In Which The Guttmacher Institute Continues to be Awful

One of the more exciting hobbies of The Guttmacher Institute — besides receiving annual donations from Planned Parenthood — is demanding greater legal access to abortion in countries where abortion is restricted. This demand blooms from studies of these countries — usually Guttmacher’s — which consistently find high numbers of illegal abortions and abortion-related maternal deaths.

Their message is simple: Legalize abortion, for there exists a massive need for it, and women are dying in their attempt to meet that need with unsafe, illegal abortion. And for the past thirty years or so, we’ve all nodded dutifully, thanked Guttmacher for their hip-as-all-get-out videos explaining this, worked up compassionate faces, and legalized abortion.

Here’s the issue: The methods with which The Guttmacher Institute and researchers of the same vein use to procure these drastic numbers are decisively moronic.

A study published today by Koch et al. in the International Journal of Women’s Health entitled “Fundamental discrepancies in abortion estimates and abortion-related mortality: A reevaluation of recent studies in Mexico with special reference to the International Classification of Diseases” — which I will be quoting from — politely points this out.

The Guttmacher Institute determines the number of induced abortions in a given country through the use of surveys.

First, they pass out what’s called a Health Facilities Survey to subjects who work in — you guessed it — healthcare facilities, asking them “to remember the total number of women who received post-abortion care ‘in the average month and in the past month.’” Once this recalled number is obtained, they move on to stage two — the Health Professionals Survey.

Guttmacher surveys healthcare professionals “selected on the basis of their professional affiliation, training, experience and specialization on the subject.” (1) Who these people are remains unavailable, as do their qualifications (what counts as specialization?), as do the questions asked in the survey (and whether those questions contain any relative bias), thus rendering the survey unrepeatable — an issue for any scientist. But the Guttmacher Institute is resolute, well-funded, and undeterred by such trifles. The Health Professionals Survey is used to estimate “an expansive multiplier of abortion rates (x3, x4, x5, etc)”, which is then applied to the numbers obtained by the Health Facilities Survey. Voila, the number of abortions.

Even a layman like myself can see why this is iffy at best. As Koch et al. state, such “estimation methods are subjective in nature and extremely subject to selection and recall bias”, that is, to the intentional or unintentional manipulation of answers by those biased on the issue of legalized abortion. Furthermore, there is no information on how the subjects of the Health Professionals Survey were selected, and if the sample size is enough to represent the total population of medical professionals in Mexico.

Don’t take my word for it though. The numbers show how drastically this survey-method of “counting” abortions overestimates reality.

Guttmacher — using their surveys — estimated that for the year 2006 in the Federal District of Mexico (Mexico DF) there were between 137,145 and 194,875 induced abortions. Normally their word would have been taken as gospel truth, but because Mexico DF offers abortion on request to any woman up to 12 weeks into a pregnancy — one of the few Mexican states in which abortion is legal – there exists another way of counting abortions in the same area — actually counting abortions via the required reporting of abortion rates by hospitals.

The number of recorded abortions in 2007 — the year abortion was legalized in the Mexico DF — was 10,137. This number, for those interested, is less than 137,145 and 194, 875. We are left with two options.

Option 1: Either immediately upon abortion being legalized in the Federal District of Mexico, from 2006 to 2007, the abortion rate experienced an epic, up to 2000% decrease. This would be bizarre, given that, as Stanley Henshaw of the Guttmacher Institute itself has explained, “In most countries, it is common after abortion is legalized for abortion rates to rise sharply for several years” (2) and that it defies common sense.

It wouldn’t be a bad argument to make that, since legal abortion was new in the year 2007, there were still illegal abortions taking place, abortions that would have been included in the Guttmacher surveys but missed by the actual counting of legal abortions. However, as the study points out:

 …the figure of legally induced abortions carried out in the five cumulative years from April 2007 until April 2012 (ie, a period of time probably long enough to replace illegal abortion with legal procedures in Mexico DF) was 78,544; which is nearly 50% of the original estimate by the [Guttmacher Institute] for only a single year [2006].

We move, therefore, to Option Two: The survey method of obtaining abortion rates is inaccurate, verging on ridiculous. Yet still it continues:

[The Guttmacher Institute] have recently conducted another study insisting on the use of the same methodology and showing figures of induced abortion overestimated by approximately 1000% for 2009 (ie, estimating 122,455 induced abortions instead of the actual figure of 12,221 for Mexico DF in 2009) despite the existence of epidemiological surveillance on this matter by an independent non-governmental agency.

Which, by and large, was dumb. Now that legal abortion is available in Federal District of Mexico, and has been legal long enough so as to make illegal abortions a negligible percentage of total abortions, the Guttmacher Institute still demands we believe that abortion rates are 1000% higher than reported. There have been problems with underreporting regarding the recording of legal abortion rates, but there is no serious consideration that underreporting could be this low. As Koch et al point out:

We acknowledge that underreporting of legal abortions may limit the reliability of estimations based on actual records in Mexico DF. Nevertheless, Mexican health authorities have been actively working towards decreasing the underreporting of maternal mortality statistics which, at least in terms of MMR, have decreased to a negligible percentage since 2003. Even if such efforts have yet to be translated into a decrease in the potential underreporting of legal abortion records in Mexico DF, especially within the private sector, the figures proposed by [the Guttmacher Institute researchers] would still be overestimated. For instance, speculatively assuming an underreporting of 1- to 3-fold, the figure proposed by these authors would be overestimated by 2.5 to 5 times.

Now there is a similar issue with the method by which researchers currently determine induced-abortion-related mortality, that is, the number of women who die from abortions.

Abortion-related mortality is determined by dividing the number of abortion-related deaths by the number of live births.

The International Classification of Diseases considers abortion-related mortality to include deaths by “all pregnancies with abortive outcome”. While this may sound straightforward enough, the reality is complicated, for death by all “pregnancies with abortive outcome” does not necessarily indicate death by botched illegal abortions, but refers to “causes of death ranging from abnormal products of conception to unspecified, and other abortions.” This, as Koch et al show, includes such complications as miscarriage, “hydatidiform mole [and] ectopic pregnancy”.

Again, the study does the universe a favor by pointing out the obvious:

[These] should not be included in the assessment of abortion mortality, particularly when the focus of the study is to address the influence of illegal abortion on maternal health. For example, if one wanted to measure the deleterious effects of alcoholism on the liver, one would want an indicator specific to alcoholism. If that indicator instead included liver damage caused by fulminant hepatitis, Wilson’s disease, and drug-related liver damage, then the specific damage attributable to alcohol would be obscured. Similarly, if one wants to determine mortality from induced abortion, then deaths from other causes (such as hydatidiform mole or ectopic pregnancy) should be excluded.

But studies such as Schiavon et al, “Analysis of maternal and abortion related mortality in Mexico over the last two decades” do include these “abortion-related deaths”. Thus their frightening conclusion, that “[u]nsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico” is rendered a skeptical one.

When Koch et al. removed the “abortion-related deaths” that were not specific to induced abortion — which, after all, is what was being studied — and looked at the numbers again, they found the following:

When taking this into consideration, even though the AMR shown by Schiavon et al displays discrete changes between 1990 and 2008, unspecified abortion (O06) combined with other abortion (O05) between 2002 and 2008 shows a downward trend, with a 22.9% overall decrease from 1.44 to 1.10 deaths per 100,000 live births. This observation further supports the notion that the apparent lack of progress in abortion-related maternal mortality in Mexico is likely to be related to causes other than unspecified abortion (O06) and other abortion (O05), and therefore seems to be unrelated to illegal induced abortion. (Emphasis my own.)

The study goes on to suggest that the apparent lack of progress in abortion-related maternal mortality seems more strongly correlated with an increase in violence against pregnant women in Mexico.

Obviously, there is much more to the study, including recommended alternatives to Guttmacher’s surveys and the the general use of ICD codes to determine abortion-related mortality. But these two points represent a paradigm shift in the way we view the legalization of abortion. If the primary method of establishing abortion rates in countries that restrict abortion is flawed, producing impossibly exaggerated numbers, the oft-repeated argument that legalizing abortion is a dire necessity is rendered null. If the primary method by which researchers determine the number of women dying from illegal abortions is flawed, including deaths that are not the result of induced abortion, then the oft-repeated emotional argument that women are dying from the lack of legalized abortion is similarly called into question. In fact, the argument sidetracks the conversation, and detracts resources away from the issues that truly do effect maternal mortality, such as the “adequate medical treatment of conditions such as hemorrhage, gestational hypertension, eclampsia, and indirect causes of maternal death, mainly characterized by pre-existing chronic diseases.”

The importance of this study cannot be understated. The lessons of Mexico should, at the very least, curb our enthusiasm for the widespread legalization of abortion.

1. Singh & Bankole, Ginecol Obstet Mex 2012;80(8):554–561. Article in Spanish

2. Stanley Henshaw, Guttmacher Institute (16 June 1994)

  • Vision_From_Afar

    So, because Chicken Little (Guttmacher) yelled that the sky was falling a lot and demanded legal hard hats (abortion) for everyone who wanted one and got what they wanted, resulting in (according to the Koch study) a 23% decrease in falling-object (abortion)-related deaths, we should completely ignore the benefits of said legal hard-hats?
    I guess those in the 23% who would’ve likely died can take comfort in the fact that at least you would feel better about yourself because you pointed out an exaggeration of a real issue that was addressed.
    :facepalm:
    Yes their numbers were off, and now we can address that in future studies. That doesn’t wipe away the actual benefit that resulted. Like any illegal activity, it’s something that’s not easy to estimate, especially in a highly-religious, violence-laden country like Mexico has become in the last few years.

    • ladycygnus

      Yet there is a problem that they never address. Women still die from legal abortions (Guttmacher just ignores those – as well as any other unfortunate side effects like sterility). When abortion is legalized more women will get abortions. Thus you are likely substituting one death for another. Since Guttmacher is funded by the one who makes money off of abortions, they won’t ever really study this effect.

      So, using your analogy, it’s a hard hat that has the potential to kill you or maim you for life…but hey, it saved some of the people who would have stood under a landslide.

    • http://www.brandonvogt.com/ Brandon Vogt

      The problem with your analogy is that it assumes 1) the sky is falling everywhere (i.e. abortion is unavoidable) and therefore 2) women are forced to stand under the debris (hence the need for a hardhat.)

      But there’s a foolproof way to avoid such falling debris (i.e. abortion-related deaths): don’t stand underneath the downpour (i.e avoid abortion.)

      You don’t need hardhats (i.e. legal abortions) if there the sky is not falling (i.e. if there are no abortions.)

      • Vision_From_Afar

        The problem with your argument is that is assumes 1) The sky is falling nowhere (i.e. – making abortion illegal will mean it won’t happen) and therefore 2) women who would be hit anyway shouldn’t have a hardhat and deserve what happens.

        There is indeed a way to avoid such debris. It’s called condoms, the pill, IUDs, etc.

        • Lady Raven

          Condoms, pills and IUDs. fail. Even Guttmacher admits that most women get abortions because those contraceptive devices failed (in which case, the sexual act worked and the procreation process has started. This results in a new life). There is a way to not get pregnant that is completely fool-proof: Don’t have sex. Not having sex won’t kill you. And if you look at the rates of how many people have STDs and how many women die from abortions, it seems like having sex actually might kill you.

          • Good Catholic GIrl

            Well, there you go! No one should ever make love and then the human race can die off . . . .

          • Lady Raven

            Or people could just use common sense and keep sex where it’s meant to be, inside the sacrament of marriage.

          • L.

            Some of us married people still don’t want babies, and are happy that abortion is there for us, in a worst-case scenario if our contraception fails.

          • Phil

            Try some self control. That always works.

          • L.

            It doesn’t always work, alas, which is why I use contraception, too. Not all of us who are closed to life will choose to permanently abstain from sexual relations.

          • Phil

            No one said you had to, but if it’s not working, you don’t have enough self control. There’s no reason self control, properly applied, should not work every time.

          • L.

            Au contraire — there are many reasons why your definition of “properly applied” should NOT work every time, when a woman’s fertility is unpredictable. So thank God for the blessing of IUDs!

    • http://www.facebook.com/brotherbuster Buster Adams

      It’s more like Chicken Little demanded that doctors be able to kill babies with shot guns in the name of freedom.

      They used false statistics to convince people of a grave evil.

    • Melissa McCracken

      There is an easy way to test your hypothesis, VFA. Abortion is still illegal in most of Mexico. Has he maternal mortality from abortion decreased in other parts of Mexico where abortion remains illegal? If maternal mortality has decreased elsewhere as well, you can hardly attribute the decrease to legalization.

      It is simply not true that legalizing abortion reduces the maternal death rate from abortion. Correlation does not imply causation. Here in the States the maternal mortality rate from abortion was falling, precipitously, for DECADES before abortion was legalized. It continued to fall after. Abortion advocates disingenuously claimed that the decline in abortion related deaths was due to legalization, and the media repeated their claim, and then the urban myth of the dangerous back-alley abortion contrasted with the super-squeaky-clean legal abortion was born.

      http://realchoice.blogspot.ca/2012/12/1988-safe-legal-and-fatal-for-florida.html?

    • MaryB435

      Legal or illegal, there’s simply no safe way to kill a baby.

  • Tim

    Is the title of the post missing a word?

    • ColdStanding

      Which post are you referring to? Oh! You meant to say “Is the HEADLINE of THIS post missing a word?”

      • Tim

        Okay… You really got me… What am I missing?

        • ColdStanding

          I’ll see your disambiguity and raise you an intentional misreading.

        • Vision_From_Afar

          Just ignore him, he splits hairs more fanatically than an OCD barber.

  • http://twitter.com/xpolilla Por Polilla

    The meme killed me…

  • Fizz

    Marc, 2000% decrease results in the event happening “negative 19 times of the original event” or in other words, there’d be -2,850,000 abortions.

    • Geoff_Fides

      The percent decrease thing always messes with me. What would the appropriate percentage decrease be? 99.9% ish?

      • Rick

        Actually the decrease% = 1 – 100/Increase%. So if the increase was ‘almost 2000%’ the decrease is 1 – 100/2000 = 95% decrease.

    • sara

      It’s a retrospective analysis of the information published by Guttmacher. In 2007, abortion was legalized in the Mexico DF. Prior to 2007 (in 2006), abortion was not legal in the Mexico DF.

      Guttmacher ‘found’ there were between 137,145 and 194,875 induced (and illegal) abortions in 2006. Guttmacher then estimated a much lower number of recorded (albeit newly legal) abortions in 2007: 10,137.

      This is counter-intuitive in that one would think there would be more abortions once the practice is legalized. Instead, according to Guttmacher, there was over the course of one year between 2006 and 2007 an approximate 1920% decrease in (a LOT fewer) induced abortions over time in the Mexico DF. (Marc said up to 2000%, and it’s closer to 1920%. 10,137 * 19.2 = 194,630.4, pretty close to the high end of Guttmacher’s report for 2007.)

      Guttmacher’s reports tell us that induced abortions happened about 1920% less in 2007 than they did in 2006. This is A) extremely unexpected considering the nature of people acting against or with laws and B) not conducive of a strong argument for Guttmacher to show that people in the Mexico DF want or need induced abortions. If people had fewer abortions once the practice was legalized, then what does it benefit Guttmacher or PP if abortion is legalized? According to Guttmacher’s work, fewer people will have the procedure…

      The initial conclusion we can make is that Guttmacher’s findings are bunk.

  • sara

    Are Guttmacher’s studies peer-reviewed?? How in the name of science was this ‘research’ published? As a former student of proper statistics and research, this was painful to read about– type I and type II errors everywhere!

    This leads me to conclude that Guttmacher’s ‘research’ is nothing more than white noise. It’s a pity that the people of Guttmacher wasted time compiling more hot air to throw into the void. I think PP’s funding of such a silly Institute further condemns PP abortion clinics to the category of ridiculous business practices, with no business in health care or the development of said ‘care’.

    • Geoff_Fides

      GI states that their research is peer-reviewed. However, the peer review often comes from in-house researchers or “sister” organizations which leads to the presumption of bias.

      However, presumption of bias is not enough to discount their studies. I believe that having someone properly trained in statistical methods give a breakdown of their research would be nice. This is exactly what Koch et al. attempts to do.

      Sadly, any research that questions the golden calf of abortion or the Guttmacher Institute is roundly rejected by all the “major” journals today (Lancet, Nature, etc.). This has forced Koch to publish in less respected publications like Dove and PLoS-one.

      Perhaps Marc would allow you to do a brief guest post re: stat’s in GI studies vs. Koch’s analyses?

    • bobthechef

      Peer-review. As a scientist, I find the term amusing. For those not blessed with common sense, I would expect any remaining meaning in the term to be drained halfway through grad school. Unfortunately, some don’t catch on to the joke.

  • Geoff_Fides

    Man, I really hope I dont get drawn into this again. Koch’s statistics are more sound than GI’s but because GI is louder Koch gets drowned out.

    Please note that Koch never argues for or against abortion, he consistently states that the decrease in MMR is not attributable to legalized abortion.

  • Jacqueline C. Harvey, Ph.D.

    Scholars launched ReproductiveResearchAudit.com yesterday for this very reason. Guttmacher is junk science to propel a pro-abortion agenda, but is cited as legitimate. RRAudit exists to expose the bias and present facts.

  • http://www.facebook.com/people/Tony-Esolen/1184164082 Tony Esolen

    Guttmacher has been lying since speech was invented. They lied with gleeful abandon in the US in the 1960′s: see Rachel Weeping, which logs the lies.

  • Good Catholic GIrl

    No question about it – abortion is evil and simply another form of premeditated murder.
    The alternative is better birth control education. To argue that birth control is wrong is ridiculous, especially in underdeveloped countries. People should be educated regarding the alternatives; teaching people how they can protect themselves would be humane. Not everyone is Catholic so we can’t impose our religious beliefs on them just as we don’t want secular or other religious beliefs imposed on us.

    • Vision_From_Afar

      Are you real? A Catholic who gets it?
      I call shenanigans. :)

      • GoodCatholicGirl

        Just pinched myself . . . yes, I’m real . . . and a realist.

        • L.

          There are also plenty of people who are avidly pro-abortion rights (like myself) who truly believe unwanted pregnancies are best avoided in the first place, either through abstinence/NFP for those who choose it, and correct/conscientious use of contraception for those who don’t.

          • Good Catholic GIrl

            No, abortion is not an acceptable means of birth control. Unless the circumstances are especially dire (and those circumstances are rare), it’s just not right. It’s punishing an innocent person for something they didn’t do by killing them. While I understand that carrying an unwanted pregnancy to full term would be difficult physically and emotionally, the humane and Christian thing to do would be to give up the baby for adoption. There is always the chance, albeit a slim chance that as the pregnancy progresses, the parents may change their minds and decide to keep the child. Either way, the child lives.

          • L.

            …did you not understand what I said about unwanted pregnancies “best avoided in the first place?” I thought I was clear.

  • http://www.facebook.com/profile.php?id=614084273 Rebecca Binns

    -Of course they have to survey. With abortion only legal in the tiny-ass distrito federal, simply taking data from that area will be incomplete. Since, you know, we want data on THE ENTIRETY OF MEXICO.

    -Not all abortions take place in hospitals–especially not when it’s illegal.

    -There is a science to survey-making that accurately predicted the presidential election outcome with a 90-something percentile. Thank you, Nate Silver.

    “Destupidification” my ass. Inane argument is inane. I mean Jesus, the fucking mental loops you have to do to find any logic in this article astound me.

    • Liz S

      Did you not read the entire post? They are comparing Guttmacher’s estimates of abortion rates in Mexico D.F. with the reported rate of abortion in Mexico D.F. after legalization. Mexico D.F. is also known as Mexico City and is the capital of Mexico. That “tiny-ass distrito federal” has an estimated metropolitan population of 21.2 million people and is the largest metropolitan district in the western hemisphere.

      The point is that Guttmacher came up with an estimate at least 13 times higher than the number of women seeking abortions in hospitals where they were reported. Do you really think over 120,000 women would choose to have illegal or “back alley” abortions over a legalized, hospitalized one? Yes, there is a science to survey making, but just because some people are good at that task it does not follow that the Guttmacher Institute must be good at making and interpreting surveys. Nate Silver is a complete non sequitur. I believe you are the one lacking any logic.

    • http://twitter.com/xpolilla Por Polilla

      “we want data on THE ENTIRETY OF MEXICO”… Are you saying that abortion needs to be decriminalized only for “you” (I don’t know what you mean by “we”) to able to count it????

  • Micaela

    How can people continue to defend GI in the face of their blatant bias and poor research ethics? It’s almost as if they don’t care if the “data” GI produces is true, as long as said “data” supports their opinions.

    Oh. Wait…

  • MaryB435

    Summary: People who kill babies are also liars.

    • http://twitter.com/xpolilla Por Polilla

      That’s an awesome summary! can I use it?

      • MaryB435

        Any time.

  • http://twitter.com/xpolilla Por Polilla

    Did you see the comment on your blog by Frank Weathers??? excellent!!! http://www.patheos.com/blogs/yimcatholic/2012/12/the-guttmacher-institute-gets-gutshot-by-the-kid.html

  • JoyceArthur

    The research of Koch et al has been comprehensively refuted, both by
    Guttmacher and myself. He has no excuse to keep recycling the same crap.
    Koch does not conduct scientific “studies” – he has a major anti-choice
    axe to grind, and has a vendetta against Guttmacher. His work is shoddy
    and dishonest, especially since he KNOWS he has been refuted, but keeps
    repeating the same things.

    “Disgraceful Example of B.A.D. Science (biased, agenda-driven): Anti-Choice “Research” on Maternal Mortality in Chile” http://choice-joyce.blogspot.ca/2012/08/a-disgraceful-example-of-bad-science.html

    “Anti-choice researchers in Chile try to hide illegal abortion — and women who die from it” http://rabble.ca/columnists/2012/06/anti-choice-researchers-chile-try-hide-illegal-abortion-and-women-who-die-it

    “Refutations of Dr. Elard Koch’s errors and distortions in his rebuttal to the Guttmacher Institute” http://mypage.direct.ca/w/writer/Koch-rebuttal.html

    • http://twitter.com/xpolilla Por Polilla

      Dr. Koch has hardly been refuted. In fact, as covered by a series of very good press pieces, “Author of study showing abortion limits do not increase Maternal Mortality demolishes pro-abortion critique” and “Guttmacher fails to debunk Chilean Maternal-Mortality study”. I would appreciate if you could give one argument, not phylosophically flawed or not attacking the personal views of the scientists involved, that can debunk statistical methods used by Koch et al. in their articles in PLoS ONE and International Journal of Women’s Health. Note that no scientist has been able to do that so far.

      If you want to accuse the National Registry of Vital Statistics of Chile (or of Mexico for that matter) in saying that they “hide” deaths by abortion, you better have VERY good proof. It’s not a light accusation the one you are making, especially when WHO declares Chile and Mexico as among the countries with the BEST registries in the WORLD.

      If you want to accuse of recycling information, you are basically saying that the independent peer review that took place for publication of such articles was completely useless. I really don’t think that the Editorial Committees of these journal would appreciate that kind of judgement, especially without proof.

      Please! We cannot let personal agendas to taint the discussion. Science is science. And reality is reality. By the way, the latest article by Koch et al. has been covered by several secular media outlets, which do not follow any particular agenda. How do you explain that? Are we all crazy?

      • JoyceArthur

        Thanks Por, I don’t have much time to respond to Koch’s latest study now, but I will in more detail hopefully within a week or 2 on my blog (http://choice-joyce.blogspot.ca/). For now, I just want to say that when media reports on studies, the reporters rarely do any critical thinking, they just report the findings. So it’s meaningless that there are media stories out there about it. The vast majority of stories are from the anti-choice and religious press anyway. There is not much cross over, and Guttmacher has as much credibility as ever. Further, what may seem like my “personal agenda” is actually the conclusion of my research on Koch and his research methods – which are very shoddy, so I had to conclude that the reason is because he’s anti-choice and letting his biases get the best of him. (One of his papers actually conflated Mexico City’s abortion rates with all of Mexico! There is no excuse for that, except dishonesty.)

        I have to challenge your incredible line: “Dr. Koch has hardly been refuted.” Why don’t you actually read the refutations first, before you say that?! Because you obviously haven’t. I link to five rebuttals from here: http://choice-joyce.blogspot.ca/2012/08/a-disgraceful-example-of-bad-science.html, including 2 from Guttmacher and 2 from me. Which both include arguments debunking the statistical methods used by Koch et al. Also, it’s not a matter of “hiding” abortion deaths, it’s just that they are not reported when abortion is illegal or not widely unavailable (even in Mexico City). Koch is wrong to assume that official stats tell the whole story, and he’s wrong to assume that other research methods are not valid. Those are my main points.

        Koch et al PAY to publish their “studies” at PLOS One and Dove Press. The peer review process at these websites is very quick and it’s extremely unlikely that it is rigorous. These are not reputable scientific journals, but are shortcuts for those in a hurry, or for studies with biased agendas or undisclosed methodological flaws.

        • http://twitter.com/xpolilla Por Polilla

          Ms. Arthur, if you are proposing that AGI can be unbiased in an attempt to debunk a critique directed to them, you are saying that there is no bias in a “you said, I said” battle. It simply doesn’t make any sense. Perhaps, you need to see an opinion from a third uninvolved party. I recommend you the newly formed Reproductive Research Audit (see link above). They have a very extensive and thorough opinion about Koch’s research. I might add that so far, and as I understand the whole story, Koch never critized the institutions but the methodologies.
          Regarding the credibility of AGI, please look at comments on blogs all around the world. I have read your blog and you are entitled to your opinion (as am I) but you appear to be alone in that opinion. Maybe I am missinformed, but could you be so kind to direct me to any blog (besides yours) that defend the methodology employed?
          Finally, any scientist can tell you that ANY research published as OPEN ACCESS needs to be payed for. This is in ANY journal. Paying for an open access document should not be cause for declaring the research as biased or flawed. After all, you can find very “shoddy” research in the Lancet as well.

          • JoyceArthur

            Reproductive Research Audit is an anti-choice site with an obvious
            agenda and built-in bias against well-established scientific conclusions on abortion, contraception, sexual health etc. As I said, the vast majority of reviews/reporting out there about Koch is from the anti-choice/religious side, which basically kills its credibility.

            However, I should clarify that the issue is not necessarily whether one has an agenda or bias, but whether one lets that interfere with their research work. Almost everyone is either anti-choice or pro-choice, after all, with few people on the fence. However, as a general rule, pro-choice researchers are far more objective than anti-choice researchers, most of whom are well-known for shoddy and flawed research – B.A.D. science, or junk science – and who continue to promote discredited views even after being rebutted. Koch has become a big player in this mythinformation industry.

            Here’s a comprehensive piece from 2006 explaining the origin of the B.A.D. science mythinformation industry and how it works: http://www.publiceye.org/magazine/v20n2/chamberlain_politicized_science.html

            This newer blog has a comprehensive list of the current anti-choice purveyors of B.A.D. science: http://scathinglywrongrightwingnutz.blogspot.ca/2012/06/psa-bad-biased-agenda-driven-science.html

            As one example that’s been studied, here’s a 2002 study showing that anti-choice websites on mifepristone are significantly less complete and accurate than pro-choice sites: http://www.ncbi.nlm.nih.gov/pubmed/12013165

            You mention that you’ve read my blog and that I’m entitled to my opinion. But it was very clear that my concluding opinion was based on the facts and evidence I laid out proving that Koch is guilty of selective use of data, shocking omissions, and glaring errors. What about all that? What about my proof that Koch ignored valid statistical sources that didn’t fit his conclusion about Chile? What about my proof that Koch refuted his own conclusion that the 1989 abortion ban in Chile meant a “major transition from a partially restrictive to a fully restrictive abortion law”, because legal abortion was already very rare many years before 1989? What about Koch’s proven error of conflating abortion rates for all of Mexico with Mexico City? How do you explain such shocking omissions and fundamental errors by a so-called scientific expert other than by dishonesty? Please explain.

            Although it’s disheartening that other credible researchers besides Guttmacher have not come on board to help refute Koch so far, I think the problem is that mainstream society and most scientists and researchers simply don’t take Koch’s kind of ideological research seriously, so they ignore it. As long as his work stays confined within anti-choice circles, that will continue. However, if Koch starts to make inroads into real science and gets published in reputable journals, for example, then that will change, as it did for Joel Brind, David Reardon, and Priscilla Coleman, who have all been widely discredited by the scientific community at large.

          • http://twitter.com/xpolilla Por Polilla

            This goes back to my earlier thought on “you said, I said”. I think it is very difficult to get unbiased opinions when you ask the parties involved, because they are just defending their point of views, which is natural to the human condition. You say “it’s disheartening that other credible researchers besides Guttmacher have not come on board”. In my book, there are only two reasons to explain this: they don’t agree with the methodology or they do agree with it, but they are not willing to come forward… sad, really.

            I am really trying to understand your point of view, regardless of
            agreeing or not with it. What is so B.A.D. about comparing an estimated figure of abortion for Mexico DF of 122,455 in 2009 when the actual figure for that year was 12,221? Looks pretty overestimated for me… or are you saying the abortion surveillance by the GIRE is so B.A.D. that they missed (underreported) 110,234 abortions that year? let me remind you that GIRE works closely with IPAS in Mexico, and IPAS works closely with the Guttmacher Institute… are you saying that they contradict each other?

          • JoyceArthur

            Btw, re your comment: “could you be so kind to direct me to any blog (besides yours) that defend the methodology employed?” I find this very puzzling. Because once you take away anti-choice sources, you will find nothing but overwhelming support and respect for Guttmacher’s research work and their methodologies, which have been verified and used by many other researchers and organizations throughout the world for decades.

            As Guttmacher itself explains in its rebuttal to Koch (https://www.guttmacher.org/media/resources/response-to-methodology-critique.pdf), which you apparently have not read, its methodology for calculating abortion rates “was developed about 20 years ago and has been widely used in studies that have appeared in reputable peer-reviewed journals. It is recognized by experts in both the academic community and international organizations, such as the World Health Organization (WHO).”

            So, far from being “alone” in my opinion, there’s a huge body of scientific research from others out there, supporting Guttmacher’s findings and methodologies.

          • http://twitter.com/xpolilla Por Polilla

            I apologize if I didn’t explain myself (I am not a native English speaker). Let me rephrase my question: could you be so kind to direct me to a blog -not the Guttmacher Institute website but a blog- different from yours that can provide scientific support to the methodology used by Guttmacher Institute to estimate induced abortion figures -and when I say “provide scientific support”, I mean valid epidemiological support. That’s it… just a link so I can further educate myself.
            When you say “body of scientific evidence”, are you talking about Guttmacher Institute “in house” reports or journals? or are you referring to other articles, written by Guttmacher Institute researchers, which cite Guttmacher Institute “in house” reports or journals as the original source for the methodology?

          • JoyceArthur

            I don’t understand why this is so difficult for you. Or why you want a “blog,” as blogs are not usually scientific. Why would you think a blog supporting Guttmacher’s methodology is better than actual scientific papers or research that actually use or validate the methodology independently? Anyway, I’ve put below a quick list of references I found that do so (which are easy enough to find). You also keep talking about bias and how Guttmacher is just supporting their “point of view” when in fact their rebuttals are full of detailed scientific explanations and data that deserve consideration.

            For example, you ask what’s wrong with questioning the figures out of Mexico, which reveals your complete ignorance of Guttmacher’s previous rebuttal to the Mexico City figures (I’ve copied and pasted below a summary from their new rebuttal published yesterday.) I also had rebutted Koch’s Mexico City obfuscations, which you seem ignorant of, even though you claim to have read it. I’m very curious to know the following: How do you read something without actually having any of it register? Why would you do so? And since you’re taking it upon yourself to defend Koch and attack Guttmacher, how can you possibly do so without reading Guttmacher’s rebuttals? To be frank, I think it’s unfair and dishonest of you to not read them first, and with at least some degree of objectivity.

            You cannot simply assume that Koch is right and therefore dismiss anything Guttmacher says from henceforth, without even reading it or just pretending to read it. Guttmacher has a right to respond and a right to be taken seriously – which is what they have done with Koch himself by rebutting him point by point – and it is now Koch’s responsibility (as well as other critics like you) to review the rebuttals and respond appropriately. Koch has not done so, except for one inadequate response that I rebutted (http://mypage.direct.ca/w/writer/Koch-rebuttal.html). Guttmacher also addressed the key issues with their major rebuttal in July, which debunked Koch’s own methodology too: “In sum, Koch et al. fail in both their attempt to discredit the AICM and their attempt to present a credible alternative for estimating abortion incidence in countries where the procedure is highly restricted.Its underlying assumptions have no scientific basis and show no respect for contexts, a significant problem. Their erroneous procedures and assumptions have led Koch et al. to inaccurate results and to an unfounded attack on the Guttmacher Institute’s AICM [methodology]” (http://www.guttmacher.org/media/resources/response-to-methodology-critique.pdf).

            Koch’s new paper simply repeats his debunked errors and debunked methodology. But ignoring objections to one’s hypothesis and methodology and continuing to promote them as if they haven’t been questioned is very sloppy and shows a lack of scientific integrity.

            Here’s some examples of independent researchers who have used or support the same methodology as Guttmacher (I have even omitted the many reports where independent researchers have collaborated with Guttmacher):

            World Health Organization (WHO), Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2003, fifth ed., Geneva: WHO, 2007.

            WHO, Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: WHO, 2011.

            Mario S and Pantelides EA, Estimación de la magnitud del aborto inducido en la Argentina, 2005, Notas de Población, No. 87, 2009.

            Gómez-Ramírez C, Estimación del aborto inducido en Costa Rica, 2007, Informe de Resultados, San José, Costa Rica: Asociación Demográfica Costarricense, 2008.

            Ferrando D, El Aborto Inducido en el Perú: Hechos y Cifras, Lima, Peru: Flora Tristan and Pathfinder International, 2002.

            I want to bring your attention to another Guttmacher publication: http://www.guttmacher.org/pubs/compilations/IUSSP/IUSSP-Chapter6.pdf – which is a detailed explanation and validation of their AICM methodology. The only time Koch cites this (http://www.plosone.org/annotation/listThread.action?root=50%2C183), he dismisses it out of hand on the basis that it’s supposedly not independently peer-reviewed. But that’s like an ad hominen attack, because that factor by itself has nothing to do with the actual validity of the methodology, which will stand on its own if it’s reliable. Koch has a habit of trying to discredit any Guttmacher-involved research by throwing around the term “publication bias”, but with zero evidence that’s the case – it’s just a smear, and an excuse not to deal with the issue seriously. Well, it doesn’t work that way. If Koch is going to overturn decades of painstaking, validated research on how to estimate unsafe/illegal abortions, he’s got a massively huge hole to dig himself out of first.

            From Guttmacher’s new rebuttal to Koch (Dec 14) http://www.guttmacher.org/media/inthenews/2012/12/14/eng.html:

            “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.”

            From my own rebuttal (which I researched and posted BEFORE Guttmacher issued theirs): “Koch grossly underestimates the number of abortions in Mexico by playing fast and loose with the facts. He wrongly compares Guttmacher’s previous estimated illegal rates for all of Mexico (between 700,000 and 1 million), to today’s officially reported legal rate for only Mexico City (just over 20,000 in 2011). Mexico City is the only area in the entire country where abortion on request is legal. Less than 20% of Mexicans live in the capital, and most women from other states would be too poor to be able to travel to the capital, which means they are still having unreported illegal abortions in their own communities. But even in Mexico City, legal access is still limited, leading many women there to continue resorting to illegal abortion. Further, only public sector abortions are counted in official numbers, not legal abortions done in the growing private sector.” (http://mypage.direct.ca/w/writer/Koch-rebuttal.html)

            Allow me to close with my conclusion from that same rebuttal to Koch’s Chilean research, because this point is too often missed, including by Guttmacher: “One of the most offensive things about Koch’s insistence that illegal abortion does not negatively impact women’s health is that it throws under the bus the most vulnerable groups of women who have little power or voice in society, and who resort to illegal abortion the most. But the most offensive thing of all is that, because maternal deaths from illegal abortion do appear to be quite low in Chile (compared to other developing countries), Koch seems to think it’s acceptable that those few should be sacrificed unnecessarily under Chile’s harsh criminal laws, and that the rest – anywhere from 40,000 to 160,000 a year – should continue jeopardizing their health and lives, not to mention arrest and imprisonment, and all the upheaval and psychological trauma that these things entail, just because they needed an abortion – an action taken by half of all women around the world to protect their lives, families, and futures.”

          • http://twitter.com/xpolilla Por Polilla

            After carefully reading your answer and trying as hard as I can not to be “ignorant” as you put it in your latest reply, I have learnt three things out of this argument:

            1. For some reason, you think I am defending or attacking people… I am not a lawyer or an advocate, so nope, I am not trying to defend or attack anyone here. For some reason, you think I am defending ideas. I am not a lobbyist of any kind, so nope, I am just dicussing ideas. I am just looking at the evidence, and it so happens Koch’s evidence is more convincing than Guttmacher’s. Just that. It’s just my opinion. Please, I would greatly appreciate if you stop putting words into my mouth.

            2. Regarding to the AICM: I cannot grasp the idea that anybody can quantify abortion figures through opinions, no matter how much expertise they may have in the subject of abortion. I think that, after some tweaking on the selection process of the second survey to randomize it and increase sampling, the AICM would be an excellent tool to gauge the opinion about the number of abortions of any country. An opinion survey will never produce an quantifiable estimation on the number of abortions, because it’s based on the opinion of the surveyed subjects and not on any objective number.

            3. Except for the first one, all the references you included on your list are from researchers from the Guttmacher Institute, so obviously they will swear by the AICM method. In addition, I understand the WHO report was elaborated by using AICM… so it’s all the same… Can anybody give me a real independent confirmation?????

            So… since I am an “ignorant”, I am stopping the argument right here. After all, I may be ignorant, but also I am way too tired of your tautologic rhetoric that ends up quoting yourself and your blog.

          • JoyceArthur

            Hi Por, sorry if I mistook you for an advocate, but you were the one who started debating me with your comment that “Dr. Koch has hardly been refuted.” Refute means: “Prove (a statement or theory) to be wrong or false; disprove.” I’ve amply explained and shown that Koch’s work has been refuted. This is not subjective, or a matter of deciding which is more “convincing”, unless you find Koch’s lies and errors “convincing.” He has been caught out, and it only takes one good rebuttal to do that.

            You are dismissing Guttmacher’s responses as well as my own on the basis that there should be more than 1 or 2 rebuttals. But if I showed you 3 or 4, then I guess you’d then claim there must be 5 or 6! In other words, you’ll never be satisfied, because it seems you have your own beliefs and ideology to protect. Further, you dismiss our responses on the assumption that we’re “biased” when I’ve tried to explain to you that you need to evaluate arguments on their own merits, not on whose making them or even what their POV on abortion is. But I see I’ve been wasting my time debating with you. It appears that you’re not interested in facts or evidence, but only in upholding your own religious beliefs. I can only hope that other readers might learn something.

            The 5 references I gave you were all unaffiliated with Guttmacher (GI), so you are mistaken. And if someone like WHO uses the AICM method, that is a validation of it, an independent confirmation. So I gave you what you asked for. Your odd comment about the WHO report using AICM “so it’s all the same” simply proves that you dismiss GI’s methodology out of hand without even considering it, which as I tried to explain is unfair (and unethical if you were a scientist). Anyway, as I said, the methodology will stand on its own if its reliable, regardless of who uses it, including GI researchers.

            Let me add that the GI methodology has not only been used and verified multiple times by many researchers, both GI and non-GI, over the last 2 decades, but that Koch’s methodology is COMPLETELY unsupported by anybody except Koch and his co-researchers. So here you are demanding independent confirmation of GI’s methodology, but where is the independent confirmation of Koch’s?! There is none. He just made it up recently. It has no proven track record, and GI has shown that it’s inadequate.

            Your comment about the AICM maybe being an excellent tool if the surveying process was improved, overlooks the challenges of calculating abortion rates in an illegal environment. You talk about an “objective number”, but obviously there can be no such thing. One of the major points I’ve made in my rebuttals is that without official records, other ways of determining the rates must be found, and GI and others do an incredible job under the circumstances in ensuring that the numbers are as accurate and objective as possible. Koch’s insistence on using only official numbers simply takes advantage of the clandestine nature of abortion to make his fake case. What hypocrisy! And what a terrible betrayal of women resorting to illegal abortions – anti-choice people like you want to pretend they don’t exist, so you contribute to them continuing to suffer and die in anonymity, while GI and others struggle to give voice to them and save them.

          • http://twitter.com/xpolilla Por Polilla

            I am sorry if I failed to explain myself (yet again). It’s not about the arguments on one or the other side. It’s about what is possible given the demographics of a population. Let me give you an example, an maybe then, we may understand each other. According to the AICM of the Guttmacher Institute, in Chile (where I live), there are 120,000 abortions per year. Last year, there were about 250,000 live births registered. If the figure given by the AICM was coherent with reality, that would mean Chile displays an abortion rate (1 abortion per 2 live births) higher than Spain, Russia, Hungary, Finland, Denmark, and England (to name a few), where abortion is widely available on request and it’s already used as a sort of a contraceptive method. This leaves us with two possibilities: either the AICM is not such a good method and is far from providing figures that reflect reality, or Chile is the country with the safest illegal abortion of the entire planet. Your pick!

          • JoyceArthur

            Thanks Por. Well, numbers of abortions can vary hugely depending mostly on availability of contraception. Countries with the best access to contraception (and open attitudes to sexuality etc.) generally have the lowest abortion rates, such as Belgium, Holland, etc., while countries that do not have as good access (historically or now) tend to have higher abortion rates, as well as higher rates of unwanted births. The hypothesized rate you give for Chile is well within the range for a country that has relatively good access to contraception. Eg, in Canada in 2008, there were about 378,000 live births and 96,000 abortions. That’s about 1 abortion for every 4 births. Since we know that contraception availability in Chile is not all it’s cracked up to be, a rate of 1 abortion for every 2 live births is well within the realm of possibility. It could however be closer to Canada’s ratio.(As I mentioned in my rebuttal, the abortion rate for Chile is estimated at anywhere between 40,000 to 160,000 a year.) In Russia and eastern Europe, especially in the past, the abortion rate was often much higher than the live birth rate, like at least double!

            It’s well-documented that countries with better availability of contraception have lower abortion rates. That’s why abortion has been steadily declining in most western countries over the last decade or more. Also, countries with strict bans on abortion tend to have very poor access to contraception, as the two go hand in hand. That’s why the abortion rate is at least as high or higher in countries where it’s illegal. Unwanted births are also higher, but in general, the more unwanted pregnancies you have, the more abortions you’ll have because that is the main cause of abortion.

            Chile is a rare exception in that it provides contraception while keeping abortion illegal. But that never stops abortion of course, it only reduces the numbers. Chile has a better healthcare system too, which further reduces deaths and morbidity, compared to say African countries. But many women are still suffering and some are dying in Chile. The reporting system in Chile makes it impossible to tell the difference between complications of miscarriage versus induced abortion. The deaths that occur, even if quite low in number compared to other ‘illegal’ countries, are completely preventable though. There’s no excuse to sacrifice even a few women unnecessarily because of laws against abortion, and there’s no excuse to criminalize them for doing what women around the world have to do, and have always done, to protect their lives and families.

            So my “pick” is that Chile may indeed be the country with the safest (but not safe) illegal abortion on the entire planet. Which makes the AICM a very good method! :-)

  • http://www.facebook.com/people/Doc-Kimble/100001742531811 Doc Kimble

    Reminiscent of Kinsey’s flawed methodologies in determining the percentage of adults involved in illicit sexual activity; he used selected sex criminals in prison to skew his results.
    “Liars aren’t liars because they lie, they lie because they’re liars.”
    ~My Dad~

  • the best

    The math is wrong. GI states 137,145. After legalization, 10,137. That is a decrease of approximately 92.6%. Say we had 5 procedures one year. The next year there was zero procedures done. That means a 100% decrease. Another example: Say we had 5 procedures done. The next year 49 procedures are done. That is an increase of 880%. In terms of something that can only be counted positive (i.e. procedures, prices, or something) there can only be a decrease of up to 100%, but the increase can be more. Am I reading something wrong?

  • Bob

    There is an article in the current issue of The Economist showing abortion rates in the different regions of the world. They are highest in Latin America, the region with the most restrictive abortion laws. Abortion opponents need to decide if they really want to reduce abortions, or just to punish young women for having sex. If you want to reduce abortions, you might want to take a look at where in the world the rate is the lowest – right here at home.


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