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The Lancet Global Health
July 2020

Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019

Jonathan Bearak,Guttmacher Institute
Anna Popinchalk,Guttmacher Institute
Bela Ganatra,World Health Organization
Ann-Beth Moller,World Health Organization
Özge Tunçalp,World Health Organization
Cynthia Beavin,Guttmacher Institute
Lorraine Kwok
Leontine Alkema,University of Massachusetts, Amherst
The time is now. Will you stand up for reproductive health and rights?
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First published online: July 21, 2020 DOI: https://doi.org/10.1016/S2214-109X(20)30315-6

Background
Unintended pregnancy and abortion estimates document trends in sexual and reproductive health and autonomy. These estimates inform and motivate investment in global health programmes and policies. Variability in the availability and reliability of data poses challenges for measuring and monitoring trends in unintended pregnancy and abortion. We developed a new statistical model that jointly estimated unintended pregnancy and abortion that aimed to better inform efforts towards global equity in sexual and reproductive health and rights.

Methods
We developed a model that simultaneously estimated incidence of unintended pregnancy and abortion within a Bayesian framework. Data on pregnancy intentions and abortion were compiled from country-based surveys, official statistics, and published studies found through a literature search, and we obtained data on livebirths from the World Population Prospects. We analysed results by World Bank income groups, Sustainable Development Goal regional groupings, and the legal status of abortion.

Findings
In 2015–19, there were 121.0 million unintended pregnancies annually (80% uncertainty interval [UI] 112.8–131.5), corresponding to a global rate of 64 unintended pregnancies (UI 60–70) per 1000 women aged 15–49 years. 61% (58–63) of unintended pregnancies ended in abortion (totalling 73.3 million abortions annually [66.7–82.0]), corresponding to a global abortion rate of 39 abortions (36–44) per 1000 women aged 15–49 years. Using World Bank income groups, we found an inverse relationship between unintended pregnancy and income, whereas abortion rates varied non-monotonically across groups. In countries where abortion was restricted, the proportion of unintended pregnancies ending in abortion had increased compared with the proportion for 1990–94, and the unintended pregnancy rates were higher than in countries where abortion was broadly legal.

Interpretation
Between 1990–94 and 2015–19, the global unintended pregnancy rate has declined, whereas the proportion of unintended pregnancies ending in abortion has increased. As a result, the global average abortion rate in 2015–19 was roughly equal to the estimates for 1990–94. Our findings suggest that people in high-income countries have better access to sexual and reproductive health care than those in low-income countries. Our findings indicate that individuals seek abortion even in settings where it is restricted. These findings emphasise the importance of ensuring access to the full spectrum of sexual and reproductive health services, including contraception and abortion care, and for additional investment towards equity in health-care services.

Full article available in The Lancet Global Health
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New Estimates Show Worldwide Decrease in Unintended Pregnancies

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Unintended Pregnancy and Abortion Worldwide

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The percentage of unintended pregnancies ending in abortion has increased in countries where abortion is restricted

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Abortion occurs worldwide where it is broadly legal and where it is restricted

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Unintended pregnancy and abortion vary across country income groups

Resource

Guttmacher Data Center

Topic

Global

  • Abortion: Legality and Safety
  • Pregnancy

Geography

  • Global
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