Unsafe abortions: visualising the “preventable pandemic”

In the past few weeks, I was appalled to read that an UK resident was given a prison sentence for the supposed “crime” of having an abortion. This happened because she lives in Northern Ireland, a country where having an abortion is in theory punishable by a life sentence in jail – unless the person in need happens to be rich enough to arrange an overseas appointment for the procedure, in which case it’s OK.

Abortion rights have been a hugely contentious issue over time, but for those of us who reside in a wealthy country with relatively progressive laws on the matter, and the medical resources needed to perform such procedures efficiently, it’s not always easy to remember what the less fortunate may face in other jurisdictions.

In 2016, can it really still be the case that any substantial number of women face legal or logistic issues in their right to choose what happens to their body, under conditions where the huge scientific consensus is against the prospect of any other being suffering? How often do abortions occur – over time, or in different parts of the world? Is there a connection between more liberal laws and abortion rates? And what are the downsides of illiberal, or medically challenged, environments? These, and more, are questions I had that data analysis surely could have a part in answering.

I found useful data in two key places; a 2012 paper published in the Lancet, titled “Induced abortion: incidence and trends worldwide from 1995 to 2008” and from various World Health Organisation publications on the subject.

It should be noted that abortion incidence data is notoriously hard to gather accurately. Obviously, medical records are not sufficient given the existence of illegal or self-administered procedures noted above. It is also not the case that every women has been interviewed about this subject. Worse yet, even where they have been, abortion remains a topic that’s subject to discomfort, prejudice, fear, exclusion, secrecy or even punishment. This occurs in some situations more than others, but the net effect is that it’s the sort of question where straightforward, honest responses to basic survey questions cannot always be expected.

I would suggest to read the 2012 paper above and its appendices to understand more about how the figures I used were modelled by the researchers who obtained them. But the results they show have been peer reviewed, and show enough variance that I believe they tell a useful, indeed vital, story about the unnecessary suffering of women.

It’s time to look into the data. Please click through below and explore the story points to investigate those questions and more. And once you’ve done that -or if you don’t have the inclination to do so – I have some more thoughts to share below.

Thanks for persisting. No need to read further if you were just interested in the data or what you can do with it in Tableau. What follows is simply commentary.

This blog is ostensibly about “data”, the use of which some attribute notions of cold objectiveness to; a Spock-like detachment coming from seeing an abstract number versus understanding events in the real world. But, in my view, most good uses of data necessarily result in the emergence of a narrative; this is a (the?) key skill of a data analyst. The stories data tells may raise emotions, positive or negative. And seeing this data did so in me.

For those that didn’t decide to click through, here is a brief summary of what I saw. It’s largely based on data about the global abortion rate, most often defined here as the number of abortions divided by the number of women aged 15-44. Much of the data is based on 2008. For further source details, please see the visualisation and its sources (primarily this one).

• The abortion rate in 2008 is pretty similar to that in 2003, which followed a significant drop from 1995. Globally it’s around 28 abortions per 1,000 women aged 15-44. This equates to nearly 44 million abortions per year. This is a process that affects very many women who go through it, affecting also the network of people that love, care for or simply know them.
• Abortions can be safe or unsafe. The World Health Organisation defines unsafe abortions as being those that consist of:

a procedure for terminating an unintended pregnancy either by individuals without the necessary skills or in an environment that does not conform to minimum medical standards, or both.

• In reality, this translates to a large variety of sometimes disturbing methods, from ingestion of toxic substances, inappropriate use of medicines, physical trauma to the uterus (the use of a coathanger is the archetypal image for this, so much so that protesters against the criminalisation of abortion have used them as symbols) – or less focussed physical damage; such as throwing oneself down stairs, or off roofs.
• Appallingly, the proportion of abortions that were unsafe in 2008 has gone up from previous years.
• Any medical procedure is rarely 100% safe, but a safe, legal, medically controlled abortion contains a pretty negligible chance of death. Unsafe abortions are hundreds of times more likely to be fatal to the recipient. And for those that aren’t, literally millions of people suffer consequences so severe they have to seek hospital treatment afterwards – and these are the “lucky” ones for whom hospital treatment is even available. This is to say nothing of the damaging psychological effects.
• Therefore, societies that enforce or encourage unsafe abortions should do so in the knowledge that their position is killing women.
• Some may argue that abortion, which few people of any persuasion could think of as a happy or desirable occurrence, is encouraged where it is freely legally available. They are wrong. There is no suggestion in this data that stricter anti-abortion laws decrease the incidence of abortions.

  A WHO report concurs:

Making abortion legal, safe, and accessible does not appreciably increase demand. Instead, the principal effect is shifting previously clandestine, unsafe procedures to legal and safe ones.

• In fact, if anything, in this data the association runs the other way. Geopolitical regions with a higher proportion of people living in areas where abortions are illegal actually, on the whole, see a higher rate of abortion. I am not suggesting here that more restrictive laws cause more abortions directly, but it is clearly not the case that making abortion illegal necessarily makes it happen less frequently.
• But stricter laws do, more straightforwardly, lead to a higher proportion of the abortions that take place anyway being unsafe. And thus, on average, to more women dying.

Abortion is a contentious issue and it will no doubt remain so, perhaps mostly for historic, religious or misogynistic reasons. There are nonetheless valid physical and psychological reasons why abortion is, and should be, controlled to some extent. No mainstream view thinks that one should treat the topic lightly or wants to see the procedure becoming a routine event. As the BBC notes, even ardent “pro-choice” activists generally see it as the least bad of a set of bad courses of action available in a situation that noone wanted to occur in the first place, and surely no-one that goes through it is happy it happened. But it does happen, it will happen, and we know how to save thousands of lives.

Seeing this data may well not change your mind if you’re someone who campaigns against legal abortion. It’s hard to shift a world-view that dramatically, especially where so-called moral arguments may be involved.

But – to paraphrase the Vizioneer, paraphrasing William Wilberforce, with his superb writeup after visualising essential data on the atrocities of modern-day human trafficking – once you see the data then you can no longer say you do not know.

The criminalisation-of-abortion lobby are often termed “pro-lifers”. To me, it now seems that that nomenclature has been seized in a twisted, inappropriate way. Once you know that the policies you campaign for will unquestionably lead to the harming and death of real, conscious, living people – then you no longer have the right to label yourself pro-life.