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. This shift is part of a larger context where researchers and health care practitioners have continued to compile evidence about the most effective means to decrease the impact of unsafe abortion globally and the obstacles to implementing these measures.
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. Dramatically falling abortion rates in Eastern Europe largely drove the decreased abortion rate within developed regions. Not surprisingly, the underlying cause was a decline in unintended pregnancy due to increased access to and use of modern contraceptives.
| Region Type | Rate in 1990–1994 (per 1,000 women) | Rate in 2010–2014 (per 1,000 women) |
|---|---|---|
| Developed Regions | 46 | 27 |
| Developing Regions | 36–39 | 36–39 |
The 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 annually. Unsafe abortions are almost exclusively concentrated (97%) in developing countries.
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. Yet, millions of women living in developing countries where abortion is highly restricted continue to experience the widespread and dangerous consequences of unsafe abortion.
A Roadmap for Policymakers
The evidence is clear that the most effective way to reduce abortion rates is to prevent unintended pregnancies through modern contraceptives. These trends provide a roadmap for policymakers and health care providers to further reduce the incidence and impact of unsafe abortion by:
- 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.
Challenges and Global Risks
Previous gains related to sexual and reproductive health and rights—particularly those reducing the impact of unsafe abortion—are in jeopardy. In the international sphere, the administration has imposed and expanded the global gag rule and defunded the United Nations Population Fund (UNFPA). Advocates for women’s health fear that these attacks will roll back improvements in sexual and reproductive health services that were built over decades. This is especially true in developing regions where unsafe abortion is a serious public health issue and the limited progress to date is in jeopardy.