A New Tool to Support Global Safe Abortion Advocacy

Access to safe abortion care is an essential component of comprehensive sexual and reproductive health and rights (SRHR). Ensuring this access globally is vital to protecting the health, lives and well-being of millions of people, eliminating preventable maternal mortality and morbidity, and upholding the reproductive autonomy of individuals to make decisions about their own bodies, fertility and future. Abortion care is proven to be extremely safe and effective, yet it remains prohibited or restricted in many countries and severely underfunded, despite being clearly documented as a cost-effective health intervention. New data from the Guttmacher Institute illustrate how improved provision of safe abortion care can effectively reduce health system costs.

Introducing the Safe Abortion Calculator

Guttmacher’s new Safe Abortion Calculator is a tool to help advocates, policymakers and program implementers better visualize the health and economic impacts of expanding access to safe abortion care within the health system and provide easily accessible evidence to support their advocacy and decision-making. Drawing from Guttmacher’s Adding It Up 2024 research, the Safe Abortion Calculator generates estimates of the health impacts and cost implications of providing and expanding safe abortion access across 117 low- and middle-income countries (LMICs).

At a time when global SRHR funding streams face enormous cutbacks, the Safe Abortion Calculator provides evidence showcasing that funding safe abortion care is a high-value investment for national health systems that is compatible with constrained funds. Investing in safe abortion care is an efficient use of health system resources that will reduce costs and improve health outcomes.

Preventing Unsafe Abortion Remains a Global Imperative

Under the 1994 International Conference on Population and Development’s Programme of Action, national governments committed to addressing the severe impacts of unsafe abortion as a major public health concern. The Programme of Action further established that access to quality services and treatment for complications arising from abortion was essential to addressing preventable maternal mortality and morbidity. Thirty years later, Guttmacher’s latest estimates still show a high prevalence of unsafe abortions across all LMICs. Out of the 57 million pregnancies that ended in abortion across 128 LMICs in 2024, more than half were unsafe, resulting in millions of women^* requiring postabortion care for complications arising from unsafe procedures.

Those wishing to end their pregnancy may resort to unsafe abortion methods when faced with barriers to accessing care that is safe, legal, timely, geographically reachable, affordable, respectful, non-discriminatory and free from stigmatization. Evidence further shows that women in marginalized situations—such as those living in poverty, in humanitarian settings, with disabilities or in rural areas—risk the most by having an unsafe abortion, as they have few options for access to treatment if needed for complications resulting from an unsafe abortion. These barriers are often the result of deliberate political choices and intersecting forms of discrimination, which disproportionately affect those from low-income backgrounds, and are incompatible with governments’ human rights obligations.

In settings where the need for safe abortion care is not met, the costs of providing postabortion care to treat otherwise avoidable complications can be a tremendous burden for health systems. Across LMICs, when women are unable to access safe abortion care, health systems incur millions of dollars in costs to treat postabortion cases that result from denying women access to safe abortion services. In this context, investing fully in safe abortion care would lower these costs for health systems and free up resources that could be directed to meeting other needs.

Defending the Right to Safe Abortion Care

Ensuring access to safe abortion care is fundamentally a public health and human rights priority. Governments have a responsibility to protect women’s rights to health, bodily autonomy and dignity. Safe abortion care is recognized as an essential health care service, and there is no medical reason why any abortion should be unsafe. The current 2025 WHO abortion care guidelines also make clear that an abortion can be safely self-managed outside of a health care facility with medication, provided an individual has access to accurate information, quality medicines and support from a trained health worker, if wanted or needed. The Safe Abortion Calculator defines all safe abortion care as including access to accurate information, counseling and services provided within the formal health care system. Although the calculator does not currently include self-management of medication abortion in its estimates of safe abortion care (as sufficient data are not available to quantify its use at the population level), it is essential that people self-managing an abortion have access to these services if they want or need them.

Realizing the right to safe abortion care requires that abortion not only be guaranteed by law, but also that broader policy and health systems create an environment that allows everyone who needs quality safe abortion care to access it in practice. In recognition of the essential linkages among safe abortion, social justice and gender equality, SRHR advocates have undertaken enormous efforts to enshrine safe abortion care in broader international, regional and national policy frameworks focused on health, human rights and sustainable development.^† The Safe Abortion Calculator can support those fighting to ensure safe abortion access for all, including civil society organizations, feminist movements, health advocates and allied policymakers.

A Tool for Advocates: Putting the Safe Abortion Calculator to Use

To secure a future where access to safe abortion care is a reality for all who need it, it is critical to continue building a global safe abortion advocacy toolbox that is responsive to key audiences, including financial decision-makers and budget implementers. By providing evidence that the integration of safe abortion care into public health systems dramatically reduces complications and lessens the strain on resources, the Safe Abortion Calculator supports advocates and policymakers in making the investment case for safe abortion services.

The 117 countries featured in the Safe Abortion Calculator represent a broad and diverse range of legal, social and policy contexts for abortion access and provision, spanning from least to most restrictive. The calculator can be used to support different advocacy efforts geared toward integrating or expanding access to safe abortion care, including:

• Highlighting to stakeholders within finance ministries and budget decision-makers that cuts to SRHR funding and a lack of investment in safe abortion care lead to higher financial costs to national health systems, in addition to devastating costs for women, their families and broader communities.
• Making the case for safe abortion services to be integrated into universal health coverage plans.
• Strengthening the provision of safe abortion care in humanitarian settings and recognizing safe abortion services as an essential component of humanitarian service packages that is critical to reducing maternal mortality.
• Supporting messaging on the financial benefits to be gained through proposed bills and policies that seek to expand safe abortion care.
• Upholding government accountability by highlighting the costs of failing to ensure widespread access to safe abortion care in contexts where there are legal grounds for abortion, but barriers to access remain.

Expanding Safe Abortion Care in a Time of Resource Scarcity

Restricting access to safe abortion care produces grave, but avoidable, consequences that place the health of individuals in danger, increase maternal deaths and harm communities. Providing safe abortion care is vital to population health and well-being, yet investments in safe abortion services are facing acute and more severe threats of cuts amid shrinking global health funding and austerity measures. There is a long and harmful history of essential SRHR interventions, such as safe abortion care, being neglected by traditional health and development policies. As severe global health funding shortfalls jeopardize national budgets and governments face increasing pressures to prioritize certain health interventions over others, there is a heightened risk of the progress that was achieved thus far being reversed or lost altogether.

Global feminist and SRHR movements have faced these challenges before and know the evidence is unambiguous: Providing safe abortion care is considerably less costly than treating the complications of unsafe abortion. And yet, recent global budget cuts have resurfaced calls for “pragmatic” approaches to development funding and budget prioritization; these range from the prioritization of aid based on economic or strategic interests to the complete weaponization of foreign aid to drive an agenda that explicitly restricts health care, bodily autonomy and equity for all. In this current environment of shrinking global solidarity, the Safe Abortion Calculator makes cost and health benefit data available to advocates and policymakers to illustrate that the only pragmatic approach to global health and development funding must be one that centers reproductive rights and bodily autonomy.