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Half of All Abortions Now Unsafe, Study Finds

UNITED NATIONS, Jan 19 2012 (IPS) - The proportion of abortions deemed unsafe rose from 44 percent in 1995 to almost half (49 percent) in 2008, according to a new study released Thursday.

Launched in London, “Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008″ by the Guttmacher Institute and World Health Organisation (WHO) notes that in 2008, the global abortion rate was 28 per 1,000, virtually unchanged since 2003.

However, in hard numbers, there were 2.2 million more abortions in 2008 (43.8 million) compared with 2003 (41.6 million) due to the growing global population. Since 2003, the number of abortions fell by 0.6 million in the developed world, but increased by 2.8 million in developing countries.

According to a WHO report from March 2011, unsafe abortion is one of the three leading causes of maternal mortality, along with haemorrhage and sepsis from childbirth.

“The number of unsafe abortions has increased from 19.7 million in 2003 to 21.6 million in 2008,” Dr. Iqbal Shah from the WHO’s Department of Reproductive Health and Research in Geneva and one of the report’s co-authors, told IPS.

“The numbers have gone up primarily because of the increase in the size of women’s population in the reproductive age of 15-44 years, without accompanying a rise in modern contraceptive uptake or access to safe abortion,” he explained.

“One can safely say that the unsafe abortion rate of 14 per 1,000 women in ages 15-44 years has not gone down from 2003 to 2008,” he added.

Researchers found that nearly half of all abortions worldwide are unsafe procedures, and almost all unsafe abortions occur in the developing world, placing the health and lives of millions of women and adolescent girls at risk.

Unsafe abortion is defined by WHO and the authors of the report as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.

Shah also stressed that the reason for the lack of progress in reducing unsafe abortions has been the lack of progress in contraceptive uptake in recent periods, and lack of progress in improving access to safe abortion.

Nevertheless, the study points out that some countries are trying to address the problem, especially in Southern Africa and South-Central Asia.

“Within the developing world, abortion is becoming safer in South Africa,” Dr. Gilda Sedgh of the Guttmacher Institute, a co-author of the study, told IPS.

“After the law was liberalised in 1997, many providers were trained in how to do abortions and abortion services were established at public facilities. Between 1994 and 2000, the number of maternal deaths from unsafe abortion fell by 90 percent.”

“It happens that the overall abortion rate in Southern Africa (a region comprised largely of South Africa), fell from 19 to 15 abortions per 1,000 women aged 15-44 between 1995 and 2008,” she added. “Southern Africa is the only region in Africa where the rate has fallen sharply; it is also the region where the level of contraceptive use has risen most dramatically between 1990 and 2009.”

Abortion remains, particularly in the developing world, a broadly polarising issue, and in many countries it is illegal.

“Most people on both sides of the abortion debate would agree that fewer abortions are preferable. Stakeholders can help reduce the level of abortion – whether safe or unsafe – by taking measures to ensure that women have access to family planning services, so they can avoid unintended pregnancies in the first place,” Sedgh told IPS.

“Evidence shows that, in order to be effective, these services need to provide not just contraceptives, but also information and counselling to help women be satisfied users of contraception,” she added.

Asked about the importance of wider access to contraception in reducing abortion rates, Shah said, “A wider access to contraception, especially modern methods of contraception, is very important in reducing abortion rates. Countries where prevalence of modern contraceptives is high show one of the lowest abortion rates.”

“Just meeting the unmet need for modern methods of family planning for women wishing to postpone or cease further childbearing can reduce the number of abortions and 90 percent of global mortality and morbidity due to unsafe abortion,” he added.

“Our findings on abortion rates across sub regions and over time, taken together with United Nations estimates of contraceptive levels and trends, add to the body of evidence that contraceptive use is one of the strongest known predictors of abortion levels,” Sedgh told IPS. “Where contraceptive use is high, abortion rates are low.”

“Still, about 215 million women in the developing world have an unmet need for contraception – that is, they are having sex, they don’t want to get pregnant, and yet they are not using a modern method of contraception,” she added.

In the report, the authors conclude that “restrictive abortion laws are not associated with lower abortion rates.”

“Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps toward achieving the Millennium Development Goals.”

Dr Beverly Winikoff and Dr Wendy R. Sheldon, Gynuity Health Projects, New York also said: “The study shows that it is precisely where abortion is illegal that it must become safer. The public health community will not be able to address maternal mortality adequately and attainment of Millennium Development Goals is questionable until we directly confront the issue of unsafe abortion.”

“These latest figures are deeply disturbing. The progress made in the 1990s is now in reverse,” Dr Richard Horton, editor of the British medical journal The Lancet which published the study, said in a release.

“Promoting and implementing policies to reduce the number of abortions is now an urgent priority for all countries and for global health agencies, such as WHO,” Horton said. “Condemning, stigmatising, and criminalising abortion are cruel and failed strategies. It’s time for a public health approach that emphasises reducing harm – and that means more liberal abortion laws.”