Despite attempts from pro-life Senators to prevent him from speaking, yesterday, Health Minister Adolfo Rubinstein gave a presentation before the Senate’s Health Committee in which he laid out facts and statistics related to the decriminalization of abortion. The emphasis was on the reduction in maternal mortality and complications as a result of illegal abortions, as well as the significantly lower cost to the public health service versus clandestine abortions.
Rubinstein began his presentation by defending the accuracy of his statistics, knowing that these have previously come under fire from pro-life lawmakers. “The figures that I give have been checked and are solid and robust. They are the official figures from the Ministry of Health and the estimates will be based on this data and on the best scientific evidence will be the strongest and most rigorous possible,” he said.
He started by presenting the rates of hospitalizations due to abortion complications in Argentina. Dating from 2014, the most recent year available, figures showed that there were 47,063 women hospitalized due to complications resulting from abortions, of whom 70 percent had undergone an illegal abortion. Furthermore, in the last 5 years of available data, there had been between 44,000 and 53,000 hospitalizations annually.
Rubinstein acknowledged that even though these figures were high, they still did not paint the full picture: “We know for sure that in each of these complicated abortions, in some cases fatal and nearly fatal, we do not know the proportion of women who had serious complications in the medium- and long-term post-hospitalization. Nor the social consequences,” he said, stating that the official mortality rate was much lower than the reality.
Despite these high numbers, figures show that there has been a steadily dropping rate of hospitalizations since 2005, which he imputed to the health and sex education policies introduced in the past 10 years. However, while numbers are dropping, abortion remains the principal cause of maternal mortality, with statistics showing that there were 245 deaths in 2016, of which 43 were due to abortions and 31 to induced abortions, a number that does not include hidden cases.
The Minister also turned his attention to countries that have legalized abortion, citing Ireland as an example of a Catholic country who was in the process of reversing restrictive abortion legislation. In the vast majority of these countries, he said, there was a decrease in abortions following legalization, and by extension, the reduction of maternal mortality, something that had not happened in countries with a more restrictive framework.
He then went on to analyze the projected costs and savings of introducing legal abortion in Argentina. After comparing the rates of abortions without complications in countries where it is legal versus current rates in Argentina, Rubinstein projected a massive saving for the public health service each year. Currently, the cost per abortion stands at AR $11,500, while the cost should the bill be passed would drop to just AR $1,914. Annually, this would represent a total cost of AR $678.6 million versus the current cost of AR $4.1 billion.
“This difference has to do with the dramatic reduction of the complication rate in situations where abortions are performed in a legal environment… The fundamental difference between these two scenarios has to do with the reduction of hospitalizations, because this is causes the highest costs,” he said. The figures show that there will be a massive decrease of 98 percent fewer hospitalizations and 92 percent fewer deaths should abortion be legalized and properly implemented in Argentina.
In his conclusion, Rubinstein also criticized focusing too much on the percentages and proportions when it comes to evaluating women’s lives – and deaths. “The preventable death of any woman is something that should worry us, but furthermore, death is just the pinnacle of a social and sanitary reality which is much broader.
“Abortion is a problem for public health because it produces avoidable deaths in young, healthy women who are socially vulnerable. Countries with restrictive legal frameworks don’t reduce the number of abortions, but increase the number of unsafe abortions. Legalizing abortion reduces mortality and hospitalizations due to complications, without implying higher costs for the public health service.”
The presentation then led a fiery question and answer session, principally led by pro-life Senators. María Cristina Fiore Viñuales (Salta), who had attempted to block Rubinstein’s presentation, challenged his right to speak on behalf of the Government. She then said that abortion ranks 70th on the list of causes of women’s deaths in Argentina, behind malnutrition, heart disease, and femicides, questioning why the Government was “prioritizing” this cause. She said that even with a limited implementation of complete sexual education, hospitalization rates were falling, and so asked why abortion was being proposed as a solution rather than better sexual education.
Rubinstein replied that he was not speaking on behalf of the Government, but in his capacity as Minister of Health. “I understand that personal positions depend on convictions and values. I don’t want to present my personal conviction but instead to present the facts. The problem exists, it isn’t the principal problem in public health, but it is a problem that affects vulnerable people, and it has been demonstrated that legalization produces immediate results.”
He also argued that the mid- to long-term solution to the issue was not necessarily legalizing abortion but instead preventing them from taking place, taking the example of countries where it has been legalized, which by and large demonstrate lower rates of abortion than in countries where it is legal. “I understand that the decision that you will take will be guided by your convictions, by context, and by the political reality, but I want you to also take these figures into account. My main objective is that you, the Senators, make an informed decision,” he said.
In response to a question from Senator Verasay from Mendoza, the Minister also addressed the issue of conscientious objection, saying that it was a worthy argument and one that would be addressed in its full should the bill be passed through the Senate, although Senator Pichetto for Río Negro rebutted that “doctors who enter into public healthcare should have to accept all the practices that public healthcare entails.”
The debate then became much more contentious. Senator Silvia Elías de Perez from Tucumán accused Rubinstein of lying about the figures, citing Spain and England as examples of countries where the rate of abortions had not decreased post-legalization, while mentioning Chile and Honduras as countries that have managed to reduce maternal mortality without “resorting” to abortion, to which Pichetto shouted out, “profound neurosis!”
After the room calmed, Rubinstein showed that in the last five years, Spain has seen lower rates of abortions and while England is an anomaly, it is to do with a crisis about the serious health consequences of some contraceptive methods, which saw a steep drop in the use of contraceptives in England at the time that abortion had been legalized. “The reality,” he said, “is that illegal abortion is a significant cause of maternal mortality, currently representing 18 percent of deaths.”
Pichetto continued on Rubinstein’s side. “Your responses are concrete and compelling,” he said, even if “obscurity, hiding, and illegality do not allow us certainty on all of the figures.” He then went on to mention that the French Minister for Health who legalized abortion, Simone Veill, was interred in the Panthéon with the “heroes of Paris,” before turning to President Macri’s position. “Four or five days ago, the President said that the interruption of a pregnancy is a woman’s right… It seems that even the President’s attitude has been opening and evolving over the course of this debate, which for me is a positive thing.”
The debate continued going round in circles somewhat, as pro-life Senators continued to ask Rubinstein about personal beliefs, the right of the child to be born, and the apparent disregard for other ways to reduce the rate of abortion. At this point, the Minister seemed frustrated with the discussion. “I’ve already said twenty thousand times that I don’t have an opinion on values and beliefs, my personal opinions are neither important nor relevant.”
When the session finally wrapped up after an hour and a half of discussion, it was clear that the deep divisions within Senate over this bill continue. Although Rubinstein, in his capacity as Minister for Health and as a former doctor, called on Senators to disregard the personal and focus on the objective, it will be nigh on impossible for many to make a decision solely based on fact in such an emotive vote.
Even if the statistics do demonstrate financial and social benefits for Argentina should the bill be passed, resistance in Senate means this seems increasingly unlikely.