The Roadmap to Safe Abortion Worldwide: 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. Much of this evidence has been synthesized in a new study by the Guttmacher Institute on abortion around the world. These trends provide a roadmap for policymakers and health care providers to further reduce the incidence and impact of unsafe abortion. 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.

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, the data shows the following trends in abortion rates per 1,000 women of reproductive age (15–44):

• Developed Regions: An estimated 27 abortions occurred each year during 2010–2014, down from 46 during 1990–1994.
• Developing Regions: The rate remained almost the same at 36–39 per 1,000 women.
• Eastern Europe: Dramatically falling abortion rates in this region largely drove the decreased rate within developed regions.

The evidence is clear that the most effective way to reduce abortion rates is to prevent unintended pregnancies through modern contraceptives. 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. These unsafe abortions are almost exclusively concentrated (97%) in developing countries.

Concrete Measures for Policy Reform

This body of evidence provides a roadmap for policymakers to take concrete measures to protect the health, rights and lives of women worldwide. To further reduce the negative consequences of unsafe abortion, stakeholders should focus on:

• 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.

Political Challenges and Global Impacts

Previous gains related to sexual and reproductive health and rights—particularly those reducing the impact of unsafe abortion—are in jeopardy. The Trump administration and social conservatives in Congress are engaged in broad-based attacks on sexual and reproductive health and rights in the United States and globally. In the international sphere, the administration has imposed and expanded the global gag rule and defunded the United Nations Population Fund (UNFPA), while calling for outright elimination of all U.S. international family planning aid. At the heart of these attacks is an extreme animus toward abortion rights. Advocates for women’s health fear that these attacks will roll back improvements in sexual and reproductive health services that were built over decades, especially in developing regions where the limited progress to date is in jeopardy.