The latest issue of GQ Magazine, which contains sexually provocative photos of several lead “stars” of the Fox television show Glee, has been at the center of many conversations among parents and youth. The cover image shows Cory Monteith who plays Finn, a football player, posing with Diana Agron his first girlfriend, Quinn, (who lied to him in Season One, and told him she became pregnant with his child when she was in fact pregnant with someone else’s) and Lea Michele, who plays Rachel, who is his current partner.
I’ll admit my bias now: I’m not a fan of the show. Yes, I’m one of the several who got tired of them performing Blackness so early into the show (which they continue to do) and then all the other –isms they performed came into play as well. With that said I have a very simple response to this new concern/conversation that parents are now troubled to have with their children and youth in their lives who enjoy this show.
Now is the time to teach yourself and the young people in your life about media literacy. (That’s a link to an article I use often when teaching media literacy skills to my students and highly recommend it for everyone as it is a very accessible read, an updated article specifically for educators is available here.)
Instead of being disappointed that the young actors from a hit show are not in that same role 24/7/365, or that GQ Magazine created a cover that is very much objectifying of White women, or that many people are exposed to this form of media, I encourage folks to gain a new set of skills for how to deconstruct and critically examine these forms of media. Now, I will admit again, that I’m biased. I find it far too easy to blame the media for some forms of education and imagery when we as community members, educators, parents, mentors, partners, and activists must learn new skills.
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I speak of this as someone who very much lives an analog life. I do not receive or send text messages, I still use my Polaroid camera (and yes I have plenty of film left for it in the fridge), still use rabbit ears on my television antennae, and the one stereo I have in my home has a dual tape deck and one CD player because I got it when I was in middle school circa 1989. I remember when the Internet was called the “information super highway” and I’m still trying to figure out how to spell check a Microsoft Word document in the latest edition my college offers.
I get it, learning new things is not always fun, nor is it always necessary. However, in this case I do believe it is a useful tool and skill. Without media literacy skills we would not be able to have a productive conversation around the fact that bodies of Color and bodies of size (which are exclusively ignored in almost all forms of media and especially in GQ) ignored in the media. Many of the critiques I’ve read have not even mentioned race, ethnicity, or body shape and size (and yes, I am biased about what and where I consume my media, that’s a media literacy skill).
Would the reaction be the same if the characters were different? Take White male actor Kevin McHale, an able-bodied actor who plays Artie, a young man who is in a wheelchair. Partner him on the cover with Amber Riley who plays Mercedes, the only Black character and also the only character of any size, along with Jenna Ushkowitz who plays Tina, Artie’s ex who leaves him this season for an Asian man, Mike, performed by Harry Shum Jr. Would we be disappointed we did not see Kevin McHale in a wheelchair? Would we want to? I’d argue that many people are not even willing to discuss sexuality and the intersections of differently-abled people in the media as the recent terror by readers of ESPN The Magazine’s body issue have shared regarding the nude photograph of Esther Vergeer.
I don’t doubt these conversations must occur, I just want us to have all the tools and weapons we need in our arsenal to have constructive conversations that are not only reactionary but that also lead to some form of action.
Last month, Jackson Women’s Health Organization in Mississippi—also known as “Pink House,” the last abortion clinic in the state—was vandalized overnight in an attempt to cut the building’s power lines. In Kalispell, Montana last summer, All Families Healthcare suffered vandalism so severe that it was forced to close.
These facilities aren’t alone. According to the Feminist Majority Foundation’s (FMF) latest National Clinic Access Project Survey, released early this year, nearly 68 percent of reproductive health clinics nationwide experience frequent and regular anti-abortion activity andonly 45 percent rated local law enforcement “good” or “excellent” in their response to the harassment.
A new book by lawyer-authors David S. Cohen and Krysten Connon, Living in the Crosshairs: The Untold Stories of Anti-Abortion Terrorism, gives these statistics a human face often missing in media coverage as it details the real, day-to-day experiences of abortion providers in this country. In addition to bringing to light stories of harassment, Crosshairs also calls for reforms in the legal system, making it an absolute must-read for anyone in media and/or reproductive rights advocacy.
Cohen and Connon’s first order of business in their introduction to Crosshairs—which precedes interview-based individual stories that refer to the subjects using pseudonyms; a broader look at the tactics harassers use; examples of legal responses; and potential ways to improve the current state of safety for clinic workers—is to expand the term “provider” beyond just the doctors who perform the procedures. Their national interview-driven research encompassed all those whose efforts provide patients with “a safe, caring, and medically-skilled environment in which to have an abortion.” This broader definition includes referring physicians, nurses, physician’s assistants, administrative staff, counselors, clinic owners, security guards, and volunteer escorts.
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In fact, all those involved in full-spectrum reproductive health services are vulnerable to abuse such as assaults; threats in person and by mail; targeting of private practices and other places of employment; bombings; home picketing; stalking of providers’ young children; kidnappings; Internet attacks; and intimidation of extended family and neighbors. Some people participating in harassment are individuals who have personal motivations; others are backed and organized by long-standing anti-abortion groups such as Operation Rescue and the Pro-Life Action League. Still others are from splinter groups like Abolish Human Abortion, who feel the “pro-life” movement has not been militant enough.
These widespread activities have consequences that extend beyond individual safety. Cohen and Connon note that the number of medical facilities performing abortions is down 40 percent since 1982. Although the reasons for this downturn are themselves diverse, and include legislative restrictions, the authors note that harassment likely plays a role. With abortion providers in only 11 percent of U.S. counties, it is long past time that we instituted safeguards for those who do the work of full-spectrum reproductive health care, lest we see access erode further.
Yet this pervasive culture of abuse is rarely covered in the media, as Cohen and Connon point out, with mainstream outlets typically only reporting on anti-abortion activity when someone dies. To make matters worse, our Supreme Court has declared one form of targeting to be “free speech.” The repressive climate of harassment has been going on so long that even providers are at times numb to the conditions under which they work, accepting it as part of the job. For example, the first person quoted in Crosshairs, Rachel Friedman, says she often doesn’t recognize how out-of-the-ordinary her professional life has become:
I often say that as an abortion provider, you lose your sense of perspective. You think everybody has the FBI on speed dial on their phone. Doesn’t everybody have it on their phone? You forget that it really is a very unique set of circumstances that you work under.
Perhaps because the stories we do hear on the subject tend to focus on doctors, the anecdotes detailing the treatment of their friends, family, and neighbors stand out in the book as especially horrifying. In one section, Rodney Smith, an abortion doctor for almost three decades, recounts the aftermath of Dr. George Tiller’s murder. United States marshals had arrived to protect him within an hour of the shooting. Then, in the middle of the night, someone called his adult daughter and said, “Your mother and father were both just killed.” (In reality, both were unharmed.)
Volunteer targeting is also routine, yet largely unreported on. Kristina Romero, regional director for a clinic group, tells the story of one of her long-time volunteers:
She was in her 80s, it was her birthday, and the protesters cut the heads off of a bunch of roses and put them on the fence around her home with a card that said, “Hopefully you’ll have another birthday and here’s your dead roses.”
Along with incessant harassment, providers have also grown accustomed to the inconsistent response of law enforcement. The story of medical director Inez Navarro details the best and the worst of those charged with protecting and serving.
Clinic picketers, note Cohen and Connon, often use personal information—including someone’s hometown or their children’s names—in taunts outside the clinic, which they acquire by following, Googling, or looking up the license plates of staff and volunteers. Out of the blue, Navarro noticed the picketers at her clinic shouting her name. A few weeks later, she started hearing “No one is going to protect you” from one of the louder regulars. She notified the police.
“If anything did happen, I wanted them to know there was a history, it wasn’t just a one-time random incident,” Navarro explains. The police laughed, she says; her complaint was never taken seriously. She was “irritated and pissed and emotional all at the same time.” Like many people reporting harassment for the first time, she assumed she would at least be heard.
“Maybe I had a naive faith that the police were there to protect me,” Navarro tells Cohen and Connon. “I can tell you right now, I no longer trust that this police force is here to help. That was kind of my eye-opening experience with them.”
After a man followed her home and chased her into her gated neighborhood complex, she was again told the police were “unable to pursue anything.” She and her husband decided to move to another jurisdiction, where they contacted that police department ahead of time. The response couldn’t have been more different. The proactive police chief gave Navarro his cell phone number; offered to help with anything they needed; identified their house for special emergency assistance so that 911 calls would be flagged; sent a detective to perform a security assessment; and marked both their license plates for notification should anyone search for their information.
According to research done by the authors, anti-choice harassers rely on these kinds of inconsistencies in policing—along with the silence created by stigma—to push boundaries and instill fear. FMF research backs up the interviews in Crosshairs: Its 2010 clinic survey reported that “[c]linics which rated their experience with law enforcement as ‘poor’ were twice as likely to experience high levels of violence in 2010 as clinics rating their experience as ‘good’ or ‘excellent.’”
Of the ten reforms Cohen and Connon offer to better protect providers, improving communication between health clinics and law enforcement is one that anyone can advocate for in their community. Police should also implement programs to educate their officers on the history of anti-choice violence so that they can understand what would reasonably create fear. Cohen and Connon also call to increase penalties under the FACE Act; prohibit home picketing; protect providers’ identities in government databases; and strengthen anti-stalking laws.
The authors don’t propose their suggestions are the only available avenues for improving provider safety, nor do they claim that individualized harassment could be entirely eliminated without stigma-ending culture change. In fact, the recognition of this latter need is part of the impetus behind their final recommendation for federal law enforcement: labeling provider harassment as terrorism.
Anti-abortion targeting already fits the FBI’s shorthand definition of “domestic terrorism,” which reads: “Americans attacking Americans based on U.S.-based extremist ideologies.” Many providers, too, emphatically use the word “terrorized” to describe the climate created by constant harassment as well as their collective memory of arson and assassinations.
Officially and overtly labeling individual and coordinated attacks against providers as terrorism would allow greater coordination among jurisdictions and levels of law enforcement, Cohen and Connon note. Cases would be treated in a uniform fashion across the country and policymakers would be able to track related activity and develop protective policies. Law enforcement officials would more consistently access the history and tactics of the “pro-life” movement—context that is invaluable to investigating and prosecuting threats.
Beyond the legal implications, Crosshairs points out that a terrorism label could bolster public sympathy concerning the trials providers face. Cohen and Connon write:
By shifting terminology to include targeted harassment within the concept of terrorism, society will further brand these actions as unacceptable, possibly reducing the amount providers face through a shift in societal norms.
Overall, after dozens of alarming accounts, many readers will likely approach the conclusion of Living in the Crosshairs wondering why anyone would continue doing this work under such conditions. Dr. Warren Hern speaks to this at the beginning of the final chapter without hesitation:
I love my work. I could have been a dermatologist and nobody would care. I didn’t choose this because I wanted controversy. I thought this was the right thing to do. I felt that doing abortions was the most important thing I could do in medicine … And if somebody asks, ‘Why do you do this?’ Well, it matters. It matters for the health of the woman. It matters for the health of her family. It matters for the health of our society, and now it matters for freedom.
Hern’s sentiments echo many other providers’ throughout the text, which they often offer to their interviewers unprompted. Those individuals cite varying reasons for why they’ve stayed in the field, including commitment to patients and health care, commitment to reproductive choice, a refusal to “let the terrorists win,” and the memory of pre-Roe v. Wade suffering.
All those providers featured in Crosshairs will leave readers inspired and motivated to make their vital work safe and free from attack. It is nearly impossible to finish Living in the Crosshairs: The Untold Story of Anti-Abortion Terrorism without a renewed desire to help protect people like Marsha Banks, who responded to decades of attacks, arson, and protest in her professional life this way: “It’s what I was born to do really, to be a human rights advocate. It’s human rights. How could anybody tell anybody what to do with their body? It’s as simple as that.”
A recent study in the British Medical Journal Open that looked at the effect of abortion laws on maternal mortality in Mexico is egregiously flawed and biased. Written by ten anti-choice authors, it poses an unacceptable risk to public health because it could be used to advocate the criminalization of necessary health care for women.
The study purports to show that Mexican states with more restrictive abortion laws have lower maternal mortality rates than states with more permissive laws. Although the authors refrain from hypothesizing a causal link between criminalized abortion and better maternal health outcomes, that preposterous implication comes through nonetheless. It’s even clearer in the authors’ press release about the study.
BMJ Open is an open access journal that offers easier and quicker publication of studies, but its website also states (emphasis added): “Our aim is to provide a home for all properly conducted medical research to be fully reported, after a rigorous and transparent peer review process.”
So what happened? Why did BMJ Open accept this study without subjecting it to greater scrutiny? Some anti-abortion language even slipped through—on page three of the study, the authors characterize the Mexican states’ constitutional amendments protecting the “unborn” from conception as “progressive changes.” The study was peer-reviewed by two medical doctors, but neither appears to have expertise in abortion research or Mexico. One of the reviewers refuses to prescribe birth control to his patients, while the other specializes in safe driving education and injuries from agricultural accidents.
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Four of the ten co-authors of the BMJ Open study were named as “False Witnesses” in an investigative series carried out last year by Rewire. The investigation found that those four researchers “pushed false information designed to mislead the public, lawmakers, and the courts about abortion” in their previous research or public statements. Those co-authors are:
Elard Koch (lead author of the BMJ Open study)
John Thorp (final author, which usually means the principal investigator or main writer)
Monique Chireau (second author)
Byron Calhoun (sixth author)
Five of the six other authors have published previously with lead author Koch on abortion-related research. The remaining author, Joseph Stanford, signed the Dublin Declaration that denies the need for legal abortion even to save a woman’s life. In fact, all of the other co-authors signed this anti-choice declaration as well, with the sole exception of Fernando Pliego.
Lead author Koch and co-authors Chireau and Calhoun are members of the group We Care, a group of anti-abortion researchers and doctors that formed around 2011 to publish their own research in mainstream venues, in an apparent effort to put a gloss of scientific respectability on their anti-abortion stance. Indeed, the current BMJ Open study suffers from repeated citations of their own past writings on abortion (over a dozen different citations from Koch and various co-authors), as if their work is equally legitimate to mainstream research. The effect is to create a false picture of scientific confusion and conflicting data in the abortion field.
The methodology of previous Koch-led studies related to abortion (in Chile, Colombia, and Mexico) has been shown to be seriously flawed and biased, rendering their conclusions invalid. My blog has a compendium of rebuttals of Koch et al.’s previous work from both professional and lay sources.
For example, in 2012, Ipas-Mexico published an analysis of maternal and abortion-related mortality in Mexico from 1998 to 2008, showing that one in 13 maternal deaths were from abortion. Koch and some co-authors then published a rebuttal to this, and Ipas responded with a statement that referred to the Guttmacher Institute’s previous rebuttals to Koch et al.’s work. Guttmacher had explained and defended widely accepted scientific methodologies for estimating numbers of illegal abortions and resulting maternal mortality rates—which Koch et al. had grossly underestimated.
Fatal Flaw #1: Data Dredging to Find an Association
The BMJ Open study concludes that “maternal and abortion-related mortality ratios were lower in states with less permissive abortion legislation compared with states with more permissive legislation.” However, this is based on arbitrarily dividing Mexican states into two categories using a variable with little significance for maternal mortality: those that ban abortion for reasons of “serious genetic or congenital conditions” in the fetus, and those that don’t. It’s worth quoting the authors in full to expose the nature of their error:
In exploratory analyses, segregating states by the number of exemptions provided in criminal codes did not result in detectable differences in sensitivity analyses, with the exception of abortion allowed by genetic or congenital fetal malformations. The remaining seven exemptions were distributed differentially in almost every state or very few states, thus offering no discrimination potential. Therefore, to differentiate between states with more or less permissive abortion legislation in subsequent statistical analyses, states allowing pregnancy termination due to serious genetic or congenital conditions were considered more permissive (14 states) while the remaining states were considered less permissive (18 states).
In other words, the authors subjected each legal exemption to a “sensitivity analysis”—which checks all the data to look for patterns among variables—until they found a variable that happened to show a detectable difference in maternal mortality. They then presented this as the primary finding. This error is called “data dredging” because chance associations between just about any two things are easy to find if you crunch enough numbers. To make their random association sound more meaningful, the authors manipulated the definition of “states with less permissive legislation” into something it didn’t actually mean at all.
Twelve Mexican states actually have a more liberal exemption allowing abortion in cases of serious risk to the woman’s health, yet nine of those states ended up in the study’s category of “less permissive.” This demonstrates the arbitrariness of the chosen exemption factor of fetal anomaly, and indicates that the study could well have come to the opposite conclusion if the health exemption had been chosen as the dividing criterion instead. (All Mexican states allow abortion in cases of rape. Otherwise, abortion is mostly or completely illegal in all states except Yucatán, where it is allowed for economic or social reasons, and the Federal District of Mexico City, which allows abortion on request up to 12 weeks.)
The selected exemption for fetal anomaly cannot possibly by itself show any trends or differences in abortion mortality rates between states. That’s because abortions due to fetal abnormality are always a tiny minority of abortions in any country. In Britain for example, only 1 percent of abortions are carried out for reasons of fetal anomaly, and the numbers are similarly tiny for other countries. Further, almost all abortions for fetal abnormality occur later in pregnancy because the anomaly cannot usually be detected until then.
In settings like Mexico, the numbers of abortions for fetal anomaly will likely be far smaller than 1 percent regardless of legality, because of stigma and other obstacles. Indeed, here’s a study showing that most Mexican geneticists advise against abortion when the fetus has a genetic or chromosomal disorder. And there’s no reason to assume that the average Mexican woman would even know that abortion might be legally available for reasons of fetal abnormality, let alone that she would have the means, resources, or courage to pursue that option. In other words, abortions for reasons of fetal abnormality must be very rare throughout Mexico, and cannot possibly serve as a proxy for tracking trends in maternal mortality due to abortion.
This fatal flaw renders the study meaningless and the conclusion invalid, because it relies solely on a rarely occurring variable that would not have any noticeable statistical effect on maternal mortality.
Fatal Flaw #2: Mistaking Legal Abortion for Accessible Abortion
Similarly, the study assumes that because about half of Mexican states tightened their already strict laws against abortion after 2007—by passing a constitutional amendment protecting “the unborn” from conception—this would have a measurable effect on death from unsafe abortion. There is absolutely no basis for this assumption. Criminal laws restricting most abortions were already in effect everywhere outside Mexico City, so women would not be driven to unsafe abortion in any greater discernible numbers.
This helps expose the second major flaw in the study: the authors’ assumption that abortion law accurately predicts abortion practice. In reality, few Mexican women actually obtain abortions under the legal exemptions due to fear and stigma, lack of resources or knowledge, and refusals by anti-abortion doctors.
One study (in Spanish) by the Mexico City-based Group on Reproductive Choice (GIRE) showed that between 2007 and 2012, only 39 women in Mexico actually got a legal abortion under the country-wide rape exemption, out of a total of 120 who had applied for one. Why would so few apply? First, most states lack sufficient administrative mechanisms for seeking out a legal abortion under any of the exemptions, which means there’s simply no way to even apply for an abortion. Second, abortion is highly stigmatized in Mexico, and it takes courage to apply for one—or seek medical attention after an illegal abortion. At least 679 women in Mexico were reported or sentenced for having an illegal abortion between 2009 and 2011. Mexico is one of at least seven countries in the world that imprisons women for having illegal abortions. From 2007 to 2012, 127 women were put on trial for abortion in Mexico, and in one particularly conservative state, Guanajuato, dozens of women have been prosecuted for abortion since 2000, with some of them receiving sentences of up to 30 years in prison.
Oddly, Koch et al. never mention such shocking facts, nor do they mention the deeply rooted stigma and shame surrounding abortion in Mexico, the judgmental attitudes of many health-care workers, or indeed any of the social, economic, or logistical difficulties that may inhibit women from even attempting to exercise their legal right to abortion in Mexico. Instead, the study’s methodology and conclusion depend on the unspoken assumption that legal exemptions for abortion mean that all or most of those exempted abortions are actually taking place as needed. Nothing could be further from the truth.
Failing to Account for Underreporting and the Impact of Safer Medical Abortion
Koch et al. fail to acknowledge that “do-it-yourself” medical abortions have increased substantially over the last decade or more, with pills to end pregnancy now widely available in Mexico and most other Latin American countries. In fact, the words mifepristone and misoprostol never appear once in the BMJ Open study, which is a serious oversight. Clandestine use of the drug misoprostol is generally accepted as being much safer than traditional and more dangerous methods (for example, significantly reducing the rate of infection), even when women misuse it or misinterpret its effects because they don’t have instructions on how to use it or what to expect.
In one of Koch’s 2012 rebuttals to the Guttmacher Institute, he asserted that “no study currently exists to date that seriously supports a decline in maternal mortality associated with the use of abortifacient drugs such as misoprostol in Chile.” But he ignored several studies from countries such as Brazil and Mexico that showed significant declines in the severity and number of abortion-related complications and sometimes mortality over the same periods in which misoprostol use has grown.
In the BMJ Open study, Koch and his co-authors follow the same pattern as in a previous Koch-led study on Chile: They underestimate the number of abortions and associated maternal mortality by relying only on official statistical sources, while failing to consider that large numbers of illegal abortions are not accounted for in these sources, and that related complications and deaths may often be misclassified. In a criminalized and stigmatized environment, many women will not admit to having an abortion, and many health professionals will not officially report complications or deaths as caused by abortion, either through ignorance of the real cause, or out of compassion for women and their families.
Koch et al. claim there is no reason for health-care professionals in Mexico to “misreport deaths from a suspected illegal abortion” due to the existence of separate reporting codes for various types of abortions, including for an unknown cause. This overlooks the fact that issues with miscoding have become more common with misoprostol-related complications. For example, it can be challenging for doctors to distinguish medical abortion from miscarriage or other obstetrical complications. Further, Koch et al.’s analysis ignores the effects of fear and abortion stigma on how abortion occurs in illegal settings and whether complications or deaths resulting from them are reported as such.
Using Reduced Maternal Mortality to Mask Abortion Deaths
It’s already well established—practically self-evident—that maternal mortality can be significantly reduced by educating women, upgrading health systems, and improving access to contraception, skilled birth attendants, clean water, sanitation, and so on. Yet, this study and previous Koch-led studies seem to treat such factors like their own new discovery that obviates any need to reform abortion laws.
Unsafe abortion is just one of many factors that affect maternal mortality rates, though it’s among the top five causes. An estimated 13 percent of maternal mortality globally is due to unsafe abortion. It is simply not possible to try to take into account a lot of contributing factors to maternal mortality and conclude that restrictive abortion laws have little or no effect, because the other factors can easily swamp the effect of unsafe abortion on maternal mortality rates. Is it possible that the anti-abortion authors of the BMJ Open study are using such factors as a smokescreen to cover up the effect of unsafe abortion on maternal mortality?
Mexico still has a relatively high maternal mortality rate compared to other countries—about 45 per 100,000 live births, compared to 28 for the United States, 13 for Canada, and four for Sweden. In Latin America, where abortion is mostly illegal, it’s 22 for Chile and 69 for both Brazil and Argentina (2013 data). It’s likely that the declines Mexico has been seeing in maternal mortality would be even steeper if abortion was safe, legal, and accessible, and the same goes for Chile.
Estimating the incidence of illegal, unsafe abortion as well as the resulting deaths and complications is of course a challenging task. Such abortions are unreported and usually never come to the attention of authorities, so vital statistics can only provide a fragment of the evidence-based picture. A variety of methods must be used to carefully piece together a picture that is as reliable as possible. These include, for example, surveys of women, surveys of specific health-care facilities, and interviews with knowledgeable health-care workers.
Such methodologies are embodied in the Abortion Incidence Complications Method (AICM), which was developed about 20 years ago. The AICM has been widely used in studies appearing in peer-reviewed journals, and is recognized by experts around the globe, including the World Health Organization. Despite this, Koch has simply tossed out the AICM on the basis that it uses “imaginary numbers.” Not only is this dismissal disingenuous and unwarranted, it amounts to a gratuitous slur against the hundreds of reputable scientists and researchers who spend large amounts of time carefully gathering, comparing, and adjusting abortion-related data under challenging circumstances.
Real World Absent From Study
The BMJ Open study has an important focus on maternal mortality, but unfortunately that focus tends to disguise certain facts that never see the light of day in the study:
More than a million (1,026,000) abortions take place in Mexico each year, the large majority of them illegal.
About 159,000 women were treated at public hospitals for abortion complications in 2009.
An estimated 36 percent of all women who have illegal abortions develop complications that need medical treatment.
One-quarter of those do not seek treatment, putting them at risk of lasting negative health consequences.
The question that Koch et al. need to answer is this: Even if the study did demonstrate that restrictive abortion laws are associated with lower maternal mortality, does that make it acceptable to let a million desperate Mexican women, year after year, suffer the distress and trauma associated with risking their lives, health, and freedom to obtain an illegal abortion?
Koch et al.’s studies, including the current one in BMJ Open, are promoted widely on the Internet by anti-abortion groups and individuals. Because the studies appear professional and are published in reputable journals, there is a real danger that they can be used to influence policy decisions of governments. For example, they may play a role in decisions to decrease or cut funding for reproductive health programs in developing countries—such as what occurred in Canada in 2010—or to further restrict abortion, despite current laws that still kill 47,000 women a year and injure over eight million.
By rendering those women invisible, such studies become dangerous weapons that threaten to slow down the global decrease in maternal mortality and continue allowing women to suffer and die unnecessarily. The BMJ Open study is the latest contribution to this ideological battle disguised as science, one that poses a grave public health risk to women.
Author’s note: I would like to thank the Guttmacher Institute for its past work, cited in this article, exposing the serious methodological flaws in Elard Koch’s work and debunking his false claims.