Fudged data and dodgy reporting: how foreign money pushes abortion in Africa
In April, the Liberian Ministry of Health launched the report of a study on the incidence of abortion and severity of related complications in the country. The study had been carried out mainly by the African Population and Health Research Centre (APHRC), with funding and collaboration from the Clinton Health Access Initiative (CHAI) and the Guttmacher Institute.
According to the report, a summary of whose findings is available on the APHRC’s website, 38,779 induced abortions happened in Liberia in 2021, an annualised rate of 229 per 1,000 live births. In other words, nearly a fifth of all pregnancies in Liberia were ended by an induced abortion (without counting miscarriages).
This is a staggering number, and featured strongly in an August attempt to overhaul Liberia’s abortion legislation to legalise clinical abortion. But there is something very fishy about these numbers. And it’s a weakness that arguably so hobbles studies into the incidence of abortion in African countries as to make them virtually worthless.
As it happens, abortion is largely illegal in most African countries (including in Liberia). Though very few people have ever been prosecuted, and even fewer convicted, for procuring them, the laws remain on the books, primarily because they are a reflection of public opinion; Africans generally disapprove of abortion, and resist most attempts to normalise the murderous practice.
But that hasn’t stopped Western merchants of death, like the institutions that funded the Liberian study, from advocating for the expansion of access to abortion on the continent. However, they cannot do that unless they can first prove that there exists a substantial “unmet need” for so-called safe abortion services.
Enter the studies on abortion incidence and complications. Owing to its illegality across much of the continent, it is impossible to collect direct data about abortion. Incidence and complications studies, therefore, attempt to produce estimates based on a number of presumably related factors.
The Liberian study, like most others carried out by the APHRC, was done using a popular methodology known as the Abortion Incidence Complications Method (AICM), which was developed in the early 1990s and has been used to estimate abortion incidence in dozens of countries around the world.
Based on the assumption that complications related to induced abortion would be reported as miscarriages to circumvent the law and stigma, this technique tries to comb through a representative sample of reported miscarriages; tease out which of these were likely induced; and then extrapolate that into a national estimate.
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A critical review of the methodology would make this article rather long and boring. Suffice it to say that it’s not the only methodology that has been used to estimate the incidence of abortions in jurisdictions where it is illegal or direct data is otherwise unavailable. Other methods, like Anonymous Third Party Reporting (ATPR) and list method, have been implemented in other studies.
The problem is, they all produce wildly different numbers. A comparative 2019 study of five methods in Ghana, published in the British Medical Journal, yielded figures of 27 abortions per 1000 reproductive-age women, according to one methodology, and 61 per 1000 according to another, a variance so huge as to invalidate the results, leading the poor researchers to only credit their study with highlighting the “strengths, pitfalls and requirements of each approach.”
But that is not all. Even the AICM itself produces variances large enough to call results obtained by it into question. The full Liberian report hasn’t been published online, and I couldn’t obtain a copy from the APHRC in time for this article. However, the report of a similar 2012 study, carried out in Kenya by the same institution, is available online. It illustrates this weakness rather well.
It estimated that 464,690 abortions were induced in Kenya in 2012, yielding a rate of 48 per 1000 women, or 300 per 1000 live births. This shocking figure has been embellished and bandied around ever since to push for the expansion of access to abortion in Kenya. What is rarely reported is that it was the medium estimate. The low estimate 344,778, was 239,823 less than the high estimate of 584,601, a variance equivalent to 51.6% of the widely-reported number.
Further complicating things, the AICM was developed with miscarriage data from developed countries. This is what is used to estimate the proportion of miscarriages to induced abortions, based on reports from under-resourced healthcare facilities in African countries (where maternal and infant mortality figures trail the developed world by up to 60 years), which is then applied to estimate the total number of abortions (an estimate based on an estimate based on untested assumptions).
If this is starting to sound familiar, it’s because it isn’t much different from a wild-goose chase, cloaked in the respectability of science. Needless to say, none of these results has ever been replicated, and the method has never been validated. In short, the promoters of abortion are clutching at straws.
But perhaps this is not the most egregious violation of good faith in this matter. For, in their attempts to paint the picture of a high demand for abortion in Africa, these studies tend to produce numbers so ridiculous they strain credulity, even without regard for the technical weaknesses for their methodologies.
The purported abortion incidence figures for Liberia and Kenya (229 and 300 per 1000 live births, respectively), exceed the proportion for the United States, which stood at 198 per 1000 live births in 2020, according to the CDC (the decrease from 2019 was only 2 percent, obviating the influence of the Covid-19 pandemic). Importantly, this was a directly reported number, rather than an estimate.
It boggles the mind that the promoters of these studies can, with a straight face, expect reasonable people to believe that highly fertile and strongly pro-life African countries, in which abortion is illegal to boot, have higher abortion ratios than the United States before Dobbs.
It’s a theatre of the absurd.
Mathew Otieno is a Kenyan writer, blogger and a dilettante farmer. Until 2022, he was a research communications coordinator at a university in Nairobi, Kenya. He now lives in rural western Kenya, near the shores of Lake Victoria, from where he's pursuing a career as a full-time writer while concluding his dissertation for a master's degree. His first novel is due out this year.
Cartoon by Brian Doyle
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