SIR: In his article titled: “Legalising abortion and question of maternal mortality reduction: Matters arising,” (The Guardian, Tuesday 26, 2011) Jerry Okwuosa on Page 56 argues that legal and safe abortion access does not reduce maternal mortality. In fact, very strong evidence suggests just the opposite.
Mr. Okwuosa cites data from South Africa to argue his case, saying that an increase in maternal mortality rate is somehow related to expanded legal abortion access. On the contrary, since South Africa legalised abortion in 1997, deaths due to unsafe abortion have declined by more than 50%. Post abortion complications also declined significantly. As the World Health Organisation and others have noted, the increase in maternal mortality in South Africa is due to HIV/AIDS and is in no way related to abortion.
Mr. Okwuosa also uses the examples of Nepal and Ethiopia, countries that liberalised their abortion laws yet still have high rates of maternal mortality. Liberal abortion laws went into effect in 2004 in Nepal and in 2005 in Ethiopia. While access to safe abortions has improved in both countries, it takes more time and research to establish the impact on maternal mortality. Given the experiences of South Africa and other countries, including Romania following the liberalisation of the abortion law in 1990, it is expected that maternal deaths from unsafe abortion will decline once safe abortion becomes more widely available,
To deny that unsafe abortion is directly linked to maternal mortality is not only misleading, but dangerous. Letting unsafe abortion persist amounts to a death sentence for tens of thousands of women every year. When one examines the evidence, it is clear that almost all of the countries with the lowest maternal mortality rates allow legal abortion on broad grounds and almost all of the countries with the highest maternal mortality rates have highly restrictive abortion laws.
In Nigeria, abortion is legal under very limited circumstances, and the problem of unsafe abortion persists. In our 2006 study, “Unwanted Pregnancy and Induced Abortion in Nigeria,” the Guttmacher Institute estimated that three-quarters of a million Nigerian women have an induced abortion each year. About one-quarter of these women experience serious complications and poorly performed abortions are known to contribute to Nigeria’s high maternal mortality rate of 840 maternal deaths for every 100,000 live births in 2008 according to the World Health Organisation – far more than the global average rate of 260.
The evidence is clear and compelling: to save women’s lives, we must address the issue of unsafe abortion and its root cause, unintended pregnancy. Legal abortion care must be made safer by improving training for medical staff and appropriate post abortion care should be available and affordable. Family planning services must be expanded to ensure women and their families can plan how many children to have and when to have them and young people should be provided with appropriate reproductive health education so that they are armed with the knowledge they need to make responsible decisions.
• Akinrinola Bankole,
Director of International Research,
The Guttmacher institute
United States.
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