Elsevier

The Lancet

Volume 370, Issue 9595, 13–19 October 2007, Pages 1338-1345
The Lancet

Articles
Induced abortion: estimated rates and trends worldwide

https://doi.org/10.1016/S0140-6736(07)61575-XGet rights and content

Summary

Background

Information on incidence of induced abortion is crucial for identifying policy and programmatic needs aimed at reducing unintended pregnancy. Because unsafe abortion is a cause of maternal morbidity and mortality, measures of its incidence are also important for monitoring progress towards Millennium Development Goal 5. We present new worldwide estimates of abortion rates and trends and discuss their implications for policies and programmes to reduce unintended pregnancy and unsafe abortion and to increase access to safe abortion.

Methods

The worldwide and regional incidences of safe abortions in 2003 were calculated by use of reports from official national reporting systems, nationally representative surveys, and published studies. Unsafe abortion rates in 2003 were estimated from hospital data, surveys, and other published studies. Demographic techniques were applied to estimate numbers of abortions and to calculate rates and ratios for 2003. UN estimates of female populations and livebirths were the source for denominators for rates and ratios, respectively. Regions are defined according to UN classifications. Trends in abortion rates and incidences between 1995 and 2003 are presented.

Findings

An estimated 42 million abortions were induced in 2003, compared with 46 million in 1995. The induced abortion rate in 2003 was 29 per 1000 women aged 15–44 years, down from 35 in 1995. Abortion rates were lowest in western Europe (12 per 1000 women). Rates were 17 per 1000 women in northern Europe, 18 per 1000 women in southern Europe, and 21 per 1000 women in northern America (USA and Canada). In 2003, 48% of all abortions worldwide were unsafe, and more than 97% of all unsafe abortions were in developing countries. There were 31 abortions for every 100 livebirths worldwide in 2003, and this ratio was highest in eastern Europe (105 for every 100 livebirths).

Interpretation

Overall abortion rates are similar in the developing and developed world, but unsafe abortion is concentrated in developing countries. Ensuring that the need for contraception is met and that all abortions are safe will reduce maternal mortality substantially and protect maternal health.

Introduction

Induced abortion is one of the greatest human rights dilemmas of our time. The need for scientific and objective information on the matter is therefore imperative. However, because of the sensitive nature of the topic, data sources are limited and accurate information on the occurrence of induced abortion is difficult to obtain.

The distinction between safe and unsafe abortion is crucial because each has different public-health implications. Safe abortion has few health consequences, whereas unsafe abortions are a threat to women's health and survival.1, 2, 3, 4, 5 WHO is involved in efforts to improve maternal health and reduce maternal mortality in 63 priority countries.5 The UN Millennium Development Goals, adopted by 189 nations, include the goal of improving maternal health and the specific target of reducing the maternal mortality ratio by three-quarters between 1990 and 2015.6 Unsafe abortion is a major cause of maternal mortality, and measuring its incidence is important for monitoring progress on this goal. Unsafe abortion also has other consequences, including economic costs to health systems and families, stigmatisation, and psychosocial effects on women.

All abortions, whether safe or unsafe, are a compelling indicator of the incidence of unintended pregnancies, and information on abortion rates can affect the allocation of resources by national authorities, donor nations, and international agencies for contraceptive services and supplies.

This Article presents new estimates of the incidence of induced abortion worldwide, by region, and according to the safety of the procedure, for 2003, the most recent year for which worldwide estimates could be made. We define safe and unsafe abortion and indicate how these definitions intersect with abortion laws and regulations. This work is the product of a comprehensive review of the evidence and systematic methods of estimation, and represents the first known worldwide assessment of abortion incidence since 1995, when estimates were originally developed. It used methods similar to those used in 1995, and we assessed trends in safe and unsafe abortion since that time.

Section snippets

Data sources

For estimation purposes, safe abortions were defined as those that meet legal requirements in countries in which abortion is legally permitted under a broad range of criteria. Unsafe abortion is defined by WHO as any procedure to terminate 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 (panel 1).6 These include abortions in countries with restrictive abortion laws, as well as abortions

Results

An estimated 42 million induced abortions occurred in 2003, compared with the 1995 estimate of 46 million (table 1). The abortion rate (yearly number of induced abortions per 1000 women aged 15–44 years) worldwide was 29 in 2003, down from 35 in 1995. The total abortion rate, which can be interpreted as the number of abortions a woman will have if current rates prevail throughout her reproductive lifetime, was 1·1 in 1995 and 0·9 in 2003. An assessment of trends between 1995 and 2003 should

Discussion

The findings presented here provide new estimates of abortion incidence at the worldwide and regional levels, which had not been updated since 1995. In the face of a dearth of information for many countries, particularly those in which abortion laws are highly restrictive, this study drew on all available sources of information and used systematic and consistent methods to estimate abortion incidence. Information on abortion rates and trends has important implications for stakeholders in many

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