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Maternal mortality submission to OHCHR
SPUC submission to the Office of the United Nations High Commissioner for Human Rights re: Resolution 11/8: "Preventable maternal mortality and morbidity and human rights"
2 December 2009
The Society for the Protection of Unborn Children (SPUC) strongly supports the Millennium Development Goal (MDG) number 5 to improve maternal health. The number of women who die from complications relating to pregnancy and childbirth in developing countries is unacceptably high and needs to be urgently addressed. The evidence suggests that the best way to achieve better maternal health is by improving access to antibiotics, drugs to prevent haemorrhage, blood transfusions, clean facilities and properly trained health professionals. Access to legal abortion in countries where abortion is currently illegal does not achieve the desired goals and may lead to an overall increase in maternal mortality and morbidity. Furthermore, legal access to abortion conflicts with the existing international legal framework. Upholding the rights of women and of their unborn children is a consistent and complimentary approach to dealing with existing weaknesses in health care systems.
Abortion is not a means of protecting women's health.
The reduction of maternal mortality rates in developed countries has been achieved by increased standards of maternal health care and by improving the general health status of women. This is true whether women have an abortion or carry to term. Better ante and post-natal care, the availability of midwives and birth attendants, medical interventions such as assisted delivery and caesarean section, decent sanitation, clean water and the ability to provide antibiotics and blood transfusions where necessary, have all contributed to dramatically reducing maternal mortality. Such improvements in basic health care, combined with policies such as health insurance, free maternity services, offering protection to pregnant women from domestic violence, involving men in maternal health, increasing efforts to prevent child marriage and ensuring young women postpone their first pregnancy, will significantly help the achievement of the MDG goal to reduce the global maternal mortality rate.
In the US, the availability of penicillin from 1943 dramatically helped to reduce the number of maternal deaths due to abortion from around 700 per 100,000 live births per year by nearly two thirds in 1953[1]; and, in subsequent years, prior to the introduction of legal abortion, maternal deaths had declined to just 10-20 per year[2].
The World Health Organisation has declared that the dramatic decline in maternal mortality rates in the developed world coincided "... with the development of obstetric techniques and improvement in the general health status of women."[3] WHO do not cite abortion as a cause, because no link has been shown to exist.
In England and Wales, maternal mortality declined dramatically during the 40's and 50's with the introduction of antibiotics, transfusions, and better pregnancy management techniques.[4] More recently, countries like Malaysia and Sri Lanka have achieved rapid improvements in maternal health by making professional midwives and supervisory nurse-midwives widely available.[5] In both examples, abortion was not legally available. It is clear that the key to maternal health is modern medicine and better health care, not legal abortion.
In Ireland, where abortion is illegal, the maternal mortality rate is less than one third of that in neighbouring England and Wales[6], where abortion laws are permissive. In India, where abortion laws have recently been widened to include abortion for social and economic reasons, the procedure is still practised under dangerous conditions and maternal mortality rates remain high.[7] By contrast, in Paraguay, maternal mortality rates have been declining even though abortion is generally prohibited and "clandestine abortion is common."[8] In 1993, Poland severely restricted its abortion laws and its maternal death rate declined correspondingly.[9]
It is well-established that legalising abortion increases the number of abortions. For example, in South Africa the number of abortions increased from 1,600 in 1996, the year before abortion was made legal, to 85,621 in 2005.[10] Therefore, in countries where access to quality health care is poor, if abortion were to become legal, the increased numbers of women accessing abortion would potentially increase overall maternal mortality and morbidity as legal abortions would be occurring in the context of already substandard health care. Furthermore, already stretched health care would become even more pressured, resulting in poorer care for women's health in general.
In the US, more than 300 women have died from legal abortions since the procedure was legalised nationwide in 1973.[11] Even under the best medical conditions an experienced abortionist may cause injuries that lead to haemorrhage, infection and death. In the developing world where conditions are often unsanitary, emergency facilities and supplies are absent or inadequate, doctors and health staff lack training in handling such situations and even the most basic of medical equipment such as antibiotics and sterile gloves are scarce or unavailable, mortality rates would be expected to be substantially higher regardless of whether abortion is legalised or not. Women who are generally at risk because they lack access to a doctor, hospital or antibiotics in countries where abortion is illegal will face the same circumstances even if the procedure were legalised.
International abortion statistics
If it is accepted that there is a direct link between illegal abortion and poor maternal health, the extent of the problem becomes even more significant. Even though SPUC argues that there is no evidence of such a link, artificially inflated abortion figures in developing nations are being used to bolster this flawed argument.
However, figures compiled by the WHO are largely constructed by statistical estimation based on meagre data and poorly supported assumptions. The UN Population Division calls the estimations of "unsafe" abortions "quite speculative since hard data are missing for the large majority of countries." Even in those countries in which abortion is legal, statistics were available for just 45 countries and in only half of those was the data believed to be "reasonably complete."
Reliance upon flawed data serves to further misidentify the real problem with maternal health in developing nations, and therefore misidentify access to legal abortion as the solution. The result is the misdirection of resources away from the real sources of poor maternal health.
Abortion and the existing international legal framework.
In addition to the evidence supporting complementarity between policies which improve maternal health and those which protect unborn children, it is essential that there also be congruity with existing international human rights. Otherwise human rights in general are weakened and the shared expressed values of the international community are not honoured.
The Universal Declaration of Human Rights 1948 (UDHR) recognises the primacy of the right to life. The Preamble together with Article 3 makes it clear that the right to life is equal and inalienable and extends to "all members of the human family". Article 2 asserts that "everyone is entitled to all the rights and freedoms set forth in this declaration, without distinction of any kind ..." [Emphasis added]. Article 6 specifically deals with the issue of persons by stating that "Everyone has the right to recognition everywhere as a person before the law." [Emphasis added].
The International Covenant on Civil and Political Rights, 1966 (ICCPR) reiterates the recognition of the "inherent dignity of the human person", and that "every human being has the inherent right to life." The fact that the right to life is described as an inherent right, uniquely so compared to other rights in the Covenant, points not only to the primacy of the right to life as the 'supreme right', but also to the fact that the right to life is not something conferred but rather intrinsic, natural, innate.
The United Nations Convention on the Rights of the Child (UNCRC) reiterates the right to life expressed in the UDHR and the ICCPR and the Preamble goes further in its recognition that "childhood is entitled to special protection and care." More specifically, and pertinent for the unborn child, the UNCRC states in the Preamble that "the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth" [emphasis added]. This injunction is one of the strongest in human rights statements regarding the requirement to protect life in the womb.
Conclusion
SPUC is committed to upholding and protecting the human rights of mothers and their unborn children. The best available evidence supports the idea that an approach which protects unborn children is consistent with improving health care for pregnant women and therefore compatible with improving maternal health and reducing maternal mortality. On the contrary increasing abortion provision increases the risks to women.
[1] National Center for Health Statistics (NCHS): Maternal Abortion Deaths, 1940 - 1971
[2] US Centers for Disease Control and Prevention
[3] Maternal Mortality Global Fact Book
[4] Ibid.
[5] World Bank World Development Report 2006
[6] Central Statistics Office, Report on Vital Statistics 2005, Ireland. http://www.cso.ie/releasespublications/documents/vitalstats/2005/annualreport_2005.pdf
[7] United Nations, Abortion Policies: A Global Review (New York: United Nations, 2002), Sales No. E.01.XIII.18, 56-58.
[8] United Nations, Abortion Policies: A Global Review (New York: United Nations, 2002), Sales No. E.02.XIII.5, 29-31.
[9] Wm. Robert Johnston, "Data on abortion decrease in Poland," Johnston's Archive, 26 May 2008, http://www.johnstonsarchive.net/policy/abortion/polandlaw.html (22 April 2009).
[10] Wm. Robert Johnston, "Historical abortion statistics, South Africa," Johnston's Archive, 26 October 2008, http://www.johnstonsarchive.net/policy/abortion/ab-southafrica.html (22 April 2009).
[11] Centers for Disease Control and Prevention, "Abortion Surveillance--United States, 2005," Morbidity and Mortality Weekly Report 57, no. SS-13 (28 November 2008).
