A new worldwide analysis by the Guttmacher Institute and the World Health Organization shows that unsafe abortions are on the rise across the world. After a period of significant decline in the global abortion rate as a whole, researchers found that those numbers had begun to plateau. The report was published in the Lancet.
From 2003 to 2008, the abortion rate per 1,000 women of childbearing age (15 to 44) changed slightly, from 29 to 28 per 1,000. women But the proportion of unsafe abortions that took place across the world rose 44 percent in 1995 to 49 percent in 2008. “The stall in the abortion rate coincides with a plateau in the level of contraceptive use, which had been increasing in prior years,” said Dr. Gilda Sedgh, lead author of the study and senior researcher at the Guttmacher Institute in New York. “Before the abortion rate stalled, it was declining, and contraceptive use was increasing. Also more abortions are unsafe because a growing proportion of abortions are taking place in the developing world.”
The WHO considers an abortion unsafe when a procedure for terminating pregnancy is performed by a person who is lacking the necessary skills or in an environment that does not conform to minimal medical standards. Scientists based the data on national surveys, official statistics, hospital records and research papers from across the globe.
Despite the decline in the overall abortion rate, the number of abortions increased, from 41.6 million in 2003 to 43.8 million in 2008 because of an increasing global population, according to the report. Over the past three decades, about 20 percent of all pregnancies around the world have ended in abortion, according to the research. Further almost all reported abortions were deemed safe in North America and Europe and nearly all abortions (97 percent) in Africa were considered unsafe in 2008. Nearly all abortions were performed under safe conditions in East Asia, but 65 percent were considered unsafe across south central Asia.
“What we clearly know is that making abortion less available does not make it performed less often,” said Dr. Lauren Streicher, assistant clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “It's just more unsafe. Condemning abortion is a cruel and failed strategy.” Even in the U.S., where abortion is currently legal, Streicher said access can be limited based on someone's insurance plan and where they live. “Fifty percent of undesired pregnancies are due to failed contraception,” said Streicher. “Of those unplanned pregnancies, 50 percent resolve in abortion, so the need for abortion is always going to be there. By criminalizing it, you're just increasing the amount of women who have poor and dangerous outcomes.”
Professor Beverly Winikoff, from Gynuity, a New York organization which pushes for access to safer abortion, wrote in the Lancet: "Unsafe abortion is one of the five major contributors to maternal mortality, causing one in every seven or eight maternal deaths in 2008. “Yet, when abortion is provided with proper medical techniques and care, the risk of death is negligible and nearly 14 times lower than that of childbirth. The data continue to confirm what we have known for decades - that women who wish to terminate unwanted pregnancies will seek abortion at any cost, even if it is illegal or involves risk to their own lives.”
Dr Richard Horton, the Lancet's editor, said, “These latest figures are deeply disturbing. The progress made in the 1990s is now in reverse. Condemning, stigmatizing and criminalizing abortion are cruel and failed strategies.”
While some countries have decreased their restrictions on abortion, others have increased barriers to safe abortion through more restrictive laws, unwillingness to train providers, increasing the cost of obtaining safe services and validating abortion stigmatization through perpetuation of cultural and societal norms, said Dr. Eva Lathrop, assistant professor of family planning, obstetrics and gynecology and global health at Emory University Schools of Medicine and Public Health.
Researchers add that family planning programs across the globe have not kept pace with the demand, which has continued to increase because of population growth and as more couple want smaller families. Experts said the key to keeping women safe requires an improvement in the availability of a full range of contraceptive methods to allow women to choose the method that is best for them.
Women are more vulnerable to dangerous infection or bleeding in these environments. The researchers found evidence that more women were using the drug misoprostol for medical abortions (as opposed to more invasive surgical abortions). Though it can certainly be safer, it can also be dangerous if given by nonmedical personnel who don’t know what they’re doing, the researchers warned. “Complications such as prolonged and heavy bleeding and incomplete abortions are associated with use of incorrect dosages,” they wrote. The researchers said they would have liked to examine data on the timing of abortions, since those performed early in pregnancy are generally safer. But information on gestational age was “scarce,” they wrote.
Very few countries have complete bans on abortions, but women and families are often unclear of those laws, so public health advocates and policymakers must provide more education that is readily available to women, health care providers and society as a whole.
“When women are dying from unsafe abortions, their families crumble,” said Lathrop. “The health of a society can be measured by the health of the women who are the backbone of that society, and when unsafe abortion rates are high, it is a general indication that the public health system is broken. Abortion is the single most important global public health issue, and the single most divisive, yet it needn't be. It is time that global leaders have an ethical and open conversation addressing access to abortion as a human right and make swift policy changes towards destigmatization and legalization of abortion.”
Kate Hawkins from the Sexuality and Development Programme at the Institute of Development Studies said, “Whether it is legal or illegal, women will seek abortions and obtain abortions. This study showed that in 2008, 86% of abortions took place in developing countries and that nearly half of all abortions worldwide were unsafe in 2008. That women continue to die in significant numbers because of unsafe abortion is a scandal and is an issue that the development sector should take seriously.”
The UK Department for International Development part-funded the study, and International Development Secretary Andrew Mitchell MP said it was a “tragedy” that the number of “back-street” abortions was rising. “Women should be able to decide for themselves whether, when and how many children to have - but for many this is not a reality as they have no access to family planning. Over the next four years, British aid will give 10 million women access to modern contraception, which will prevent millions of unintended pregnancies.”
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