Earlier this month The London Telegraph published a confronting statistic about abortion: 12,000 women die every year in Malawi after back-street abortions. "These women die like chicken and sadly, no one seems to care about them," said a local gynaecologist.
And the Royal College of Obstetricians and Gynaecologists has endorsed this by tweeting a link to the article. "We've said it before and we'll say it again, restricting access to #safeabortion risks lives," said the RCOG.
However, Dr Calum Miller , an ethicist and psychiatrist at Oxford University, has just published a peer-reviewed article in the International Journal of Environmental Research and Public Health which raises serious questions about the real number of deaths from illegal abortions.
To put it bluntly, this is "fake news".
As background, Malawi did have a reputation for having one of the highest maternal mortality rates in Africa. But, according to USAID , over the past 20 years, it has achieved dramatic gains in most health indicators, including maternal mortality, which fell by 53 percent between 1990 and 2013.
Dr Miller claims that "the latest evidence - itself from 15 to 20 years ago - suggests that 6-7% of maternal deaths in Malawi are attributable to induced and spontaneous abortion combined, totalling approximately 70-150 deaths per year." So the number of deaths from backstreet abortions is very small indeed - a tiny fraction of the 12,000 mentioned in The Telegraph .
In fact, the latest and more authoritative evidence from the World Health Organisation and the Global Burden of Disease (GBD) study estimates that the number of maternal deaths every year is between 1150 and 2100. So the number of back-street abortions cited in The Telegraph is between 6 and 10 times the number of maternal deaths from all causes .
In the real world, outside of the Twitterverse, that is called "making it up as you go along".
"Claims in the mainstream media of thousands of women dying from unsafe abortion in Malawi each year have no empirical foundation," he writes.
How did this mistake happen? Dr Miller traces its evolution through journals and reports. It seems to have started with a 2017 report from the abortion think-tank, the Guttmacher Institute. This claimed that 6-18% of maternal deaths in Malawi were attributable to abortion. Its source was a 2017 study in the journal PLoS ONE. But this, in turn, was based on a 2013 review of earlier studies by Eveline Geubbels. But this is now seriously out of date. Miller writes:
"... the most recent identifiable study from Geubbels' review was 16 years old when the Guttmacher claim was originally published, and is now 20 years old. This paper claims only 6% of deaths due to abortion and includes deaths from miscarriage. By contrast, the data suggesting figures closer to 18% are now more than 30 years old and cannot form a reliable basis for contemporary estimates."
The number of deaths from backstreet abortions is being used as a reason to decriminalise abortion. But would liberalisation of the relevant laws decrease the number of maternal deaths in Malawi - and elsewhere? Surprisingly, an article in the journal BMC Women's Health observed that "There is little or no research about abortion laws and their impact on maternal mortality." Dr Miller believes that "Once socioeconomic and infrastructural factors are taken into account, there appears to be little to no relationship between abortion legislation and abortion mortality."
This is an important health issue. In the case of Malawi, foreign aid from the UK has been disproportionately given to family planning programs, rather than strengthening health systems.
Dr Miller concludes with some common-sense advice: "Of course, the small number of women who do die from illegal abortion in Malawi is still important, as these are women with dignity and worth whose deaths are tragedies. However, their numbers should not be radically inflated."