PVH 19e jaargang – 2012 nr. 1, p. 024-025

Legal, safe and rare abortion is often seen as a necessary component of women’s health. Abortion rights groups contend that unless it is legal, backyard abortionists will fill the gap in demand and maternal mortality rates will rise.

Remarkably, though, for such a contentious issue, there is little data to back up this claim. In fact, Poland, Ireland and Malta, where abortion is severely restricted, have some of the lowest maternal mortality rates.

A study of abortion in Chile published this week in PLoS One1 suggests that “the legal status of abortion does not appear to be related to overall rates of maternal mortality”.
Chile is an important “natural experiment” for abortion policy. In 1989 abortion there was made illegal with one of the more restrictive abortions laws in the world. Good statistics from the past 50 years make it possible to compare maternal mortality rates before the ban and after.
According to Elard Koch, of the University of Chile, and colleagues, their study “provides counterintuitive evidence showing that making abortion illegal is not necessarily equivalent to promoting unsafe abortion, especially in terms of maternal morbidity and mortality.

Chile’s abortion prohibition in 1989 did not cause an increase in the [maternal mortality rate] in this country. On the contrary, after abortion prohibition, the MMR decreased from 41.3 to 12.7 per 100,000 live births ­a decrease of 69.2% in fourteen years.” The highest mortality rate was in 1961 (47.9 per 100,000 women of reproductive age), and the lowest in 2003 (0.72 per 100,000).

In other words, making abortion illegal appears to have been a primary factor in Chile’s reduced maternal mortality rates.

Other factors are also important, the researchers acknowledge: more education for women; nutrition for pregnant women and their children in the primary care network and schools; universal access to improved maternal health facilities; changes in women’s reproductive behavior enabling them to control their own fertility; and clean water and good sanitation.
Illegal abortion is often equated with unsafe abortion. However, clandestine abortions in Chile appear to be low-risk. Otherwise there would have been increased rates of death among women of childbearing age.


by Jared Yee | Mar 31, 2012

A married couple in the Netherlands
tried over and over to conceive, but in their early 30s they discovered
that the husband produced no sperm. Donor sperm from a stranger
would mean the child would not share genes with the husband. The
husband had no brothers who could donate, so the couple hit upon
a novel solution -the husband’s father. This would produce a child
whose “father” is his biological half-brother, and whose “grandfather” is
his biological father. All of the parties were at ease with this
situation, so they went to a fertility clinic with their idea.
After a bit of umming and ahing, the clinic agreed. While uncommon,
donations of sperm, egg or womb from family members to couples
trying to conceive do occur.
These arrangements bring their own complications
– especially the potential confusion over who the father is. According
to some experts, the emotional toll on the child might be too
great to justify the procedure. “The notion that this child’s
grandfather would be his biological father is just too bizarre
for the child’s sake,” said George Annas, of the Boston University
School of Public Health. “Family relationships are confused enough
as they are when they’re not intergenerational,” Annas said. The
couple’s case was reported in the March 7 issue of the journal
Human Reproduction.
by Michael Cook | Apr 08, 2012

Respect for autonomy is one of the most convincing arguments for euthanasia. It was the theme of a strong defence of legalising it in Australia in the Journal of Law and Medicine by Margaret Otlowski and Lorana Bartels in 2010. They concluded that ” in a secular society with an ageing population” legalisation is inevitable. However, in the latest issue of the JLM a criminologist at the University of Tasmania has made a vigorous response. Jeremy Prichard doubts that many people in the community will be able to give full and voluntary consent to ending their lives. He contends that the growing prevalence of elder abuse suggests that aged people could easily be manipulated. “Such procedures may be safe for socially connected, financially independent individuals with high autonomy and self-efficacy,” he writes, but “circumstances may be entirely different for isolated patients with low self-efficacy who represent an unwanted burden to their carers, some of whom may benefit financially from the death of the patient (even just in a reduction of financial pressure).”Sometimes the request for euthanasia may be genuine, but it has been prompted by subtle pressure. Carers may easily convince a patient that death is the best option for everyone.

Dr Prichard cites some disturbing anecdotes from research into elder care in Tasmania. In one, a woman describes how she is treated by her husband: “I had the stroke a few years ago, I’m absolutely helpless to do anything myself … [My husband] gets annoyed because I have to go to the toilet all the time and he has to help me. … In his own selfish way he cares for me too, it’s just that he’s so disagreeable, he’s a real disagreeable old grump, he doesn’t like anyone around … He talks about he’ll be glad when he dies all the time and I say “well what will I do?” He says “I just hope my time will hurry up and come.” That’s my life and I’ve got to put up with it … I couldn’t get anyone else to look after me. “Very little research has been done on pressures that could be exerted on the elderly and disabled. “Research on the risks of voluntary euthanasia or physician-assisted suicide is in its infancy,” he writes.” So far as this article could ascertain, only one qualitative study has investigated the issues of pressure on patients to access voluntary euthanasia or physician-assisted suicide.”