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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Dr. Miriam Grossman speaks to large audience in Mississauga, Ontario Steve Jalsevac/LifeSite
Lianne Laurence

VIDEO: How DO you to talk to kids about sex? US sex-ed critic gives practical tips

Lianne Laurence
By Lianne Laurence

MISSISSAUGA, ON, August 27, 2015 (LifeSiteNews) – Talking to their children about sex is “anxiety provoking to say the least,” for parents, says American sex-ed expert, Dr. Miriam Grossman.

“Some people just can’t even do it, and that’s okay,” the New York-based psychiatrist told the crowd of 1,000 who packed a Mississauga conference hall August 18 to hear her critique of the Ontario Liberal government’s controversial sex-ed curriculum.

After Grossman explained how the Liberal sex-ed curriculum is dangerously flawed and ideologically driven, she used the question-and-answer session to give parents much appreciated and sometimes humorous practical advice on how to teach their children about “the birds and the bees.”

“If you feel you can’t do it, maybe there’s someone else in the family or in the constellation of people that you know you can trust that could do it,” said Grossman, author of “You’re teaching my child WHAT?” and an internationally sought-after speaker on sex education.

A child, adolescent and adult psychiatrist with 12 years’ clinical experience treating students at the University of California, Los Angeles (UCLA) clinic, Grossman said explaining sexuality and procreation to children is “a process,” that “shouldn’t ideally happen all at once. A child is not a miniature adult, and absorbs…new information differently than adults do.”

And parents need to be sure just what their child wants to know.

To illustrate this, Grossman referred to her earlier story about a father who gave his son every detail on human procreation after the boy asked him, “Dad, where do I come from?”

After the father finished, his son replied, “Well, that’s funny, because Johnny told me that he came from Montreal.”

“Try to find out what your child is really getting at, and, don’t give it all at once,” Grossman said. “You start with a little bit at a time…and you know, there’s so many variables here, and people have their own traditions and their own ways of explaining things, and something that might be right for my family might not be right for your family.”

She also advised that, when confronted with a four, five, six or seven-year-old asking about a pregnant woman, or where babies come, a parent can ask, “What a good question that is. What do you think?”

And parents can also legitimately put off the discussion when appropriate, telling the child, “That’s really not something you need to know about right now.”

“Wow, what a novel idea: Telling a child that they could wait until they’re older to discuss that subject,” Grossman said, adding that parents wouldn’t brook a six- or even fifteen-year-old child asking how much money they made or had in the bank. “Excuse me? Not every subject has to be an open book.”

However, the time will come when a child needs to know “about how her body’s going to change, about reproduction, about how a new life is created.”

That time, Grossman advised, is puberty, or “as puberty is beginning,” and this is especially so for girls, who, if unprepared for the surprise onset of menstruation “might think [they’re] dying.”

“The actual nitty-gritty about the birds and the bees and intercourse” can “be told in bits and pieces, or it can be told all at once, if you feel it’s necessary,” she said, adding that it’s beneficial if the parent acknowledges his or her awkwardness, because the child will think: “This must be such an important subject that my mother or my father is sitting there squirming, but he’s doing it anyway. I’m really loved.”

“And the children need to understand that as you grow up, you change a lot, not only physically but emotionally,” Grossman said, “and what may seem odd or disgusting when you’re ten years old, or whatever age, it becomes something very special and beautiful when you’re older and you’ll understand it later. You don’t have to understand it now.”


Know your child and guard your home

But as an essential foundation for this discussion, parents must both know their children and guard their home from the encroachments of a culture that Grossman described as “very, very sexualized” and “really horrible.”

“Children need parents who are loving but are also firm and authoritative,” she asserted.  “They don’t need best friends. They need us to guide them, to know what they’re doing, to be on top of what they’re doing.

So parents need to be aware of whom their child is “hanging around with, and what kind of movies are they watching…what’s going on with your child.”

“You need to know that anyway, even if it’s not about sex education,” she pointed out. “Try and know your child. Every child is different.”

And Grossman emphasized that it is “extremely important to be careful about what your child is exposed to in the home, in terms of television and Internet, obviously.”

Children need to understand that “just like you have garbage you take out of the house, you put it in the garbage bin, it’s dirty, it smells…there are other things that also don’t belong in the house.”

And children learn quickly what is, and is not, permissible inside the home, Grossman said. “Me, I keep kosher…If I go into a store, my kids know from a very young age, we don’t eat that.”

So they are used to the idea of “the world outside and the inside world, of inside your home, and inside your heart as well.”

Parents can also convey this by telling their children that “the world is an upside-down place, and sometimes the most special, holy subjects are…just thrown in the gutter. And that’s a bad thing. In our family, in our tradition, we don’t do that.”

“Sexuality is one of the subjects that in this upside-down world, it is sometimes just in the gutter,” she said. “And so I want you to tell your child to come to me when you have questions, I will give you the straight story about it.”

Grossman herself is “not even sure,” as she stated in her seminar, that sex education should be in the schools: “I believe sex education should be at home for those parents that want to do it.”

She also noted that parents “can make mistakes. We all make lots of mistakes but it’s okay, you can always come back and do it differently,” adding that this is “another wonderful message for your child. You know what, it’s okay to make mistakes, you can always go back and try and fix it.”

Grossman urged parents to visit her Facebook page, website and blog. “I have so much information you can get there that you’ll find useful,” and added that she will be publishing books for children, and has posted her critique of New York City’s sex-ed curriculum, which is similar to Ontario’s.

The parental backlash to that sex-ed curriculum, set to roll out in the province’s publicly funded schools this September, has been “amazing” Grossman noted.

Grossman’s seminar was sponsored by Mississauga-based HOWA Voice of Change along with the Canadian Families Alliance, an umbrella group representing more than 25 associations and 200,000 Ontarians opposed to the curriculum. The report on her devastating critique of the sex-ed curriculum can be found here, and the video here.

Ontario readers may find information and sign up for a September 2 province-wide protests at MPPs offices here. So far, there are protests planned for 92 of Ontario’s 107 constituencies. The parents’ movement seeking removal of the curriculum is urging all concerned citizens to join this special effort to influence individual Ontario legislators.

See related reports:

Ontario’s dangerous sex-ed is indoctrination not science says U.S. psychiatrist to large audience

Videos: US psychiatrist tells parents “stand firm” against dangerous sex-ed

See the LifeSiteNews feature page on the Ontario sex-ed curriculum containing nearly 100 LifeSite articles related to the issue

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Pete Baklinski Pete Baklinski Follow Pete

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Did the pope just endorse a gay children’s book? Of course not, says Vatican

Pete Baklinski Pete Baklinski Follow Pete
By Pete Baklinski

ROME, August 28, 2015 (LifeSiteNews) -- While mainstream media is gushing with news today that Pope Francis allegedly praised a children’s book that promotes gender theory, the Vatican is decrying what they called the "manipulation" of a cordial letter from an official in the Secretariat of State to suggest that the Vatican is promoting teachings contrary to the Gospel.

Italian children’s author Francesca Pardi was reported by The Guardian to have submitted a parcel of children’s books promoting the acceptance of homosexuality and gender theory to Pope Francis in June after Venice’s mayor Luigi Brugnaro publicly banned the author’s newest book, Piccolo Uovo (Little Egg), from children’s schools. The book was criticized by pro-family leaders for promoting non-natural family structures of two men and two women.

In a letter accompanying the books, Pardi wrote: “Many parishes across the country are in this period sullying our name and telling falsehoods about our work which deeply offends us. We have respect for Catholics. ... A lot of Catholics give back the same respect, why can’t we have the whole hierarchy of the church behind us?”

The Guardian is reporting that Pardi has now “found an unlikely supporter in Pope Francis,” who through his staff has responded to the author and is presented as “praising her work.” It quotes the following from a July 9 letter to Pardi from the Vatican.

“His holiness is grateful for the thoughtful gesture and for the feelings which it evoked, hoping for an always more fruitful activity in the service of young generations and the spread of genuine human and Christian values,” wrote Peter B. Wells, a senior official at the Vatican Secretariat of State, in a the letter The Guardian is reporting it has seen.  

While the letter gently calls the author to use her talents to spread “genuine human and Christian values,” The Guardian takes it as the pope’s endorsement of gender theory.

“Pope Francis sends letter praising gay children's book,” the paper’s headline states. “Italian book that explores different family types including same sex was banned by mayor of Venice, but pontiff becomes unlikely supporter,” reads the subtitle.

In a press release that Vatican spokesman Fr. Federico Lombardi sent to LifeSiteNews on Friday, the vice speaker of the Vatican, Ciro Benedettini, made clear that the friendly reply letter to the author in no way approves of attitudes or positions that are contrary to Catholic teaching and the Gospels.

The Vatican's statement also says that in the original letter from the secretariat of state Wells merely "acknowledged receipt" of the materials sent by Pardi, and also made clear that the letter was private and not meant for publication. 

"In no way does a letter from the Secretary of State intend to endorse behaviors and teachings not in keeping with the Gospel," says the statement, decrying the "manipulation" of the letter.

Benedettini said the blessing of the pope at the end of the letter was meant to be for the author herself, and not to affirm positions concerning gender theory that are contrary to the Church's teaching. Using the letter to this end is erroneous, he said.

Pope Francis has strongly condemned the notion of “gender theory” on numerous occasions, saying that it is an “error of the human mind that leads to so much confusion.”

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Poll suggests most US Catholics wrongly believe Pope Francis backs gay ‘marriage’

Lisa Bourne
By Lisa Bourne

August 28, 2015 (LifeSiteNews) -- A considerable majority of U.S. Catholics are in conflict with Church teaching on abortion and marriage, a new study says, and a startling number of those also believe Pope Francis backs homosexual “marriage.”

Despite Church teachings, Catholics in America also closely parallel the general populace in their support for abortion and homosexual “marriage,” falling short in the Biblical call to be “in the world but not of the world.”

The findings suggest what many Catholics have said is a climate of confusion in the midst of the Francis pontificate. Concerns over that confusion prompted a coalition of pro-family groups to respond with an international petition effort asking the pope to reaffirm Church teaching, drawing more than a half-million signatures.

The survey, conducted by Public Religions Research Institute, found that 60 percent of all U.S. Catholics favor legalized homosexual “marriage,” compared to 55 percent of all Americans. Likewise, 51 percent of Catholics think that abortion should be legal in all or most cases, with 53 percent of the general population holding this view.

The Catholic Church teaches that marriage is a sacramental union between one man and one woman, mirroring Christ and the Church respectively as bridegroom and bride.

The Church also teaches that life begins at conception, that each human life possesses dignity as a child of God and is to be afforded protection, making abortion an intrinsic evil.

Catholics, accounting for 22 percent of adults in the U.S. population, have a favorable view of Pope Francis, the study said, but they are very confused about his take on homosexual “marriage.”

Of the Catholics who back homosexual “marriage,” 49-percent also think the leader of the Catholic Church backs it along with them. Fifteen percent of those Catholics who oppose homosexual “marriage” also mistakenly believe Pope Francis supports it.

Pope Francis has made numerous statements in support of life, marriage and family, but the confusion remains.

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"After Ireland and the U.S. Supreme Court both approved same-sex 'marriage,' a strong reaffirmation of Church teaching could save the sacred institution of marriage, strengthen the family and dispel the lies of the homosexual revolution," TFP Student Action Director John Ritchie stated.  "Young Catholics -- even non-Catholics -- look to the Church as a beacon of morality and stability in our Godless culture, but some of our shepherds have issued confusing statements."

TFP Student Action is a part of the lay Catholic organization American Society for the Defense of Tradition, Family and Property, and is part of the alliance behind the Filial Appeal, the petition asking the Holy Father to reinforce Catholic teaching at the Vatican’s upcoming Synod on the Family in October.

Ritchie explained how the confusion was aiding the Church’s enemies, and warned of the potential consequences.

"This prayerful petition asks Pope Francis to clear up the moral confusion that's been spreading against Natural and Divine Law," he said. "If the enemies of the family continue to chip away at holy matrimony, the future of the family and civilization itself will be in even more serious peril."

At press time more than 500,000 signature had been gathered for the appeal, including five cardinals, 117 bishops and hundreds of well-known civic leaders.

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