WASHINGTON, D.C., December 20, 2012, (Reproductive Research Audit)—The Guttmacher Institute (GI) has responded to the recent Koch et. al study, which criticized the institute’s findings.

If you recall from RRA report on this study, “Fundamental Discrepancies In Abortion Estimates And Abortion-Related Mortality: A Reevaluation Of Recent Studies In Mexico With Special Reference To The International Classification Of Diseases” a panel of six epidemiologists led by Dr. Elard Koch confirmed that GI’s calculations of illegal abortions in Mexico were overestimated 10-fold. Furthermore, Koch and company found GI including miscarriages and ectopic pregnancies among their count of death from botched illegal abortions, and using estimates of live births rather than vital statistics, which inflated this figure by 35%.


GI’s response headline “Everything Old Is New Again—Debunked Criticism of Guttmacher Methodology Resurfaces” suggests that Koch’s new work was a mere re-hash of the work they previously critiqued – a study that questions GI’s methodology in Columbia. Yet, the Guttmacher Institute fails to note that this new Koch study debunks the criticisms from the institute’s previous response. Furthermore, GI responding to criticisms and standing behind their flawed methodology does not equal a remedy. This appears to be why Koch et. al employed GI’s criticisms of their work when conducting this new research.

Case in point, when responding to the Koch study in Colombia, GI stated, “Koch et al. erroneously assume data from one country apply to other countries” and also “Koch et al.’s approach does not stand up to scrutiny when applied to countries with good hospital records, such as Brazil and Mexico.” Koch and colleagues responded by examining hospital records in Mexico, and examining Mexico in isolation not estimation by applying figures from other nations. They did so using hospital records that GI agrees are valid, in an attempt to show the flaws with GI’s dismissal of their previous work.

GI also insists that these numbers are underreported, so the authors also took into account the audit by an independent, non-governmental agency in Mexico that supports legal abortion. Koch, et. al., conceded to GI’s claim that the numbers may be underreported in spite of the fact that abortion rates tend to increase after legalization. Yet, the underreporting of abortions would need to be 10 percent of the total in order for GI’s figures to be accurate, meaning that for every 10 abortions, only one is recorded and the other nine are ignored. This is a substantial discrepancy.

Moreover, GI does not admit to using estimates rather than vital statistics regarding birthrate in its abortion-related mortality calculation. GI claimed in a previous response that miscarriages are often induced abortions and that women in countries with abortion prohibitions and abortion stigma do not report post-abortion care accurately. Assuming this is so, Mexico has no prohibition, and furthermore, a death from an ectopic pregnancy or gestational hypertension is clearly not a botched abortion.

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In sum, Koch et. al. employed GI’s criticisms in order to bring to light GI’s flawed methodology. While the criticisms GI offers did not discredit Koch and his colleagues in July, the authors still took the reasons GI gave to “debunk” their criticism and responded. And these latest results only give more credibility to Koch et. al. and raises more questions regarding GI’s estimates. While estimates are difficult to calculate and may be wrong due to a host of circumstances or sheer human error, GI has yet to explain their rationale for choosing to label deaths from chronic illnesses as a complication of a botched abortion.

Reprinted from Reproductive Research Audit.


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