From the Director's Desk (Fall 2011)

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What kind of glasses are you wearing? Perhaps contact lenses? Or maybe you only need the occasional pair of sunglasses. Glasses are analogous to our worldview, the filter through which we interpret everything we see. It’s an analogy that breaks down, to be sure, but it is useful in reminding us that we all perceive and interpret reality in different ways. Our perspective or point of view is our worldview. And our worldview has a great deal to do with what we think, learn, and know about our world.

In the world of bioethics, worldview comes squarely up against the questions of who is a human being? What does ‘dignity’ mean? How do we gather, analyze and interpret data? What are the boundaries of medicine, science, and technology? Our worldview may lead us to evaluate all input according to a pre-determined, desired outcome. Or, it could engender a deep sense of humility and awareness of our human limitations.

Let me illustrate how a faulty worldview—the “wrong” pair of glasses—can lead to wrong, even disastrous, conclusions. The United Nations Millennium Development Goal 5 calls for a 75% reduction in maternal deaths by 2015. When the data is evaluated globally, we are far from achieving that goal. When examined country by country, the statistics disclose a less uniform pattern. Most maternal deaths occur in a few countries: Pakistan, Afghanistan, India, and sub- Saharan Africa. For example, there is a marked contrast between Sri Lanka, which had a total of 190 maternal deaths in one year, and Sierra Leone, where one in eight women die in childbirth.

So, what’s the problem?

First, the actual number of women who die in childbirth has been overreported. Rather than 500,000 deaths annually, the number likely is closer to 350,000. This may be due in part to faulty record keeping, coupled with “tortuous statistical techniques and educated guessing,” according to one World Bank researcher. Some WHO researchers admit to “adjusting the data” up to 50 percent to match what they expected to find, in order “to make the numbers turn out right,” reports Donna Harrison, MD.[1]

Secondly, what counts as “maternal mortality” varies, depending on the researcher’s worldview. If she has an agenda to legalize abortion, then the data may skew in that direction. Thus, deaths from miscarriage (spontaneous abortion) may be counted as a maternal death, but deaths from induced abortion might be excluded. Accurate data should separate childbirth, spontaneous abortion, and induced abortion (by method, whether surgical or chemical).

WHO’s Reproductive Health Indicators link the safety of abortion with its legal status.[2] This flies in the face of some of the most reliable evidence that legalized abortion may hinder reductions in maternal mortality. Maternal mortality has increased in the U.S., which has one of the most permissive abortion regimes among liberal democracies.[3]

Third, efforts to reduce maternal mortality may actually be efforts to reduce maternity. UN planners and other policy makers have made no secret of their intention to reduce population growth worldwide, particularly in majority world countries (developing nations). “Family planning services” are promoted as necessary to reduce maternal mortality. These services include pregnancy termination by induced abortion. “Fertility regulation” is a convenient label for chemical and medical abortions in countries where it is illegal. Deaths from the “abortion pill” or use of a manual vacuum aspirator would not be counted as maternal mortality due to induced abortion.

Finally, language is being misused and abused to disguise agendas that are objectionable, both in the U.S. and in the targeted nations. Obfuscation and misdirection are evidence of a worldview that does not demand truth telling, transparency, and honesty. Using code words such as “reproductive health” by which “legalized abortion” is intended displays an elitist, smug attitude and disrespect for the life-affirming, child-welcoming values in countries where they seek to impose their worldview of what is good for women and their families.

In this essay, I cannot address what women really need to reduce deaths in childbirth. Those concerns merit an entire essay. What I do want to emphasize is that we need to be aware of our own perspective, and be sensitive to the perspectives of others, whether hidden or obvious. We should not be afraid of the truth, of facts that are fairly stated, of data and evidence that are properly interpreted. By the same token, we must present the truth even when it is inconvenient to our position. If we are to exemplify integrity, we must “see” the world both as it is, and as we would like it to be.


[1] Donna J. Harrison, “Removing the Roadblocks from Achieving MDG5 by Improving the Data on Maternal Mortality.” International Organizations Research Group. (accessed December 12, 2011).

[2] Sheila Barot, “Unsafe Abortion: The Missing Link in Global Efforts to Improve Maternal Health.” Guttmacher Institute. (accessed December 12, 2011).

[3] U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. “Maternal Mortality.” U.S. Department of Health and Human Services. (accessed December 13, 2011).