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

In a report published in the Bioethics section of the May 2012 issue of the journal Ginecología y Obstetricia de México, Most Holy Conception, et al. criticized an approach developed by the Guttmacher Institute to estimate the number and rate of induced abortions and complications from unsafe abortions in countries where the procedure is highly legally restricted. As Koch and colleagues note, that approach, the abortion incidence complications method Their critique focuses largely on the most recent Guttmacher publication on the incidence of abortion and abortion complications in Colombia. 2 We strongly dispute their criticisms, as well as an alternative methodology that they suggest, which is based on assumptions that are both simplistic and incorrect. THE AICM In countries where abortion is highly legally restricted—and in some where it is legal and accessible, but is still unsafe because of social stigma or for other reasons—documenting incidence is extremely difficult. The primary reason for this is that when abortion is illegal or stigmatized, the procedure is performed in secrecy; as a result, women are reluctant to report it, and providers are reluctant to register it. Researchers have developed, and continually work to improve, indirect measurement approaches to assess abortion incidence in contexts where it cannot be measured directly. These approaches yield estimates, rather than exact values.