Analysis

Will overturning Roe lead to more pregnancy-related deaths? Statistics say no.

pregnant woman, women, rape

A pro-abortion researcher claims that banning abortion will result in more pregnant women dying, and predicts that if Roe is overturned, pregnancy-related deaths will increase by 21%. If this is true, we would expect to see that (1) countries with legal abortion would have lower rates of pregnancy-related deaths (Maternal Mortality Rates – MMRs) than ones without legal abortion, and (2) legalizing abortion would make the maternal mortality rate go down and banning it would cause it to rise.

However, this is not what the data show.

Angela Lanfranchi et al. did an analysis of the MMRs of countries before and after they legalized abortion. They found:

[F]or many countries, the link between legal abortion and improved maternal mortality… is the reverse of what its advocates claim.

Countries that have legalized abortion such as South Africa, India, Nepal, Cambodia, and Guyana have not seen the predicted maternal health benefits. By contrast, several countries that disallow abortion, such as Chile, El Salvador, Nicaragua, Egypt, Bangladesh, Afghanistan, Indonesia, Mexico, and Uganda have seen significant reductions in maternal mortality.2

Countries that legalized abortion and saw the MMR worsen

United States: In 1971 and 1972, before Roe, the MMR in the U.S. was 18.8 per 100,000 live births.1 Since then, the MMR has gone up, not down. In 2020, the MMR was 23.8. The MMR in the U.S. without legal abortion was lower than the rate with legal abortion. There are more pregnancy-related deaths today than before Roe. While legalizing abortion may or may not be the cause of the rising MMR (deaths from abortion are included in the numbers), it clearly did nothing to lower it.

Guyana, a developing nation, had a maternal mortality rate of 216 when abortion was illegal. Abortion was legalized there in 1995. By 2015, Guyana’s MMR had risen to 229 per 100,000.3 In Guyana, the MMR increased after abortion was legalized.

South Africa: Until 1996, abortion was legal in South Africa only in cases of rape, incest, fetal abnormality, or health risk to the mother. Then, South Africa passed one of the most permissive abortion laws in the world. Shortly thereafter, the MMR, which had been dropping for decades, began to rise. A major study of MMR in the Cape Peninsula, which tracked the MMR from 1953 to 2003, found that it had risen “markedly” since the late 1990s.5

In fact, according to Lanfranchi et al., “In 1990 maternal mortality was 108 per 100,000 live births, but by 2015 it was up to 138 – a rise of almost 30%.”6 In 2019, it was down to 113 – still higher than before legalized abortion.

Countries that banned abortion and saw the MMR improve

Chile: From 1931 to 1988, abortion was legal only to save the life of the mother in Chile. In 1989, it was banned in all cases. If abortion was needed to save women’s lives, the MMR would have gone up. But that’s not what happened. In 1980, when abortion was legal to save a woman’s life, Chile’s MMR was 70. By 2008 (when abortion was banned in all cases) the MMR had fallen to only 21.Chile has since loosened its abortion law slightly, allowing abortion in cases of rape and fetal anomaly. Its MMR has been declining steadily for the past two decades, but the decline started when abortion was banned in Chile for any reason.

El Salvador banned abortion in 1998. Before 1998, it had an MMR of 155 per 100,000 live births.10 Today, its MMR is 46– less than a third of what it was with legal abortion.

Nicaragua banned abortion in 2006. In 2005, its MMR was 190.11 In 2017, it was 98.

Poland banned abortion in almost all cases in 1989. Since then, the MMR has gone from 17 to 2.

Countries with legal abortion vs. countries without

Many poor developing nations with substandard medical infrastructure have higher death rates from all medical causes. We must compare countries with comparable levels of wealth and development.

Chile, with abortion banned except for rape or fetal anomaly, has a much lower MMR than the U.S., with abortion on demand in most states.

Ireland, before legalizing abortion in 2018, had an MMR of 5,  far lower than the U.S., and lower than that of the UK at the time (7) with legal abortion. From 2013 to 2015, Ireland had an MMR of 6.5, and the UK had one of 8.76.11

Malta, where abortion is illegal in all cases, and surgery for ectopic pregnancy is allowed on a case-by-case basis, had an MMR of 6 in 2017. In Poland, it’s 2. Both countries have lower maternal mortality rates than the U.S. and UK, which have legal abortion.

Hungary has an MMR of 12 (three times higher than Poland’s and twice as high as Malta’s). Ukraine had an MMR of 19 in 2017. The Russian Federation has an MMR of 11.2. Abortion is legal and common in these countries.

Mexico allows individual states to have their own abortion laws. A study in the British Medical Journal found that states with more restrictive laws had MMRs approximately 25% lower than those with more permissive laws.13

Angela Lanfranchi et al. speculated about why countries that ban abortion often have lower MMRs than comparable countries that allow it:

The reality seems to be that countries that do not allow abortion are much more likely to make sustained efforts to improve the quality of care for pregnant women and mothers.

They offer better emergency obstetric care, transportation to emergency obstetric care, delivery by trained birth attendants, education for women, and better postnatal care for mothers and infants… In short, countries that do not offer abortion on request have a much better record of promoting maternal and infant health than countries that do.14

Regardless of the reasons, it is clear that legalizing abortion does not lead to better health outcomes for pregnant women, and banning abortion doesn’t increase maternal deaths.

  1. Cited in Thomas W Hilgers, MD The Fake and Deceptive Science Behind Roe v. Wade (New York: Beaufort Books, 2020) 30-31,  from National Health Center for Health Statistics, 2004 Death Report, as reported in The Associated Press
  2. Angela Lanfranchi, Ian Gentles, and Elizabeth Ring-Cassidy Complications: Abortion’s Impact on Women, Second Ed.: Revised and Updated (Toronto, Canada: The deVeber Institute for Bioethics and Social Research, 2018) 19
  3. Ibid., 21-22
  4. SR Fawcus, HA van Coeverden de Groot, S Isaacs “A Fifty-Year Audit of Maternal Mortality in the Peninsula Maternal and Neonatal Service, Cape Town (1953 – 2002)” BJOG September 2005 112 (9): 1257 – 63, p. 1260
  5. Angela Lanfranchi et al., Complications…, 33, cites Maternal Mortality Estimation Inter-– Agency Group Trends in Maternal Mortality: 1990 to 2010 (2012) 44
  6. M Chopra, E Daviaud, R Pattinson, S Fonn, JE Lawn “Saving the Lives of South Africa’s Mothers, Babies, and Children: Can the Health System Deliver?The Lancet August 2009; 374 (9692): 835 – 46
  7. Angela Lanfranchi et al., Complications…, 33
  8. R Leiva “Illegal Abortion and Safety: The Case of El Salvador” Canadian Medical Association Journal February 3, 2009
  9. MC Hogan, KJ Foreman, M Naghavi, SY Ahn, M Wang, SM Makela, AD Lopez, R Lozano, CJL Murray “Maternal Mortality for 181 Countries 1980 – 2008: A Systematic Analysis of Progress toward Millennium Development Goal 5” The Lancet April 2010; 375 (9726): 1609 – 162
  10. Angela Lanfranchi, Complications…, 24; World Health Organization, Global Health Observatory (GHO), Country Views data 2017
  11. Angela Lanfranchi, Complications…, 43
  12. Maternal Mortality in 1990 – 2015 WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group: Nicaragua
  13. MDE (Maternal Death Enquiry): Confidential Maternal Death Enquiry in Ireland. Report for 2013 – 2015. December 2017, p. 18
  14. Elard Koch, Monique Chireau, Fernando Pliego, Joseph Stanford, Sebastian Haddad, Byron Calhoun, Paula Aracena, Miguel Bravo, Sebastian Gatica, John Thorp “Abortion Legislation, Maternal Health Care, Fertility, Female Literacy, Sanitation, Violence against Women and Maternal Deaths: A Natural Experiment in 32 Mexican StatesBMJ Open 2015
  15. Angela Lanfranchi et al., Complications…, 6

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