Abortion Worldwide: A Decade of Uneven Progress Guttmacher Institute © October 2009.

Abortion Worldwide:A Decade of Uneven Progress

Guttmacher Institute© October 2009

What’s new

• Trends in contraceptive use, unmet need for contraception and unintended pregnancy rates

• Changes in the legal status of abortion

• More comprehensive look at abortion and women’s lives

Most trends are positive

• Worldwide decline in abortion incidence

• Global rise in contraceptive use

• Decline in unintended pregnancy

• Liberalized abortion laws in a number of countries

• Growing access to abortion, even in legally restrictive countries

Abortion has declined worldwide

0

10

20

30

40

50

60

1995 2003 1995 2003 1995 2003

World More developed countries

Less developed countries

35

29 29

39

26

34

Abortions per 1,000 women aged 15–44

92

64

96

7886

49

72 67

0

20

40

60

80

100

Africa Asia* LatinAmerica &Caribbean

DevelopingWorld*

1995 2008

Unintended pregnancy rates are down in the developing world

*Excludes Eastern Asia

Unintended pregnancies per 1,000 women aged 15–44

Contraceptive use is on the rise

28

68

71

68

72

63

17

57

62

66

71

54

0 10 20 30 40 50 60 70 80

Africa

Asia

Latin America

Europe

North America

World

% of married women aged 15–49 practicing contraception

1990

2003

Safe abortion is more available

• 19 countries (including the Mexican Federal District) have liberalized their laws

• Availability of medication abortion has improved

• Use of manual vacuum aspiration has increased

But progress has been uneven

• Levels of unsafe abortion have not declined

• Unmet need for contraception remains high in some regions

• Many women lack access to safe abortion

• Abortion-related mortality and morbidity remain higher

• The poor bear the greatest burden

Unsafe abortion rates have not changed

0

10

20

30

40

50

60

1995 2003 1995 2003 1995 2003

Unsafe

Safe

World More developed countries

Less developed countries

35

29 29

39

26

34

Abortions per 1,000 women aged 15–44

40% of women worldwide live under highly restrictive abortion laws

6%

21%

10%

4%

38%

21%

None

Only to save woman's life

Also to protect a woman'sphysical health

Also to protect a woman'smental health

Also for socioeconomicgrounds

Without restriction as toreason

1.55 billion women aged 15–44, 2008

Legal Grounds

Unmet need for contraception is still high…

0% 20% 40% 60% 80% 100%

Unmet need

Met need

No need

1990–1995

2002–2007

1990–1995

1990–1995

2002–2007

2002–2007

Africa

Asia

Latin America & Caribbean

Married women aged 15–44

Leading to high rates of unintended pregnancy

66%14%

20%

Modern method

No methodTraditional

method

Unintended pregnancies in developing countries, by women’s contraceptive use

More than one-third of pregnancies in developing countries are unintended

19%

50% 16%

15%

Abortion

Unwanted ormistimed birth

Miscarriage

Wanted birth

All pregnancies in developing countries

Almost all unsafe abortions occur in the developing world

0 20 40 60

Less developedcountries

More developedcountries

World

Safe

Unsafe

Millions of abortions, 2003

42

7

35

Nearly all abortions in Africa and Latin America are unsafe

0

10

20

30

40

Africa Latin America &Caribbean

Asia

Unsafe

Safe

Abortions per 1,000 women aged 15–44

Four in 10 women having unsafe abortions experience complications requiring treatment

25%

15%60%

Complicationstreated

Complicationsnot treated

No complications

19.2 million unsafe abortions

In countries with restrictive abortion laws, providers of abortion are often untrained

Guatemala, 2003 Mexico, 2007 Pakistan, 2002 Uganda, 2003

Doctor, nurse or trained midwife Pharmacist

Misoprostol–any type of provider Traditional provider

Woman herself

% of women having abortions

100

80

60

0

40

20

Poor women are most likely to experience serious abortion complications

67

4246

55

38

28 3138

0

20

40

60

80

100

Guatemala, 2003 Mexico, 2007 Pakistan, 2002 Uganda, 2003

PoorNonpoor

Of women having abortions, % experiencing serious complications

Health consequences are often severe and long-term

• Kenya: 28% of abortion complications among women seeking treatment were severe

• Nigeria: Among hospitalized patients:

– 1 in 3 had hemorrhage

– 1 in 4 had sepsis

– 1 in 10 suffered other injuries

• Second trimester abortion greatly increases risk

• Many women experience long-term consequences

Costs of unsafe abortion to women, their families and society are large

• Postabortion care costs Africa and Latin America nearly $300 million annually

• An estimated 220,000 children are left motherless every year from abortion-related deaths

• Loss of productivity affects household functioning

Unsafe abortion accounts for one in eight maternal deaths

0

150

300

450

600

750

900

World Lessdeveloped

Moredeveloped

Africa Asia LAC

Unsafe abortion

All other pregnancy-related causes

Maternal deaths per 100,000 live births

Safe abortion saves lives: South Africa

• Between 1994 and 2000, severity of abortion- related complications dropped:

– Fewer postabortion infections

– Largest gains by young women

• Deaths due to unsafe abortion declined by at least 50%

Preventing unintended pregnancy is cost-effective

• Estimated $19 million spent annually in treating unsafe abortion complications in Nigeria

• It would cost only $4.8 million to provide the contraceptive services needed to prevent the pregnancies resulting in these abortions

• This is a cost-benefit ratio of about 4:1

Increased contraceptive use leads to fewer abortions

The worldwide decline in abortion over the past decade has been accompanied by:

– A worldwide decline in unintended pregnancy

– A global increase in the proportion of women using contraception

Key interventions to reduce unsafe abortion and its consequences

• Expand access to modern contraceptives and improve family planning services

• Expand access to legal abortion and ensure that safe services are available to women in need

• Improve the quality and coverage of postabortion care, which would reduce maternal death and disability due to unsafe abortion

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