{"id":4237,"date":"2021-11-01T12:39:03","date_gmt":"2021-11-01T11:39:03","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4237"},"modified":"2021-11-01T12:39:03","modified_gmt":"2021-11-01T11:39:03","slug":"backstreet-abortion-deaths-not-as-common-or-preventable-as-thought","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/11\/01\/backstreet-abortion-deaths-not-as-common-or-preventable-as-thought\/","title":{"rendered":"Backstreet abortion deaths: not as common or preventable as thought"},"content":{"rendered":"

By Calum Miller.<\/p>\n

One of the foremost<\/a> arguments<\/a> for<\/a> legalising<\/a> abortion<\/a> in developing countries attempts to bypass fetal moral status by appealing to practical considerations: 1) banning abortion doesn\u2019t prevent abortions, but 2) it does put women at risk of dangerous backstreet abortions, killing women in large numbers. Since 3) legalising abortion significantly reduces unsafe abortions, without increasing overall abortions, abortion should be legal.<\/p>\n

Many would argue that serious rights, like the right to life, should be upheld regardless of the consequences (as in the ICCPR, article 4.2<\/a>). And there is overwhelming<\/a> empirical<\/a> evidence<\/a> that banning abortion does reduce the numbers, as economic theory would predict. In a recent paper<\/a>, however, I challenge what is often thought to be the least controversial part of the argument: that large numbers of women die from backstreet abortions, and that legalising abortion will prevent many of these deaths.<\/p>\n

In my research, I found how frequently and demonstrably these statistics are misrepresented or even fabricated, even at elite professional levels. Just a few weeks ago, the International Federation of Gynaecology and Obstetrics claimed<\/a> that unsafe abortions accounted for 13% of global maternal mortalities. They cite the World Health Organization, which in fact says<\/a> 4.7-13.2% \u2013 the lower estimate, and even mean estimate, being omitted by FIGO. Moreover, the study on which this figure is based explicitly says<\/a> that this statistic includes deaths from ectopic pregnancy, miscarriage, and a number of other conditions. The WHO misrepresented this statistic from the study, even though the study was conducted by its own researchers. To claim that 13% – or even 4.7-13.2% – or maternal deaths are attributable to unsafe induced abortion alone is a clear misrepresentation of the facts.<\/p>\n

In many cases, the statistics are simple misrepresentations like this, usually by conflating miscarriage and induced abortion. But in some cases the statistics appear entirely fabricated. The Royal College of Obstetricians and Gynaecologists recently tweeted<\/a> a claim from The Telegraph that 12,000 women in Malawi die from unsafe abortions each year. But the latest estimate<\/a> for total<\/em> maternal deaths in Malawi each year is 1,150 \u2013 less than 10% of that figure. And as I argue in my paper<\/a>, the latest evidence (now 15-20 years old) suggests that only 6-7% of these<\/em> deaths are due to miscarriage and induced abortion combined<\/em>. Hence, the RCOG has overestimated the number of deaths at least one-hundredfold. Such radical overestimates are not uncommon. In the paper, I point to various studies suggesting that the majority of these 6-7% are in fact due to miscarriages, not induced abortions.<\/p>\n

Still, the women who no doubt do die from unsafe abortion clearly matter. I therefore address the question of whether legalising abortion significantly reduces mortality from unsafe abortion, arguing that it does not \u2013 in some cases, it can increase abortion mortality. I point to countries such Rwanda<\/a>, the Netherlands<\/a>, and Ethiopia<\/a>, where abortion mortality or morbidity increased upon liberalisation, as well as to Chile<\/a> and Poland<\/a>, whose abortion mortality and maternal mortality continued falling after abortion was criminalised.<\/p>\n

Why is this? A few reasons:<\/p>\n