Updated April 20, 2022 to correct descriptions of the analysis, the Maputo Protocol and the Montevideo Consensus.

Key Points              

• A new study by the Guttmacher Institute and the World Health Organization (WHO) provides the first-ever comparable modeled estimates of unintended pregnancy and abortion rates for 150 countries and territories, including 87 for which there were previously no reliable estimates of these measures.
• These new estimates reveal disparities between countries within regions, which signals the need for targeted investments to achieve greater equity in sexual and reproductive health care.
• Country-level evidence on unintended pregnancy and abortion sets the foundation for programmatic and policy planning among both national governments and global and regional stakeholders, including informing key discussions on universal health coverage, the Sustainable Development Goals and more. 

Much progress has been made over the past 30 years to increase access to and use of contraception, leading to a global decline in unintended pregnancy rates. But despite global commitments such as the Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health, there are wide disparities in access to contraceptive and abortion care between countries. Strengthened commitment and targeted investment are urgently needed to ensure access to the full spectrum of quality comprehensive sexual and reproductive health care, particularly for vulnerable and marginalized groups.

New Country-Level Estimates of Unintended Pregnancy and Abortion

Globally, more than half of unintended pregnancies (61%) ended in abortion each year from 2015 to 2019. People seek and obtain abortions in all countries, even in those with restrictive abortion laws, where barriers to safe abortion care are high. In fact, over the past three decades, the proportion of unintended pregnancies that end in abortion has increased in countries that have many legal restrictions in place.

But at the country level, there remains little reliable evidence on abortion in many countries. A new study by the Guttmacher Institute, WHO and the United Nations Human Reproduction Programme offers country-level estimates of unintended pregnancy and abortion for 150 countries and territories for the first time, providing a more comprehensive picture of the sexual and reproductive health needs in those places. In particular, 87 countries included in the model did not previously have reliable studies on abortion incidence, making it more difficult for advocates to make the case for policies that would facilitate access to safe abortion and other essential sexual and reproductive health care.

The new estimates illustrate inequality in reproductive autonomy across countries more comprehensively, more accurately and with greater nuance than was possible previously. Prior studies with country-specific estimates provided evidence for single countries or compared estimates for selected groups of countries, but information was not always available for the same year, making comparisons difficult. These new estimates will allow national stakeholders—including governments, advocates and medical providers—to better understand their country’s context and develop more targeted interventions to address unmet needs for sexual and reproductive health care.

Disparities Between Countries Within the Same Region

The release of the first comparable estimates of unintended pregnancy and abortion for the majority of countries in the world provides a clearer picture of differences in sexual and reproductive health outcomes. While regional averages often inform regional and global health strategies, they can obscure disparities between countries.

These new estimates reveal substantial differences in annual unintended pregnancy rates between countries in the same region, for both high- and low-income regions. For example, while the unintended pregnancy rate for Sub-Saharan Africa overall was 91 per 1,000 women aged 15–49 for each year in the period 2015–2019, the rate ranged from 49 per 1,000 in Niger to 145 per 1,000 in Uganda. Sub-Saharan Africa was the region with the most countries whose rates differed greatly—either higher or lower—from the regional average, illustrating the importance of developing policies and programs that address the specific needs of every country.

Differences in abortion rates within regions are even more pronounced: In Eastern and Southeast Asia, rates ranged from five abortions per 1,000 women in Singapore to 64 per 1,000 in Vietnam. Overall, there was more variation in rates within regions than between them, highlighting once more the need for tailored approaches to address gaps in sexual and reproductive health care at the country level.

Policy Recommendations

Country-specific unintended pregnancy and abortion estimates demonstrate the need for targeted national investments to achieve greater equity in sexual and reproductive health care. Ensuring the integration of sexual and reproductive health interventions in universal health coverage is also essential to broaden access to care for the most vulnerable and marginalized communities. Advocacy for the Guttmacher-Lancet Commission’s comprehensive definition of sexual and reproductive health and rights helps to advance policies, services and programs that address the sexual and reproductive health needs of all individuals effectively and equitably. Recommendations for key stakeholders—national governments, multilateral agencies and donors, advocates and health care providers, and regional bodies—follow on these three main topic areas.

Prioritize targeted investment in sexual and reproductive health and rights

National governments

• Prioritize domestic funding to expand overall access to quality, affordable sexual and reproductive health services, particularly contraception and safe abortion, and provide specific budget allocations for targeted interventions.

Multilateral agencies and donors

• Protect and strengthen investments in sexual and reproductive health care and improve flexibility in funding to address countries’ emerging needs.

 

Integrate sexual and reproductive health interventions in universal health coverage

National governments

• Prioritize the inclusion of sexual and reproductive health care in plans, strategies and budgets for achieving universal health coverage, with a particular focus on ensuring access to care for marginalized and vulnerable people.
• Improve access to quality contraceptive services, by addressing multiple barriers to contraceptive use, providing a range of methods that meet women’s needs at different stages of their lives and in different personal circumstances, and offering mechanisms to allow them to switch methods when appropriate.
• Adopt and implement WHO standards (or equivalent national standards) on abortion and postabortion care, including task shifting to more types of health care workers to expand access to services.

Multilateral agencies and donors

• Include the essential package of sexual and reproductive health interventions as part of universal health coverage efforts at the global and regional levels.

Advocates and health care provider associations

• Advocate for access to a wider range of quality contraceptive methods and information and counseling, to help women learn more about the methods available to them and how to address side effects.
• Advocate for contraceptive counseling and services and integrate them into primary, antenatal, postnatal and postabortion care.
• Advocate for decriminalization and liberalization of abortion laws and full implementation of existing laws, to ensure that abortion care is included in public health services.
• Promote telehealth options for self-managed abortion and support task shifting to a broad range of health care workers to improve access to abortion care.

Regional bodies

• Support compliance with the legal abortion criteria in the African Union's Maputo Protocol and the adoption of the Montevideo Consensus' recommendations to prevent unsafe abortion in Latin America and the Caribbean.
• Facilitate the sharing of best practices, policies and tools with national governments.

Advocate for the Guttmacher-Lancet Commission’s comprehensive definition of sexual and reproductive health and rights

National governments

• Support changes in laws, policies and social norms that enable all people to fulfill their sexual and reproductive health needs and rights.
• In settings where abortion is legal, take steps to fully implement laws and policies, ensure that abortion care is affordable and accessible, and undertake education campaigns to raise awareness about the availability of services.
• In restrictive settings, improve access to permitted safe abortion care and provision of quality postabortion care.

Multilateral agencies and donors

• Adopt the comprehensive definition of sexual and reproductive health and rights, or key aspects of it, and prioritize an essential package of sexual and reproductive health interventions.

Advocates and health care provider associations

• Frame advocacy initiatives for specific interventions within the comprehensive definition of sexual and reproductive health and rights.