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This article by Lucia Muchova from provides new analysis on the UN WHO report “Induced Abortion: incidence and trends worldwide from 1995 to 2008”  we looked at a couple weeks ago on this blog.

A widely publicized report in The Lancet medical journal calling for the legalisation of abortion contained inflated numbers, flawed data collection and highly misleading language.

The recent article on “Induced Abortion: incidence and trends worldwide from 1995 to 2008” updates abortion estimates to show progress on improving maternal health. The Alan Guttmacher Institute and staffers with the World Health Organization claim the number of unsafe abortions per 1,000 women has risen from 44% to 49% between 1995 and 2008 while the global abortion rate has declined from 29 to 28 abortions per 1,000 women of childbearing age. “Unsafe abortions” are concentrated in developing countries. In Middle and Western Africa 100% of abortions are deemed “unsafe.” Presenting various statistics, the authors call for increased efforts to legalize abortion and expand investment in contraception in developing countries.

However, the paper suffers from three main faults. First, the authors use quasi-legal rather than medical definitions. Second, the authors use problematic data collection. Third, the authors have manipulated the data non-transparently. These recurring problems in World Health Organization (WHO) data on maternal mortality have been well documented by Donna J. Harrison, M.D.

Though not a WHO paper per se, much of the Lancet article draws on previous WHO studies, with the estimation of unsafe abortions “developed and commissioned by WHO.”  The WHO defines “unsafe” abortion as “a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.”

However, in academic papers written by WHO staff members, like the Lancet article, this definition becomes interchangeable with a quasi-legal one: “As elaborated by WHO, abortions done outside the bounds of law are likely to be unsafe even if they are done by people with medical training… Thus, as in previous efforts to estimate abortion incidence and consistent with WHO practice, we used the operational definition of unsafe abortions, which is abortions done in countries with highly restrictive abortion laws, and those that do not meet legal requirements, in countries with less restrictive laws. Safe abortions were defined as those that meet legal requirements, in countries with liberal laws, or where the laws are liberally interpreted such that safe abortions are generally available.” No mention is made of medical standards or skills of those performing abortion.

What this means is that abortions performed in countries with liberal laws, like the U.S., which result in serious complications or death would be classified “safe” abortions. Abortions in restricted countries, sometimes facilitated by activist groups funded by progressive governments and foundations, fit in the “unsafe” category.

WHO researchers acknowledge the difficulty in obtaining good data on abortion. Records of hospital admissions cannot distinguish between spontaneous and induced abortions; surveys underreport the number of abortions; ambiguous language prevents clear classifications of pregnancy outcomes; and in countries where abortion is illegal or hardly accessible, information is limited. Unsafe abortion in particular is, according to the WHO, “one of the most difficult indicators to measure.” Even for “safe” abortion, only 66% (2/3) of the countries with liberal abortion laws have a mechanism to collect relevant data. Nevertheless, statistics are reproduced, referenced and relied upon as if their validity was set in stone.

The most recent WHO Unsafe Abortion report asserts that 13% of maternal deaths are due to unsafe abortion, identified as one of the three main causes of maternal deaths globally, together with haemorrage and sepsis due to childbirth. This statistic is relied upon in the Lancet article. Given the ambiguity of the term “unsafe” and the unreliability of the data, one is left wondering why more money should be spent on increasing access to abortion instead of measures to improve antenatal and post-partum care.

The Lancet article indicates that “on the whole,” chemical abortion procedures are classified as unsafe. Crucially, this includes misoprostol, regarded as unsafe due to the risks of heavy bleeding associated with incorrect usage. This means that organizations, such as the International Consortium on Medical Abortion, that encourage and actively distribute misoprostol for abortions are in fact raising the numbers of unsafe abortions, which they claim to be preventing. Note: Lucia Muchova writes for the Catholic Family and Human Rights Institute. This article originally appeared in the pro-life group’s Friday Fax publication and is used with permission.

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