Ireland’s stellar record in reducing maternal and infant mortality
By Ian Gentles, Vice-President, deVeber Institute for Bioethics, Toronto
Ireland is currently considering the removal of its constitutional ban on induced abortion. An argument frequently heard for making this momentous change is that it would eliminate the horrendous consequences of illegal or ‘back street’ abortions. We have heard of the terrible loss of life suffered by women desperate to terminate their pregnancies. We have also heard of thousands of women flying to the UK every year to obtain the abortions denied them in Ireland. Heart-wrenching stories have been told of women injured and dying because legal abortion is not available in Ireland. But has the ban on abortion in fact been a grave disservice to women’s ‘reproductive health’, as is so often alleged? A calm look at the actual evidence on maternal mortality suggests a different reality.
In spite of the rapid economic growth that Ireland has experienced since being admitted to the European Union, it remains a less affluent country than its neighbour the United Kingdom. Yet even with this disparity in wealth Ireland has for many years recorded rates of maternal and infant mortality that are either equal to or lower than in the UK. In the 25 years between 1990 and 2015, according to UN statistics, Ireland’s maternal deaths fell from 11 to 8 per 100,000 births, while its neonatal mortality dropped from to 5 to 2 per 1000 births, one of the lowest rates in the world – significantly lower than the U.S., for example. During the same period the UK’s maternal mortality fell from 10 to 8, and its neonatal mortality from 5 to 3, slightly higher than Ireland’s.
Other countries that do not permit abortion have had a similar experience to Ireland’s, matching or bettering the maternal and infant mortality rates of countries that allow it on request. Poland banned abortion in 1990. Since then its maternal and infant mortality rates have dropped significantly. Infant deaths from cerebral palsy have plummeted spectacularly from over 100 a year to fewer than 10. Neighbouring Russia and Hungary, with abortion on demand, suffer much higher maternal and infant mortality.
Looking at Asia, Bangladesh, one of the world’s poorest countries, does better than India, Cambodia and Nepal which have abortion on demand. The same is true of two other poor countries that do not allow abortion: Afghanistan and Indonesia. In Africa, very poor but non-abortion countries such as Egypt and Uganda enjoy lower maternal and infant mortality than South Africa, a richer country that decided to allow abortion on demand in the early 1990s.
Turning to Latin America, we find the same phenomenon. Chile has long had a complete ban on abortion, which it has recently altered slightly. A relatively poor country, it nevertheless boasts one of the best maternal and infant health rates in the world, dramatically better than neighbouring Guyana where abortion is available on demand. Guyana’s maternal death rate has actually worsened in the past 35 years. Furthermore, almost none of the negligible maternal mortality in Chile is due to illegal abortion. Nicaragua and El Salvador banned abortion in the 1990s. Since then their maternal and infant mortality rates have improved significantly.
Even more interesting is the experience of Mexico. Until 2007 it had one of the most protective pregnancy abortion laws in the world. In that year each of the 32 states was allowed to pass its own abortion legislation. Most retained the law against abortion, but some urban states, notably Mexico City, adopted permissive laws. A recent study in the British Medical Journal came up with the astounding finding that the states with restrictive laws experienced 25 per cent lower maternal mortality than the states with permissive legislation. The death rate from induced abortion was almost 50 per cent lower in the restrictive states. The authors of the study noted that higher female literacy, skilled attendance (or should this be “attendant”? at birth, clean water and sanitation, as well as lower rates of inter-partner violence “…appeared to have a more favourable distribution in [the less permissive] states” than in the permissive states. It would seem that in the restrictive jurisdictions the authorities take more seriously the need to protect and promote the health of mothers and young children, and this applies to countries as diverse as Poland, Chile and Uganda.
In conclusion, does Ireland need to over-turn its abortion law in order to reduce maternal mortality and improve women’s ‘reproductive health’? Our global study of the impact of restrictive abortion laws on both maternal mortality and children’s health demonstrates that nothing could be farther from the truth.
Ian Gentles is the co-author of Complications: The Impact of Abortion on Women, published by the deVeber Institute for Bioethics in Toronto.