Regular readers will be aware of the study recently published in PLoSONE on maternal mortality rate (MMR) trends in Chile and the American continent. Professor Koch from Universidad Católica, Concepción and colleagues from Universidad de Chile and others show that the MMR is relatively low in Chile, outperforming most countries including the US and second only to Canada. In addition, the authors report, somewhat controversially, a null effect of abortion law introduced in Chile on MMR, suggesting that banning abortion in the country did not, as one might expect, lead to potenitally dangerous clandestine practices resulting in a rise in maternal mortality. In fact, the study claims, the drop in MMR is largely accounted for by an increase in maternal education and a change in reproductive behaviour; ideas that will require further reserch to confirm or deny. However, the study conclusions have provoked reaction from some quarters, in particular the Guttmacher Institute have issued a statement claiming to have 'debunked' the PLoSONE article. They claim that, " the study has several serious conceptual and methodological flaws that render some of its conclusions pertaining to abortion and maternal mortality invalid." Koch and colleagues have provided a full point by point rebuttal of the report which can be read here. An obviously sensitive issue, particularly in the US, we encourage readers to carefully consider the evidence provided by the data. The press release from Professor Koch's Department is reproduced below.
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, acknowledged 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-review 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 (link), 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.”
I’ve been following the discussion of Dr Koch’s academic article on MMRs in Chile with interest – mainly on Twitter. I found Koch’s conclusions (and his references to Ireland) thought-provoking because they runs counter to all the conventional wisdom about the impact of restrictive abortion legislation on women’s health and, indeed, on the level of clandestine abortions.
When the debate developed into a spat between Dr Koch and the Guttmacher Institute, I became even more fascinated, as GI’s Abortion Incidence Complications Method (AICM) methodology for estimating clandestine abortion rates in Africa, Latin America and Asia has been used for two decades with little controversy. Until now.
When the focus of the spat then moved from Chile to Columbia, I began to think there was something else at play here – perhaps a ‘wider agenda’ as Ireland’s Senator Ronan Mullen might put it. All previous estimates for the level of clandestine abortions in Columbia were in the ‘100,000 – 500,000 a year’ range – a wide range admittedly, but perhaps not surprising when you consider the use of different estimation approaches over different time periods. GI’s estimates (from a comprehensive report which can be found at www.guttmacher.org/pubs/Unintended-Pregnancy-Colombia.pdf) is towards the top end of the range, at 400,000.) Enter Dr Koch with a new estimate of 22,000 abortions a year, giving Colombia one of the lowest, if not the lowest, abortion rates in the world.
At this point I smelt a rat, so I did a bit of digging.
It happens that Dr Koch is also on Twitter as @ElardKoch on Twitter. He doesn’t tweet much – mainly retweeting Pro-Life messages from a guy called @StevenErtelt and there’s nothing wong with that, I thought. But one of the biggest attackers of @Guttmacher on Twitter is a ProLife organisation called www.lifenews.com. When you try to follow Life News on Twitter, you get directed to the Twitter address of, wait for it, @StevenErtelt. Worrying.
Another big attack on @Guttmacher’s research into abortion in Columbia is Steven Mosher, president of the Population Research Institute. I thought the Population Research Institute must be a well-respected academic institution so I googled it: www.pop.org. It turns out that the Population Research Institute is just another Catholic Pro-Life organisation which also opposes same-sex marriage in strident terms.
So it seems this diverse group of rightwing Catholic Prolifers lining up against @Guttmacher are pushing a Catholic agenda opposed to both contraception and abortion. As a Catholic myself, I get annoyed when fellow Catholics will ignore scientific evidence in favour of a strongly-held religious belief. When scientists doing it, my annoyance turns to horror.
Back to Dr Koch: On 27 May 2012, @ElardKoch launched a scathing attack on @Guttmacher on Twitter in which he told me:
“I’m not surprised with the desperate attempt by GI. They are defending a poor methodology biased by an ideological agenda”
“GI used opinion surveys to estimate induced abortions in Colombia and LA. It is not a valid method in Epidemiology.”
“An opinion survey to 289 individuals: How many stray dogs exist in Colombia? Evidently, it is just an ‘opinion’ “
In fairness to @ElardKoch, he also said: “Perhaps it is the first publication by an independent research team seriously questioning the metodology by the GI” and he may well have a point there. However, it’s hard to take him seriously when he appears to let his own Pro-Life views influence his scientific conclusions, particularly when he paints Colombia as an almost abortion-free country. He also does his fellow-countrymen and women a disservice by brushing under the carpet the tragic human issues associated with clandestine abortions.
thanks for your interesting view. Yes, you have a good point about the counter-intuitive nature of the findings, I would have expected anti-abortion laws to lead to more deaths through clandestine abortions. Then again sometimes scientific findings throw up results that challenge the orthodox view. I suppose a strength of the method is that it relies on deaths rather than self-reported events which can be more reliable. On the other hand, official stats have their problems too. For example in the past suicide rates in catholic countries have been impossibly low, presumably some suicides were recorded as ‘accidental death’ or something. Perhaps the same has happened here. But I agree there is a big difference between the estimates.
I don’t know about Prof Koch’s personal views on abortion myself, or the GI, maybe they will comment??
Thanks for this. I just had a rebuttal to Koch published on Friday: www.rhrealitycheck.org/article/2012/06/01/anti-choice-researchers-in-chile-try-to-hide-illegal-abortion-and-women-who-die-f
And a second statement responding to some points in Koch’s rebuttal of Guttmacher is here: http://mypage.direct.ca/w/writer/Koch-rebuttal.html
Koch is definitely anti-choice, he is also an affiliate of this site: www.wecareexperts.org/affiliates, with the purpose of producing anti-choice “research.”
Mr. O’Diothigh (I hope I wrote your last name correctly) has very interesting views. I have no doubt that when data fits so perfectly well with a particular agenda, my first thoughts are of disbelief or suspicion. Nevertheless, I follow up with carefully reviewing the evidence (press coverage, social networks, commentaries and the whole shebang) before making a statement. After all, big minds argue ideas and solely little minds argue with people. So here it goes…
As a scientist myself, I am bound to make deductions on the basis of data and observation. My personal opinion and views (whatever they may be) are not involved in the process (or at least I try my best for them not to be). After reviewing several works in the subject, I can make two deductions:
1. Out of the articles I read, apparently the only one using actual vital records to obtain a conclusion in this matter is the study by Koch et al. The other studies were based on opinion surveys and not actual data. Therefore we have observation versus perception in the literature. I lean towards observation rather than perception here. Elard Koch may or may not be biased in his thinking-process (I am not inside his head) but that cannot alter hard data that I have corroborated myself. The data is there for anyone who want to look.
2. The study by Koch et al. concludes that the main factor influencing the decrease in maternal mortality in Chile is women’s educational level and that abortion legislation had nothing to do with it. I can’t see the flaw in that statement. It’s a logical deduction from the hard data. The way I see it is that this conclusion turns out to be in line with a pro-life agenda, but it just turns out to be that way. It appears unlikely that one can make hard data to conveniently change out of sheer willpower. Not when the data has been obtained by an independent entity and has it out there for anyone to check on them. After all, the data is the data…
Finally, and on a personal note, I hate labels… pro-life versus anti-choice… pro-choice versus… anti-life? (wow there!). I’d rather be labeled as pro-active :)
Just my 2 cents… Paula
Quite certainly to me there is nothing wrong with personal standpoints as long as they do not use the scientific method to twirl numbers and turn them into a specific statement that fits personal agendas. Sir Karl Popper clearly stated:
“…the tabula rasa theory is absurd: at every stage of the evolution of life and of the development of an organism, we have to assume the existence of some knowledge in the form of dispositions and expectations. Accordingly, the growth of all knowledge consists in the modification of previous knowledge - either its altaration or its large-scale rejection. Knowledge never begins from nothing, but always from some background knowledge…”
One that claims himself a scientist, must therefore be aware of this previous knowledge, and inexorably subjet it to his inner moral system, to finally state a conclusion, which finally represents the personal standpoint. To deny this personal standpoint is to deny our own nature of being human, which is -logically- impossible.
Hi all, I thought I’d just reiterate who the authors of this study are in case there is any confusion:
Camila X. Romero
Here’s a link to the research group at UCSC too:
Paula: You talk about “hard data that I have corroborated myself” and that the “data is there for anyone who want to look.” But the point is that the data is NOT there for anyone to look at. Data on illegal abortion and its consequences are missing because illegal abortions are not reported. This is Koch’s major flaw and bias - he pretends that only vital statistics are valid because that’s all there is, conveniently ignoring the fact that illegal abortion is widespread, as it is anywhere where abortion is criminalized.
There’s a relevant article in the Telegraph this morning that flags up a Save The Children report on maternal mortality rates in the developing world
I haven’t read the report itself yet which is due out today but the focus is on teenage pregnancy