This article, in press, is about the difference between estimates of maternal deaths from unsafe abortion from the World Health Organization and those from the Institute for Health Metrics and Evaluation (IHME), USA, both published in 2014 in two different Lancet journals. The article, co-authored by Iqbal Shah, Carla AbouZahr and me, is in the International Journal of Gynecology & Obstetrics (IJGO). The article begins:
“The publication of two papers with widely differing estimates of abortion-related deaths has caused concern and confusion among individuals who work on mortality and morbidity related to unsafe abortion. Both papers claim to offer correct estimates based on robust and rigorous methodologies. We wish to highlight this issue and discuss how the differences might be overcome.”
If you subscribe to the IJGO you can find it here: http://dx.doi.org/10.1016/j.ijgo.2016.05.012
It has taken submissions to three journals, Lancet, WHO Bulletin and IJGO, over a period of 11 months, the first two unsuccessful, to have this published.
The likelihood that the IHME and WHO staff responsible for their respective estimates on deaths from unsafe abortion will sit down together to resolve their differences is anyone’s guess.
Meanwhile, we are all left not knowing whose figures to use. I took a personal decision, based on the arguments made in our article, to go with the IHME figures, as there is no other way of resolving this. I am using IHME’s estimate that 43,684 (14.9%) maternal deaths in 2013 can be attributed to unsafe abortion (Lancet 2014). I am also sharing the Guttmacher Institute’s estimate that there were 56.3 million abortions per year globally for the years 2010-2014 (Lancet, 11 May 2016), as few people seem to be aware of this new estimate either.
Based on my own (limited) knowledge of other people’s articles and presentations, and from what I’ve seen quoted in the mainstream media, the out-of-date WHO figures for 2008, published in 2011 — 46 million abortions with 47,000 abortion-related deaths annually — are still commonly being used. For those who are aware of the conflicting WHO and IHME estimates, few will have the expertise to choose between the two methodologies, but the sad part is, that shouldn’t be necessary.
At the end of the article we say: “As the leader in global health, WHO has a constitutional responsibility to support countries in strengthening their health-information systems. Likewise, IHME has a stature commensurate with its technical expertise and generous funding. Surely it is incumbent upon both organizations to put their differences aside and reach a consensus on the method required to produce one set of estimates that are comparable over time and that everyone accepts as the best possible information to guide clinical practice, policy and program priorities. Yet they remain unwilling to do so. In the absence of a neutral body with comparable responsibility, we believe that WHO should insist that its experts invite IHME experts, and others who might be considered neutral, to reach an agreement on the way forward.”
That pretty much sums up what we had to say from an advocacy point of view. The article goes into more detail, and also on the methodological issues too.