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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Two Congressmen confirm: National 20-week ban on abortion will come up for a vote shortly

Dustin Siggins Dustin Siggins Follow Dustin
By Dustin Siggins

WASHINGTON, D.C., April 17, 2015 (LifeSiteNews.com) – A bill to end abortion in the United States after 20 weeks will move forward, and it will have the strong support of two leading pro-life Congressmen, the two Republicans told LifeSiteNews.com at the eighth annual Susan B. Anthony List Campaign for Life Summit on Thursday.

Rep. Chris Smith, R-NJ, told LifeSiteNews and the National Catholic Register that ongoing House discussions on H.R. 36, the "Pain Capable Unborn Child Protection Act," will result in a pro-life bill moving forward.

"Very good language" is being put together, Smith told The Register. He told LifeSiteNews that he fully anticipated being able to support the final bill, because the House Republican caucus "wouldn't have something that would be unsupportable. Our leadership is genuinely pro-life."

In 2013, the "Pain Capable Unborn Child Protection Act" easily passed through the House of Representatives, only to be stalled by a Democratic-controlled Senate. This year, an identical bill was halted by Rep. Renee Ellmers, R-NC, and other Republicans -- surprising and angering pro-life leaders who thought its passage was assured. That bill, H.R. 36, is now being rewritten so it can be voted on by the full House, though its final wording remains uncertain.

Some fear that the House leadership will modify the bill to mollify Ellmers. She and others objected that the bill allows women to abort a child after 20 weeks in the case of rape – but only if they report that rape to the authorities.

Pro-life activists say removing the reporting requirement would take abortionists at their word that the women whose children they abort claimed to be raped. Congresswoman Ellmers has publicly stated the House leadership is considering such a proposal.

Jill Stanek, who was recently arrested on Capitol Hill as part of a protest to encourage Republicans to pass H.R. 36, said that would be "a loophole big enough for a Mack truck."

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Congressman Smith said the bill will come to the floor shortly. "The commitment to this bill is ironclad; we just have to work out some details," Smith said.

He also noted that, while a vote on the 20-week ban has been delayed for nearly three months, "we did get the No Taxpayer Funding for Abortion Act passed, and that would have been in the queue now, so we just reversed" the order of the two bills.

Congressman Smith spoke to both outlets shortly after participating in a panel at the Summit.

Another speaker was Rep. Steve King, R-IA, who also supports the 20-week ban.

"I can't think of what” language that is actively under consideration could make him rethink his support for the bill, King said. He also told attendees that the nation was moving in a direction of supporting life.

The outspoken Congressman declined to answer further, noting "that's asking me to anticipate an unknown hypothetical."

The annual Campaign for Life Summit and its related gala drew other high-profile speakers, including presidential candidate Senator Rand Paul, potential presidential hopeful Senator Lindsay Graham, and Republican National Committee Chairman Reince Priebus.  

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"Someone who doesn’t flinch at the dismemberment of babies is not going to flinch at the dismemberment of some evangelical baker’s conscience."
Jonathon van Maren Jonathon van Maren Follow Jonathon

Pro-lifers are winning. So now they’re coming for our cupcakes?

Jonathon van Maren Jonathon van Maren Follow Jonathon
By Jonathon van Maren

As I travel across Canada (and at times the United States) speaking on abortion and various facets of the Culture of Death, one of the things I hear often is a hopelessness, a despair that the West is being flattened by the juggernaut of the Sexual Revolution. There is a feeling among many people that the restriction of religious liberty, the continued legality of abortion, and the redefinition of marriage are inevitable.

This is, of course, one of the most prominent and successful strategies of the Sexual Revolutionaries—create an aura of inevitability while concurrently demonizing all those who oppose their new and mangled “progress” as Neanderthals on the cusp of being left behind by History. That inevitability becomes a self-fulfilling prophecy, because many people don’t realize that the various battles in the Sexual Revolution actually all correlate to one another—that what we are seeing now is the end game of an incredibly vast and well-planned cultural project.

It is because we miss many of these connections that we often cannot see, with clarity, how the culture wars are actually unfolding. I read with great interest a recent column by Rev. Douglas Wilson, eloquently titled “With stirrups raised to Molech.”

“We are now much occupied with the issues swirling around same sex mirage,” he writes, “but we need to take great care not to get distracted. Why have the homosexual activists gone all in on this issue? Why is their prosecutorial zeal so adamant? We went, in just a matter of months, from ‘let’s let individual states’ decide on this, to federal judges striking down state statutes, followed up hard by official harassment of florists, bakers, and photographers. Why the anger, and why the savage over-reach? And do they really think we couldn’t remember all the things they were assuring us of this time last year?”

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It’s a compelling question, and one that I’ve heard many Christians puzzling over recently. Why do the advocates of the Sexual Revolution despise those who disagree with them so viciously? It is partly because their cultural project does not, as they claim, consist of “living and let live.” It is about compulsory acceptance of any and all sexual behaviors, with tax-payer funding for the rubbers and pills they need to ensure all such behaviors remain sterile, and extermination crews to suction, poison, and dismember any inconvenient fetuses that may come into being as the result of casual coitus.

The ancient mantra “the State has no business in the bedrooms of the nation” has long been abandoned—the emboldened Sexual Revolutionaries now demand that politicians show up at their exhibitionist parades of public indecency, force schools to impose their so-called “morally neutral” view of sexuality on children, and force into silence those who still hold to traditional values.

Rev. Wilson, however, thinks that this loud and vicious war on conscience may be about even more than that. The pro-life cause, he notes, has been very successful in the Unites States. The abortion rate is the lowest it has been since 1973. Hundreds of pro-life laws are passing on the state level. The abortion industry has been successfully stigmatized. True, the successes are, for pro-lifers, often too feeble and not nearly adequate enough in the face of such unrestrained bloodshed. Nevertheless, the momentum has turned against the Sexual Revolutionaries who have championed abortion for decades—their shock and anger at the strength of the pro-life movement evident in pro-abortion signs at rallies that read, “I can’t believe I still have to protest this s**t.”

It is because of the pro-life movement’s success, Wilson muses, that the Sexual Revolutionaries may be coming at us with such fury. “If a nation has slaughtered 50 million infants,” he writes, “they are not going to suddenly get a sense of decency over you and your cupcakes. Now this explains their lack of proportion, and their refusal to acknowledge the rights of florists. Someone who doesn’t flinch at the dismemberment of babies is not going to flinch at the dismemberment of some evangelical baker’s conscience. This reveals their distorted priorities, of course, but it also might be revealing a strategy. Is the homosexual lobby doing this because they are freaking out over their losses on the pro-life front? And are they doing so in a way intended to distract us away from an issue where we are slowly, gradually, inexorably, winning?”

It’s a fascinating perspective. It’s true—and has always been true historically—that when one group of human beings is classified as nonhuman by a society as nonhuman and subsequently butchered, the whole of society is degraded. No nation and no culture can collectively and systematically kill so many human beings without a correlating hardening of the conscience. But on the pro-life front, there has been decades of fierce resistance, hundreds of incremental victories, and a renewed energy among the upcoming generation of activists. For the Sexual Revolutionaries who thought the battle was over when Roe v. Wade was announced in 1973, this must be a bitter pill to swallow indeed.

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Lisa Bourne

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‘Prominent’ Catholics attacking Archbishop Cordileone are big donors to Pelosi and pro-abort Democrats

Lisa Bourne
By Lisa Bourne

Note: To sign a petition supporting Archbishop Cordileone, click here

SAN FRANCISCO, CA, April 17, 2015 (LifeSiteNews.com) -- Big donors to the Democrat Party and pro-abortion Nancy Pelosi are among those publicly harassing San Francisco Archbishop Salvatore Cordileone for protecting Catholic identity in the area’s Catholic high schools.

A big-ticket full-page ad ran April 16 in the San Francisco Chronicle attacking the archbishop and calling Pope Francis to oust him for his efforts to reinforce Catholic principles in the schools.

A number of prominent San Francisco-area residents identifying as Catholic are signatories of the ad, and several are wealthy donors to Democrat entities and pro-abortion politicians, Catholic Vote reports.

Federal Election Commission records indicate Charles Geschke, Adobe Systems chairman and previous head of the Board of Trustees at the University of San Francisco, gave more than $240,000 to Democrat groups, as well as $2,300 to Nancy Pelosi and $4,000 to John Kerry, both politicians who claim to be Catholic but support abortion and homosexual “marriage.”

Also on the list is political consultant and businessman Clint Reilly, who gave nearly $60,000 to Democrat organizations, along with $5,000 to Barack Obama, whose administration vehemently promotes abortion and homosexual “marriage” and has continually opposed religious liberty. Reilly gave $4,600 to Pelosi as well.

Another individual in the ad attacking the archbishop who also gave big campaign donations to California pro-abort Democrats was Lou Giraudo, a former city commissioner and business executive who contributed more than $24,000 to Nancy Pelosi, $6,000 to Dianne Feinstein and $4,300 to Barbara Boxer.

Nancy Pelosi herself challenged the archbishop for his stance on Catholic teaching last year when she tried to pressure him out of speaking at the March for Marriage in Washington D.C., claiming the event was “venom masquerading as virtue.”

The archbishop responded in a letter that he was obliged “as a bishop, to proclaim the truth—the whole truth—about the human person and God’s will for our flourishing ... especially the truth about marriage as the conjugal union of husband and wife.”

The April 16 ad attacking Archbishop Cordileone was the latest in an ongoing assault since the archbishop took steps in February to strengthen Catholic identity in the schools and clarify for faculty and staff in handbooks and contract language the long-standing expectation that they uphold Church principles. 

It said Archbishop Cordileone has “fostered an atmosphere of division and intolerance” and called on Pope Francis to remove him.

“Holy Father, Please Provide Us With a Leader True to Our Values and Your Namesake,” the ad said. “Please Replace Archbishop Cordileone.”

The Confraternity of Catholic Clergy (CCC), a national association for priests and deacons, condemned Archbishop Cordileone’s harassers in a statement, saying the archbishop “teaches in conformity to the Catechism of the Catholic Church.”

“The character assassination and uncharitable venom being cast upon a bishop merely defending the doctrines of his religion is appalling and repugnant,” the CCC said. 

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“It is totally inappropriate, improper and unjust for the media and others to vilify and brutally attack him when he is doing precisely what an ordained minister and pastor of souls is obligated to do,” the group stated, “namely, speak the truth in season and out of season.”

Those behind the attack ad said the proposed handbook language was mean-spirited, and that they were “committed Catholics inspired by Vatican II,” who “believe in the traditions of conscience, respect and inclusion upon which our Catholic faith was founded.”

The Archdiocese of San Francisco denounced the ad upon its release, saying it was a misrepresentation of Catholic teaching and the nature of the teacher contract, and a misrepresentation of the spirit of the Archbishop.

“The greatest misrepresentation of all is that the signers presume to speak for “the Catholic Community of San Francisco,” the archdiocese responded. “They do not.”

The CCC pointed out that just as physicians are expected to be faithful to the Hippocratic Oath, bishops, priests, and deacons are expected to be faithful to the Church, its teachings and its authority, “since their objective is the salvation of souls, not a popularity contest.” 

In openly declaring their support for Archbishop Cordileone, the group urged the media and others to show “prudence, civility, and fair-mindedness” toward those with whom they disagree.

“He took an oath to be faithful to the Gospel,” the Confraternity stated of Archbishop Cordileone, “and in the words of the disciples in the New Testament, ‘better to obey God than men.’”

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