Facts on Induced Abortion Worldwide
October, 2007
WORLDWIDE INCIDENCE AND TRENDS
• The number of induced abortions declined worldwide between 1995 and 2003, from nearly 46 million to approximately 42 million. About one in five pregnancies worldwide end in abortion. [1]
• For every 1,000 women of childbearing age (15–44) worldwide, 29 were estimated to have had an induced abortion in 2003, compared with 35 in 1995.[1]
• The decline in abortion incidence was greater in developed countries, where nearly all abortions are safe and legal (from 39 to 26 abortions per 1,000 women aged 15-44), than in developing countries, where more than half are unsafe and illegal (from 34 to 29).[1]
• Most abortions occur in developing countries—35 million annually, compared with seven million in developed countries[1]—a disparity that largely reflects the relative population distribution.
• On the other hand, a woman’s likelihood of having an abortion is similar whether she lives in a developed or developing region; in 2003, there were 26 abortions per 1,000 women aged 15–44 in developed countries compared with 29 per 1,000 in developing countries.[1]
REGIONAL INCIDENCE AND TRENDS
• The most dramatic decline in abortion incidence occurred in Eastern Europe, a region where abortion is, for the most part, legal and safe: the rate fell from 90 to 44. The decrease coincided with substantial increases in contraceptive use in the region. [1], [2]
REGIONAL INCIDENCE AND TRENDS
• The most dramatic decline in abortion incidence occurred in Eastern Europe, a region where abortion is, for the most part, legal and safe: the rate fell from 90 to 44. The decrease coincided with substantial increases in contraceptive use in the region. [1], [2]
Although abortion rates and ratios (the number of abortions for every 100 births) in Eastern Europe have fallen significantly in recent years, they remain higher than in any other region. In 2003, there were more abortions than births in that region (105 abortions for every 100 births).[1]
• The estimated number of induced abortions in Africa has increased since 1995; however, the region’s abortion rate has declined because of an increase in the number of reproductive-age women. [1]
• Induced abortion rates and numbers in Asia and Latin America show modest declines since 1995.[1]
• The lowest abortion rate in the world is in Western Europe (12 per 1,000 women aged 15–44). The rate is 17 in Northern Europe and 21 in Northern America (Canada and the United States of America).[1]
• Because the world’s population is concentrated in Asia, most abortions occur there (26 million yearly); nine million of these take place in China.[1]
ABORTION LAW
• Legal restrictions on abortion do not affect its incidence. For example, the abortion rate is 29 in Africa, where abortion is illegal in many circumstances in most countries, and it is 28 in Europe, where abortion is generally permitted on broad grounds. The lowest rates in the world are in Western and Northern Europe, where abortion is accessible with few restrictions. [1]
• Where abortion is legal and permitted on broad grounds, it is generally safe, and where it is illegal in many circumstances, it is often unsafe. For example, in South Africa, the incidence of infection resulting from abortion decreased by 52% after the abortion law was liberalized in 1996. [3]
• Between 1995 and 2005, 17 countries liberalized their laws to increase access to safe abortion: Albania, Benin, Bhutan, Burkina Faso, Cambodia, Chad, Colombia, Ethiopia, Guinea, Mali, Nepal, Portugal, Saint Lucia, South Africa, Swaziland, Switzerland and Togo. Three countries tightened restrictions on abortion: El Salvador, Nicaragua and Poland.[4]
UNSAFE ABORTION
• The World Health Organization defines unsafe abortion as a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. [5]
• Worldwide, 48% of all induced abortions are unsafe. However, in developed regions, nearly all abortions (92%) are safe, whereas in developing countries, more than half (55%) are unsafe.[1]
Samples of Unsafe Abortion Methods Used
• Drinking turpentine, bleach or tea made with livestock manure
• Inserting herbal preparations into the vagina or cervix
• Placing foreign bodies, such as a stick, coat hanger or chicken bone, into the uterus
• Jumping from the top of stairs or a roof
• More than 95% of abortions in Africa and Latin America are performed under unsafe circumstances, as are about 60% of abortions in Asia (excluding Eastern Asia).[1]
• The worldwide unsafe abortion rate was essentially unchanged between 1995 and 2003 (15 and 14 abortions per 1,000 women aged 15–44, respectively). Because the overall abortion rate declined during this period, the proportion of all abortions that are unsafe increased from 44% to 47%.[1], [2]
CONSEQUENCES OF UNSAFE ABORTION
• Worldwide, an estimated five million women are hospitalized each year for treatment of abortion-related complications, such as hemorrhage and sepsis.[6]
• Complications due to unsafe abortion procedures account for an estimated 13% of maternal deaths worldwide, or 67,000 per year.[7]
• Almost all abortion-related deaths occur in developing countries. They are highest in Africa, where there were an estimated 650 deaths per 100,000 unsafe abortions in 2003, compared with 10 per 100,000 in developed regions.[7]
• Approximately 220,000 children worldwide lose their mothers every year from abortion-related deaths.[8]
• Additional consequences of unsafe abortion include loss of productivity, economic burden on public health systems, stigma and long-term health problems, such as infertility.[8]
UNINTENDED PREGNANCIES: THE ROOT OF ABORTION
• More than one-third of the approximately 205 million pregnancies that occur worldwide annually are unintended, and about 22% of all pregnancies end in induced abortion. [1,9, 10,11]
• Of the 23 million pregnancies that occur in developed countries, more than 40% are unintended, and 28% end in induced abortion. [1,9, 10,11]
• Of the 182 million pregnancies that occur in developing countries, more than one-third are unintended, and 19% end in induced abortion (8% are safe procedures and 11% are unsafe).[1,9, 10, 11]
• The average woman must use some form of effective contraception for at least 20 years if she wants to limit her family size to two children, and 16 years if she wants four children.[9]
• Two-thirds of unintended pregnancies in developing countries occur among women who are not using any method of contraception.[12]
• More than 100 million married women in developing countries have an unmet need for contraception, meaning they are sexually active; are able to become pregnant; do not want to have a child soon or at all; and are not using any method of contraception, either modern or traditional. [13]
• The reasons why women (married and unmarried) do not use contraceptives most commonly include concerns about possible health and side-effects and the belief that they are not at risk of getting pregnant.[13]
References
1. Sedgh G, Henshaw S, Singh S, Åhman E, Shah IH. Induced abortion: rates and trends worldwide. Lancet 2007; 370: 1338–45.
2. Henshaw SK, Singh S and Haas T, The incidence of abortion worldwide, International Family Planning Perspectives , 1999, 25(Suppl.):S30–S38.
3 Jewkes et al, "The impact of age on the epidemiology of incomplete abortion in South Africa after legislative change," BJOG 2005, 112, 355-9.
4. Center for Reproductive Rights, Abortion worldwide: twelve years of reform, July 2007, , accessed Sept. 13, 2007.
5. World Health Organization (WHO), The prevention and management of unsafe abortion: report of a technical working group, Geneva: WHO, 1992.
6. Singh S, Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries, Lancet, 2006, 368(955):1887–1892.
7. World Health Organization (WHO). Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2003, Geneva: WHO, 2007. In Press.
8. Grimes DA et al., Unsafe abortion: the preventable pandemic, Lancet, 2006, 368(9550):1908–1919.
9. The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society and Abortion Worldwide, New York: AGI, 1999.
10. Population Division, United Nations Department of Economic and Social Affairs, World population prospects: the 2004 revision, New York: United Nations, 2005.
11. Leridon H, Human Fertility: The Basic Components, Chicago: University of Chicago Press, 1977.
12. Singh S et al., Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care, New York: AGI and United Nations Population Fund, 2003.
13. Sedgh G et al., Women with an unmet need for contraception in developing countries and their reasons for not using a method, Occasional Report, New York: Guttmacher Institute, 2007, No. 37.
