After a period of substantial decline, the global abortion rate has stalled, according to new research from the Guttmacher Institute and the World Health Organization (WHO). Between 1995 and 2003, the overall number of abortions per 1,000 women of childbearing age (15–44 years) dropped from 35 to 29; according to the new study, the global abortion rate in 2008 was virtually unchanged, at 28 per 1,000. This plateau coincides with a slowdown, documented by the United Nations, in contraceptive uptake, which has been especially marked in developing countries. The researchers also found that nearly half of all abortions worldwide are unsafe, and almost all unsafe abortions occur in the developing world. The study, Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008, by Gilda Sedgh et al., was published online today by The Lancet.
In the developing world, the abortion rate was 29 per 1,000 in both 2003 and 2008, after falling from 34 per 1,000 between 1995 and 2003. The situation was somewhat different in the developed world, excluding Eastern Europe, where the abortion rate was much lower, at 17 per 1,000 in 2008, having declined slightly from a rate of 20 in 1995.
“The declining abortion trend we had seen globally has stalled, and we are also seeing a growing proportion of abortions occurring in developing countries, where the procedure is often clandestine and unsafe. This is cause for concern,” says Gilda Sedgh , lead author of the study and a senior researcher at the Guttmacher Institute. “This plateau coincides with a slowdown in contraceptive uptake. Without greater investment in quality family planning services, we can expect this trend to persist.”
Research from WHO shows that complications due to unsafe abortion continued to account for an estimated 13% of all maternal deaths worldwide in 2008; almost all of these deaths occurred in developing countries. Globally, unsafe abortion accounted for 220 deaths per 100,000 procedures in 2008, 350 times the rate associated with legal induced abortions in the United States (0.6 per 100,000). Unsafe abortion is also a significant cause of ill-health: Each year approximately 8.5 million women in developing countries experience abortion complications serious enough to require medical attention, and three million of them do not receive the needed care.
“Deaths and disability related to unsafe abortion are entirely preventable, and some progress has been made in developing regions. Africa is the exception, accounting for 17% of the developing world's population of women of childbearing age but half of all unsafe abortion–related deaths," notes Iqbal H. Shah, of the WHO and a coauthor of the study. “Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to postabortion care, when they need treatment for complications.”
The findings provide further evidence that restrictive abortion laws are not associated with lower rates of abortion. For example, the 2008 abortion rate was 29 per 1,000 women of childbearing age in Africa and 32 per 1,000 in Latin America, regions where abortion is highly restricted in almost all countries. In contrast, in Western Europe, where abortion is generally permitted on broad grounds, the rate is 12.
The Southern Africa subregion, where close to 90% of women live under South Africa’s liberal abortion law, has the lowest abortion rate in Africa, at 15 per 1,000 women. Other very low subregional rates are found in Western Europe (12) and Northern Europe (17), where both abortion and contraception are widely available either for free or at very low cost.
Eastern Europe presents a very different situation, with an abortion rate that is nearly four times that of Western Europe. This discrepancy corresponds with Eastern Europe’s relatively low levels of modern contraceptive use and low prevalence of highly effective methods such as the pill and the IUD. After a striking decline in the abortion rate between 1995 and 2003, from 90 to 44 per 1,000 women, Eastern Europe experienced virtually no change in the rate between 2003 and 2008.
"These latest figures are deeply disturbing. The progress made in the 1990s is now in reverse. Promoting and implementing policies to reduce the number of abortions is now an urgent priority for all countries and for global health agencies, such as WHO,” says Richard Horton, editor of The Lancet. “Condemning, stigmatizing, and criminalizing abortion are cruel and failed strategies. It's time for a public health approach that emphasizes reducing harm - and that means more liberal abortion laws."
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