ELARD KOCH, MIGUEL BRAVO , Andres Carreño
Family Health Department Faculty Medicine University of Chile
Buenos Aires, March 2011 .- Doctors and researchers visit Argentina and Chile will present on Wednesday, March 2, 2011 at 11am. in the Chamber of Deputies (Annex Building) results and key findings from their research on the number of abortions performed in Chile and Argentina each year and on the linkage between abortion and maternal mortality.
The prohibition of abortion to protect unborn human life combined with a strategy that increases maternal antenatal care and skilled care delivery, reduce both maternal mortality and the magnitude the problem of illegally induced abortion in time.
An eventual legalization of abortion in Argentina substantially increase the magnitude of abortions on demand (2.3 times the next 10 years and 5.1 times after 50 years of legalization or decriminalization) estimated that by 2020 induced abortions will increase from 47,636 to 113,586.
The number of clandestine abortions reported for Argentina recently, is overestimated.
The increase in health costs and diversion of resources to meet the demand for abortions on demand thus bring a reduction in resources for increased prenatal and obstetric care specialist with a deleterious impact on maternal and neonatal health.
According to a current report of the World Health Organization (WHO), 60% of maternal deaths in Latin America occurs in hypertension, haemorrhage and obstruction of labor and delivery, while abortion is the fourth of the causes, accounting for only 12% of the total. However, abortion has received disproportionate attention on the grounds that it was banned in developing countries would be the main determinant of the high mortality Aterno, taking recently been evaluated in Chile, whose results contradict this paradigm.
In Argentina, abortion is illegal to protect human life from birth, permitted only under strict conditions and restricted. This has caused criticism from various national and international NGOs, urging the Argentine government to legalize abortion in order to reduce the high number of illegal abortions, which by some estimates reach the 466,998 abortions. Have porpuesto different models or statistical methods to estimate the magnitude of abortion, some scientific sustetno lacking.
HYPOTHESIS:
- illegal abortion figures reported in Argentina are overstated by at least 50% of its magnitude.
- the decriminalization or legalization of induced abortion increases its magnitude as a function of time.
METHODOLOGY:
Based on official vital statistics, the author traces and analyzes a series of maternal mortality ratio (MMR) between 1980 and 2009. The number of induced abortions was estimated using two models by Koch et al. First, we use the model of expected pregnancies (EPM). Based on the biological likely a viable conception published by Wilcox et al. in the New England Journal of Medicine, and from objective data as the total fertility rate (TFR) and the female population of childbearing age, one can estimate the number of pregnancies that occur each year in a country. In light of this new knowledge, not available when other methods of estimating illegal abortions were proposed, one can know the total number of pregnancies expected, the proportion of pregnancies that are interrupted very early spontaneous, as seamlessly as a loss evidenced clinically. The remaining viable pregnancies are divided into 3 groups: those ending in live naciods that each country is in their vital statistics, stillbirths, of which there are reliable records and the group for induced abortions calculated as the remaining missing. The second method less accurate than the EPM, corresponds to an equation linearly related to TGF with a goodness of fit of 95%. Finally, the model uses a quadratic function of time based on data from 18 European countries with legal abortion to project the trend in the number of abortions over time if hypothetically decriminalized in 2011.
RESULTS:
Between 1951 and 2007, abortion mortality in Chile fell from 69.51 to 1.65 per 100,000 live naciods, representing a reduction of 97.6%. After the complete banning of therapeutic abortion, maternal mortality from this cause fell 87.9% (ie from 13.72 to 1.65 per 100,000 live births). Currently the risk to die of abortion in Chile is less than 1 in two million women of childbearing age. Applying the EPM, in Chile currently estimated 19,390 induced abortions illegal, while in 1957 the figure was estimated close to 200,000 abortions. This confirms a parallel reduction in maternal mortality from abortion and the problem of illegally induced abortion in Chile.
DEIS Official figures from Argentina, during the study period, the highest MMR was observed in 1980, 70 per 100,000 live births, and lowest in 2000, 35 per 100,000 live naciods. By 2009, the MMR declined 21.4% on a cumulative basis. While the MMR has been declining in recent 29 years, the data indicate that Argentina requires a reduction additional 40% to achieve the goal of public health operating plan (ie achieve a MMR of 33 per 100,000 live births by the year 2011), proposed by the Ministry of Health of the Nation to reduce maternal mortality in general and abortion.
This goal is potentially achievable if you increase the coverage of antenatal care, emergency obstetric care and professional care during childbirth, the latter achieved 83.7% coverage of live births in 2009, while still leaving a significant percentage of patients at high risk obstetrics without access to specialist care in hospitals, in contrast with 99.9% coverage of current observed Chile.
In 2009, there were 410 maternal deaths in Argentina. According to the ICD-10, the direct and indirect obstetric causes, excluding codes 000 to 007 (including the different types of abortion) were the main causes, reaching 78.7%. Of the 87 pregnancies ended in abortion, official reports to which we had access not indicate the share of induced abortions compared to other types of abortions, especially ectopic pregnancy, a major cause of obstetric emergency. Applying the EMP
similar to the Chilean case, the number of clandestine abortions in Argentina in 2007 was estimated at 47,636, ie 9.8 times fewer abortions than the figure reported by the agency Human Rights Watch, who relied on a study of Mario and Pantelides. This overestimation in the magnitude of induced abortions was also observed when using the same methodology in Mexico, amplifying 10 times the number of illegal induced abortions.
Using a predictive model based on a linear equation related to the TGF, induced abortions are estimated at more than 68,978 illegally induced abortions in Argentina. In considering this magnitude, is crude incidence rate of 7.12 abortions per 1000 women of childbearing age is lower than the overall rate observed in most European countries with legalized or decriminalized abortion.
The ratio for live birth abortion, a measure that allows comparison between countries is 0.098 (ie 1 abortion for every 10.1) for Argentina, which is very close to the value of 0.092 estimated for Chile (ie 1 abortion for every 10 , 8 live births). Using estimates of Mario and Pantelides for 700,792 live births reported for Argentina in 2007, this ratio would be of 0.66 abortions per live birth or expressed conversely, that Argentina would happen one abortion for every 1.5 live births; if this figure were valid, would be the highest ratio in the world (over Romania), somewhat unlikely, if we think in European Union countries with legalized abortion, this ratio varies from 1 abortion for every 1.68 (Romania) to 1 in 6.79 (Greece) born in the present.
If hypothetically induced abortion was decriminalized in Argentina in 2011, we project the stage for the next 10 years, adjusting for the observed rate of induced abortion in Spain for the period 1998-2008 in the female population of childbearing age (15 to 44 years), considering that the year 2020 induced abortions will increase from 47,636 to 113,586 after legalization (ie an increase of 138% from current illegal abortions). The trend in the number of abortions for the next 50 years according to the average of 18 European countries with abortion legal, the year 2060 is expected in Argentina and 245,371 legal induced abortions (ie legal induced abortions will increase 415%), while in Chile, if the decriminalization of abortion, would rise from 19,390 currently to 81.788 illegal abortions induced abortions for 2060.
It concludes that the legalization of ABORTION IS NOT AN EFFECTIVE STRATEGY TO REDUCE MATERNAL MORTALITY CONTROL PROBLEM AND INDUCED ABORTION, AND COULD EVEN BRING deleterious consequences FOR MATERNAL AND NEONATAL, especially in countries with high mortality REMAINING MATERNAL.
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