Advancing Sexual and Reproductive Health and Rights
 
In Brief: Fact Sheet

Facts on Induced Abortion Worldwide

WORLDWIDE INCIDENCE AND TRENDS

• After declining substantially between 1995 and 2003, the worldwide abortion rate stalled between 2003 and 2008. [1]

• Between 1995 and 2003, the abortion rate (the number of abortions per 1,000 women of childbearing age—i.e., those aged 15–44) for the world overall dropped from 35 to 29. It remained virtually unchanged, at 28, in 2008. [1]

• Nearly half of all abortions worldwide are unsafe, and nearly all unsafe abortions (98%) occur in developing countries. In developing world, 56% of all abortions are unsafe, compared with just 6% in developed regions. [1]

• The proportion of abortions worldwide that take place in developing regions increased between 1995 and 2008 from 78% to 86%, in part because the proportion of all women who live in developing countries increased during this period. [1]

• Since 2003, the number of abortions fell by 600,000 in the developed world but increased by 2.8 million in developing regions. In 2008, six million abortions were performed in developed countries and 38 million in developing countries, a disparity that largely reflects population distribution. [1]

• A woman’s likelihood of having an abortion is slightly elevated if she lives in a developing region. In 2008, there were 29 abortions per 1,000 women aged 15–44 years in developing countries, compared with 24 in developed regions. [1]


REGIONAL INCIDENCE AND TRENDS

• The overall abortion rate in Africa, where the vast majority of abortions are illegal and unsafe, showed no decline between 2003 and 2008, holding at 29 abortions per 1,000 women of childbearing age. [1]

• The Southern Africa subregion, dominated by South Africa, where abortion was legalized in 1997, has the lowest abortion rate of all African subregions, at 15 per 1,000 women in 2008. East Africa has the highest rate, at 38, followed by Middle Africa at 36, West Africa at 28 and North Africa at 18. [1]

• Both the lowest and highest subregional abortion rates are in Europe, where abortion is generally legal under broad grounds. In Western Europe, the rate is 12 per 1,000 women, while in Eastern Europe it is 43. [1] The discrepancy in rates between the two regions reflects relatively low contraceptive use in Eastern Europe, as well as a high degree of reliance on methods with relatively high user failure rates, such as the condom, withdrawal and the rhythm method.

• In Europe, 30% of pregnancies end in abortion. A higher proportion of pregnancies end in abortion in Eastern Europe than in the rest of the region. [1]

• In Eastern Europe, the abortion rate held steady at 43 per 1,000 women between 2003 and 2008, after a period of steep decline between the mid-90s and the early 2000s. [1]

• Western Europe, Southern Africa and Northern Europe have the lowest abortion rates in the world, at 12, 15 and 17, respectively. [1]

• The abortion rate fell in Latin America from 37 to 31 abortions per 1,000 women between 1995 and 2003; it has held fairly steady since, reaching 32 in 2008. [1]

• In Latin America, subregional abortion rates range from 29 in Central America (the subregion that includes Mexico) to 32 in South America and 39 in the Caribbean. The Caribbean (the subregion that includes Cuba, where abortions are generally safe) has the lowest proportion of abortions in the region that are unsafe (46%), compared with nearly 100% in Central and South America. [1]

• In Asia, abortion rates across subregions held steady between 2003 and 2008, ranging from 26 per 1,000 in South Central Asia and Western Asia to 36 per 1,000 in Southeastern Asia. [1]

• Abortion incidence appears to have risen in China since 2003, after an extended period of decline. Evidence shows that this is due to an increase in premarital sexual activity and disruptions in access to contraceptive services resulting from rapid urbanization.

ABORTION LAW

• Highly restrictive abortion laws are not associated with lower abortion rates. For example, the abortion rate is 29 per 1,000 women of childbearing age in Africa and 32 per 1,000 in Latin America—regions in which abortion is illegal under most circumstances in the majority of countries. The rate is 12 per 1,000 in Western Europe, where abortion is generally permitted on broad grounds. [1]

• Where abortion is permitted on broad legal grounds, it is generally safe, and where it is highly restricted, it is typically unsafe. In developing countries, relatively liberal abortion laws are associated with fewer negative health consequences from unsafe abortion than are highly restrictive laws. [2] [3]

• In South Africa, the annual number of abortion-related deaths fell by 91 % after the liberalization of the abortion law. [2]

• In Nepal, where abortion was made legal on broad grounds in 2002, it appears that abortion-related complications are on the decline: A recent study in eight districts found that abortion-related complications accounted for 54% of all facility-treated maternal illnesses in 1998, but for only 28% in 2008–2009. [3]

• Between 2008 and 2015, the grounds on which abortion may be legally performed were broadened in 12 countries: Fiji, Hong Kong, Indonesia, Kenya, Lesotho, Luxembourg, Mauritius, Monaco, Rwanda, Somalia, Spain and Uruguay. [4]

UNSAFE ABORTION

• The World Health Organization defines unsafe abortion as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.

• Between 1995 and 2008, the rate of unsafe abortion worldwide remained essentially unchanged, at 14 abortions per 1,000 women aged 15–44. [1]

• During the same period, the proportion of all abortions that were unsafe increased from 44% to 49%. [1]

• In 2008, more than 97% of abortions in Africa were unsafe. Southern Africa is the subregion with the lowest proportion of unsafe abortions (58%). [1] Close to 90% of women in the subregion live in South Africa, where abortion was liberalized in 1997.

• In Latin America, 95% of abortions were unsafe, a proportion that did not change between 1995 and 2008. Nearly all safe abortions occurred in the Caribbean, primarily in Cuba and several other countries where the law is liberal and safe abortions are accessible. [1]

• In Asia, the proportion of abortions that are unsafe varies widely by subregion, from virtually none in Eastern Asia to 65% in South Central Asia. [1]

• In Western Asia, the proportion of abortions that are unsafe increased from 34% to 60% between 2003 and 2008. [1]This increase is likely due to improved measurement of unsafe abortions and to a steady decline in abortions (partly due to the increasingly widespread use of effective contraceptives) in countries where abortion is legal and safe.

• Worldwide, medication abortion (a technique using a combination of the drugs mifespristone and misoprostol, or misoprostol alone) has become more common in both legal and clandestine procedures. [5]

CONSEQUENCES OF UNSAFE ABORTION

• Different approaches have been used to estimate mortality from induced abortion. The most recent evidence indicates that the proportion of maternal deaths due to unsafe abortion ranges from 8% to 18%, and the number of abortion-related deaths in 2014 ranged from 22,500 to 44,000. [6-8]

• The severity of complications from induced abortion may have declined in recent years. This is likely due to a number of reasons, including increased access to medication abortion, expansion of programs to train providers in manual vacuum aspiration and development of health care systems in general. But evidence on the impacts of such changes is incomplete.

• In the United States, legal induced abortion results in 0.6 deaths per 100,000 procedures. Worldwide, unsafe abortion accounts for a death rate that is 350 times higher (220 per 100,000), and, in Sub-Saharan Africa, the rate is 800 times higher, at 460 per 100,000. [9]

• Almost all abortion-related deaths occur in developing countries, with the highest number occurring in Africa.

• Unsafe abortion is a significant cause of ill-health among women in developing regions. Estimates for 2012 indicate that 6.9 million women in these regions were treated for complications from unsafe abortions, at a rate of 6.9 women treated per 1,000 women aged 15–44. [10]

• Treating medical complications from unsafe abortion places a significant financial burden on public health care systems in developing regions. According to estimates for 2014, the annual estimated cost of providing postabortion care in developing countries as a whole is $232 million, and treatment for all those needing postabortion care would cost $562 million.[8]

• In developing countries, poor women have the least access to family planning services and the fewest resources to pay for safe abortion procedures; they are also the most likely to experience complications related to unsafe abortion.

• Unsafe abortion has significant negative consequences beyond its immediate effects on women’s health. For example, complications from unsafe abortion may reduce women’s productivity, increasing the economic burden on poor families; cause maternal deaths that leave children motherless; cause long-term health problems, such as infertility; and result in considerable costs to already struggling public health systems.

UNINTENDED PREGNANCY: THE ROOT OF ABORTION

• The uptake of modern contraceptive methods worldwide has slowed in recent years, from an increase of 0.6 percentage points per year in 1990–1999 to an increase of only 0.1 percentage points per year in 2000–2009. In Africa, the annual increase in modern contraceptive use fell from 0.8 percentage points in 1990–1999 to 0.2 percentage points in 2000–2009. [11]

• An estimated 225 million women in developing regions have an unmet need for modern contraceptives, meaning they want to avoid a pregnancy but are using a low-efficacy traditional family planning method or no method. [8]

• Some 81% of unintended pregnancies in developing countries occur among women who have an unmet need for modern contraception. [8]

• In developing regions, women’s reasons for not using contraceptives most commonly include concerns about possible side-effects, the belief that they are not at risk of getting pregnant, poor access to family planning, and their partners’ opposition to contraception. [12]

• Reducing unmet need for modern contraception is an effective way to prevent unintended pregnancies, abortions and unplanned births.


Most data in this fact sheet are from Sedgh G et al., Induced abortion: incidence and trends worldwide from 1995 to 2008, The Lancet, 2012, 379(9816):625–632 and the World Health Organization. Additional resources can be found in the fully annotated version (in English) available at http://www.guttmacher.org/pubs/fb_IAW.html and www.who.int/topics/reproductive_health/en/.

References

1. Sedgh G et al., Induced abortion: incidence and trends worldwide from 1995 to 2008, The Lancet, 2012, 379(9816):625–632.

2. Jewkes R and Rees H, Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act, South African Medical Journal, 2005, 95[4]:250.

3. Pradhan A et al., Nepal Maternal Mortality and Morbidity Study 2008/2009: Summary of Preliminary Findings, Kathmandu, Nepal: Family Health Division, Department of Health Services, Ministry of Health, 2009.

4. Center for Reproductive Rights (CRR), The World’s Abortion Laws 2015, New York: CRR, 2015.

5. World Health Organization (WHO), Safe Abortion: Technical and Policy Guidance for Health Systems, Geneva: WHO, 2012.

6. Kassebaum NJ et al., Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013, The Lancet, 2014, 384(9947):980–1004.

7. Say L et al., Global causes of maternal death: a WHO systematic analysis, Lancet Global Health, 2014, doi:10.1016/S2214-109X(14)70227-X.

8. Singh S et al., Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014, New York: Guttmacher Institute, 2014.

9. WHO, Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: WHO, 2011.

10. Singh S et al., Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries, BJOG, 2015, doi:10.1111/1471-0528.13552.

11. Department of Economic and Social Affairs, United Nations Population Division, World contraceptive use 2010, 2011, http://www.un.org/esa/population/publications/wcu2010/WCP_2010/Data.html.

12. Sedgh G and Hussain R, Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries, Studies in Family Planning, 2014, 45(2):151–169.