Many proponents of abortion, particularly in Chile, have campaigned on its legalization being necessary to protect the lives of women. The country’s lack of exception for threats to the mother’s life has often been held up as an example of barbaric policies taken too far. However, the question is, is there any evidence that this actually caused an increase in maternal mortality or worse health outcomes?
Historically, Chile had one of the strongest prohibitions on abortion. Until 2017, abortion was prohibited in all cases in Chile, and the intentional and direct inducement of abortion was illegal for any reason, including cases of threat to the mother’s life.
However, the provision of medical care, even if dangerous to the child, is not prohibited. In addition, delivery after 22 weeks of pregnancy was legal for medical reasons, allowing for premature delivery to preserve the mother’s life, and such early deliveries were frequently performed.(1)(2)
This makes for a good case study, because this is largely the most stringent form of anti-abortion laws proposed by proponents, and it is fascinating to examine the effect Chile’s abortion laws have had upon maternal mortality.
While the popular narrative follows that restrictive abortion laws produce negative impacts on maternal health, resulting in more women dying of either not obtaining an abortion or breaking the law to obtain one, this certainly has not been an observed result in Chile despite their ban on abortion in cases of threat to the mother’s life.
Instead, Chile has experienced a massive decline in maternal mortality. Though heavily restricted throughout the entire period between 1909 and 2009, the maternal mortality ratio decreased over 58%, falling from 40.8 to 16.9 per 100,000 live births. Similarly, despite theories of increasing unsafe illegal abortions, hospitalizations due to complications of illegal abortions have decreased, and the abortion mortality rate dropped by over 96%. When abortion laws have been loosened, maternal mortality has tended to increase, and when restricted again maternal mortality has generally decreased.(3)
The drops in maternal mortality in Chile, despite laws prohibiting abortion, have been so significant that Chile has one of the lowest maternal mortality ratios of any country on the American continent, surpassing its neighbors and even the United States.
It is difficult to attribute how much of the drop in maternal deaths after banning abortion can be attributed to its prohibition. While restrictions on abortion are often correlated with significant declines in maternal mortality, the biggest influence on maternal mortality is the quality of maternal healthcare, and the educational level of a country, not whether abortion is legal or not. (4)(5)
Ultimately however, while those against the prohibition of abortion are often quick to make apocalyptic predictions of the dire effects it will have upon women’s health, these sorts of claims have not been shown to be accurate. There is little to no direct scientific evidence of a harmful cause–effect relationship between abortion restrictive laws and maternal health, and abortion restrictions are neither associated with increased overall maternal mortality nor with increased total numbers of abortions or abortion related deaths.
While we frequently push developing countries to liberalize their abortion laws, with the promise that doing so will reduce maternal mortality, Chile demonstrates that the legalization of abortion is unnecessary to improve maternal health, and it may in fact worsen it.
Sources
- Act No. 18.826 of 24 August 1989 Annual Review of Population Law. 1989; 16:28. Act promulgated August 24, 1989; published September 15, 1989. PMID: 12344363. Official Chilean legislative record Bibliographic record (Europe PMC)
- Abortion Policies and Practices in Chile: Ambiguities and Dilemmas Reproductive Health Matters. November 2007; 15(30):202–210. doi:10.1016/S0968-8080(07)30328-5. Publisher record Abstract record (Europe PMC)
- Impact of Reproductive Laws on Maternal Mortality: The Chilean Natural Experiment The Linacre Quarterly. May 2013; 80(2):151–160. doi:10.1179/0024363913Z.00000000022. Publisher record Full-text PDF hosted by the author’s institute
- Women’s Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007 PLOS ONE. May 4, 2012; 7(5):e36613. doi:10.1371/journal.pone.0036613. Archived full text
- Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states BMJ Open. February 23, 2015; 5(2):e006013. doi:10.1136/bmjopen-2014-006013. Archived full text
