GLOBAL INCIDENCE AND TRENDS
• During 2010–2014, an estimated 56 million induced abortions occurred each year worldwide. This number represents an increase from 50 million annually during 1990–1994, mainly because of population growth.
• The global annual rate of abortion, estimated at 35 abortions per 1,000 women of childbearing age (i.e., those 15–44 years old) in 2010–2014, has declined slightly, from 40 per 1,000 in 1990–1994.
• Women in developing regions have a higher likelihood of having an abortion than their counterparts in developed regions: The abortion rates are 36 per 1,000 women and 27 per 1,000, respectively.
• Between 1990–1994 and 2010–2014, the abortion rate declined markedly in developed regions, from 46 to 27 per 1,000. In contrast, it remained roughly the same in developing regions.
• The annual number of abortions fell in developed regions, from about 12 million to seven million during this period, whereas it increased in developing regions from 38 million to 49 million as the reproductive-age population grew at a similar pace. The proportion of abortions worldwide occurring in developing regions rose from 76% to 88%.
• Globally, 25% of pregnancies ended in abortion in 2010–2014. In developed countries, the proportion declined from 39% to 27% between 1990–1994 and 2010–2014, whereas it increased from 21% to 24% in developing countries.
REGIONAL INCIDENCE AND TRENDS
• The highest annual rate of abortion in 2010–2014 was in the Caribbean, estimated at 59 per 1,000 women of childbearing age, followed by South America, at 48. The lowest rates were in Northern America, at 17, and Western and Northern Europe—at 16 and 18, respectively.
• Across regions, Eastern Europe experienced the largest decline in the abortion rate, from 88 in 1990–1994 to 42 in 2010–2014. Despite this decline, there is a persistent gap in rates between Eastern and Western Europe (42 vs. 16) likely reflecting lower use of effective, modern contraceptive methods in Eastern Europe.
• The overall abortion rate in Africa was 34 per 1,000 women in 2010–2014. Subregional rates ranged from 31 in Western Africa to 38 in Northern Africa. There has been little if any change in abortion rates in these subregions since 1990–1994.
• For Latin America, subregional abortion rates range from 33 in Central America to 48 in South America. Rates have increased slightly since 1990–1994, but not by statistically significant amounts.
• Abortion rates in Asia have also fallen since 1990–1994, although not significantly. Asia’s subregions all have rates close to the regional average of 36 per 1,000 women.
• Highly restrictive abortion laws are not associated with lower abortion rates. When countries are grouped according to the grounds under which the procedure is legal, the rate is 37 abortions per 1,000 women of childbearing age where it is prohibited altogether or allowed only to save a woman’s life, compared with 34 per 1,000 where it is available on request, a nonsignificant difference.
• High levels of unmet need for contraception help explain the prevalence of abortion in countries with restrictive abortion laws.
ABORTIONS BY MARITAL STATUS
• The estimated global abortion rate in 2010–2014 was 35 per 1,000 for married women and 26 per 1,000 for unmarried women. The former seem to have comparatively higher abortion rates in all subregions except Western Africa and Northern America, where the reverse appears to be true.
• In the developed world, the abortion rate declined more among married women than among unmarried women between 1990–1994 and 2010–2014.
• Globally, as of 2010–2014, more than one-quarter of abortions—29% or 15 million in absolute terms—occurred among unmarried women. On average, unmarried women are younger than their married counterparts, and in many settings, young women are disadvantaged with respect to their ability to access contraception and safe abortion.
UNSAFE ABORTION AND ITS CONSEQUENCES
• Although induced abortion is medically safe when done in accordance with recommended guidelines, many women undergo unsafe procedures that put their well-being at risk.
• Evidence from the United States has shown that the death rate for women obtaining legally induced abortions is 0.7 per 100,000 procedures overall and 0.1 per 100,000 procedures at or before eight weeks of pregnancy.1
• Complications from unsafe abortions are common in developing regions, where the procedure is often highly restricted. Estimates for 2012 indicate that 6.9 million women in these regions were treated for complications from unsafe abortions, corresponding to a rate of 6.9 women treated per 1,000 women aged 15–44.2 Furthermore, most recent estimates suggest that some 40% of women who experience complications never receive treatment.
• Treating medical complications from unsafe abortion places a considerable financial burden on public health care systems and on women and families in developing regions. According to estimates for 2014, the annual cost of providing postabortion care in developing countries was US$232 million. If all those who needed treatment received it, the cost would be US$562 million.3
• Almost all abortion-related deaths occur in developing countries, with the highest number occurring in Africa. Recent studies estimate that 8–18% of maternal deaths worldwide are due to unsafe abortion, and the number of abortion-related deaths in 2014 ranged from 22,500 to 44,000.3–5
IMPACT OF UNINTENDED PREGNANCY
• An estimated 214 million women in developing regions have an unmet need for modern contraceptives. That is, they want to avoid a pregnancy but are either not using contraception or are using traditional methods, which can have high failure rates.3
• Most women undergoing abortion do so because they became pregnant when they did not intend to, and 84% of unintended pregnancies in developing countries occur among women who have an unmet need for modern contraception. Thus, meeting the unmet need for contraception is an important strategy for reducing unintended pregnancies, abortions and unplanned births.3
• Abortions also are obtained by women who use contraception. Although nearly all contraceptive methods will sometimes fail, some women may need more effective methods, ones better suited to their circumstances, and information and counseling to help them use their methods more effectively and consistently.
1. Bartlett LA et al., Risk factors for legal induced abortion-related mortality in the United States, Obstetrics & Gynecology, 2004, 103(4):729–737.
2. Singh S and Maddow-Zimet I, 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.
3. Singh S, Darroch JE and Ashford LS, Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014, New York: Guttmacher Institute, 2014.
4. 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, Lancet, 2014, 384(9947):980–1004.
5. Say L et al., Global causes of maternal death: a WHO systematic analysis, Lancet Global Health, 2014, 2(6):e323–e333.
Unless otherwise indicated data in this fact sheet are from Sedgh G et al., Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends, Lancet, 2016, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30380-4/abstract.
The study on which this fact sheet is based was made possible by grants from the Dutch Ministry of Foreign Affairs, the UK Government and the Norwegian Agency for Development Cooperation. The findings and conclusions contained within do not necessarily reflect the positions and policies of the donors.