Unsafe Abortion Remains a Major Global Health Challenge

London, UK: The number of induced abortions worldwide declined from nearly 46 million to under 42 million between 1995 and 2003. Abortion rates fell most significantly in Eastern Europe, a trend that corresponds with substantially increased contraceptive use in the region, according to “Induced Abortion: Rates and Trends Worldwide,” a new report by the Guttmacher Institute and the World Health Organization (WHO) published in the 13 October 2007 issue of The Lancet.

For every 1,000 women of childbearing age (15–44) worldwide, 29 were estimated to have had an induced abortion in 2003, compared with 35 in 1995. The decline was most substantial in Europe, where the rate fell from 48 to 28 abortions per 1,000 women, largely because of dramatic declines in Eastern Europe. On the whole, the abortion rate decreased more in developed countries, where abortion is generally safe and legal on broad grounds (from 39 to 26), than in developing countries, where the procedure is largely illegal and unsafe (from 34 to 29). Significantly, the abortion rate for 2003 was roughly equal in developed and developing regions—26 and 29, respectively—despite abortion being largely illegal in developing regions. Health consequences, however, vary greatly between the two regions, since abortion is generally safe where it is broadly legal and mostly unsafe where restricted.

“The overall downward trend in abortion rates is encouraging, but positive change is happening too slowly and too unevenly across different regions,” says Dr. Sharon Camp, president and CEO of the Guttmacher Institute. “We know, and the new evidence confirms yet again, that the best way to make abortion less necessary is to help women avoid unwanted pregnancies in the first place. And we know that the crucial first step in making abortion safer is to legalize the procedure, ensuring that it is performed by skilled providers under the best possible conditions. It’s high time for policymakers worldwide to renew their commitment to women’s health by addressing these crucial issues.”

The lowest abortion rate in the world in 2003 was for Western Europe (12 per 1,000 women aged 15–44), where contraceptive services and use are widespread and safe abortion is easily accessible and legal under broad grounds. The rate was 17 for Northern Europe and 21 for the Northern America region (Canada and the United States). Africa, Asia and Latin America had the highest regional abortion rates, even though abortion is generally legally restricted and often unsafe in those regions. Abortion rates in Africa, Asia, and Latin America and the Caribbean have declined since 1995, but the estimated number of abortions has increased in Africa because of the increasing number of women of reproductive age and a possible underestimate of abortions in 1995. Because the world’s population is concentrated in Asia, most abortions occurred there—about 26 million yearly; China alone accounted for nine million procedures.

The study also found that an estimated 20 million unsafe abortions occurred in 2003, 97% of these in developing regions. The prevalence of unsafe abortion remains high, with up to 39 unsafe abortions per 1,000 women aged 15–44 in Eastern Africa and 33 per 1,000 in South America. By contrast, developed regions, where almost all countries allow abortions with few restrictions, had an average unsafe abortion rate of two per 1,000. The consequences of unsafe abortion—death, serious injury, infertility and increased health care cost are largely borne by poor women. The report concludes that reducing the incidence of unsafe abortion would result in an immediate and substantial reduction of maternal mortality and improve maternal health.

"Nearly half of all induced abortions are unsafe, putting the lives and health of women at major risk. Each year, about 70,000 women die due to unsafe abortion and an additional five million suffer permanent or temporary disability," notes Dr. Paul F.A. Van Look, director of WHO’s Department of Reproductive Health and Research. “The widespread unmet need for contraception must be addressed if we are to see further decline in abortion rates, especially in Sub-Saharan Africa, where contraceptive use is low and unsafe abortion-related mortality is the high, compared with other regions"

“Induced Abortion: Rates and Trends Worldwide” was authored by Gilda Sedgh, Stanley Henshaw, Susheela Singh, Elisabeth Aahman and Iqbal Shah.

Additional resources:

Facts on Induced Abortion Worldwide

Abortion: Worldwide Levels and Trends