Chapter 2 Summary: Maternal and infant mortality: a global perspective

It is often argued that legalizing abortion is necessary to limit maternal mortality. However, evidence from around the world shows otherwise. A global analysis reveals that countries in which abortion is restricted have, in fact, lower maternal mortality rates (MMRs) than countries in which abortion is legalized. Additionally, countries with high mortality rates from unsafe abortion also have "the least effective and accessible health care services, making complications and deaths from unsafe abortion more likely."1

Chile has one of the lowest MMRs in the Americas.2 Its MMR (defined as number of maternal deaths per 100,000 live births) decreased by 70 per cent after abortion was banned.3 In contrast, after legalizing abortion, Guyana's MMR decreased by only 32 per cent.4 This trend is confirmed by El Salvador and Nicaragua, which both had significant decreases in MMR after banning abortion.5 Egypt and the Ugandan district of Soroti also have restrictive abortion laws and have had a decrease in MMR of 52 per cent and 75 per cent, respectively.6 In contrast, South Africa legalized abortion in 1996 and has actually seen a slight increase in its MMR, including an increase in deaths due to abortion, from 114 in 2002-4 to 136 in 2005-7;7 the country is considered to be making "no progress" in improving maternal health.8

Across the globe, factors that are known to decrease MMR include increased education for women, better health care, skilled attendance at birth, emergency obstetric care, primary health care facilities improvement, and long distance transportation to a hospital.9

These findings challenge the notion that abortion improves maternal health, and have powerful implications for policies aimed at decreasing maternal mortality.

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  • 1. Berer M. Global perspectives – national laws and unsafe abortion: the parameters of change. Reproductive Health Matters 2004 November; 12(24 Supplement): 1-8, p. 4.
  • 2. Population Division of the United Nations Secretariat. Abortion policies: a global review – Chile. United Nations Population Division Department of Economic and Social Affairs, 2002. Online edition: http://www.un.org/esa/population/publications/abortion/index.htm. Ruiz-Rodríguez M, Wirtz VJ, Nigenda G. Organizational elements of health service related to a reduction in maternal mortality: the cases of Chile and Colombia. Health Policy 2009 November; 90(2-3): pp. 149-155.
  • 3. Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries 1980-2008: a systematic analysis of progress toward Millennium Development Goal 5. The Lancet 2010 April; 375(9726): pp. 1609-23.
  • 4. Ibid., p. 1615.
  • 5. Mendieta W, Bohemer L, Cabrera RJ. Nicaragua and abortions. (Letter). Washington Times. December 20, 2007.
  • 6. Campbell O, Gipson R, Issa EH, et al. National maternal mortality ratio in Egypt halved between 1992-93 and 2000. Bulletin of the World Health Organization 2005; 83(6): 462-71, p. 469; World Health Organization. MPS: Making Pregnancy Safer – Implementing the MPS Initiative in Soroti district, Uganda. World Health Organization, 2010; p. 24.
  • 7. National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD). Saving mothers 2005-2007: fourth report on confidential enquiries into maternal deaths in South Africa: expanded executive summary. Pretoria, South Africa: National Department of Health, 2008 March, p. 12.
  • 8. Maternal Mortality Estimation Inter-Agency Group. Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and the World Bank estimate. World Health Organization, 2012; p. 44.
  • 9. Gonzalez R, Requejo JH, Nien JK, Merialdi M, Bustreo F, Betran AP. Tackling health inequities in Chile: maternal, newborn, infant, and child mortality between 1990 and 2004. American Journal of Public Health 2009; 99(7): 1220-1226, p. 1225.; Koch E, Thorp J, Bravo M, Gatica S, Romero CX, Aguilera H, Ahlers I. Women’s education level, maternal health facilities, abortion legislation and maternal deaths: a natural experiment in Chile from 1957 to 2007. PLoS ONE 2012 May; 7(5): p. e36613; Schuberg K. Abortion Ban Does Not Mean More Maternal Deaths, Chilean Study Finds. CNS News. 25 July 2012. http://cnsnews.com/news/article/abortion-ban-does-not-mean-more-maternal-deaths-chilean-study-finds.
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