Countries restricting abortions, particularly in Africa and Latin America, have higher rates of unsafe abortion than those that allow the procedure, according to a study published today in The Lancet journal.
The rate of unsafe abortion in Africa was 28 per 1,000 women of childbearing age and 31 per 1,000 in Latin America, regions where abortion is highly restricted in almost all countries, according to the study led by Gilda Sedgh at the Guttmacher Institute in New York, using the most recent data gathered in 2008. That compares with less than 0.5 per 1,000 in western Europe and North America.
The World Health Organization defines unsafe abortion as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills or in an environment that doesn’t conform to minimal standards. Legally restricting abortions leads to unsafe procedures as women have more difficulty locating practitioners and the ones they do find are less likely to be adequately trained, Sedgh said.
“The data continue to confirm what we have known for decades: that women who wish to terminate unwanted pregnancies will seek abortion at any cost, even when it is illegal or involves risks to their own lives,” Beverly Winikoff, a professor of clinical population and family health at Columbia University, said in a commentary published with the Lancet article.
As previous studies indicate that at most half of women in countries with restrictive laws report their abortions, the authors adjusted the data for survey-based estimates.
Globally, unsafe abortions, almost all of which occur in developing countries, accounted for 220 deaths per 100,000 procedures in 2008, 350 times the rate associated with legal abortions in the U.S., according to the study.
Legalizing abortion in certain countries has led to lower rates of abortion-related deaths and complications, Sedgh said.
Within Africa, the southern region, including South Africa, had the lowest rate of unsafe abortions, and the frequency of abortion-related deaths declined 91 percent between 1994 and the average rate between 1998 and 2001, according to a study published in the South African Medical Journal in 2005. South Africa legalized abortion in 1997 and is the only country on the continent to do so.
The authors also cite a 2009 government study of eight districts in Nepal, which made abortion legal in 2002. That study found that abortion-related complications accounted for 54 percent of hospital-treated maternal illnesses in 1998, compared with 28 percent in 2008-2009.
Guyana, French Guiana, Cuba and the U.S. territory of Puerto Rico are the only areas in Latin America where the procedure is legal, according to the New York-based Center for Reproductive Rights. Globally, 58 countries, accounting for 39 percent of the world’s population, allow abortion without restriction as to reason. Sixty-eight countries, covering 26 percent of the global population, prohibit the procedure or only permit it to save a woman’s life, and 73 countries allow it to preserve health or for socioeconomic reasons.
Eastern Europe had the highest rate of abortions at 43 per 1,000, owing to the region’s low prevalence of effective methods of birth control such as the pill and intra-uterine devices and higher preference for small families. However, the rate of unsafe abortions in the region, which with the exception of Poland allows abortion by law, was 5 per 1,000, much lower than in other developing countries.
“A liberal abortion law alone does not ensure the safety of abortions,” Sedgh said. Other necessary measures include the dissemination of knowledge about the law to providers and women, the development of health-service guidelines for abortion and the willingness of providers to obtain training and provide abortion services, she said.
Globally, the rate of abortion remained almost unchanged in 2008 compared with 2003 at 28 per 1,000, as contraceptive uptake has slowed down, according to the study.
“Without greater investment in quality family planning services, we can expect this trend to persist,” she said.
The study was funded by the U.K. Department of International Development, the Dutch Ministry of Foreign Affairs and the John D. and Catherine T. MacArthur Foundation.