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. 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. This body of evidence provides a roadmap for policymakers to take concrete measures to protect the health, rights and lives of women worldwide.

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.

Comparison of Annual Abortion Rates (per 1,000 women)

• Developed Regions (1990–1994): 46 per 1,000
• Developed Regions (2010–2014): 27 per 1,000
• Developing Regions (1990–1994): 39 per 1,000
• Developing Regions (2010–2014): 36 per 1,000

Dramatically falling abortion rates in Eastern Europe largely drove the decreased abortion 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.

The Public Health Impact of Unsafe Abortion

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, 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 and Health Care Providers

These trends provide a roadmap for policymakers and health care providers to further reduce the incidence and impact of unsafe abortion. Key measures include:

• 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.

Global Challenges and Political Obstacles

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), 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. Almost all nations have pledged to financially support at least some measures to decrease the incidence and negative consequences of unsafe abortion through their commitments at the landmark International Conference on Population and Development in Cairo in 1994.