Abortion and Women’s Health in Developing Countries: Does Legalization Make Things Better? 

Around the world, abortion continues to be a leading cause of maternal death. Each year, around seven million women are treated for injuries from unsafe abortion.1 Around 47,000 of them die.2 For the most part, these deaths occur in developing countries, where around 97% of “unsafe abortions” take place. There, abortions are often performed in dangerous conditions or by untrained providers. This results in widespread harm and death for the mother. And as we know, abortion always results in a dead baby. 

Because many developing countries ban abortion, pro-life laws are often blamed for deaths. Pro-abortion advocates point to these countries as proof that illegal abortion is unstoppable and that bans only harm women. They pressure these countries to loosen abortion laws to improve maternal health and use them to defend legality in developed countries as well.

The claim that legal abortion reduces maternal deaths is not far-fetched. Often, it does appear that when abortion is made legal, maternal deaths from abortions decrease. As such, it is accepted as fact by most researchers that legalization is the best way to reduce abortion-related deaths. 

Despite this, a number of examples blatantly defy this theory. Many times, legalizing abortion has not produced positive results. In addition, it is apparent that abortion restrictions were not harming maternal health at all. When countries don’t fit the abortion narrative, though, they tend to just be ignored.  


Until very recently, abortion was banned in all cases in Chile. No exceptions were made. Since 2017 this has changed, but even now abortion is only legal in rare cases.

Despite this, Chile has had one of the lowest maternal mortality rates in the world. It surpasses all countries in South America and is better even than the United States. Its maternal health is among the best, and abortion being illegal didn’t change this.3

Before the ban in 1989, maternal health was already improving. After the complete ban of abortion, this did not change. Between 1989 and 2009, the maternal mortality ratio decreased by over 58%, falling from 40.8 to 16.9 per 100,000 live births. Abortion-related mortality also declined by over 96% after being banned as well.4 

With the banning of abortion, it is clear that improvements in maternal health must have been the result of other factors. Studies have shown that, rather than abortion, the educational level of women, improved healthcare, and sanitation are what have driven improvements in maternal mortality.5 More than anything else, it is factors such as these that appear to help reduce deaths and protect women.


Until 2021, the legal status of abortion in Mexico varied significantly across its 32 states. Some states banned and criminalized it, while others allowed it on demand. This makes for good comparisons by researchers, and many studies have been done on the effects of abortion laws.

What research has found, however, is that states that have restricted abortion consistently have lower maternal mortality rates. Abortion bans are associated with decreases in maternal deaths, and legalization has been followed by increases in deaths. On its head, this would indicate that abortion bans likely protect countless women’s lives. When one digs deeper, however, it is evident that there is more going on than just pro-life laws saving lives. Much like in Chile, other factors have had a large impact on maternal health. Clean water, sanitation, and female literacy have been the driving forces behind declines, and the legal status of abortion has merely coincided with that.6

Other studies on Mexico have been published arguing that legalization does in fact reduce maternal deaths; however, these studies are often replete with errors. In one such example, researchers accidentally inverted signage in their calculations, leading to the study’s results being completely erroneous. The study has been redacted due to it proving its own conclusions incorrect.7

Ultimately, throughout Mexico, deaths from illegal abortions have been shown to be greatly exaggerated. In 2012, a study demonstrated that despite apocalyptic estimates of deaths, only 2–4% of total maternal deaths could actually be attributed to illegal abortions.8 Even if legalization did reduce abortion-related deaths, the effect would be practically nonexistent because it is so rare.


One of the most recent examples of abortion’s failure to improve maternal health comes from Ethiopia. In 2022, new research began to emerge shining light on legalization and its effects on maternal deaths, and not only does legalization appear to not have improved maternal health, but it may in fact have worsened it.9

Until 2005, abortion was almost entirely banned in Ethiopia. It was only allowed in cases of threats to the mother’s life or health, and even then it was rarely performed legally. The country had one of the highest numbers of maternal deaths, and almost a third of them were due to illegal abortions. All this made the country perfect for pro-choice advocates to push for legalization in the name of reducing maternal deaths.

In this case though, the results of their efforts did not line up with their claims. Even before the legalization of abortion, maternal mortality rates had been decreasing, and both abortions and deaths from them were becoming less frequent. After abortion was legalized, however, complications from abortion increased massively, and drops in maternal deaths slowed or stopped entirely. 

During this time, other conditions in Ethiopia have not worsened. The provision of reproductive healthcare has continued to increase, as has access to contraception. Healthcare has improved, and by most metrics, the country should have seen different results. Yet after legalization, septic shock and organ failure from abortions more than doubled almost immediately. Since then, the problem has only continued to worsen. Between 2008 and 2014, peritonitis and organ failure quadrupled, and shock doubled again.

To quote the authors of the most recent study on the effects of abortion legalization on Ethiopia:

Rather than being a silver bullet to reduce deaths from abortion, abortion legalization has resulted in a vast increase in the number  of  abortions,  without any appreciable decrease in abortion mortality or maternal mortality. There is some evidence mortality, and certainly morbidity, have even increased since legalization.

Despite this, many pro-abortion advocates have continued to hold up Ethiopia as a success story, and this is not an uncommon occurrence. Time and again, abortion-related deaths tend to fall to low levels before being made legal due to better healthcare, and later, legal abortion tends to be given credit for solving problems that were already in decline.

Abortion is unnecessary to improve maternal health

Over the years, other studies have been published purporting to demonstrate that stricter pro-life laws result in more maternal deaths. These studies, however, are often flawed or severely misrepresented by the media.10

Though countries like Ethiopia can be held up as examples of the devastating effects of legalized abortion, we should evaluate such research carefully. If the many news articles on the dangers of pro-life laws have taught us anything, it is that it is easy to draw faulty conclusions when there are so many factors involved. 

What is clear, however, is that abortion’s legality is not necessary to improve maternal health. Many countries with bans on abortion have still experienced declines in maternal mortality, and when abortion is made illegal, it does not stop or slow health improvements.

As we seek to help developing countries improve maternal health, we should focus on methods that are proven to work. Sanitation, maternal healthcare, skilled attendance at birth, and education should all be a priority. Abortion should not be.

Abortion kills children, and it harms mothers. Legalizing it does not change that. In recognizing the tremendous volume of death that results from abortion, we should focus less on trying to make them “safer” and more on trying to prevent them entirely.

1. “Abortion,” World Health Organization, November 25, 2021.

2. Elisabeth Ahman and Iqbal H. Shah, “New Estimates and Trends Regarding Unsafe Abortion Mortality,” International Journal of Gynecology & Obstetrics, Volume 115, Issue 2, November 2011, Pages 121-126.

3. Elard Koch, “Impact of Reproductive Laws on Maternal Mortality: The Chilean Natural Experiment,” The Linacre Quarterly, May 1, 2013.

4. Ibid.

5. Elard Koch et al., “Women’s Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007,” PLOS ONE, May 4, 2012.

6. Elard Koch et al., “Abortion Legislation, Maternal Healthcare, Fertility, Female Literacy, Sanitation, Violence against Women and Maternal Deaths: A Natural Experiment in 32 Mexican States,” BMJ Open, February 23, 2015.

7. Blair G. Darney et al., “RETRACTED: Maintaining Rigor in Research: Flaws in a Recent Study and a Reanalysis of the Relationship between State Abortion Laws and Maternal Mortality in Mexico,” Science Direct, January 2019.

8. Elard Koch et al., “Fundamental Discrepancies in Abortion Estimates and Abortion-Related Mortality: A Reevaluation of Recent Studies in Mexico with Special Reference to the International Classification of Diseases,” International Journal of Women’s Health, December 5, 2012.

9. Callum Miller, “Legalisation of Abortion and Maternal Mortality in Ethiopia,” Ethiopian Medical Journal, March 29, 2022.

10. Michael New, “No, Pro-Life Laws Do Not Increase Maternal Mortality Rates,” National Review, December 15, 2022.

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About the author

William Lawyer

William Lawyer is a freelance writer from Utah. He is the founder and executive director of The Lifeguard Initiative—a pro-life organization dedicated to protecting the preborn.