Just the facts, ma’am…

Using the World Health Organization’s 2005 maternal mortality statistics, and this summary of abortion laws, I put together the chart below, which I ordered from lowest to highest maternal mortality rate. The figure I used for maternal mortality was the official number or estimate, although many countries had a wide “range of uncertainty” (for instance, Laos had an official MMR of 660, but the range was from 190-1600). You can read more about what the different numbers and letters mean in the abortion laws portion of the chart by clicking on the above link, although they are pretty self-explanatory, with Y meaning abortion is legal, 1 meaning legal in the first-trimester only, R is legal but with significant restrictions, etc.

The abortion laws portion transferred easily to the spreadsheet, but the MMR portion did not, so I entered those numbers in by hand (so I possibly made some typographical errors — you’re welcome to double-check me). Since they were both in alphabetical order, I then had to go through and match up the lists, because some countries were listed on one but not the other. There were also several countries that were named differently in the two lists (the Republic of Congo vs. Congo, as an example), and many of these I deleted, not realizing that they were actually listed, only further down on the list. I did not take the time to go back and figure out which ones I could have matched up, so I know the list is slightly incomplete (probably fewer than half a dozen countries in this group, although probably another half-dozen or so were deleted that could not have been matched up — Vatican City, for one). I divided the list into six roughly equal portions, to make it easier to see the abortion laws of the countries.

Then, because I’m a glutton for punishment, I organized the countries by type of abortion law. Unfortunately, they often don’t fit into nice, neat little packages, so while I tried to group them, it was quite difficult. Where they were the same (for instance, no legal abortion; or only for the life of the mother; or legal for any reason), I kept them together; where they were similar (YYNNNNN and YY?NNNN), I put them under the same heading, but with a blank line between. Some countries allow abortion only to save the mother’s life and health while other countries allow abortion only to save the mother’s life and in cases of rape. Since these both had two “yeses” I put them under the same heading, but with two or more blank lines between, to show that they were separate. While I tried to be consistent, it’s possible that there are numerous inconsistencies in there, but I mostly erred on the side of assuming a restricted abortion status for question marks. There were some weird things in there — Mozambique, for instance, which supposedly allows for abortion “on demand,” but it is not legal in cases of rape, fetal defect, or for “social” reasons. I don’t know if that’s a typo — nor do I know the difference between “demand” and “social” reasons for abortion.

So, those are the facts. Why am I presenting these facts? To show that there’s more to maternal mortality than just restrictive or relaxed abortion laws, because I’ve heard numerous abortion advocates talk about liberalizing abortion laws as if it is some sort of magic panacea for maternal mortality. But if you look at the group of countries where abortion is legal on demand, you’ll see that the MMR ranges from 3-830/100,000; and countries where abortion is absolutely outlawed (or illegal except in restricted circumstances) the MMR ranges from 8-1100/100,000. Some people look at the problem of “unsafe abortion” and try to remove the “unsafe” part of it. But abortion is a symptom of a problem. The root causes of abortion run far deeper than just legality and illegality. Just making abortion “safe” does little to help the underlying causes of why women seek abortions. If a child is being raped by her uncle, giving her an abortion and then returning her to the same conditions will not really help her, because she’s just being returned to that abuse (and will likely get pregnant again, and “need” another abortion to solve her “problem”). Ditto women in abusive relationships (married or unmarried), or those that abuse drugs or alcohol.

Unsafe abortion is unsafe, whether legal or illegal; and there are far better things to do for women than to promote the legalization of abortion, especially where it is inherently unsafe: working on the infrastructure so that health services are more available and reliable, improving food and water supplies, increasing the number of midwives, educating the populace (in general, as well as in particular about safe vs. unsafe health practices, including sticking non-sterile objects into your uterus to try to terminate a pregnancy), etc. It falls under the category of “give a man a fish, and you feed him for a day; teach a man how to fish, and you feed him for a lifetime.” Far too much time and energy is focused on “giving people fish,” and not near enough is focused on improving quality of life, which will help in many more and more far-reaching ways. An example — giving someone a condom may help that person keep from conceiving a baby one time. But they need condoms every time, so it is a continual and ongoing need and expense. Teaching a couple how to avoid pregnancy using ways that do not require ongoing expense (fertility cycles, cervical mucus to tell if she’s ovulating, etc.) can help even when condoms are not available. Giving people food is good; giving people the ability to grow their own food is better. Changing “unsafe abortion” by taking away the “unsafe” part may save some women’s lives; but changing “unsafe abortion” by taking away the real or perceived need for the “abortion” part will save even more lives, of both mother and child. This involves more than just drugs and technology and “things.” Changing men’s hearts so that they do not demand sex from their wives, nor rape children or women, nor are in other ways oppressive or abusive, but are good and godly men and husbands is the real answer, but those kinds of changes are not exactly easy to implement. There are similar changes that may need to take place in women, but it will take more than just throwing money and abortions at the problem, to make the real problem go away.

8 Responses

  1. >>Far too much time and energy is focused on “giving people fish,” and not near enough is focused on improving quality of life, which will help in many more and more far-reaching ways>>

    I’m pro-choice. I’m happily married, employed and in my early 40s. Two years ago, I had a medical abortion at less than 5 weeks. I have no regrets and given the same situation, I’d have another abortion. It was the first and only time I’d ever been pregnant in my life, and it will almost certainly never happen again.

    You see, I had an abortion when the tubal ligation surgery I’d had less than two months before failed (yes, it failed – I’ve since had an HSG proving that one tube was left open). Since this disaster, I’ve gone back to using my former, very reliable method of birth control. I’m a very responsible person.

    Thank goodness we still have choice in this country. As for safety, well, consider I underwent major (failed) surgery in an effort to avoid pregnancy in the first place.

    The only foolproof method of avoiding pregnancy for a heterosexual woman of childbearing age is celibacy. That’s not a reasonable option for my husband and I.

  2. Yes, maternal mortality ranges widely despite legalization of abortion, although apart from Chile I see very few countries that have banned abortion, have a low MMR, and are not very high-income countries and/or border countries where abortion is accessible. When you all you have to do is pay your doctor out-of-pocket or cross the border to get an “illegal” abortion, safe abortion is not exactly inaccessible.

    Again, from my comment on the last post, I ask:

    If abortion were outlawed in every country in the world – if there was no legal access to abortion – do you think maternal mortality would be affected? That maternal mortality from abortion would be affected? If it increases, should we consider that collateral damage, only aim to reduce maternal mortality from other causes besides abortion? I ask these as real questions. I truly believe that you have to choose whether you’re going to prosecute something or make it as safe as possible; it’s very hard to do both at the same time.

    You are creating a straw man here: who is “throwing abortions” at a problem? I know of know major organizations supporting abortion rights that don’t also have a focus on contraception and empowerment. Yes, yes, yes I agree with you that we need to reduce the need for abortions. But until then, what do we do? Ignore abortion-related maternal mortality, and focus on other things? If that’s your answer, go ahead and say it; we don’t need to parse the statistics and argue about whether or not abortion-related maternal mortality exists; it does.

    • I wasn’t ignoring you — just thinking about the question so that I could answer it as best I could. Unfortunately, today is not a good day for me — a water pipe burst — so I probably won’t answer until later. Just wanted you to know that I am thinking about your question and will get to it eventually.

    • Sorry it took so long to answer this question. I’ve thought about it a lot, and started writing an answer many times, but the topic is so weighty, that I would put it off for one reason or another (including my children distracting me, a funeral, several birthday parties, etc.).

      First a few questions — if abortion were made legal in every country in the world for any and every reason at any time during pregnancy, 1) would you support that; and 2) would it make the maternal mortality rate go down? Currently, there are about 42,000,000 abortions performed every year, according to the Guttmacher Institute. Should we consider these deaths just “collateral damage” of a woman’s right to choose?

      The basic question is, what happens during an abortion? The answer is, a genetically unique human life is taken. An innocent human being is killed. No pro-life person or organization I know has the slightest smidgen of a problem with a woman having a D&C or any other procedure to evacuate her uterus after a miscarriage, or with a blighted ovum, hydatidiform mole, or any other non-fetal pregnancy. That’s a medical matter between her and her physician. What we object to is her treating another person as if it were her property to be disposed of and killed as she sees fit.

      Yes, maternal mortality would be affected — in some countries it might increase, but in others it might decrease. In countries where abortion is unsafe, making unsafe abortion legal, and increasing women’s access to unsafe abortions does not make them safe, and would increase maternal mortality from abortion. In Romania, about half of all pregnancies end in abortion, and about half of all maternal mortality is abortion-related. It is very legal, but not safe. That is one problem with the equivocation put out by abortion proponents (individuals and groups) — contrasting legal and unsafe, rather than safe vs. unsafe, and legal vs. illegal.

      This is one thing I noticed in something I read by NARAL or NOW or something, when I was trying to find some verification of a factoid they’d used. Anyway, the thing I’d read was a brief history of abortion, and the article started out talking about how that “women had been helping women have abortions for millennia, and that abortion wasn’t illegal” — making it sound like they were having Tupperware parties, with no hint of these abortions being dangerous… until the 1800s when there began to be restrictions on abortions. *Then*, and only then, did the article first mention that abortions of that time were dangerous. Apparently, taking poisons or sticking things into the uterus to try to induce an abortion was safe as long as it was legal. Which is ridiculous. Women died from abortions not because they were illegal, but because they were unsafe. It was unsafe in the 1700s to stick non-sterile things into your uterus or to drink toxins to try to kill the fetus; it is unsafe now. But you wouldn’t know that from this article. What made abortion safer for the mothers was to have improved medical services able to handle the inevitable complications — blood loss, infection, etc.

      [Btw, a little historical side-note — the legality and illegality of abortion in western cultures (or at least in England and America), was based on their understanding of pregnancy and the beginning of life. You’re familiar with the term “quickening,” referring to the time when the mother first felt her baby move inside her. They really thought that that was when the baby came alive — after that time, abortion was illegal because it would be murdering; before that, their understanding was that the baby was not yet alive, so it was not murder. As scientific and medical knowledge increased, scientists and doctors realized that the baby was alive prior to “quickening,” so sought to change abortion laws to protect that life. Now, we have undeniable proof that a new (and genetically unique) human life starts at conception, and the laws ought to reflect that understanding, just as they were changed in the past centuries.]

      Your questions imply that we can’t lower maternal mortality while keeping abortion illegal, but that is false, because our country did just that, with the MMR dropping to 20/100,000 before abortion became legal (except perhaps legal one or two years in one or two states).

      It is also necessary for a real and honest understanding of abortion-related maternal mortality. I’ve not read extensively on MMR and abortion statistics in underdeveloped countries, but what I have read implies that there is poor record-keeping on this topic. For instance, the link in this post from the WHO on MMR had a range of values for most if not all of the countries, because of faulty, poor, or incomplete record-keeping. Our own CDC admits that it under-counts MMR by about 30%; poorer countries must be even worse. Also, it seems that abortion proponents seem to be the ones in charge of estimating abortion mortality in many areas/countries, which means they may be biased in their reporting, overestimating abortion mortality where it is illegal *because* it is illegal. Also, they may discover that “everyone in town” knows someone who died of an abortion, but if that “someone” was just one person, abortion-related mortality may be overestimated.

      I do know that maternal mortality is under-reported in the US and in Europe. In France, a study determined that while most cases of maternal death around the time of childbirth were reported, most of the cases of maternal death due to abortion were not reported, and only uncovered by a physician survey for the study. Here in America, abortion deaths are routinely missed. The CDC relies on a passive reporting system for abortion deaths, and many women’s deaths are coded as due to the final cause (infection, hemorrhage, etc.) rather than being coded as due to abortion — there is only one “cause of death” allowed, and since there is usually some “final factor,” death due to the category “abortion” is usually empty. This helps the abortion lobby with their “abortion is safer than childbirth” spiel, but isn’t actually built on truth. See also this comment stream (about halfway down), in which the blogger lists how she got abortion data the CDC missed; and this one (bottom couple of comments). As well as this post with links to abortion deaths she found that the CDC missed throughout the decades. [Note also that the “5,000-10,000 annual deaths when abortion was illegal in America” is likewise a shameless lie that abortion proponents knew was a lie but they continued to lie about it, because it was convenient and it helped the abortion cause.] Also, a study from Finland shows that women who have abortions are four times more likely to die in the year following the end of their pregnancy than are women who have miscarriages or who give birth.

      So, if “safe and legal abortion” isn’t as safe as you think it is — if women who have abortions are four times more likely to die (including suicide), if abortion deaths are overlooked in countries where abortion is legal (and possibly over-counted where abortion is illegal) — in short, if women are dying due to abortion when they could be living if they had or chose options other than abortion, is that just “collateral damage” for “a woman’s right to choose”?

      As to your saying “throwing abortions at the problem” is a straw man — no, it isn’t. We may be meaning different things on that point, however. The blog I linked to most (RealChoice) is written by a woman who nearly aborted her firstborn. At the time she got pregnant, she and her husband were barely able to feed themselves, and the “pregnancy center” she went to for help only suggested an abortion. *That* is “throwing an abortion at the problem.” An acquaintance or co-worker actually *helped* her without an abortion — found her a better and cheaper apartment, which allowed them to make it financially even with a baby. This is one of the reasons why she is pro-life — she nearly killed her son, and were it not for a pro-life friend, she would have. Undergoing an abortion would have solved her problem in a way, but the real problem was not that she was pregnant — women get pregnant all the time. The real problem was that her household income was pitiful. But it’s easier to scrape out a woman’s uterus than to find her a better apartment, cheaper rent, or a better job. And I won’t even get started on the videos of Planned Parenthood workers coaching underage girls on how to lie about their over-age boyfriends, rather than reporting them for statutory rape like they were supposed to. And the girls that are given abortions and returned to their abusive fathers, uncles, or other perpetrators, to continue the abuse. And the women who are in abusive relationships who come for abortions repeatedly because their boyfriends/husbands won’t let them use birth control and won’t let them say no. What do abortion clinics do to empower women in these situations? I’m asking this seriously, because an abortion proponent on another blog mocked the idea that abortion clinics should do counseling to try to get the women away from their abusers, because “abortion clinics just do abortions; they don’t counsel about relationships.” Is that an accurate depiction? If so, how do they “empower” women?

      As I said earlier, the U.S. dropped maternal mortality for all reasons, including illegal abortions, from about 600/100,000 to 20/100,000 all while abortion was illegal. How did that happen? By improving medical care (antibiotics, blood transfusions, better techniques), and improving the standard of living (clean water, clean energy, etc.) primarily. Trying to make unsafe abortions legal won’t help. Making unsafe abortions safer will. Making abortion legal in countries that cannot handle abortion complications, including infections that would be simply and easily treated even on an out-patient basis here in the U.S., will increase the rate of abortions and also the rate of abortion mortality. But unless we have accurate numbers now and in the future, we won’t know that. “Ignore” abortion related mortality? Not really. But we should focus more on the underlying issues, which will solve the biggest portion of the abortion mortality problem whether abortion is legal or illegal. Just like what happened in the U.S. from the mid-30s, when the MMR was about 600/100,000 — right between Bangladesh and Djibouti in the 2005 stats — dropping to 20/100,000 while abortion was still illegal.

  3. More like “just a bunch of numbers that anyone can use to argue anything they want, ma’am.”

    This is getting very tiresome. I’m sorry you went to so much trouble, because you’re not changing anyone’s mind.

    I really, really doubt that you oppose legal abortion just because you don’t agree that illegal abortion is a driver of maternal mortality.

    I get that you prefer that abortion be illegal, and I get why. If you’re so dedicated to that position, then it shouldn’t matter to you that wherever abortion is illegal, women will still have abortions, abortions will be less safe, and more women will die from having abortions than would have if it had been legal. Why is that even relevant to you? Why would you spend so much energy arguing about it?

    Even if there were definitive proof that more women would die, you would still support a ban, correct?

    Heck, even if there were definitive proof that a ban would not prevent any abortions from happening, you would still support a ban, correct?

    The bottom line is that some people believe that abortion, no mater fetal age, is murder and should be outlawed. Other people believe that women should always have autonomy over their own medical decisions, including abortion. A discussion about whether or not and to what extent illegal abortion is a driver of maternal mortality is never going to get anyone from one camp into the other. I mean, I don’t know if that’s your goal, but if it is you’re not getting anywhere.

    There are a lot of people in both camps who are working on maternal mortality. The people who believe in a woman’s right to a legal abortion don’t think that legal abortion is a “magic panacea” to reducing maternal mortality. Obviously there’s a lot more to MMR than whether or not abortion is legal or not. Just like you wouldn’t change your mind about abortion even if it were proven that making abortion illegal kills women and saves no babies, people who support a woman’s right to a legal abortion are not going to change their minds even if it were proven that making abortion legal does not reduce maternal mortality. And you haven’t come anywhere close to proving that.

    • More like “just a bunch of numbers that anyone can use to argue anything they want, ma’am.”
      Yes, exactly. Yet I’ve heard the false “unsafe vs. legal abortion” argument to further the legalization of abortion supposedly as a means of reducing maternal mortality from several quarters. This shows that it ain’t that simple. You’ve proven my point very nicely. Thank you.

      • Like I’ve also pointed out, legalizing abortion is not about reducing maternal mortality. Legalizing abortion is about making sure that women have the right to control their own medical decisions. I don’t know who all these people are that are allegedly promoting the legalization of abortion just because they think it will reduce maternal mortality, but that’s certainly not my position and nor is it the position of any abortion rights advocate I have ever met, ever. Just like maternal mortality rates don’t have anything to do with the motives of any pro-life advocate I have ever met, ever.

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