Originally printed in Pregnancy Help News on Aug 1, 2023 and reprinted here with permission.
At the end of April while at Heartbeat International’s Annual Conference, I had the chance to speak to Dr. Calum Miller and ask him a few questions about a topic we are both passionate about: maternal mortality and how it relates to abortion.
That discussion is freely available to listen to at the Pregnancy Help Podcast here or wherever you typically listen to podcasts. It’s not a long discussion — just about half an hour. I encourage everyone to give the full conversation a listen, but here I will be outlining the main highlights of that interview and giving some good resources to check out.
Dr. Calum helped me understand how he was drawn into becoming both a medical doctor and an ethicist.
He became interested in medicine when he learned about the AIDs epidemic and since then he has cared deeply for global health and the health of the most marginalized in our society.
Additionally, while he was in medical school, he became pro-life. He is among the minority in his country in that; the UK is only about 5% pro-life.
Dr. Calum realized this and thought he needed to do something to address the issue of abortion. He has written many responses addressing the ethics of abortion.
The first topic on maternal mortality we discussed was what is a maternal mortality rate (MMR) and what is it a good measure of?
Dr. Calum rightly states that the MMR is a good indicator of how well a country is doing economically and how well they value women. A maternal mortality rate looks at how many women die related to pregnancy, whether that ends in abortion or birth.
Malta has had zero maternal deaths from any cause in the last 12 years (and they are pro-life). Poland is pro-life and also has an extremely low MMR.
The leading causes of maternal deaths or high maternal mortality rates vary throughout history.
The issue of an obstructed birth (like a baby being breach) has always existed and always will to some extent.
In the late 1800s and early 1900s in the Western world, one leading cause of maternal death was abortions, because abortions were actually becoming a bit safer (antibiotics, sanitation practices) and therefore more common; but this trend did not make it further East, say to Africa, until the 1980s and 1990s. But now, the main causes are things like hemorrhage, sepsis, preeclampsia, or other late-pregnancy diseases (all direct causes), and indirect causes such as cardiovascular disease or HIV/AIDs.
Abortion is generally not one of the leading causes of MMR anymore.
So, what does that mean for the pro-choice claim that outlawing abortions will make the MMR skyrocket?
Is there logic or data to back that claim up, and do pro-life people really have a good answer?
The logic for the claim is simple and twofold:
1. Fewer women will be able to get abortions, so more women will get pregnant and more of those who get pregnant will remain pregnant, and that increases the number of women who may experience a pregnancy-related death (especially during childbirth).
2. More women who do get abortions will be getting illegal (and therefore, assumed to be unsafe) abortions and die from those “back-alley” abortion procedures. Abortions won’t stop happening, you will just make them less safe.
So, what is our response?
We can easily address the claim that abortions won’t stop happening. While we cannot prevent all abortions from happening, we can prevent a lot of abortions from happening.
However, that still leaves us with the “intuitive implication” that women who do still get abortions will be getting illegal, unsafe ones and therefore will be more likely to die from them.
Dr. Calum admits the pro-life movement as a whole has not done a whole lot to address the empirical nature of this claim, but rather, has focused on the ethics: “yeah, but it’s a baby and you wouldn’t normally keep human rights abuses legal just because it could make them dangerous.”
While this is true, it does not address the implication that restricting abortion makes abortion more dangerous and deadly or affects the MMR.
Bottom line: laws don’t really make a difference or if they do, legalizing abortion is actually what makes deaths from abortion worse!
When the World Health Organization (WHO) gives their data on the percent of maternal deaths from “unsafe” abortions, they include deaths from illegal and legal induced abortions, spontaneous abortions (aka, miscarriages), and ectopic pregnancies.
The WHO blatantly commits an equivocation fallacy by saying “unsafe abortion” but meaning something totally different compared to what most people think of or are concerned about.
This is not the definition of abortion that most pro-life people go by, nor even what most pro-choice people go by.
This is also not what most pro-choice people mean when they are referring to deaths from abortion; they typically are only referring to deaths from illegally induced abortions.
Dr. Calum explains this in his paper, which you can read in full (it is not behind a paywall):
“These figures are often misleading because deaths from ‘abortion’ standardly include deaths from induced and spontaneous abortion combined, without distinguishing the two. They also typically include legal and illegal abortion without distinction. Interpreting all of these deaths as being attributable to illegal abortion alone will lead to an overestimate—perhaps a large overestimate—of deaths attributable to illegal abortion.”
Additional information about how the WHO misrepresents maternal mortality and deaths from “unsafe abortion” data can be found by listening to Monica Snyder of Secular Pro-Life’s talk here, where she explains that yes, actually, abortion restrictions do lower both legal and illegal abortion rates.
When pro-life countries (countries with restrictions on abortion) have good access to healthcare, maternal deaths from abortion decrease, Dr. Calum points out.
Countries with liberal abortion laws and a bad healthcare system have a lot of women dying from abortion. Maternal deaths from abortion therefore is a function of healthcare access and infrastructure in a country, not the abortion laws.
As Dr. Calum summarizes, “Even if you have a safe abortion, if you don’t have good emergency care, it’s going to become unsafe.”
So, what can we do? How do we, as a pro-life movement, address this main contributing factor to deaths from abortions and the MMR overall?
Strengthening the healthcare systems and especially access to emergency care is something which must be done in each country trying to lower MMR.
In most developing countries, money they are getting from the West to lower MMR is going towards “family planning” and abortion, not overall access to medical care. Governments must prioritize healthcare infrastructure.
We even discussed America’s MMR, which is likely not at all due to “strict” abortion laws, but more likely due to our healthcare system and access to affordable healthcare, especially in the context of motherhood.
In many pro-life states that have strict abortion laws, Dr. Calum notes the shockingly high MMR is not, like pro-choice advocates would like to proclaim, due to abortion restrictions; it is mostly likely due to access to healthcare in those states.
As pro-life people, is there a reasonable solution to our healthcare access and costs that can make motherhood less dangerous in our country? Economics can be a hard conversation topic, but if we really care about saving both babies and their mothers, it’s a conversation worth having.
Cover photo by Photo by Amina Filkins at Pexels