Advocates for legal abortion in all circumstances continue to make their case in terms of reducing maternal mortality, despite a growing body of evidence showing that dramatic improvements in maternal health worldwide have been achieved without the liberalization of laws restricting abortion. In the November issue of the UK-based journal Reproductive Health Matters, two reports from Latin America and Southeast Asia illustrate this situation and reveal the frustration of pro-abortion groups seeking to exploit a diminishing crisis.
The first article examines the use of the “health exception” as a mechanism for women to obtain abortions in Latin American countries, many of which have protective abortion laws. Results from a qualitative survey conducted by the Colombian pro-abortion group La Mesa included a quote from a medical epidemiologist, who stressed that, “in absolutely no way should one wait until harm has occurred. The health exception should be considered when there is a risk to the welfare of the woman, whether it be physical, mental, or social.” An Argentinian obstetrician added that, “it is enough that the pregnancy is unwanted for there to be a risk.” In this way, advocates seeking to decriminalize abortion in Latin America have turned an argument on behalf of maternal health into a framework for unrestricted abortion on demand.
The use of the health exception has led to skyrocketing numbers of legal abortions, according to data from two Colombian studies, which show a more than five-hundred-fold increase in total legal abortions between 2006 and 2011, where over 98% of the 2011 totals were attributed to risk to health or life. However, the author of the article offers no evidence that the enormous expansion of the health exception has led to any quantifiable improvement in women’s health.
Meanwhile, a report from Sri Lanka laments the fact that registration of the abortion-inducing drug misoprostol with the national drug regulatory authority has been indefinitely postponed. While noting that fellow South Asian countries Nepal and India liberalized their abortion laws in part by invoking the maternal mortality argument, the author states that “these reasons are unlikely to be a campaign-turner in Sri Lanka, where impressive achievements in maternal health have been attributed to the provision of free health care, well-developed health infrastructure, free education and other social welfare measures.”
Misoprostol was controversially added to the World Health Organization’s list of essential medicines as a treatment for postpartum hemorrhaging in cases where the preferred drug oxytocin was unavailable. However, many health policymakers in Sri Lanka cite the widespread availability of oxytocin in their country as a reason for the lack of urgency in registering misoprostol. The author of the Sri Lankan report concedes, “self-medication with misoprostol for inducing abortion is less than ideal,” although abortion advocacy groups routinely promote the use of self-administered misoprostol to induce abortion in countries where it is illegal.
As both of these reports demonstrate, the tactic of pushing legal abortion access as a way to protect women’s lives is becoming increasingly implausible, and advocates for abortion on demand are now shifting toward turning the health exception into the rule.