Guttmacher challenges, Koch replies
Dear ProLife Colleague,
Maternal death in pregnancy and childbirth is a horrible and often preventable tragedy. It is epidemic in third world countries, sometimes 100 times the rate found in more medically advanced nations. Decreasing maternal mortality is high priority goal of the United Nations, and rightly so.
Unfortunately, it has become a mantra of many pro-abortion organizations that legalizing abortion would go far toward reducing world wide maternal mortality, presumably by dramatically reducing “illegal abortions” and the number of pregnancies that come to term. Illegal abortions are termed “unsafe,” and a legal abortion is automatically defined as a “safe abortion.” They strongly criticize prolife doctors as not being engaged to solve the huge maternal mortality problem that stalks many nations.
This is why the research article by Dr Elard Koch and associates that we referenced in our 5-6, 5-8, and 5-14-12 emails is so important. Access them at http://www.aaplog.org/get-involved/letters-to-members/
One of the most significant findings of the study is that, contrary to widely-held assumptions, making abortion illegal in Chile 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). “Definitively, the legal prohibition of abortion is unrelated to overall maternal mortality rates” emphasized Koch.
The Guttmacher institute was quick to disagree, in the form of an article faulting Koch’s methodology and handling of the statistics. Koch immediately defended the methodology and accuracy of his article. To read the punch/counter punch, see below.
Original article by Koch, et al
News release by Koch
FOR IMMEDIATE RELEASE: May 25th, 2012
Paula Aracena, PhD – email@example.com
KOCH AND COLLEAGUES REFUTE THE GUTTMACHER INSTITUTE AND REAFFIRM NULL IMPACT OF LEGAL ABORTION RESTRICTION ON MATERNAL MORTALITY IN CHILEAN STUDY.
Chile, Santiago, 05/25/2012. On May 23rd, the Guttmacher Institute released an advisory comment (http://www.guttmacher.org/media/evidencecheck/2012/05/23/Guttmacher-Advisory.2012.05.23.pdf) attempting to debunk some conclusions of the article recently published in PLoS ONE by Koch et al. (http://dx.plos.org/10.1371/journal.pone.0036613). The authors elaborated a full point-by-point rebuttal document to the criticisms (http://es.scribd.com/doc/94847841), claiming erroneous and misleading information is being spread by the Guttmacher Institute, which may influence public opinion into disregarding important findings revealed in the controversial article.
Dr. Elard Koch, leading author of the article and fellow researcher of the Universidad de Chile and Universidad Católica de la Santísima Concepción, states that “the single conclusion that the Guttmacher Institute challenges appears to relate only to the null effect we found of abortion ban on maternal mortality trend in Chile, since this country already had restrictions of abortion in place before 1989”. Koch remarks, however, that the opinion of the Guttmacher Institute in terms of how restrictive the Chilean abortion law was before and after 1989 is essentially misinformed. Yet, even if the argumentation by the Guttmacher Institute experts stating, “Chile’s pre-1989 abortion law was already highly restrictive” was correct, this in no way invalidates that abortion restrictive laws had a null influence maternal mortality trends in Chile. “In fact, maternal mortality ratios steadily decreased over the last fifty years, mainly associated to an increase in educational level of women and maternal health facilities and regardless of the extent of abortion restrictions in the country” Koch says.
Furthermore, Koch indicates that researchers from the Guttmacher Institute failed to present any actual evidence in support of any severe methodological flaw in the PLoS ONE study. In fact, Chile has a robust and reliable registry of vital and socioeconomic data, with the Chilean National Institute of Statistics being recognized as a referent in Latin America by the World Health Organization, United Nations and the Organization for Economic Co-operation and Development. Moreover, Koch explains, “ours is the first in-depth analysis of parallel time series with a sufficient number of time points, year-by-year over fifty years, of maternal deaths and the simultaneous assessment of their determinants at a country level.”
Arguments by the Guttmacher Institute are mainly based on the idea that their own methodology, using data sources such as opinion surveys, can accurately estimate the amount of induced abortions in countries with abortion restrictive laws. Nevertheless, Koch et al. stress that opinion surveys are purely indirect approaches that may lead to under- or overestimations, and due to their subjective nature, can be extremely biased. “A completely different scenario is observed when calculating figures of illegal abortions on the basis of actual vital statistics, scientifically valid epidemiological methods, and well known biological reproductive rates”, states Koch.
Koch and his colleagues extensively explored the potential discrepancies between these two methodologies when estimating figures of illegal abortion in several Latin American countries. Their findings have been recently published as a peer-reviewed article last May 18th (http://www.nietoeditores.com.mx/ginecologia-y-obstetricia-de-mexico/5/4883-sobrestimacion-del-aborto-inducido-en-colombia-y-otros-paises-latinoamericanos.html), just a few days after the controversial article published in PLoS ONE.
Koch indicates, “Not surprisingly, we found that the methodology developed by scientists from the Guttmacher Institute appears to grossly overestimate the number of possible induced abortions in developing countries.” For instance, induced abortion estimates by Koch et al. in Colombia (21,978) indicate that the Guttmacher Institute likely overestimates figures in this region (400,400) at least by 18-fold. “In other words, estimates drawn through the methodology developed by the Guttmacher Institute is beyond what is empirically possible”, Koch says.
In their full point-by-point rebuttal document to the criticisms by the Guttmacher Institute, Koch and colleagues conclude that “it is imperative to remark that, because abortion restrictive law in Chile is unrelated to maternal mortality and this country reached one of the lowest rates of maternal-related and abortion-related deaths of the world (at the present, 16.9 and 0.39 per 100,000 live births, respectively) without legalizing abortion, the Chilean fifty-year natural experiment provides strong evidence, for the first time, that a liberal law of abortion is unnecessary to improve maternal health: it is a matter of scientific fact in our study.”
See the entire rebuttal document by Koch et al. at
For futher reading on this, see:
Blog comments and Counter rebuttal by Koch
Article in NC Register by Steve Weatherbee