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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Congressman: Give us Nucatola or we’ll subpoena

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By Ben Johnson

WASHINGTON, D.C., July 23, 2015 (LifeSiteNews) - Dr. Deborah Nucatola has become awfully shy since she became the first national Planned Parenthood figure featured in an exposé of its practice of harvesting, and allegedly profiting from the sale of, the organs of aborted children. Within hours of the video release by the Center for Medical Progress, she removed her social media accounts. 

Now, she is considering dodging a call to testify before a Congressional committee investigating whether she admitted to breaking the law during her covertly recorded cameo with actors posing as agents of a human biologics company.

The House Energy and Commerce Committee called her to address the committee by month's end. 

Roger K. Evans, Planned Parenthood's Senior Counsel for Law and Policy, responded by saying that asking her to speak to Congress "no later than July 31 ... is short notice given the number of questions raised." 

He instead offered to substitute Dr. Raegan McDonald-Mosley in Nucatola's place.

Faced with the possibility that Planned Parenthood would refuse to send its star witness, at least one congressman has said he will take steps to ensure the abortion provider shows up.

Rep. Joe Pitts, R-PA, responded to Evans' letter by saying that the committee has called Dr. Nucatola to the witness stand before the end of the month, and she will comply or face the consequences.  

“If they say no, we’ll subpoena her,” the pro-life Republican said. 

The committee is focused on whether the process Dr. Nucatola - the doctor seen in the first video, eating salad and sipping wine - amounts to a violation of federal felony law forbidding the sale of human organs for "valuable consideration." 

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Why selling ‘baby body parts’ has captured America’s attention (VIDEO)

By Pete Baklinski

WASHINGTON, D.C., July 23, 2015 (LifeSiteNews) - A key player in last week’s startling video exposé of Planned Parenthood says that it took 30 months of strategic planning from numerous pro-life organizations to give the story the hard-hitting power with which it has walloped the abortion industry over its practice of harvesting the body parts of aborted babies. 

“We are seeing the fruit of a lot of careful thought, a lot of disciplined activities, and a lot of undercover work,” Rev. Frank Pavone, executive director of Priests for Life, told LifeSiteNews in an interview in Washington. 

Since breaking Tuesday of last week, the story has trended first place in social media platforms such as Facebook and has been given top priority on mega news aggregation websites such as Drudge Report. The first of now two undercover videos has been viewed over 2.5 million times on YouTube. 

Pavone said that this is not the first time Planned Parenthood has faced the heat for what many considered to be a barbaric practice of harvesting human organs for profit. Similar investigations in the late 1990s into the practices of Planned Parenthood found that aborted babies were being dissected alive, harvested, and sold in pieces for research. 

“Now this is fresh evidence. Now this is evidence going to the highest levels of Planned Parenthood. We know that people at the national level of Planned Parenthood are aware of and are admitting that these baby body parts are being harvested, that transactions are taking place, that money is changing hands. And so, this is catching the attention of the American public because it brings the abortion issue down from the abstract level to the concrete,” he said. 

“This is not just about viewpoints, it’s about victims. It’s not just about beliefs, it’s about bloodshed. When people see and hear terms like ‘eyes, livers, hearts’ it’s like, ‘What are we talking about here? This is ghoulish disgusting activity,’” he said. 

Pavone praised pro-life activists such as Operation Rescue president Troy Newman and Life Dynamics president Mark Crutcher for helping the exposé along, giving “strategic input, guidance, and advice.” Pavone highlighted the hard work of lead investigator David Daleiden of the Center for Medical Progress for going undercover to film meetings with high profile Planned Parenthood employees and attending numerous Planned Parenthood conferences.

Pavone believes the story has received so much traction in social media outlets like Facebook because it gives people a platform to express outrage over the injustice of abortion in response to mainstream media’s unwritten rule of silence and apathy on abortion. 

Traditional media outlets are “in the pocket” of Planned Parenthood and the abortion industry, he said, adding that they “don’t want to say a bad word about Planned Parenthood.”

“Social media has become the engine for those who feel so frustrated that things we have known for years that the abortion industry is doing, and yet we can’t seem to get the word out, now these people are taking this and running with it. And I think you’re seeing years and even decades of frustration being channeled in productive ways to say, ‘We’ve got to shout this from the rooftops.’ And social media is the perfect rooftop,” he said. 

When asked what the undercover videos released so far reveal about the abortion industry and the people who work in it, Pavone responded: 

When an abortionist dehumanizes the baby that he or she is about to kill, the abortionist also dehumanizes himself. And this is what we are seeing in these people. We see it in Deborah Nucatola sipping the wine and eating the salad and talking about the body parts. We see it in the newest video [about] Dr. Mary Gatter. We saw it in [jailed abortionist] Gosnell.

What’s wrong with [these people]? There are two things wrong. Number one, these people are dehumanized. They are deeply damaged by the abortions they perform. Because when you perform your first abortion, a voice of protest rises up within you saying, ‘No. Stop. You can’t do this.’ But then if you ignore that voice, and go ahead and do that abortion, then the next time you have to explain to yourself, and to everybody else, why you ignored that voice. And so, the voice of protest gets buried under layer, and layer, and layer of excuses and rationalizations. And in doing that, you are becoming disconnected from your own conscience.

How can these people talk about this with apparent peace on their face? It’s because they are disconnected from themselves, from their own conscience.

Pavone said that new undercover videos to be released in the coming days will continue to shed light on the gruesome practices happening at Planned Parenthood abortion centers across the nation. 

“We want to defund Planned Parenthood and get them to stop what they are doing. This is a very concrete way of doing that. We want to end Planned Parenthood because they are the largest abortion business in the world, and we want that to stop,” he said. 

Already a Congressional investigation is underway, but so far, Planned Parenthood is refusing to cooperate with the demands of the Committee investigating. 

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The Planned Parenthood scandal shows the power of exposing abortion’s grotesqueness

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By Jonathon van Maren

July 23, 2015 (UnmaskingChoice) -- If there’s one thing that confuses me about how many pro-lifers decide on strategies to change hearts and minds on abortion, it’s the fact that they seem to believe that we have to approach the most controversial issue there is without controversy—that somehow, we have to take an issue that people have incredibly strong feelings about and ensure that none of those feelings surface during a discussion.

As our postcard campaign nears our record-breaking mark of one million postcards delivered to one million homes, reactions have been widely varied—we have phone calls from people “horrified” by the postcard, who don’t seem to realize that the action depicted is much more horrifying. We have people who demand to know what they are supposed to say if their children see the picture of “the dead baby”—who don’t seem to realize that with their own words, they have admitted that we live in a country where dead babies are tossed in garbage cans behind government-funded clinics. We also have people who call us to thank us for the information, and express anger that such barbarism could be happening in Canada. We have people who phone to tell us that the postcard has changed their vote, and the votes of their neighbors. And we have people like the old man who wanted to shake my hand because he was encouraged to see that “some people cared about things.”

Huge numbers of Canadians have no idea that abortion decapitates, dismembers, and disembowels a pre-born human being. Huge numbers of Canadians are being exposed to that tragic and horrifying fact.

By the polling numbers, we see many people influenced against abortion—even if they don’t like us, the image stays with them, and they like abortion even less. Even if only ten percent of people were influenced against abortion because of postcards depicting abortion imagery, I would point out that that is still a far bigger number than any other pro-life strategy even claims to impact. For the first time, statistically significant portions of the population are being exposed to the reality of abortion—and they are reacting to that reality.

Pro-lifers are often tempted to run scared because they believe what the pro-abortion movement says about our best evidence—that it will “turn people” off. It will, of course. In the words of one abortion activist: “Your pictures turn people off of abortion.” If people get angry with us, but are still influenced against abortion, we have accomplished exactly what we set out to do. That being said, people only focus on the angry commenters that they see—a handful of social media posts, and the same tired news story from each and every single media outlet. I’m not sure if most journalists are unimaginative or just lazy, but most seem unwilling or incapable of even visiting a few websites and trying to find out what the rationale behind the strategy is. Most of them, I suspect, have pre-written stories and just call around to get the quotes they want. We know, for example, that reporters have specifically ignored people who have received the postcard and offered to comment positively—that is not, they openly say, the story they are looking for.

The abortion movement, on the other hand, can’t decide whether the imagery we use is extremely effective, or very ineffective. Canadian abortion blogger “Fern Hill” is usually babbling the talking points about how what we’re doing is so counter-productive, and that we’re obsessed with “gore porn,” and then calling us a bunch of names. (If pro-abortion groups really did believe that what we were doing strengthened support for abortion so much, I suspect that they’d be a lot less angry about what we’re doing—after all, we’re just doing their job!) But a couple of days ago, after responding to pictures of the dozens of lovely young women on our staff by snapping that they were all one unplanned pregnancy away from being pro-choice (such a depressing world these people live in), she tweeted an article at me that I found interesting.

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It was a piece on David Daleidan of the Center for Medical Progress, the man behind the recent exposes of Planned Parenthood. He’s captured video of Planned Parenthood employees casually discussing not only the abortion procedure, but also how to best pillage the corpses of these dead children in order to sell their body parts for profit. The videos have horrified people across North America, and reaction has been swift. Amanda Marcotte, a pro-abortion blogger who often writes for Slate, has responded to the new scandal in an article called “Grossing people out can have short-term impact, but does it matter in the long-term?” She quotes Michelle Goldberg over at The Nation:

Further, it’s a way for the anti-abortion movement to focus the abortion debate on the graphic details of rare, late-term procedures, about which there is less public consensus than there is about early abortion. It serves the same purpose as the ban on so-called “partial-birth abortion,” and as blown-up pictures of bloody fetuses. It induces disgust, a very politically potent emotion, since most people associate things that are gross with things that are immoral. In his book The Righteous Mind: Why Good People Are Divided by Politics and Religion, Jonathan Haidt describes how researchers asked students at Cornell University to fill out surveys about their political attitudes while standing either near or far from hand sanitizer. Those standing closer to it became temporarily more conservative. If something that minor can affect people’s politics, then a video like this one is sure to have a visceral impact.

Amanda Marcotte goes on to say that while abortion imagery and exposes are very potent, that the impact of them is not long-lasting. Why? Because, she writes with hilarious immaturity, most things in life are gross—sex, going to the bathroom, surgery—and we all get over those things, don’t we? So surely abortion pictures will also be forgotten.

She’s forgetting something—abortion pictures aren’t powerful because they’re “gross.” Abortion pictures are powerful because they show the results of abortion—a dead, butchered human being. The power in the imagery is that people recognize that, and something in them responds to this injustice. It’s why even the people angry with our postcards have responded to the media by talking about the postcards depicting the “dead babies” or the “slain babies” or the “torn-up babies.” No-one thinks that what they’re looking at is a removed appendix. No one thinks that what they’re looking at is bodily waste. Everyone knows, almost immediately, that what they’re looking at is a dead human.

That is why the impact of abortion pictures doesn’t just disappear. One more piece of evidence? Almost everyone I know in the pro-life movement was convicted to join the pro-life fight because they saw a picture or a video of abortion, including myself. As Marcotte herself pointed out, that was what convicted David Daleidan as well. We now have over forty young people on our staff, all convicted by seeing what abortion does to babies and what they can do about it.

The movement is just getting started.

Reprinted with permission from the Canadian Centre for Bioethical Reform.

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