June 29, 2022

Did legalizing abortion in Ethiopia lead to fewer deaths?

In 2005 Ethiopia legalized abortion in the hope of reducing maternal mortality. Its law was quite liberal – more or less like abortion legislation in the United Kingdom. It was effectively abortion on demand. What was the outcome? Did maternal morbidity and mortality decrease? A study in the Ethiopian Medical Journal by an academic at Oxford University, Calum Miller, presents some surprising findings.

Dr Miller found that abortion mortality was already decreasing before legalization, and that rates do not appear to have changed greatly. However, maternal morbidity did increase:

“Over the period of legalisation, the proportion of women with septic shock more than doubled, with the same result for organ failure. The proportion admitted to intensive care nearly tripled. Between 2008 and 2014, the percentage of women receiving post-abortion care who have severe complications increased by over 50%, from 7% to 11%. During this time, the proportion of women presenting with organ failure quadrupled, the proportion with peritonitis quintupled, and the proportion with shock nearly doubled. Overall, complications doubled between 2008 and 2014, from 53,000 to 104,000. This is despite greatly improved reproductive healthcare, increased contraception, and ‘major progress’ in safe abortion provision. Only a small proportion of this can be attributed to population growth.”

He goes on to observe that legalization has failed to fulfil its promise:

“Rather than being a silver bullet to reduce deaths from abortion, abortion legalisation has resulted in a vast increase in the number of abortions, without any appreciable decrease in abortion mortality or maternal mortality. There is some evidence mortality, and certainly morbidity, have even increased since legalisation. Ethiopia’s progress in reducing maternal deaths has been considerably less than expected, especially with respect to abortion. It is possible that, as in other countries, a disproportionate focus on family planning based on inflated claims of abortion mortality has diverted resources from emergency obstetric care and thereby failed to reduce maternal mortality more significantly.”