British Medical Journal perpetuates myths about illegal abortions

There is an article in the British Medical Journal this week with the provocative title ‘Ensuring that women have access to safe abortion is “pro-life”’.

You will need a subscription to read it but the author gives an anecdotal account of some deaths from illegal abortions in Liberia as grounds for arguing that abortion should not be further restricted in the UK.

It concludes as follows:

'Unsafe abortion is a little discussed yet major cause of morbidity and mortality in countries like Liberia, which are unable or unwilling to provide safe abortion services. In the United Kingdom it has become easy to disregard the harm that our reproductive health services prevent. We must protect and promote access to safe abortion services. Safe abortion is pro-life. Safe abortion saves lives. Just ask your grandmother.'

There is no peer-reviewed data quoted for either Liberia or UK but the stories of the developing world are being used as a pretext for arguing against any restriction on abortion here.

Deaths from unsafe abortions in developing countries like Liberia are tragic but the answer is not legalised abortion and the extrapolation the author makes to the UK is not actually evidence-based.

The argument advanced is that any move to restrict abortion now in the UK would drive women back into the hands of backstreet abortionists leading again to thousands of deaths.

The reality is much more complex than that. But you have to look at the actual evidence to understand what really happened in Britain to maternal mortality before and after abortion was legalised.

UK and US figures are discussed in more detail in my recent blog, ‘How many women really died from abortions prior to the Abortion Act?’, but the main points are as follows.

First, maternal mortality from all causes, including abortion fell dramatically long before abortion was legalised as a result of better medical care.

Second, many so called ‘back-street abortions were actually carried out ‘illegally’ by ‘skilled professional’ nurses and doctors using surgical instruments in sterile conditions.

Third, legalising abortion did not eliminate all maternal deaths, as some women now began to die of legal abortions, and in addition there was still a trickle of illegal abortions.

However since 1968 all abortion deaths in Britain have fallen to almost zero.

Legalising abortion is not pro-life. In developed countries with good medical systems it does not save a significant number of mother’s lives and simply leads to a massive increase in the abortion rate.

And in developing countries what is needed is a comprehensive package of better antenatal care, family planning and obstetric and gynaecological services but the most important ingredient is maternal education and the relief of poverty.

This has been dramatically illustrated in the experience of Chile where, contrary to widely-held assumptions, making abortion illegal did not result in an increase in maternal mortality.

In fact, after abortion was made illegal in 1989, the MMR continued to decrease from 41.3 to 12.7 per 100,000 live births (69.2% reduction).

The result is that Chile is now doing better with maternal mortality than the United States.

I expect we will hear a lot this week, with the family planning summit, about the need for so-called 'safe abortion' in the developing world. When we do we need to ask for the evidence that it will make any difference to maternal health.