Nearly half the abortions that take place worldwide are now unsafe, with women in parts of Africa and Latin America faring the worst, a new report by the World Health Organization and the Guttmacher Institute in New York says. A staggering 97 percent of abortions in Africa — 100 percent in regions across central and West Africa — are estimated to be risky if not fatal, adding to persistently high maternal death rates.
“Monitoring abortion trends is thus crucial to assess improvement of maternal health, and the progress toward the Millennium Development Goal 5, to reduce maternal mortality and achieve universal access to reproductive health,” the study says. The report, by Gilda Sedgh and others at the Guttmacher Institute, find that restrictive laws against abortion do not lower abortion rates. Moreover, because abortions are not documented in countries with such laws, they may be significantly underestimated. In other places where abortion is highly stigmatized, even if legal, abortions may also be underreported.
Abortion rates were found to be lower where women are living under liberal laws, the authors of the study wrote.
The study, titled “Induced abortion: incidence and trends worldwide from 1995 to 2008” and just published online in the current issue of the British medical journal The Lancet, shows that while abortions rates per 1,000 women age 15 to 49 had begun to fall after 1995, that decline stalled between 2003 and 2008 (the latest available global data).
Meanwhile, by 2008 the proportion of unsafe procedures had risen to 49 percent of all abortions, from 44 percent in 1995. Only induced abortions, not spontaneous miscarriages (pregnancy losses) were considered.
Global decline but a rise in poor nations
The lack of family planning information or services as well as contraceptive needs that go unmet are factors in areas of high abortion prevalence because they lead to large numbers of unintended pregnancies, the report says. Even where abortions are legal, they may be unsafe.
The report estimates that 43.8 million abortions occurred in 2008, a decline globally since 1995. But while abortion numbers dropped 0.6 million from 2003 to 2008 in the developed world, they rose in developing nations by 2.8 million. Eighty-six percent of all abortions occurred in the developing countries in 2008.
When calculating the percentage of unsafe abortions as of 2008, the report found a rate of less than 0.5 percent in North America, East Asia and most of Europe (excluding Eastern European countries, where the rate was 13 percent). At the most dangerous end of the spectrum, Central America and South America had rates of unsafe abortions as high as 100 percent. The Caribbean region was much lower, at 46 percent. Africa – excluding southern Africa – had universally high rates of unsafe abortions, more than 95 percent.
Abortion is not just a procedure, safe or unsafe, but part of the larger reproductive-health story.
“Various developing countries have broadened the grounds under which abortion is legal in recent years,” the report says. “However, a liberal abortion law alone does not ensure the safety of abortions. Other necessary steps include the dissemination of knowledge about the law to providers and women, the development of health service guidelines for abortion provision, the willingness of providers to obtain training and provide abortion services and government commitment to provide the resources needed to ensure access to abortion services, including in remote areas.”