Chilean Study Exposes Fundamental Flaws in Maternal Health Research

By Susan Yoshihara, Ph.D. | May 31, 2012

NEW YORK, June 1 (C-FAM) A Chilean medical researcher published a landmark study on the connection between the availability of abortion and maternal health. He found legal abortion does not contribute to maternal health and showed this using voluminous data from the extensive medical history of Chile.

The Alan Guttmacher Institute, founded by Planned Parenthood, attempted to debunk the study and some say has harmed its own credibility in the process.

Guttmacher asserts that the Chilean paper was not consistent with most of the literature published in peer-reviewed medical journals. The researcher, Dr. Elard Koch, an epidemiologist on the faculty of the University of Chile, countered that the peer-reviewed studies are themselves flawed since they rely largely on unscientific data such as surveys. In contrast, Koch said his own study relies exclusively on scientific methods and exceptionally high quality country data.

Koch’s rebuttal to Guttmacher also reveals how unfamiliar Guttmacher researchers are with the facts surrounding abortion and maternal health in many countries and not just Chile. For example, Guttmacher reiterated its bedrock assumption that women routinely lie about having abortions and do not seek post-abortion care in countries where abortions are illegal. Koch noted Chile’s impeccable records in this regard and called Guttmacher’s swipe “inconsistent and biased,” noting the lack of “strict scientific rigor” has led Guttmacher to get abortion figures wrong so often in Latin America.

The Chilean study found that after abortion was prohibited in 1989, the maternal death rate decreased by nearly 70% in that country. What is remarkable about the Chile study is that it could analyze detailed records from the periods before and after legal restriction, something no other study has been able to use. The Guttmacher critique was silent on this point.

The Guttmacher analysis sidestepped altogether the study’s main finding. During a 50-year period from 1957-2007, the Chilean maternal mortality rate decreased 93.8%. What mattered most, the study found, were improvements in women’s education level. This helped women take advantage of other improvements such as better antenatal care programs, more deliveries by skilled attendants, clean water, and sanitary sewer access.

The study found that women’s education is so important that it can have a modulating effect on the other factors formerly believed to be most important in projecting maternal death rates such as a country’s total fertility rate. 

This is the second indicator of cracks in the rigor of the international maternal health research establishment in a week. The recently-released World Health Organization report on maternal health tacitly acknowledged the methodological primacy of another band of independent researchers, from the University of Washington, over UN researchers regarding global trends in maternal mortality.

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