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FactCheck: Who's right about Ireland's record on maternal deaths?

FactCheck readers asked us to referee a recent dispute between Cora Sherlock and Fintan O’Toole, so we obliged.

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A ROW BROKE out recently over the airwaves and in print, after the Pro-Life Campaign’s Cora Sherlock claimed Ireland had a “phenomenal record” on maternal health, up to the introduction of the Protection of Life During Pregnancy Act in 2013.

In a recent op-ed, Irish Times literary editor and columnist Fintan O’Toole said the claim was “based on figures that have long since been shown to be ludicrous”.

Later in the week, Sherlock retorted in a letter to the same publication, insisting that: “Ireland without abortion has been among the world leaders in maternal healthcare”.

FactCheck readers Linda Arnold in Westmeath and Derek Larney in North Co Dublin contacted us to ask who had their facts right on the issue of maternal deaths.

(Remember, if you hear a fact-fight over the airwaves, or read one in the news, email factcheck@thejournal.ie or tweet @TJ_FactCheck).

Claim: Ireland has had a “phenomenal” record on maternal mortality, up to the introduction of abortion legislation in 2013
Verdict: Mostly TRUE

  • Since 1985, Ireland has had one of the world’s lowest rates of maternal death, consistently ranking around joint 6th in Europe and the world
  • That high standard has continued unchanged since the limited introduction of abortion in 2013
  • Ireland’s maternal mortality rate has been better than, worse than, and the same as various countries with relatively liberal abortion regimes.

What was said:

Since Cora Sherlock’s comments on Morning Ireland two weeks ago formed an important part of Fintan O’Toole’s criticism, let’s take that as our primary articulation of the claim.

You can listen to the interview here, but this is the statement we’re most interested in:

Ireland…had a phenomenal record in protecting women’s health and protecting maternal health, right up to 2013, when abortion was introduced in this country…

The Facts

zika-outbreak Source: Andrew Matthews/PA Images

Notes

Since the statistics on maternal deaths formed the core of the dispute between Fintan O’Toole and Cora Sherlock, and the requests we got from readers, we will be focusing on that.

Ireland’s broader record on maternal health and women’s health is a different subject, and not the specific focus of this FactCheck.

We asked Cora Sherlock for evidence to support her claim, and she cited figures from the Confidential Maternal Death Enquiry, as well as a major 2015 report put together by the World Health Organisation (WHO), World Bank, UNICEF and the UN Population Fund.

The evidence

FactCheck gathered the most up-to-date, comprehensive data available, covering the period of 1985 to 2015, from the World Health Organisation report also cited by Cora Sherlock.

The data for previous years has been revised (including 2007, when flaws in methodology saw Ireland’s maternal mortality rate fall to just one), and figures in previous reports should not be considered reliable. As the report states:

These results supersede all previously published estimates for years within that time period…

For the sake of clarity:

  • The maternal mortality rate (MMR) is the number of maternal deaths for every 100,000 live births in a country in a given year.
  • The WHO defines a maternal death as:
The death of a woman while pregnant or within 42 days of termination of pregnancy…from any cause related to or aggravated by the pregnancy or its management (from direct or indirect obstetric death), but not from accidental or incidental causes.
  • In many cases, the WHO report uses statistical models to arrive at estimates for MMR, due to the wide range of methodologies used across 183 countries and 30 years, to count maternal deaths.

You can download a spreadsheet with all the relevant data, below, but here are the results:

irelandMMR Source: For a full-size version of this chart, click here

Over the last 30 years, Ireland’s MMR has been among the world’s lowest.

Out of 183 countries measured by the WHO, Ireland’s ranking has remained consistently around joint 6th, occasionally rising to 5th and dropping to 7th.

Out of 41 European countries, our ranking has also consistently been around joint 6th.

In the context of the wider abortion debate, it’s worth noting:

  • Ireland’s average MMR from 1985-2015 was 9
  • That’s worse than some countries with relatively liberal abortion regimes, such as Canada and Belgium (8), Sweden (6)
  • It’s the same as that of Denmark (9), another European country with a relatively liberal abortion regime
  • It’s also better than some countries with relatively liberal abortion regimes, such as the UK and Netherlands (11), and France (12)
  • Malta, the only other European country with an abortion regime roughly as restrictive as Ireland’s, had an average MMR of 13, the same as Singapore, which has a relatively quite liberal abortion regime.

Those comparisons are made only for context, and to point out that the data does not appear to suggest any robust correlation between the availability (or otherwise) of abortion, and the rate of maternal deaths.

In response to our queries, Sherlock stipulated:

…I am not suggesting the non-availability of abortion in Ireland is in itself the reason we have a better record but rather that the availability of abortion doesn’t make a country any safer in protecting the lives of women.

“Without abortion”? “Up to 2013″?

5/7/2016. Pro Life Campaigns Issues Source: Leah Farrell/RollingNews.ie

Finally, the data clearly shows that Ireland’s high standard on maternal deaths continued unchanged after the Protection of Life During Pregnancy Act was introduced in 2013.

Our MMR has effectively stayed at 8 for the last five years, and our world ranking has stayed at joint 6th.

On Morning Ireland, Cora Sherlock stated that Ireland “had a phenomenal record…right up to 2013, when abortion was introduced…” [Emphasis is added].

This might suggest she was qualifying our impressive record around the introduction of the Protection of Life During Pregnancy Act, or implying a change to that record after 2013.

However, when asked by FactCheck, Cora Sherlock clarified that she phrased the claim in this way to emphasise that Ireland’s maternal mortality record was, in her words, “phenomenal” before and without the introduction of abortion in 2013.

This is a reinforcement of her earlier argument, that “the availability of abortion doesn’t make a country any safer in protecting the lives of women”.

She added that there was “no suggestion” on her part that the statistics on maternal deaths had changed after 2013.

To be clear: Ireland, with and without abortion, before and after 2013, has had and continues to have, an extremely high standard in its record on maternal deaths.

Local figures

Screen Shot 2016-08-15 at 1.41.41 PM Source: Confidential Maternal Deaths Enquiry/UCC

The Confidential Maternal Death Enquiry (MDE), cited by Fintan O’Toole in his column, and Cora Sherlock in her response to FactCheck, is a project started in 2009 and based in UCC.

It links in with a similar, long-standing enquiry in the UK, and uses a slightly different methodology from the WHO, as well as primarily presenting Ireland’s MMR in three-year bands, rather than on an annual basis.

For 2009-2011, our MMR was 8.6. For 2010-2012 it was 10.5. For 2011-2013 it was 10.4.

However, the report stresses that that apparent increase in the MMR is not, in fact, statistically significant.

For the 2011-2013 period, the UK’s MMR was 9.02, as opposed to 10.4 in Ireland. But again, the MDE report stresses that this is not a statistically significant difference.

This means that according to this source, Ireland has effectively the same rate of maternal death as the UK.

Related statements

The Pro-Life Campaign has previously made claims about Ireland’s maternal health record, and their website (as pointed out by Fintan O’Toole last week) contains statements describing our record as “world-leading”, and saying:

According to the latest research from the UN and World Health Organisation, Ireland leads the world in safety for pregnant mothers.

While this claim was somewhat justifiably based on research available at the time, the findings for Ireland were based on a badly flawed methodology, and have since been explicitly superseded by the UN and WHO themselves.

Therefore, these claims are not currently supported by the best available evidence.

Fintan O’Toole’s description of the claim that Ireland has the world’s best maternal health record as a “wild untruth” is on the mark.

But this description does not extend to any claim that Ireland has an impressive, or even “phenomenal” record.

The data is clear in showing that, as of 2015, we rank joint 6th in the world out of 122 rankings (and 183 countries), which is a very high standard, regardless of the adjective you use to describe it.

Finally, Enda Kenny’s statement in the Dáil in June 2014 that Ireland is “one of the safest countries in the world in which to give birth”.

Notwithstanding the maternity unit scandals which have emerged in recent years, and a number of high-profile and tragic deaths, in terms of our MMR, the Taoiseach’s claim is true.

And Fintan O’Toole’s description of it as “untruthful” is not borne out by the data, which shows Ireland consistently ranking around joint 6th in the world for our maternal mortality rate.

Ireland clearly is one of the safest countries in the world in which to give birth, according to the best evidence available.

Conclusion

www.GIFCreator.me_wd6nLI

Ireland does indeed have a very impressive record, by international standards, when it comes to maternal deaths.

We have never ranked first or had a “world-leading” record, but whether you describe it as “phenomenal”, “outstanding” or with a similar positive adjective, our MMR has ranked joint 5th, 6th or 7th in Europe and the world for the last three decades – a very high standard.

We rate Cora Sherlock’s claim – that Ireland has had a “phenomenal” record on maternal deaths – Mostly TRUE (allowing some room for interpretation of the exact meaning of the word “phenomenal”).

However, it is crucial to note that since the introduction of the Protection of Life During Pregnancy Act in 2013, there has been no change in Ireland’s MMR or in our European and global rankings.

To download a spreadsheet containing all the relevant data, click here.

Send your FactCheck requests to factcheck@thejournal.ie

Correction: This article previously referred to Fintan O’Toole as deputy editor of the Irish Times. In fact, he is literary editor and a columnist.

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