25 Million Unsafe Abortions Annually Worldwide

Author: WHO/Guttmacher Institute
Published: 2017/09/28 - Updated: 2023/02/10 - Peer-Reviewed: Yes
Contents: Summary - Main - Related Publications

Synopsis: A study by WHO and the Guttmacher Institute reveals majority of unsafe abortions occurred in developing countries in Africa, Asia, and Latin America. Increased efforts are needed, especially in developing regions, to ensure access to contraception and safe abortion. When women and girls cannot access effective contraception and safe abortion services, there are serious consequences for their health and their families.

Abortion

Abortion is the termination of a pregnancy by removing or expulsing an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently, "induced miscarriage." The unmodified word abortion generally refers to an induced abortion.

Main Digest

Worldwide, 25 million unsafe abortions (45% of all abortions) occurred every year between 2010 and 2014, according to a new study by WHO and the Guttmacher Institute published today in The Lancet. The majority of unsafe abortions, or 97%, occurred in developing countries in Africa, Asia, and Latin America.

"Increased efforts are needed, especially in developing regions, to ensure access to contraception and safe abortion," says Dr. Bela Ganatra, lead author of the study and a scientist in the WHO Department of Reproductive Health and Research.

"When women and girls cannot access effective contraception and safe abortion services, there are serious consequences for their health and their families. This should not happen. But despite recent advances in technology and evidence, too many unsafe abortions still occur, and too many women continue to suffer and die."

Classifying Abortion Safety

The new Lancet study estimates safe and unsafe abortions globally.

For the first time, it includes sub-classifications within the unsafe abortion category as less safe or least safe. The distinction allows for a more nuanced understanding of the different circumstances of abortions among women who cannot access safe abortions from a trained provider.

When WHO guidelines and standards perform abortions, the risk of severe complications or death is negligible. Approximately 55% of all abortions from 2010 to 2014 were conducted safely, which means they were performed by a trained health worker using a WHO-recommended method appropriate to the pregnancy duration.

Almost one-third (31%) of abortions were "less safe," meaning they were either performed by a trained provider using an unsafe or outdated method such as "sharp curettage" or by an untrained person albeit using a safe method like misoprostol, a drug that can be used for many medical purposes, including to induce an abortion.

About 14% were "least safe" abortions provided by untrained persons using dangerous methods, such as introducing foreign objects and using herbal concoctions. Deaths from complications of unsafe abortion were high in regions where most abortions happened in the least safe circumstances. Complications from "least-safe" abortions can include incomplete abortion (failure to remove all of the pregnancy tissue from the uterus), bleeding, vaginal, cervical, and uterine injury, and infections.

Restrictive Laws Associated with High Rates of Unsafe Abortions

The study also looks at the contexts that commonly result in women seeking unsafe abortions, including countries' laws and policies on abortion, the financial cost of accessing safe abortion services, the availability of safe abortion services and trained health providers, and societal attitudes toward abortion and gender equality.

In countries where abortion is banned or permitted only to save the woman's life or preserve her physical health, only 1 in 4 abortions were safe, whereas, in countries where abortion is legal on broader grounds, nearly 9 in 10 abortions were done safely. Restricting access to abortions does not reduce the number of abortions.

Most abortions in Western and Northern Europe and North America are safe. These regions also have some of the lowest abortion rates. Most countries in these regions also have relatively permissive laws on abortion; high levels of contraceptive use, economic development, and gender equality; as well as high-quality health services - all factors contributing to making abortion safer.

"Like many other common medical procedures, abortion is very safe when done by recommended medical guidelines, and that is important to bear in mind," says Dr. Gilda Sedgh, co-author of the study and principal research scientist Guttmacher Institute.

"In the high-income countries of North America and Western and Northern Europe, where abortion is broadly legal, and health systems are strong, the incidence of unsafe abortions is the lowest globally."

Among developing regions, the proportion of abortions that were safe in Eastern Asia (including China) was similar to developed regions. In South-Central Asia, however, less than 1 in 2 abortions were safe. Outside of Southern Africa, less than 1 in 4 abortions in Africa were safe. Of those unsafe abortions, the majority were characterized as "least safe."

In Latin America, only 1 in 4 abortions were safe. However, the majority were categorized as "less safe," as it is increasingly common for women in the region to obtain and self-administer medicines like misoprostol outside formal health systems. This has meant that this region has seen fewer deaths and fewer severe complications from unsafe abortions. Nevertheless, this informal self-use of medication abortion that women resort to secretly does not meet WHO's safe abortion standards.

Preventing Unsafe Abortion

Unsafe abortion occurs when a pregnancy is terminated either by persons lacking the necessary skills/information, in an environment that does not conform to minimal medical standards or both.

To prevent unintended pregnancies and unsafe abortions, countries must make supportive policies and financial commitments to provide comprehensive sexuality education; a wide range of contraceptive methods, including emergency contraception; accurate family planning counseling; and access to safe, legal abortion.

Provision of safe, legal abortion is essential to fulfilling the global commitment to the Sustainable Development Goal of universal access to sexual and reproductive health (target 3.7). WHO provides global technical and policy guidance on contraception to prevent unintended pregnancy, safe abortion, and the treatment of complications from unsafe abortion.

Earlier this year, WHO and the Population Division of the United Nations Department of Economic and Social Affairs launched a new, open-access database of laws, policies, and health standards on abortion in countries worldwide. The database aims to promote greater transparency of abortion laws and policies, as well as to improve countries' accountability for the protection of women and girls' health and human rights.

Resources That Provide Relevant Information

Attribution/Source(s):

This peer reviewed publication pertaining to our Disability Statistics section was selected for circulation by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "25 Million Unsafe Abortions Annually Worldwide" was originally written by WHO/Guttmacher Institute, and submitted for publishing on 2017/09/28 (Edit Update: 2023/02/10). Should you require further information or clarification, WHO/Guttmacher Institute can be contacted at the who.int website. Disabled World makes no warranties or representations in connection therewith.

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