Did banning abortion in Chile lead to lower maternal mortality?

Question

One of the common arguments for legalised abortion is that abortions will continue anyway despite being illegal and these illegal abortions will lead to higher rates of maternal death.

This, somewhat partizan, site claims that there have been natural experiments that have tested this idea and found it wanting. Specifically the site claims that the ban on abortion in Chile led to lower maternal death rates supposedly refuting the common argument. The site argues:

“Outlaw abortion and abortion won’t stop. Women will just do it illegally and women will die!”

Or so the argument goes… But facts are pesky things, and they show that the opposite is true in Chile.

The site also claims this is observed elsewhere:

It’s not sheer coincidence that Malta, The Republic of Ireland, and Chile, all of which have prohibited abortion, have lower maternal mortality rates than the United States.

Are the statistics quoted correct? And, more importantly, do they show that banning abortion is good for women as it reduces maternal mortality?

Answer 1

I can find plenty of evidence of the opposite to be true.

Before the 1966 law went into effect, the Romanian maternal mortality rate was similarto those ofother Eastern European countries. Afterward, abortion-related maternal mortality increased to a level 10 times that of any other European country (Figures 2 and 3). For the decade 1980 to 1989, the average Romanian maternal mortality rate was 150 maternal deaths per 100 000 live births.6 Many women obtained abortion illegally, and every year approximately 500 otherwise-healthy women of childbearing age died from postabortion hemorrhage, sepsis, abdominal trauma, and poisoning.

P Stephenson, M Wagner, M Badea, and F Serbanescu. Commentary: the public health consequences of restricted induced abortion--lessons from Romania. American Journal of Public Health October 1992: Vol. 82, No. 10, pp. 1328-1331.

When abortion is made legal, safe, and easily accessible, women’s health rapidly improves. By contrast, women’s health deteriorates when access to safe abortion is made more difficult or illegal

David A Grimes, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E Okonofua, Iqbal H Shah Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.

Illegal abortion is responsible for up to half of maternal deaths and consumes a large proportion of health resources in many developing countries, particularly in Africa and Latin America. The legal situation of abortion in a country does not influence the abortion rate, but illegality is associated with a much greater risk of complications and death.

Faúndes A, Hardy E. Illegal abortion: consequences for women's health and the health care system. Int J Gynaecol Obstet. 1997 Jul;58(1):77-83.

The article with regards to Chile might be this (unfortunately I can't find the body, and the abstract does not make the claims you mention):

Foro Red de Salud y Derechos Sexuales y Reproductivos; .Red Salud de las Mujeres Latinoamericanas y del Caribe Humanized care of unsafe abortion in Chile: monitoring as practical women's citizenship: Santiago de Chile; Foro Red de Salud y Derechos Sexuales y Reproductivos­Chile; 2003. 26 p. tab.

But I've also found this peer-reviewed criticism (emphasis mine):

According to a 2001 Ministry of Health Quality of Life and Health Survey,12 in 1990 there were 44,468 hospitalisations for abortion (spontaneous and induced), while in 2001, there were 34,479, a decrease of 22%. While the author (Shepard) could not duplicate the full methodology of the original study, her estimates, using the same correction and multiplier factors, suggest that the total number of abortions may also have decreased by 22% in 2001, with a 9% decrease in the abortion rate in Chile.6 Both decreases occurred during a period in which the population of women of fertile age rose by 23%. This decrease in abortions of 22% is higher than the 16% decrease in births during the same period. These estimates should be taken with caution, since they are based on hospital data, and experts attribute the reduction of hospitalisation related to abortion to the increasing use of aseptic procedures and antibiotic therapy among clandestine abortion providers, the increasing availability of misoprostol and increased contraceptive use.

BL Shepard, L Casas Becerra Abortion Policies and Practices in Chile: Ambiguities and Dilemmas. Reproductive Health Matters 2007;15(30):202–210

Answer 2

A bit late in the day but in case it is helpful:

The prohibition of abortion in Chile did not improve Maternal Mortality Rate (MMR) but neither did it have any effect. In other words access to abortion did not make women safer (at least in the Chilean context). see this study for the details: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036613

They did conclude that women's education level had an effect along with healthcare access and better sanitation infrastructure.

It is a strong argument against those who say abortion makes women safer, suggesting that the improvements in MMR seen in some countries that have introduced abortion may be rooted in improving conditions in education, health etc. This might explain why many of the countries with strictest abortion rules have poor maternal health as they are often poor with bad education, health access and sanitation.

To be able to conclude all this definitively though research would have to be done into each country in order to show which factors are most responsible and to adjust for the effect of these in judging the effect of abortion on women's health.