Do restrictive abortion laws kill women?

There is no more powerful argument for legal abortion than the fear that many more women will die if they are forced to resort to underground abortion mills. However, the experience of Chile, where abortion is illegal for any reason, even rape or incest, suggests that this doesn’t necessarily happen.

From a statistical point of view, Chile is a natural experiment because abortion was legal there from 1931 to 1989, when it was banned by one of the world’s most restrictive laws.

In the current issue of the Journal of the Chilean Society of Obstetrics and Gynecology (PDF in Spanish), epidemiologist Elard Koch crunches the statistics and finds that, counter-intuitively, the rate of abortion-related mortality has fallen since 1989. Even hospital discharges due to abortion have significantly decreased during the last decade.

Proof of whether abortion-related mortality rises or falls when abortion is banned is a bit more complicated than it might seem. In World Health Organisation statistics, “illegal abortions” only represent a fraction of “all abortions”, because these also include spontaneous abortion or ectopic pregnancies.

According to official data, hospital discharges due to complications of abortions suspected to be illegally induced have been dropping at a rate of 2% per year since 2001. There was no decrease in hospital discharges due to other types of abortion, such as spontaneous abortion or ectopic pregnancies. The high quality of Chilean vital statistics, says Elard, means these findings are unlikely to be the result of an artefact of the registry system. Rather, a decrease in hospital discharges due to complications from illegal abortion appears to explain virtually all the reduction in hospital discharges due to any type of abortion in Chile during the last decade.

The Chilean experience represents a paradox in our times, he contends: even under a restrictive abortion law, maternal health indicators can be significantly improved by other factors, including a noteworthy reduction in mortality and morbidity associated to abortion.


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