The Roadmap to Safe Abortion Worldwide: Lessons from New Global Trends on Incidence, Legality and Safety
Although unsafe abortion remains a serious public health issue in many countries, access to safe abortion care is increasing in parts of the developing world where it was once available only to the most privileged. Reproductive rights are under attack, but this body of evidence provides a roadmap for policymakers to take concrete measures to protect the health, rights and lives of women worldwide. Much of this evidence has been synthesized in a study by the Guttmacher Institute on abortion around the world, which found substantial changes over time in abortion incidence, legality and safety.
Tracking Abortion Incidence and Safety
The Guttmacher report projects that the overall abortion rate declined slightly over the last 25 years. This global trend varied by development status: The rate in developing regions did not change, whereas the decline in developed regions was substantial. Specifically, an estimated 27 abortions per 1,000 women of reproductive age (aged 15–44) occurred each year in developed regions during 2010–2014, down from 46 per 1,000 during 1990–1994. By contrast, the rate in developing regions remained almost the same at 36–39 per 1,000 women.
The following table summarizes these shifting global trends:
| Region Development Status | Time Period | Abortion Rate (per 1,000 women) |
|---|---|---|
| Developed Regions | 1990–1994 | 46 |
| Developed Regions | 2010–2014 | 27 |
| Developing Regions | 2010–2014 | 36–39 |
The Role of Modern Contraceptives
Dramatically falling abortion rates in Eastern Europe largely drove the decreased abortion rate within developed regions. The underlying cause was a decline in unintended pregnancy due to increased access to and use of modern contraceptives in former Soviet Bloc states after they gained independence. The evidence is clear that the most effective way to reduce abortion rates is to prevent unintended pregnancies through modern contraceptives.
Public Health Impact of Unsafe Abortion
When it comes to abortion safety, the news is mixed. Globally, 56 million abortions occur each year and nearly half (25 million) are unsafe. Unsafe abortion is an important preventable cause of maternal death and disability, accounting for 8–11% of maternal mortality worldwide and claiming the lives of 22,800–31,000 women. Yet, abortion is becoming safer worldwide as a result of slow but important improvements made to abortion policies, programs and practices in a number of countries.
A Roadmap for Policymakers
These trends provide a roadmap for policymakers and health care providers to further reduce the incidence and impact of unsafe abortion. To achieve this, nations must focus on several critical objectives:
- Adopting clinical guidelines on comprehensive abortion care.
- Increasing access to postabortion care.
- Facilitating correct use of medication abortion in clandestine settings.
- Combatting stigma and reforming restrictive abortion laws.
- Investing in services to prevent unintended pregnancies and the often-unsafe abortions that may follow.
Obstacles to Progress
Previous gains related to sexual and reproductive health and rights—particularly those reducing the impact of unsafe abortion—are in jeopardy. The administration and social conservatives have engaged in broad-based attacks on reproductive rights globally, including the imposition of the global gag rule and defunding the United Nations Population Fund (UNFPA). At the heart of these attacks is an extreme animus toward abortion rights, and advocates for women’s health fear that these actions will roll back improvements in sexual and reproductive health services that were built over decades. This is especially true in developing regions where the limited progress to date is in jeopardy.