An estimated 42 million abortions occurred throughout the world in 2003, and although the vast majority were in developing countries, where abortion laws generally are restrictive and unsafe procedures common, overall abortion rates were similar in developed and developing countries—26 and 29 per 1,000 women of reproductive age, respectively. Nearly half of abortions were unsafe procedures, which occurred at a rate of 16 for every 1,000 women aged 15–44 in developing countries and two per 1,000 women in developed countries. These findings are part of the picture painted by the first comprehensive assessment of abortion worldwide since 1995.1
The researchers gathered data on safe abortions—“those that meet legal requirements in countries in which abortion is legally permitted under a broad range of criteria”—from official national reporting systems, nationally representative surveys and published reports. They examined the quality of the data and corrected for underreporting of abortions when the data appeared to be incomplete. To estimate the incidence of unsafe abortions—procedures performed “by people lacking the necessary skills or in an environment that does not conform to minimum medical standards”—they relied mainly on data from hospital records, surveys and published studies. United Nations population and birth estimates were used for the calculations of abortion rates and ratios.
Worldwide, 42 million abortions took place in 2003—29 for every 1,000 women of reproductive age. Both the number and the rate represent declines from 1995, when an estimated 46 million abortions occurred, yielding a rate of 35 per 1,000 women; the rate declined more sharply in developed than in developing regions. The great majority of abortions in 2003 (35 million) were in developing countries, but the overall rate differed little between developed and developing countries (26 and 29 per 1,000, respectively). At the regional level, greater variation in rates was evident. Rates were 28–31 per 1,000 in Africa, Asia, Europe, and Latin America and the Caribbean, but only 17–21 per 1,000 in Northern America and Oceania. Moreover, differences within regions were often dramatic. Whereas Northern, Southern and Western Europe had overall abortion rates of 12–18 per 1,000, Eastern Europe, which registered the greatest decline among developed areas, had a rate of 44 per 1,000 (the highest of any subregion). In Asia, rates ranged from 24 (in the western part of the region) to 39 (in the southeast).
Almost 20 million abortions in 2003 (nearly half of the worldwide total) were unsafe procedures, and 97% of these occurred in developing countries. Unsafe procedures made up more than half of all abortions in the developing world, but fewer than one in 10 in developed countries. Fourteen unsafe abortions occurred per 1,000 women worldwide—16 per 1,000 in developing countries and two per 1,000 in developed ones. In Africa and in Latin America and the Caribbean, where abortion laws are highly restrictive, 29 unsafe abortions occurred per 1,000 women; by contrast, rates were 11 per 1,000 in Asia and at most three per 1,000 in the remaining regions. Even within the regions with the highest overall levels of unsafe abortion, however, incidence varied. Rates ranged from 18 to 39 per 1,000 in Africa, from 16 to 33 in Latin America and the Caribbean, and from eight to 23 in Asia.
The 22 million safe abortions that occurred worldwide represented a rate of 15 per 1,000 women, or 24 and 13 per 1,000 in developed and developing countries, respectively. Rates of safe abortions per 1,000 women were 15 in Oceania, 18 in Asia, 21 in Northern America and 25 in Europe. In most of Europe, rates were below 20 per 1,000, but in the eastern part of the region, 39 safe abortions occurred per 1,000 women. Virtually no abortions in Africa or in Latin America are considered safe procedures.
For every 100 live births worldwide in 2003, an estimated 31 abortions occurred—16 safe and 15 unsafe procedures. This measure, the abortion ratio, varied widely among and within regions. It was as low as 17 in Africa (likely reflecting the region’s high fertility levels), but was about twice that in Asia, in Latin America and the Caribbean, and in Northern America; it reached 59 in Europe. Abortion ratios ranged from 14 to 24 per 100 live births in Africa, from 22 to 51 in Asia, from 26 to 42 in Latin America and the Caribbean, and from 23 to 105 (signifying that abortions outnumbered live births) in Europe.
In all, 20% of pregnancies ended in abortion in 2003, including 28% of those in the developed world and 19% of those in developing countries. The proportion was lowest (12%) in Africa and highest (32%) in Europe. Similarly, at the subregional level, it ranged from one in 10, in Middle Africa, to nearly half, in Eastern Europe.
The researchers observe that the safety of abortion largely reflects its legal status, but “unrestrictive abortion laws do not predict a high incidence of abortion, and…highly restrictive abortion laws are not associated with low abortion incidence.” Unsafe abortions may occur in countries with liberal laws, they suggest, because information or access to safe medical services is poor. And although some abortions in restrictive environments are performed safely, most are performed in settings that pose high risks to a woman’s health and well-being. Noting that unintended pregnancy is the “root cause” of abortion, the researchers point out that continued assessments of unintended pregnancy, abortion and consequences of unsafe abortion will “help establish where service improvements are most needed.”
1. Sedgh G et al., Induced abortion: estimated rates and trends worldwide, Lancet, 2007, 370(9595):1338–1345.