of Chilean women, an observation that requires further research.

We also discuss the fact that the practically null abortion mortality observed does not imply that there are no illegal or clandestine abortions in Chile nowadays.

Rather, the current abortion mortality ratio and recent epidemiologic studies of abortion rates in this country suggest that clandestine abortion may have been reduced in parallel with maternal mortality and may have currently reached a steady state based on stable ratios between live births and hospitalizations by abortion.

It is to be expected that any major increase in the magnitude of clandestine abortions will necessarily be followed by an increase in abortion hospitalizations. But our analysis shows that Chile exhibits a steady decrease in abortion-related hospitalizations over the last four decades, suggesting a decrease in clandestine abortions. In consequence, by observing the current Chilean registry of hospitalization for any kind of abortion, we can monitor possible changes in the trend of clandestine abortions, whatever the method used.

MercatorNet: In hindsight, was the 1989 ban justified? Did it save lives?

Elard Koch: In Chile, therapeutic abortion was prohibited in 1989 since it was considered unnecessary for protecting the life of the mother and her baby. From the perspective of the Chilean medical practice, the exceptional cases in which the life of the mother is at risk are regarded as a medical ethics problem to be solved by applying the principle of double effect and the concept of indirect abortion.

Thus, in Chile, exceptional problems that require medical intervention to save the life of the mother are considered a decision of medical ethics and not a legal issue. Therefore, any kind of directly provoked abortion was prohibited in 1989, in agreement with Article 19 of the Chilean Constitution which protects the life of the unborn.

The second question—does it save lives?—is very complex and important. We can address this important issue from different perspectives.

First, from a public health view, restrictive laws are hypothesized to cause a dissuasive effect on the population, similar to restrictions on tobacco or alcohol consumption. We observed that reduction of maternal mortality in Chile was paralleled by the number of hospitalizations attributable to complications of clandestine abortions. While over 50% of all abortion-related hospitalizations were attributable to complications of clandestine abortions during the 1960s, this proportion decreased rapidly in the following decades.

Indeed, only 12-19% of all hospitalization from abortion can be attributable to clandestine abortions between 2001 and 2008. These data suggest that over time, restrictive laws may have a restraining effect on the practice of abortion and promote its decrease. In fact, Chile exhibits today one of the lowest abortion-related maternal deaths in the world, with a 92.3% decrease since 1989 and a 99.1% accumulated decrease over 50 years.

Second, from the perspective of human life, especially if a developing country is looking to simultaneously protect the life of the mother and the unborn child, a plausible hypothesis after the Chilean study is that abortion restriction may be effective when is combined with adequately-implemented public policies to increase educational levels of women and to improve access to maternal health facilities. A restrictive law may discourage practice, which is suggested by the decrease of hospitalizations due to clandestine abortions estimated in Chile.

Third, from the perspective of protecting human life from the very beginning, obviously, abortion restriction saves many lives, in contrast to countries where elective—on demand—abortion is allowed, because in these countries all the unborn lose their lives.

Finally, it is necessary to remark that our study confirms that abortion prohibition is not related to overall rates of maternal mortality. In other words, making abortion illegal does not increase maternal deaths: it is a matter of scientific fact in our study.

Nevertheless, although our study definitively ruled out any deleterious influence of abortion prohibition on the maternal mortality trend, it cannot be immediately concluded that solely making abortion illegal is a direct causal factor for decreasing maternal mortality by itself.

The reduction in the maternal mortality trend in Chile is controlled by other factors, especially the educational level of women that positively influences other key variables, such as access to maternal health facilities, sanitary services and reproductive behaviour.

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Elard S. Koch is an epidemiologist from the Department of Family Medicine, Faculty of Medicine, University of Chile. This article reprinted from Mercatornet.com under a Creative Commons license.

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TLC pulls ‘19 Kids and Counting’ from schedule following Duggar molestation allegations

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By Ben Johnson

SPRINGDALE, AR, May 22, 2015 (LifeSiteNews.com) – The television network TLC has removed the Duggar family's reality show, “19 Kids and Counting,” from its schedule, at least temporarily.

Multiple news outlets have confirmed that the show, featuring the large and expanding evangelical Christian family, will not be on the air until the network makes a final decision about the program's fate.

The network had previously removed “Here Comes Honey Boo Boo” from its network after “Mama June” Shannon had been seen associating with convicted child molester Mark McDaniel, possibly exposing her children to a sexual predator. Shannon has told the entertainment news outlet TMZ that she would sue the network for unfair and inconsistent treatment.

TLC has not made a final determination as of yet and aired a Duggar marathon Thursday evening as the controversy brewed.

Friday's move comes after media outlets obtained police records showing Josh Duggar, as a young teenager 12 years ago, inappropriately touched as many as five girls, often while they were sleeping. The police records show the incidents began in March 2002, the month the oldest Duggar child turned 14. He admitted the incident to his parents that July, but another incident took place in March 2003. At that time, the family sent him to a program that required counseling and hard physical labor.

Three years later, a letter containing details of the molestation was found, and its recipient notified police, who launched an investigation.

One of his victims told police, after Josh returned in July 2003, he had clearly “turned back to God.” No further incidents have been alleged.

Duggar's wife of six-and-a-half years, Anna, said Josh revealed the painful episode to her two years before they got engaged.

Since the allegations have been made public, Josh Duggar admitted his long ago wrongdoing, calling his teenage actions “inexcusable.” He also resigned his job at FRC Action, a pro-family lobbying organization.

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Some figures have offered the Duggars their reassurance that, whatever sins Josh committed as a teen, he can be – perhaps has been – forgiven by God.

Former Arkansas Gov. Mike Huckabee, now a presidential hopeful, said that Josh “and his family dealt with it and were honest and open about it with the victims and the authorities. No purpose whatsoever is served by those who are now trying to discredit Josh or his family by sensationalizing the story.”

He said those who leaked the story were motivated by “insensitive bloodlust” to destroy the Duggar family. “There was no consideration of the fact that the victims wanted this to be left in the past, and ultimately a judge had the information on file destroyed—not to protect Josh, but the innocent victims.”

God, Huckabee said, forgives all sins.

“In my life today, I am so very thankful for God’s grace, mercy and redemption,” Josh wrote.

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Rebecca Kiessling of Save the 1 - United States Steve Jalsevac/Vatican City
Rebecca Kiessling

I told her I was conceived in rape. She told me to prove I shouldn’t have been aborted.

Rebecca Kiessling
By Rebecca Kiessling

(Savethe1) - Why should I have to prove my worth and my right to life? When I first learned at the age of 18 that I was conceived in rape, I instantly felt targeted and devalued by our society because I’d heard what people said about pregnancy “in cases of rape.” Right away, I felt I was in a position where I would have to justify my own existence – that I would have to prove to the world that I shouldn’t have been aborted and that I was worthy of living.

I’ve since found my own value, identity and purpose in Christ, being created by God, in His image, and for a purpose, so I no longer feel I need to prove my worth to others in order to feel worthy. Instead, I share my worth out of gratitude for my own life being spared and in order that others may see the value of those who are still at risk – those who are in harm’s way as yet unborn and being targeted for abortion in the clinics, in legislation, and in people’s hearts and minds.

Whenever I speak, I share this aspect of my journey, but people are shocked to hear that I actually do get challenged to prove my value, to demonstrate my positive contribution to society and to justify my right not to have been aborted. This recent e-mail is a case in point. It was a tough inquiry to receive, but you’ll see my hopefully patient (and prayerful) responses below, and the ultimate outcome of the exchange:

I’m feeling sad and skeptical about rape babies.  I’d love to consider myself pro-life due to biblical reasons, but I just don’t really see what good can ever come out of a rape baby. I still think that it sometimes furthers the victimization of a rape victim. And it’s also because I’m very sad and disturbed by your blog.

I just think sometimes that it would be better if these babies never existed -- that every single one would naturally be miscarried by God’s will, so no one could bully them for their skeleton in their closet. Like I said, the subject manner disturbs me to the point where I vomit. I wish that every child was conceived in love and not violence because that's the way it should be. And I'm sad to say that the only way I could fully believe all of you rape mothers and children is if you were to pray for the peace of God that transcends all my futile understanding and my volatile, overly-sensitive emotions. 

There is no story in the whole world that can fully change my mind. The only way I could ever is if I were to befriend a victim or become the Bride of a man whom was the product of abuse. I'm so sorry to be brutally honest; it's just that my heart grieves to the point where I feel the struggle to overcome the sin of prejudice. I'm so angry at God that he allows this to occur.

Dear __, I appreciate you going to our blog and taking the time to reach out to us.  Your concerns are the most common, but research shows that rape victims are four times more likely to die within the next year after the abortion vs. giving birth. Dr. David Reardon's book Victims and Victors: Speaking Out About Their Pregnancies, Abortions and Children Resulting From Sexual Assault explains this.  So it's a myth which gets perpetuated -- that a rape victim would be better off after an abortion, that her child would be a reminder of the rape, and that she would even see her child as a "rape baby," as you put it.

I understand a lot of what you're saying.  You would definitely feel differently if you knew someone personally.  I wished I wasn’t conceived in rape, but I do believe now that God definitely brings good out of evil, and uses tragic situations to bring healing.  He doesn't intend the evil of course, but his trademark is redeeming really awful situations.

-- Rebecca

Her reply (again, challenging for me to read, but I think she candidly articulates a lot of what most people really wonder or think):

What has God done in your life personally besides this blog that has made your tragic family life worth the pain? Tell me what you have been doing: like marriage, dating, children, jobs, friendship, volunteer work; any of that. I am curious to see how God has given your life joy and purpose. I'm sorry if I have ever been difficult to handle. I'm emotionally impulsive when I hear something sad.

First of all, my birthmother and her husband legally adopted me 3-1/2 years ago because my adoptive family was really screwed up (long story of abuse and abandonment.) My own adoption by my birthmother was our fairy-tale ending.  She says I'm a blessing to her, I honor her and I bring her healing! I love adoption -- my two oldest are adopted (very open adoption,) and we adopted a baby with special needs -- Cassie -- who died in our arms at 33 days old. It was an honor to take care of her and was definitely one of the most important things I'd ever done in my life. She died because of medical malpractice.

Married for nearly 17 years, we have 5 children now – two adopted sons and our three biological daughters.  Here's my son's story. He wrote it last September at 12 years old.

Besides being the president and founder of Save The 1, I also co-founded Hope After Rape Conception. I'm a family law attorney, though I closed my law practice to have my children and to home school until 2-1/2 years ago.

I make baby quilts which I donate to pregnancy resource centers and I give to moms in unplanned pregnancies. My birthmother taught me to sew! I also taught my children to quilt, as well as many of my friends and their children. I've volunteered with orphan care, Sunday school, feeding the disadvantaged, free legal work, volunteer work for a maternity home, and helping in various ways with pregnancy resource centers. I changed the hearts of Gov. Rick Perry and Newt Gingrich on this issue during their presidential campaigns!

A large part of what I do is helping others to understand their value, identity and worth because lots of people struggle with these issues -- not just those conceived in rape. I hope this helps!  -- Rebecca

Her final response – from someone who said “there is no story in the world that can fully change my mind”: 

Dear Rebecca, thank you so much for your time to straighten out my emotional acting out -- I'm really glad you told me about your life. I really think I'll be okay now. I still wish that men wouldn't rape, but at least the world knows a lot more than they used to and I can say that I'm pro-life to my college professors without paranoia or anxiety. I even talked about helping people like you with my mom and dad. They told me I'm too sensitive in personality to be involved directly in domestic politics; yet, I'm praying about being a free English tutor for troubled families as well as being an anti-pornography informant or activist. After all, the porn industry has been statistically linked to the sexual violence pandemic. I'm so glad that you are living life well and to the best of your ability; keep telling people that just because your birth father was an evil scumbag doesn't mean that you are. Thanks Rebecca, you have really touched and strengthened my heart. With much sincerity.

 

BIO: Rebecca Kiessling was conceived in rape and nearly aborted, but legally protected by law in Michigan pre-Roe v Wade.  She's an attorney, pro-life speaker and blogger, and President of Save The 1. Her own website is www.rebeccakiessling.com

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Boy Scouts president: We need to allow open homosexual leaders

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By Dustin Siggins

May 22, 2015 (LifeSiteNews.com) – Boy Scouts of America president Robert Gates says the youth organization must change with the times and allow open homosexual men to serve as Scout leaders.

Gates, the former U.S. Secretary of Defense and CIA Director, said in a speech at the 2015 Boy Scouts of America (BSA) National Annual Meeting Thursday that the Boy Scouts would have to adjust to "the social, political, and juridicial changes taking place in our country -- changes taking place a pace this past year no one anticipated."

According to Gates, the way to balance the religious affiliations of "some 70% of our scout units" and avoid "a broad [court] ruling that could forbid any kind of membership standard" is to offer individual troops a flexible membership policy. 

"For me, I support a policy that accepts and respects our different perspectives and beliefs, allows religious organizations -- based on First Amendment protections of religious freedom -- to establish their own standards for adult leaders, and preserves the Boy Scouts of America now and forever."

"I truly fear that any other alternative will be the end of us as a national movement," said Gates, who said that BSA should "seize control of our own future, set our own course, and change our policy in order to allow charter partners -- unit sponsoring organizations -- to determine the standards for their Scout leaders."

This is not the first time that Gates, who led the military to end its two decades-long Don't Ask, Don't Tell policy, has supported gay Scout leaders. Last year, he said that he "would have supported having gay Scoutmasters, but at the same time, I fully accept the decision that was democratically arrived at by 1,500 volunteers from across the entire country."

In 2013, BSA allowed openly homosexual scouts for the first time. That policy reads: "No youth may be denied membership in the Boy Scouts of America on the basis of sexual orientation or preference alone,” and took effect on January 1, 2014.

A year ago, Gates said he "was prepared to go further than the decision that was made" to allow gay Scout members, but decided that "to try to take last year's decision to the next step would irreparably fracture and perhaps even provoke a formal, permanent split in this movement - with the high likelihood neither side would subsequently survive on its own."

This week, though, Gates said that "events during the past year have confronted us with urgent challenges I did not foresee and which we cannot ignore."

"We cannot ignore growing internal challenges to our current membership policy, from some councils... in open defiance of the policy," said Gates. 

However, Gates' remarks may have come too late to prevent internal challenges from splitting BSA. Due to the 2013 vote, a number of Scouting alternatives launched, including the organization Trail Life USA. The latter group says it aims "to be the premier national character development organization for young men which produces Godly and responsible husbands, fathers, and citizens." 

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In January, Trail Life USA said it has "over 540 Troops in 48 states and the registration of nearly 20,000 adults and boys..."

Furthermore, the decision by BSA to allow gay scouts has led to criticism from people on both sides of the debate. Homosexual activists say the group did not go far enough, whereas many Christian parents and organizations say BSA is bowing to public pressure from homosexual advocates to affect its membership, despite its Christian roots.

Corporate pressure has also been aggressive. Last year, Walt Disney World threatened to not allow employees to volunteer for BSA as part of its VoluntEARS program in 2015 if the organization does not allow gay Scout leaders. Diversity Inc. reports that Merck & Co., Ernst & Young, Major League Baseball, and AT&T are just some of the other companies that have pressured BSA to further change its policies.

LifeSiteNews asked BSA whether Gates' comments indicated support for a totally flexible scout leadership policy, or just related to gay scout leaders, as well as whether BSA would take a stand against state and local laws that deny First Amendment rights to people who oppose same-sex "marriage."

BSA declined to comment, telling LifeSiteNews in a statement: "Dr. Gates’s remarks speak for themselves. ... It is important to note that no decisions were made during the National Annual Meeting. A decision is expected no later than the Boy Scouts of America’s National Executive Board meeting in October."

A video of Gates' remarks is below. The comments about membership standards begin at 8:40.

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