Major newspapers have prominently reported the words of Lue Hung-chi (呂鴻基), a retired professor of pediatrics at National Taiwan University, at a forum on July 16, when he gave a startling figure of 500,000 for the number of abortions performed in Taiwan each year. The Bureau of Health Promotion (BHP) estimates that at least 240,000 abortions are carried out in Taiwan each year, based on figures for induced abortion under the National Health Insurance program and the use of the abortion-inducing drug RU-486.
If it were true that there are 500,000 abortions in Taiwan every year, it would be a NT$5 billion (US$173.2 million) medical market. According to market principles, an invisible hand operates behind the scenes of the economy to balance supply and demand.
Why is it, then, that the number of gynecologists in Taiwan has declined sharply in recent years, with practitioners getting older to the extent that more than 80 percent are over the age of 40? Why are gynecologists moving in droves into the fields of beauty and weight loss? Meanwhile, the Taiwan Association of Obstetrics and Gynecology frequently seeks support funding. This picture of a sunset profession is clearly at odds with the thriving market that Lue portrays.
Behind the picture that Lue is promoting lies the aim of restricting women’s reproductive rights. Lue reportedly said that overly liberal laws and excessive women’s self-determination have made abortions a casual affair. However, a professor who quotes dubious statistics will not gain morals respect. As convener of the Child Health Alliance Taiwan, Lue should focus on the health of children and teenagers. When he blames women’s reproductive rights for the fact that fewer children are being born, it is clear that he has another purpose, and such pronouncements create a false impression that Taiwanese women will go for abortions at the drop of a hat.
According to figures compiled by the BHP, an average of 180,000 to 190,000 induced abortions are reported through the National Health Insurance system each year. In addition, RU-486 is used in 40,000 to 50,000 cases a year. Based on these figures, the Bureau of Health Promotion comes up with an estimate of at least 240,000 abortions each year. The bureau’s estimate, however, is wide of the mark. It is talking about diagnosed miscarriages and therapeutic abortions, along with early abortions, which are not paid for by National Health Insurance, all in the same breath.
The nature of human reproduction is such that only 30 to 50 percent of pregnancies last beyond three months, the rest being anembryonic gestations — what doctors sometimes call a “dummy pregnancy” — or ending with a natural miscarriage.
Miscarriages that can be detected by a doctor account for 15 to 30 percent of all pregnancies, and complications that can occur during the first three months of a pregnancy include ectopic and molar pregnancies, choriocarcinoma, complications associated with assisted reproduction, and so on. Even when a pregnancy lasts beyond the first trimester, there is a 5 percent chance of the fetus being malformed, and various complications can occur, such as premature rupture of membranes (breaking of the waters), ante-partum hemorrhage (bleeding), and premature birth.
For women, getting pregnant may be welcome news, but it can also be a threat to life. Now the BHP has lumped in the reported figures for all these diagnosed miscarriages and therapeutic abortions to reach its inflated estimate of 240,000 abortions per annum. Besides a lack of expertise, the bureau could be accused of egging on the “pro-life” lobby.
Most early abortions in Taiwan are induced by RU-486, and, estimating on the basis of the BHP’s figure of 40,000 to 50,000 cases, and based on a figure of 70 percent of induced abortions before nine weeks being brought on by medication, about 70,000 early abortions are performed in Taiwan each year. This is the number estimated by the Taiwan Association of Obstetrics and Gynecology, and is probably a fairly sound one.
Any attempt to inflate the number of abortions in Taiwan, even when it comes from respected professors or bodies, is aimed at turning the clock back to the situation we had three decades ago, when women’s reproductive rights were restricted, and when they put their health and lives in grave danger using the services of back-street abortionists.
In Taiwan, September is supposedly the peak time for abortions, but this year it has arrived early. Why that should be provides food for thought. Convincing abortion statistics have never been available in Taiwan, so when newspapers post big, bold headlines about “500,000 abortions a year,” those who deserve a slap on the wrist include not just professors who rely on dubious figures and a BHP that can’t come up with accurate statistics, but also the news media for accepting these numbers without question.
The number of births in Taiwan has fallen steeply over the past decade, allowing for a saving of about NT$3.5 billion in National Health Insurance spending, but women’s healthcare has not improved much over the same period. Taiwan’s lack of accurate abortion statistics is an embarrassment that needs to be corrected. The right way to go would be to make all legal abortions, including those defined under Article 9, Paragraph 6 of the Genetic Health Act (優生保健法), eligible for National Health Insurance payment. Without spending a lot, our national health system could compile accurate statistics, and it could cut the number of abortions by providing contraceptive devices and making sure people know how to use them. Now that would be progress.
Chiang Sheng is an attending doctor in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.
Translated by Julian Clegg
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