ArticlesInduced abortion: incidence and trends worldwide from 1995 to 2008
Introduction
Information on global and regional abortion rates and trends can help identify gaps in contraceptive use. Although abortions done according to medical guidelines carry very low risk of complications,1, 2, 3 unsafe abortions contribute substantially to maternal morbidity and death worldwide.4, 5, 6 Monitoring abortion trends is thus crucial to assess improvement of maternal health, and the progress toward the UN Millennium Development Goal 5 (MDG 5), to reduce maternal mortality and achieve universal access to reproductive health.
Moreover, one of the many controversies surrounding abortion is whether restrictive abortion laws prevent women from obtaining abortions. Analyses of the association between abortion incidence and the legal status of abortion can clarify whether law is a factor that affects abortion incidence.
However, abortions are not documented in countries with highly restrictive abortion laws and are often under-reported elsewhere, especially where the practice is highly stigmatised. Therefore, estimation of regional and global incidence requires compilation of information from a range of sources and careful assessment of information for quality and completeness. Various data sources and estimation approaches have been assessed, refined, and applied over the years, and are now widely accepted as sources of reasonable national estimates.4, 7, 8, 9
We estimated the incidence of safe and unsafe abortion globally and in all the major regions and subregions of the world in 2008. We assessed trends since 1995 and 2003, the only other years for which similar assessments were done. We also examined the associations of abortion incidence with the legal status of abortion across the world's subregions.
Section snippets
Definitions and data sources
We adhered to the definition of unsafe abortion established by WHO, namely, a procedure for termination of an unintended pregnancy done either by people lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both.10 As elaborated by WHO,4, 11 abortions done outside the bounds of law are likely to be unsafe even if they are done by people with medical training for several reasons: such procedures are usually done outside facilities authorised to
Results
An estimated 43·8 million abortions occurred in 2008, compared with 41·6 million in 2003, and 45·6 in 1995 (table 1). About 78% of all abortions took place in the developing world in 1995, and increased to 86% in 2008, whereas the proportion of all women of reproductive age who live in the developing world rose from 80% to 84% in the same interval. Since 2003, the number of abortions fell by 0·6 million in the developed world, but increased by 2·8 million in developing countries. The estimated
Discussion
Our findings show that the substantial decline in the abortion rate observed between 1995 and 2003 has tapered off, and the proportion of abortions that are unsafe has increased since 1995, such that nearly half of all abortions worldwide were unsafe in 2008.
Our estimates of the rates of unsafe abortion across countries and regions tend to align with independent subnational, national, and regional research of the incidence of abortion-related morbidity and mortality, where such evidence exists.
References (50)
Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999
Am J Obstet Gynecol
(2006)- et al.
Unsafe abortion: the preventable pandemic
Lancet
(2006) Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries
Lancet
(2006)- et al.
Unsafe abortion in 2008: global and regional levels and trends
Reprod Health Matters
(2010) - et al.
Self-induction of abortion among women in the United States
Reprod Health Matters
(2010) - et al.
Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States
Int J Gynaecol Obstet
(2002) - et al.
Induced abortion: estimated rates and trends worldwide
Lancet
(2007) - et al.
Risk factors for legal induced abortion-related mortality in the United States
Obstet Gynecol
(2004) How safe is therapeutic abortion?
Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008
(2011)
Legal abortion worldwide in 2008: levels and recent trends
Int Perspect Sex Reprod Health
Estimating induced abortion rates: a review
Stud Fam Plann
The prevention and management of unsafe abortion. Report of a technical working group
Abortion worldwide: a decade of uneven progress
Summary and key findings, abortion assessment project-India
Health care providers' attitudes towards termination of pregnancy: a qualitative study in South Africa. BMC Public Health, 2009, Vol. 9, Art. 296
Reproductive, maternal and child health in Eastern Europe and Eurasia: a comparative report (revised 2005)
How commonly do US abortion patients report attempts to self-induce?
Am J Obstet Gynecol
Measuring the incidence of abortion in countries with liberal laws
Underreporting of abortion in surveys of US women: 1976 to 1988
Demography
Underreporting of induced and spontaneous abortion in the United States: an analysis of the 2002 National Survey of Family Growth
Stud Fam Plann
The abortion incidence complications method: a quantitative technique
The estimated incidence of induced abortion in Ethiopia, 2008
Int Perspect Sex Reprod Health
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