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Illegal abortion and safety: the case of El Salvador
- Rene Leiva (3 February 2009)
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Rene Leiva Medical Staff
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rene.leiva{at}mail.mcgill.ca Rene Leiva
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Ms Cook states that "laws limiting access to abortion services do not reduce the number of abortions, only their safety ". Epidemiology of abortion and maternal mortality are largely based on statistical estimates that lend themselves to inaccuracies (2). In order to asses objectively this problem, the case of El Salvador might present an interesting real life example that might cast serious doubt on this hypothesis. El Salvador criminalized abortion for all reasons in 1998. Maternal mortality ratio (MMR per 100,000 live birth) prior to 1998 was calculated to be 155 (3). In 2006, the Salvadorian Ministry of Health completed the most comprehensive study carried out so far to evaluate true MMR in the country (3). This study was funded by the U.S. Center of Disease Control (CDC), the WHO, UNICEF, UNFPA and USAID. In addition, technical assistance and supervision was provided by the WHO and U.S. CDC. In short, the study was a prospective reproductive-age mortality study (RAMOS). This approach involved identifying and investigating the causes of all deaths of women of reproductive age (10 to 54) in El Salvador from June 2005 to May 2006 by using multiple sources of data ( interviews of family members, vital registrations, health facility records, burial records, traditional birth attendants). It is recognized that if properly conducted, this approach provides a fairly complete estimation of maternal mortality (3). The study found that the MMR was 71.2. Out of 2,468 all-cause deaths, pregnancy related deaths numbered 100. 50 cases related directly to pregnancy complications, 32 cases indirectly to the pregnancy, and 18 non- related to the pregnancy. Out of the 32 indirect cases, 13 were due to suicide related to the pregnancy. Out of the 50 direct cases, 6 deaths were related to abortion as follows: 1 septic abortion, 2 ectopic pregnancies, and 3 indirect deaths after having completed the induced abortion. 5 out of these 6 cases were handled in tertiary care centers. Concluding, there seems to be no evidence that overall maternal mortality has worsen in El Salvador since the criminalization of abortion. Second, most of cases of maternal deaths in El Salvador are unfortunately due to common preventable medical complications. Third, it is also unfortunate that a significant mortality is due to suicide. No clear connection can be drawn here since suicide and maternal psychiatric morbidity seems to be also increased with induced abortions (4). At the end,what it is important is to provide health education and material support to pregnant women in the third world. 1. Cook RJ, Transparency in the delivery of lawful abortion services CMAJ 2009; 180: 272-273 2. WHO. Maternal Mortality in 2005 Estimates developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva: World Health Organization, 2007. 3. Gerencia de Atención Integral en Salud a la Mujer. Linea de Base de Mortalidad Materna en El Salvador. Junio 2005-Mayo 2006. Ministry of Public Health and Social Assistance. San Salvador. El Salvador. 2007. 2nd edition. http://www.mspas.gob.sv/p_attmujer.asp(Accessed February 2, 2009) 4. Gissler M, Berg C, Bouvier-Colle MH, Buekens P. Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Public Health. 2005 Oct;15(5):459-63 Conflict of Interest:None declared |
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