World Abortion Estimates: An Audit Part VI:
False Notions About So-Called "Safe Abortions"
By Randall K. O'Bannon, Ph.D., and Laura Antkowiak Hussey, M.P.M.
Editor's note: In earlier parts of this series we have seen how estimators with agendas have grossly inflated the number of so-called "unsafe abortions" in the world and then tried to use those numbers to push pro-life countries to legalize abortion under the guise of "saving women's lives." That these campaigns are based on phantom numbers is bad enough. Worse yet is the promotion of the false and dangerous concept that legalizing abortion makes it "safe" and thus would reduce maternal mortality in the developing countries.
No abortion is ever completely safe. Women suffer serious physical, emotional, and psychological damage and even death from so-called "safe, legal abortion." This article will show that the legalization of abortion in the developing world - - where basic health care, sterile techniques, antibiotics, emergency care, and clean water are absent or scarce - - would not only increase the number of abortions, but could very well increase, not decrease, maternal mortality.
Maternal mortality can be decreased in the developing world the same way it has been done in the developed world starting in 1941, long before the legalization of abortion - - by improving general and maternal health care. The World Health Organization (WHO) itself affirms this fact in its 1991 publication "Maternal Mortality, Global Fact Book," in which it states that the dramatic decline in maternal mortality in the developed world (which took place from 1941 to 1951) coincided "with the development of obstetric techniques and improvement in the general health status of women."
The most significant change following legalization of abortion has been a dramatic increase in the numbers of abortion rather than any significant decrease in maternal mortality.
Misidentifying the real causes of high abortion maternal mortality in the developing world has caused a misdirection of valuable resources from the improvement of general and maternal health care which has been proven to save women's lives.
The most frequently cited statistics claim that there are 46 million abortions performed in the world each year, with 20 million of those officially labeled "unsafe." Nearly all of these so-called "unsafe abortions" are attributed to countries and regions where abortion is largely illegal. The message, usually subtle when it comes from the statisticians, often aggressive and direct when voiced by abortion's advocates, is that the worldwide legalization of abortion would eliminate this dire threat to women's health.
But is there any correlation between legality and safety? Does legalization of abortion make it safe? Will the addition of abortion to medical services in the developing world improve women's lives? The answer to all these questions is "no."
The problems and challenges faced by women in the developing world will not be solved by abortion, but will be exacerbated by it. In the absence of any overall improvements in medical care, more women may die. And certainly millions more unborn children will lose their lives.
Legal abortion does not mean safe abortion
While it is true that women sometimes die from illegal abortions, abortion's advocates gloss over the fact that women die from legal abortions as well. It is abortion, not abortion's legality, that is the issue.
Just one example: In 1993, Guadalupe Negron, a 33-year-old Honduran immigrant and mother of four, bled to death at abortionist David Benjamin's New York City clinic. At his trial, Benjamin's lawyers argued that he had misjudged the date of the pregnancy and had tried to do the best he could to save the woman.
Prosecutors countered with evidence that Benjamin left his patient to die in a pool of blood and vomit while he went off to abort another woman, and then lied to cover up his mistakes when paramedics showed up, according to the New York Daily News. A New York City jury convicted him of second-degree murder in August 1995.
In the U.S., the world's leader in modern medicine, over 300 women have died from legal abortions since it was legalized in 1973. Certain investigators believe the number may be far, far higher than that, owing to ambiguous causes of death cited on death certificates and the fact that a woman rushed to treatment in an emergency room may be unwilling or unable to share her complete medical history with the physician providing her treatment. An additional factor may be that her abortionist may be some distance away, not available for or unwilling to do follow-up, or to come forward to take responsibility.
Even under the best medical conditions, an experienced abortionist performing an abortion may puncture a uterus, a bowel, or a bladder, leading to hemorrhage, infection, and possibly death. Under the sort of circumstances prevailing in the developing world, where conditions may not always be fully sanitary, where emergency facilities and supplies are absent or inadequate, where doctors may not be trained or equipped to handle trauma, where even basic medical and surgical supplies such as antibiotics and sterile gloves may be scarce or unavailable, mortality rates would be expected to be substantially higher, whether abortion were legal or not. The legalization of abortion would do nothing to improve these conditions, but might increase the number of times a woman was exposed to these health risks.
Death is obviously the most immediate, drastic "complication," but there are other ways that abortion may impact a woman's health and shorten her life. Women who have abortions have a higher risk of having a future ectopic (tubal) pregnancy, which itself can prove fatal, even in the medically modern west. In less optimal conditions, such as those found in the developing world, a woman's chances of survival would be expected to be much worse. So too with breast cancer, an increased incidence of which has been associated with induced abortions.
In the industrialized world, studies have shown that women who abort have higher rates of depression, substance abuse, and suicide. These definitely impact maternal mortality but would not show up in statistics measuring only recorded deaths from surgical complications. How these behavioral sequelae would play out in developing nations is unknown. But it is only to be expected that a general lack of social services in such regions would tend to make healing and recovery less likely.
Abortion is also associated with a number of complications usually not lethal in the west, but which could be so in non-western societies where antibiotics are not readily available. Women who abort may suffer from infections or pelvic inflammatory disease. While only a certain number of women hemorrhage from their abortions, if they bleed for any significant length of time (which is not uncommon), they may become anemic and vulnerable to a number of pathogens to which they may be exposed. If chemical abortion methods such as RU486 (which requires careful monitoring and follow-up) are ever widely distributed in developing countries, the heavy bleeding typically associated with this method could itself trigger a public health crisis.
Those agitating for abortion as a solution to the "maternal mortality problem" rarely bring these matters to the fore. It is a disservice to the women of the world to mislead them into thinking that legal abortion means "safe abortion" and to fail to inform them of the risks involved. It is worth asking whether those who are pressuring governments to change their laws to legalize abortion are informed of the facts, and whether those women who are pressured to seek abortions can give truly "informed consent" without this information.
How abortion increases the risk of maternal mortality
In addition to the ways in which surgical or chemical abortion exposes women to certain individual risk factors, there is another way in which abortion can increase maternal mortality risk. Over her reproductive lifetime, a sexually active woman who turns to abortion every time she faces an unwanted pregnancy will expose herself to mortality risk factors many more times than does the woman who opts to give birth to the children she conceives.
There is evidence that the legalization or liberalization of abortion laws increases the overall numbers of pregnancies and abortions. Karol Pastor, a statistician and sociologist from the Slovak Republic, notes that abortions increased 34.1% in his country without any significant change in the birth rates from 1985 to 1987 after abortion laws were broadly liberalized in 1986.
Stanley Henshaw, lead researcher for the Alan Guttmacher Institute, has admitted, "In most countries, it is common after abortion is legalized for abortion rates to rise sharply for several years, then stabilize, just as we have seen in the United States" (AGI press release, 6/16/94).
Despite claims that there were a million abortions a year before abortion was legalized nationwide in the United States in 1973, the best available evidence indicates that there were never more than 210,000 a year until individual states began to legalize abortion in the late 1960s. If so, legalization sparked a massive upsurge in the number of abortions Numbers soared to 1.5 million per year by 1980 (reaching a high of 1.6 million in 1990). Because of overall high-quality medical care, this did not precipitate any obvious upsurge in mortality in the U.S. But if abortions increased by the same percentage in a country without that standard of care, mortality could be significantly affected.
Higher abortion mortality a symptom of larger medical shortages
As shown above, whether legal or not abortion comes with certain risks. How frequently complications occur, and with what severity, is not really a function of the legality of the procedure,1 but of the overall medical circumstances in which the abortion is performed. Poor medical conditions increase the likelihood of complications and death from every abortion, legal or illegal.
Where there is already a shortage of doctors, medicine, and equipped facilities in a country, there is no logical reason to think that the legalization of abortion will suddenly increase that supply. Thus women generally at risk because they lack access to a doctor, to a hospital, or to antibiotics before abortion's legalization will face those same circumstances after legalization. And if legalization triggers a higher demand for abortion, as it has in most countries, there will be more injured women competing for those scarce medical resources.
Abortion's advocates like to paint a picture of illegal abortion as driving the high maternal mortality rates in these countries. In truth, high abortion mortality rates are likely to be a function of overall high mortality rates. As such, high abortion mortality rates would be the effect of some larger overall cause, not the cause of those high rates itself.
Women die from abortion not because it is illegal, but because there is generally poor medical care in their countries, which is responsible for high death rates across the board from every disease, condition, or medical procedure.
The basic point is attested to in the scientific literature. In a 1994 journal article on maternal mortality factors, researchers Sereen Thaddeus and Deborah Maine state factually:
Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an obstetric emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist.
Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths.2
The legalization of abortion would neither increase the number of adequately equipped facilities nor lead to better management, leaving women in the same dire straits as before.
Untreated drinking water and poor public sanitation increase the likelihood of disease and infection, with those undergoing abortion, legal or otherwise, as likely to be affected as any other vulnerable group. Famine, malnutrition, and other dietary deficiencies also contribute to higher overall mortality rates, increasing abortion-related maternal mortality along with mortality from every other cause.
Abortion's negative impact on overall health care
Misidentifying the cause of high abortion-related maternal mortality rates not only gives unwarranted support to efforts to legalize abortion worldwide, but also causes capital, energy, and efforts to be grossly misdirected and wasted. Western governments direct an inordinate amount of aid to "family planning" agencies which provide and promote "reproductive health services" in which abortion plays a central role, instead of devoting full resources to the upgrading of hospitals, equipment, emergency care, and medicines; meeting sanitation challenges and insuring the availability of clean water; and addressing agricultural, economic, and transportation issues that hinder food production and distribution. These "family planning" advocates run around promoting manual vacuum aspiration kits which can be used for abortions in areas without electricity3 while basic hospital supplies go lacking.
The abortion fixation of foreign governments and international agencies also helps distract local government attention, and funds, from more productive, beneficial uses. Population control and abortion legalization are given priority over economic development, modernization, and the creation of infrastructure. The constant insistence of many of the UN's western delegations on putting the term "reproductive health services" (which includes abortion) into special conference declarations on the environment, habitat (housing), economics, and even children, easily gives the false impression that the birth of fewer babies is the key to national progress.
This is to say nothing of how abortion distorts the entire mission of medicine, channeling what should be the healing arts into the service of death. Rather than devoting full resources and energy to the development and delivery of prenatal and postnatal care that might dramatically reduce both maternal and infant mortality, "family planning" advocates seem to have something other than the health of the mother and child as their priority.
A world without abortion would be safer for all
Abortion advocates like to point to the United States as an example of how the legalization of abortion greatly reduced abortion-related maternal mortality, saying that there were 5,000 to 10,000 deaths a year before legalization. But the evidence doesn't support that claim.
Former abortion advocate Dr. Bernard Nathanson, one of the founders of what is today known as the NARAL Pro-Choice America, admitted in his 1979 book Aborting America that there never were abortion-related maternal deaths of that magnitude in the decades preceding Roe (the 1973 U.S. Supreme Court decision legalizing unrestricted abortion in the U.S.).
"I confess that I knew the figures were totally false and I suppose that others did too if they stopped to think about it. But in the 'morality' of our revolution, it was a useful figure, widely accepted, so why go out of our way to correct it with honest estimates?"
While the number of abortion-related maternal deaths did decline in the time frame of abortion's legalization in the U.S., it was just the continuation of a larger, longer downward trend in maternal mortality. This decline began in the 1940s with the introduction of sulfa drugs and penicillin and continued through the 1950s and 1960s with the advent of better surgical and anesthetic techniques and instruments. Overall maternal mortality declined during the same time frame by roughly the same margin, a further indication that these innovations, not abortion's legalization, were driving the mortality figures down.
Intimations that high maternal mortality rates are related to abortion's illegality are contradicted by examples from the United Nation's own database. Neighboring countries such as the United Kingdom (Britain, Scotland, and Wales), where abortion on demand has been legal for some time, and the Republic of Ireland, which has long banned the practice, provide an interesting contrast.
According to the 1990 UN Demographic Handbook, it was Ireland, not the UK, that reported the lowest maternal mortality rates for 1988 - - some three and a half times lower than that reported for the British. At least in these two countries, mothers appear to be safer in the country where abortion is not legal.
The idea that there is a necessary correlation between abortion's illegality and higher maternal mortality rates is also challenged by government statistics from Poland. Poland banned abortion in 1993 after decades of abortion on demand as a Soviet satellite.
Since then, not only has the number of legal abortions dropped considerably, from 59,417 in 1990 to 151 in 1999 (these were for rape, problems with the fetus, or threats to the mother's life or health), but so has maternal and infant mortality. Maternal mortality, recorded at 15.2 per 100,000 live births in 1990, dropped to 7.3 per 100,000 by 1999. Infant mortality also showed a steady decline, from 18.1 in 1991 to just 8.9 in 1999 (and dropped again to 8.1 in 2000).
The evidence confirms that the world would be a safer place without abortion. Not only would millions of innocent unborn lives be saved, but so would the lives of many of their mothers. This would especially be so if the international agencies which have invested so much money and energy into promoting abortion would drop that death campaign and put the same effort into improving overall medical conditions in the developing world.
1. Except insofar as legalization increases the incidence of abortion.
2. S. Thaddeus and D. Maine, "Too Far to Walk: Maternal Mortality in Context," Social Science and Medicine 38:8 (1994): 1091-1110.
3. An abortion kit employing a large vacuum syringe in place of suction machines used in western abortion clinics. The idea is to enable abortionists to do abortions in areas where there is no electrical power.