One in five pregnancies worldwide and one in three in Europe ends in abortion. Further, the worldwide rates of induced abortion have fallen 17% between 1995 and 2003, and actual numbers of abortions have also fallen from 46 million to 42 million in the same period. Unsafe abortion* is concentrated in developing countries and has not declined. These are the conclusions of authors of an Article published in this week's Women Deliver Special Issue of The Lancet.
Dr Gilda Sedgh, Guttmacher Institute, New York, USA, and Dr Iqbal Shah, World Health Organisation, Switzerland, and colleagues calculated worldwide and regional incidences of safe** abortions using reports from national reporting systems, nationally representative surveys, and published studies. Figures for unsafe abortion were estimated from hospital data, survey and other published studies.
They found that on average 90% of women worldwide will have an abortion before the age of 45 (i.e. in their reproductive lifetime, aged 15-44 years) based on 2003 data. However, many women will have had multiple abortions and many none at all to come to this average.
Of the 41.6 million abortions worldwide, 35 million were in the developing world and 6.6 million in the developed world. The worldwide induced abortion rate fell from 35 per 1000 women aged 15-44 in 1995 to 29 in 2003. In 2003, 48% of all abortions worldwide were unsafe (up from 44% in 1995), and 97% of all unsafe abortions were in developing countries. In developed countries, 92% of abortions were safe, but in developing countries more than half were unsafe (55%).
Globally, there were 31 abortions for every 100 livebirths in 2003, while in Eastern Europe there were more abortions than live births (105 abortions for every 100 livebirths) – more than double the level of the next highest world region – Eastern Asia (51 abortions for every 100 livebirths). Despite this, Eastern Europe also saw the biggest decrease in abortion rates in the 1995-2003 period, down some 50%. The authors attribute this decline to increases in use of modern contraception methods. The authors say: "Although abortion rates and ratios in the countries of the former Soviet Union have fallen substantially in recent years, the rates in Eastern Europe remain higher than any other region. This finding suggests the need for continued improvements in and expansion of contraceptive service provision. The widespread preference for small families in this region indicates a high level of need for effective contraception."
In Europe as a whole, nearly a third of pregnancies (32%) end in abortion – higher than any other region due to the relatively high rates in Eastern Europe. The lowest proportion (12%) was in Africa, with the world average being one in five (20%).
The study found that abortion occurred at approximately the same rates where it is broadly legal as where it is highly restricted by law. The abortion rate per 1000 women in 2003 was similar for Africa, Asia, Europe and Latin America (between 28 and 35) as complete regions, but lower in Northern America (21) and Oceania (17). However, the lowest abortion rate per 1000 women worldwide was in Western Europe (12), and the highest in Eastern Europe (44). In the developing world, changes in rates of abortion, and actual numbers of abortions, were dominated by developments in China – which accounts for a fifth of abortions worldwide, and where abortion rates dropped 20% between 1995 and 2003.
The authors say: "Unsafe and safe abortions correspond in large part with illegal and legal abortions, respectively. The findings presented here indicate that unrestrictive abortion laws do not predict a high level of abortion, and by the same token, highly restrictive abortion laws are not associated with low abortion incidence."
They conclude: "Estimates of abortion incidence and trends are necessary means of monitoring and responding to its causes, including unmet need for contraception, and, in the case of unsafe abortion, consequences such as maternal morbidity and mortality--in light of the recent mandates of intergovernmental bodies, the contraceptive and abortion technologies now available, and the estimates presented here, prevention of unsafe abortion is an imperative public health goal."
In an accompanying Commentary, Beth Fredrick, International Women's Health Coalition, New York, USA, says: "In all the available data, one fact stands out: safe and legal abortion saves women's lives and protects their health. There is no acceptable reason to allow women to die, fall ill, or become infertile as a result of unsafe abortion when the world community has both the knowledge and the means to prevent these deaths."
Notes to Editors: Safe abortions: Abortions a) in countries where abortion law is not restrictive, and (b) that meet legal requirements in countries where the law is restrictive.
Unsafe abortions: Abortions done either by people lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both. These include a) abortions in countries where the law is restrictive and (b) abortions that do not meet legal requirements in countries where the law is restrictive.
The paper associated with this release can be viewed below:
http://multimedia.thelancet.com/pdf/press/Abortion.pdf
Dr Gilda Sedgh, Guttmacher Institute, New York, USA : T) +1 212 248 1111 E) gsuarez@guttmacher.org
Dr Iqbal Shah, World Health Organisation, Switzerland: T) +41-22-791 33 32 E) shahi@who.int
Beth Fredrick, International Women's Health Coalition, New York, USA, T) +1 212.801.1286 / +1 917.498.2874 E) bfredrick@iwhc.org
Journal
The Lancet