New Report Highlights Worldwide Variations in Abortion Incidence and Safety

A new report by the Guttmacher Institute highlights ongoing disparities in abortion rates and in access to safe abortion services in developing and developed regions. The report, Abortion Worldwide 2017: Uneven Progress and Unequal Access, pulls together the latest research on abortion incidence, safety and legality, as well as on unintended pregnancy. Globally, rates of abortion have declined over the past 25 years. In addition, procedures have become safer in many parts of the world.

Although the worldwide annual abortion rate fell between 1990–1994 and 2010–2014, most of this change occurred in developed regions, the abortion rate in developing regions hardly changed (from 39 to 36 per 1,000 women). During this same period, the global unintended pregnancy rate declined, from 74 unintended pregnancies per 1,000 women of reproductive age in 1990–1994 to 62 per 1,000 women in 2010–2014. Unlike abortion rates, unintended pregnancy rates declined substantially in both developed and developing regions.

Notably, abortion rates are similar in countries where abortion is highly restricted and where it is broadly legal: The abortion rate is 37 per 1,000 women in countries where abortion is prohibited or permitted only to save the life of the woman, and 34 per 1,000 women in countries where abortion is not restricted as to reason. Legal restrictions do not eliminate abortion. Rather, they increase the likelihood that abortions will be done unsafely, as they compel women to seek clandestine procedures. Indeed, abortion tends to be safer in countries where it is broadly legal and in countries with a high gross national income.

Where abortion laws are highly restrictive, the increased use of misoprostol has also improved safety. Even when used by an untrained person, misoprostol is still safer than traditional methods of clandestine abortion, such as inserting sharp objects into the uterus or ingesting toxic substances.

Major obstacles to eliminating unsafe abortion and its consequences remain. As of 2014, at least 22,800 women still die each year worldwide from complications of unsafe abortion. This is partly because stigma leads many women–even in countries where abortion is legal–to seek clandestine abortions, which are more likely to be unsafe. Stigma also causes women to delay seeking treatment for complications from unsafe procedures.

Moreover, high unmet need for modern contraception in many countries results in high rates of unintended pregnancy, and restrictive laws limit or prohibit the availability of safe abortion services.

Finally, regardless of abortion legality, poor and rural women in low-income countries are less likely than wealthy and urban women to be able to access safe abortion services because of cost and location.

Much work needs to be done to improve access to safe abortion care, and to reduce unsafe abortion and its toll on women's health. Governments, donors, advocates and health providers must undertake multiple strategies to achieve these goals. This includes training a wider range of health personnel to provide comprehensive abortion and postabortion care. Since unintended pregnancy is the main reason for abortions, health officials and providers must ensure that women have access to high-quality contraceptive services to prevent unintended pregnancies in the first place. Given the high costs of unsafe abortion–in terms of health and the financial burden on poor women and developing countries' budgets–reducing unsafe abortion is critical to ensuring the well-being of women, their families and their countries.

Comment:Comment: GLOWM was created to save women's lives. Mortality and morbidity from unsafe abortions is still too high and this report from Guttmacher highlights the reasons why. I highly recommend its downloading and reading. Governments have to work on: making safe abortion legal, making effective and affordable contraceptives available and training healthcare providers in safe abortion. (HMV)

For more information, read the full report:
Abortion Worldwide 2017: Uneven Progress and Unequal Access by Susheela Singh, Lisa Remez, Gilda Sedgh, Lorraine Kwok and Tsuyoshi Onda