In the December 2012 issue of the International Journal of Women’s Health, Elard Koch, of Chile's Catholic University of the Most Holy Conception, and colleagues again criticize a Guttmacher Institute–developed methodology for estimating the number and rate of induced abortions and complications from unsafe abortions in countries where the procedure is highly legally restricted. The critique largely recycles misleading arguments previously made by Koch et al. in the May 2012 issue of Ginecología y Obstetricia de México, which Guttmacher comprehensively rebutted in July 2012.
We reiterate that Guttmacher rejects these false criticisms and stands by the validity of its methodology. We refer interested parties to our July response for a detailed discussion (full-length versions are available in English and Spanish).
However, we do want to address one false claim that is central to Koch et al.’s current critique: that official government statistics accurately capture all or most abortions that take place in the Federal District of Mexico City, where first-trimester pregnancy termination was decriminalized in 2007. Koch et al. charge that Guttmacher’s estimate of 122,455 induced abortions in Mexico City in 2009 is inflated "at least 10-fold," on the basis of a comparison to official statistics for that year. Serious problems with this assertion render it invalid:
The official abortion records in Mexico City only include legal abortions that take place in public facilities. Official records exclude the significant number of abortions that take place both in private facilities and outside of facilities entirely. Many women in Mexico City obtain abortions outside the public sector, and they do so for a variety of reasons. These include lack of information about the availability of abortion services in public facilities, proximity to private services and the desire to avoid stigma associated with abortion. Some women turn to private providers; others obtain medical abortifacients from pharmacies or markets and self-induce at home with drugs such as misoprostol, which is relatively safe and offers significantly more privacy than facility-based procedures.
In short, government statistics on abortion represent a fraction of the abortions taking place in Mexico City. In contrast, the estimate produced using the Guttmacher methodology accounts for all abortions taking place in Mexico City.
Koch et al. also point out that the annual number of reported legal abortions in Mexico City’s official registry has increased since 2007, the year of abortion law reform. This does not necessarily reflect an increase in overall abortion incidence. Before 2007, nearly all abortions were performed outside the law and, therefore, were not captured in government registries. As borne out by a study of the processes following abortion law reform in Asia, Africa and Latin America (including Mexico City), the shift from illegal, clandestine abortions to legal, recorded procedures can take several years, as investments are made in establishing legal abortions services and as data collection systems are implemented.
Guttmacher research indicates that Mexico City had a moderately high abortion rate in 2009, the most recent year for which an estimate is available (54 abortions for every 1,000 women aged 15–44). Behind almost every induced abortion is an unintended pregnancy. Denying the reality of abortion undermines efforts aimed at helping women prevent these unintended pregnancies in the first place and does a great disservice to women, couples and society.
About Guttmacher’s methodology
The Guttmacher-developed abortion incidence complications method (AICM) bases its estimates on country-specific data and follows a rigorous scientific approach. Studies using the AICM cover several countries, have passed rigorous peer review, and have been published in a number of respected journals. This approach and the findings it has generated have also been used by international organizations, such as the World Health Organization.
For more information:
Debunking a critique of Guttmacher’s methodology to estimate unsafe abortion
Worldwide abortion: legality, incidence and safety
Facts on induced abortion worldwide
The Lancet: Induced abortion: incidence and trends worldwide from 1995 to 2008
Making abortion services accessible in the wake of legal reforms
Analysis: Unsafe abortion—the missing link in global efforts to improve maternal health