A Disgraceful Example of B.A.D. Science (biased, agenda-driven)

Anti-Choice “Research” on Maternal Mortality in Chile
(updated June 2018)

One of the weaknesses of the anti-choice position is the failure to confront the death toll from unsafe abortion. In recent years, however, some anti-choicers have tried to challenge the estimates. In particular, an anti-choice group of professional researchers and doctors has formed for the sole purpose of publishing their own “research” in mainstream venues, in an effort to put a gloss of scientific respectability on their religious ideology. Called “We Care,” the name exemplifies the dishonest approach of the anti-choice movement – pretending to care about women, while in reality working to relegate women to a baby-making role and hide their suffering and deaths from unsafe illegal abortion. 

One of the key members of “We Care” is Elard Koch, an epidemiologist from Chile. Through “We Care,” Koch and his associates appear to be using Chile as a testing ground for the practice of deliberately obfuscating data in order to deny the existence of unsafe abortion and its consequences. This has potentially serious global consequences. 

I have exposed Koch as an anti-choice ideologue who pretends to use the scientific method, but whose work is filled with factual errors and serious distortions because he's abusing science to promote his personal views. Koch and I have a “connection” going back to 2010, which partly explains my interest in this issue. Prior to the G8/G20 summit in Canada in 2010, Prime Minister Stephen Harper refused to include funding for safe abortion as part of Canada’s commitment to reduce maternal mortality in developing countries. On March 4, 2010, the Saskatoon Star Phoenix published my op-ed explaining that legal abortion saves women’s lives and why anti-choice claims to the contrary were wildly false. A “rebuttal" was printed 11 days later in this small Prairie paper, which is little known outside of Canada, but Elard Koch of Chile was the author.

Koch has recently made it his mission to discredit the Guttmacher Institute, a highly respected organization that specializes in global research on reproductive health. But it’s Koch, not Guttmacher, who’s using research methods so flawed they can only be called a disgrace to science. Even a non-scientist like myself can easily discredit his studies, even though Koch is highly educated and trained, with a prestigious academic position at a university – an intelligent and experienced man who should know better.

The anti-choice movement loves Koch and his “studies,” with hundreds of favourable links and comments all over the place, but very few rebuttals have been published. Below is a compendium of the small number of pieces I've come across, in order from oldest to most recent. (This list is kept updated.)

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Review of a Study by Koch et al on the Impact of Abortion Restrictions on Abortion Mortality in Chile

By the Guttmacher Institute, May 2012

Summary: The study by Koch et al. (in PLOS ONE) asserts that the expansion of abortion restrictions in Chile in 1989 did not lead to an increase in the incidence of abortion-related mortality. The study concludes that “making abortion illegal is not necessarily equivalent to promoting unsafe abortion.” However, the study has several serious conceptual and methodological flaws that render some of its conclusions pertaining to abortion and maternal mortality invalid.

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Anti-choice researchers in Chile try to hide illegal abortion -- and women who die from it

By Joyce Arthur, June 1, 2012

This article refutes Koch’s dangerously flawed study (PLOS ONE) that examined various factors associated with Chile's declining maternal mortality rate, and concluded – incredibly – that the legal status of abortion has no influence on maternal deaths in Chile, a country that completely prohibited abortion for any reason in 1989. By rendering invisible the women who are injured or die from illegal abortion, the study is a dangerous weapon that threatens to slow down the global decrease in maternal mortality and continue allowing women to suffer and die unnecessarily.

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Refutations of Elard Koch’s errors and distortions in his rebuttal to the Guttmacher Institute

By Joyce Arthur, June 1, 2012

This piece refutes several specific aspects of Koch’s study (PLOS ONE), as well as his response to Guttmacher's May 2012 rebuttal (see below). Topics addressed include:

• Illegal abortions still common in Mexico
• Increases in abortion after legalization to be expected
• Koch guilty of over-reliance on official statistics and unwarranted dismissal of evidence that doesn’t fit anti-choice ideology
• Small numbers of pre-1989 legal abortions in Chile

Conclusion: “In my opinion ... Koch's anti-choice advocacy as a privileged male academic in Chile is an irresponsible abuse of power that puts women's lives and health at risk – not just in Chile, but throughout LatinAmerica wherever abortion is mostly illegal.” 

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Estimating Induced Abortion Incidence: Rebuttal to a Critique of a Guttmacher Methodology

By Susheela Singh and Akinrinola Bankole, Guttmacher Institute, July 30, 2012

This rebuttal from Guttmacher demolishes Koch’s false accusations about Guttmacher’s “flawed” methodology for calculating the incidence of illegal abortion in Latin American countries, particularly Colombia and Mexico. The above link goes to the detailed rebuttal, but here is a Summary. Quote: “The Koch et al. critique is characterized by pervasive distortions of Guttmacher's methodology, and their proposed alternative methodology is based on scientifically unsound and illogical assumptions and contains such serious errors that its results are not valid."

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Abortion, Maternal Mortality and Scientific Truth

By GIRE, August 15, 2012 

GIRE (Grupo de Información en Reproducción Elegida, a reproductive rights group working to decriminalize abortion in Mexico) summarizes Guttmacher's above rebuttal to Koch. They conclude by saying: "Why falsify data? Conservative groups’ strategies have changed: they have moved from moralizing and demonizing reproductive rights to constructing scientific, secular and apparently aseptic semi-truths. Nevertheless, now more than ever it is important to demonstrate that just like law and bioethics, science shows that women are right: Having the power to make decisions regarding their own bodies is good, just and healthy." 

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In Which The Guttmacher Institute Continues to be Awful

By Marc, December 6, 2012 

This is an anti-choice article criticizing Guttmacher, to which I contributed many comments in an online debate underneath, with "Por Polilla."  (The above link goes directly to my first comment in the thread; it's the fourth comment posted in case you can't find it. To read the article itself, just scroll up.) 
 
Basically, Por Polilla wanted evidence that Guttmacher's methodology was credible and independently validated, and when I gave it to her, along with evidence and arguments refuting Koch's methodology, she turned off her mind and said she found Koch's proven errors and lies more believable. The debate is an illuminating window into anti-choice non-thinking – especially her last comment (which I didn't respond to), in which she simply repeats one of Koch's most egregious errors that I had already exposed as false in a previous comment to her.

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Confused critique of Ipas research doesn't hold together

(Unfortunately not available online anymore - June 2018)

By Ipas-Mexico, December 11, 2012

Ipas-Mexico first published an analysis of maternal and abortion-related mortality in Mexico from 1998 to 2008, in the Journal of Gynecology & Obstetrics (2012, S78-S86).  Koch published a “rebuttal” to this in the International Journal of Women's Health. IPAS responded with the above-linked piece. 

Excerpt: "[Koch et al.] have attempted to discredit this research, following a pattern of calling into question any public health research that reveals that clandestine, unsafe abortion has a negative impact on public health in the region. … However, Koch’s work has been discredited in the past by the Guttmacher Institute, and the current paper likewise uses methodologies that are confused and scientifically unsound. Rigorous, broadly validated research methodologies continue to show that abortion is a significant contributor to maternal mortality in Mexico, with a disproportionate effect on rural and low-income women.”

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Everything Old Is New Again—Debunked Criticism of Guttmacher Methodology Resurfaces   

by the Guttmacher Institute, December 14, 2012

Guttmacher criticizes Koch for recycling his disproven claims about Guttmacher's methodology, concluding: "We reiterate that Guttmacher rejects these false criticisms and stands by the validity of its methodology." Guttmacher also takes the opportunity to critique in more detail one of Koch's worst errors (in my opinion it's most likely a deliberate lie): He confuses the number of abortions in Mexico City with the number for all of Mexico.

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False Witnesses - Elard Koch

by Sharona Coutts and Sofia Resnick, Rewire, November 13, 2014 - and kept updated

At least twenty anti-choice activists and researchers are exposed as "False Witnesses," including Dr. Elard Koch, and several of his most common co-authors, including Byron Calhoun, John Thorp, and Monique Chireau.  At the outset of the project in 2014, the authors stated: "Each member of the False Witnesses gallery has pushed false information designed to mislead the public, lawmakers, and the courts about abortion. RH Reality Check [now Rewire] analyzed scores of public records, contracts, public statements, and research articles, and identified their key falsehoods in order to set the record straight."

Koch's "Signature Falsehood": That making abortion illegal does not result in more maternal deaths.

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BMJ Open Study on Abortion Mortality Is Deeply Flawed

by Joyce Arthur, April 9, 2015

A Feb 2015 study in the BMJ Open by Dr. Koch and 9 co-authors purports to show that Mexican states with more restrictive abortion laws have lower maternal mortality rates than states with more permissive laws. This rebuttal exposes the study as egregiously flawed and biased. As such, it poses an unacceptable risk to public health because it could be used to advocate the criminalization of necessary healthcare for women. 

A longer version of this rebuttal, which includes a key section on the biases and lack of credibility of the authors, was previously published at Rewire:  'False Witnesses' Publish Deeply-Flawed Study on Abortion Mortality in Mexico. (March 25, 2015)

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Study Still Dead After Resurrection Attempt Fails 

By Joyce Arthur, October 17, 2015

Published at BMJ Open on October 26 as an e-letter.
A longer, uncut version is posted on my blog.

The August 11 response of Dr. Elard Koch and several co-authors fails to rectify the two major flaws in their study on the effect of Mexico's abortion laws on maternal mortality. I exposed those flaws in my April 9 rebuttal. Their response further confirms those flaws, and also ignored many of my arguments and repeated many of their disputed points.

This reply explains why those two major errors remain fatal to their study’s conclusion (that restrictive abortion laws in Mexico are unrelated to maternal mortality, and may even reduce it). I then address the question of anti-abortion bias, which I believe played a key role in the flawed design of the study. To be fair, I also address my own biases. Finally, I deal with several ancillary issues arising from Koch et al.’s response.