Abortion and unintended pregnancy decline worldwide as contraceptive use increases

But Progress Over Past Decade Has Been Uneven, and Unsafe Abortion Remains a Key Challenge to Women’s Health

London, UK — Increases in global contraceptive use have contributed to a decrease in the number of unintended pregnancies and, in turn, a decline in the number of abortions, which fell from an estimated 45.5 million procedures in 1995 to 41.6 million in 2003. While both the developed and the developing world experienced these positive trends, developed regions saw the greatest progress. Within the developing world, improvement varied widely, with Africa lagging behind other regions, according to “Abortion Worldwide: A Decade of Uneven Progress,” a major new Guttmacher Institute report released today.

The decline in worldwide abortion occurred alongside a global trend toward liberalizing abortion laws. Nineteen countries have significantly reduced restrictions in their abortion laws since 1997, while only three countries have substantially increased legal restrictions. Despite these trends, 40% of the world’s women live in countries with highly restrictive abortion laws, virtually all of them in the developing world.

In Africa, 92% of reproductive-age women live under highly restrictive abortion laws, and in Latin America, 97% do so. These proportions have not changed markedly over the past decade.

The report finds that while the incidence of abortion is closely related to that of unintended pregnancy, it does not correlate with abortion’s legal status. Indeed, abortion occurs at roughly equal rates in regions where it is broadly legal and in regions where it is highly restricted. The key difference is safety—illegal, clandestine abortions cause significant harm to women, especially in developing countries.

“The progress made during the past decade in increasing contraceptive use and reducing the need for abortion is fundamentally good news—the world is moving in the right direction,” says Sharon Camp, president and CEO of the Guttmacher Institute. “And yet, we still have two widely disparate realities. In almost all developed countries, abortion is safe and legal. But in much of the developing world, abortion remains highly restricted, and unsafe abortion is common and continues to damage women’s health and threaten their survival.”

Unsafe abortion causes an estimated 70,000 deaths each year, and an additional five million women are treated annually for complications resulting from unsafe abortion. Approximately three million women who experience serious complications from unsafe procedures go untreated.
Worldwide, the unintended pregnancy rate declined from 69 per 1,000 women aged 15–44 in 1995 to 55 per 1,000 in 2008. The proportion of married women using contraception increased from 54% in 1990 to 63% in 2003. Increases also occurred among sexually active single women. However, regional levels of contraceptive use varied greatly: While 71% of married women in Latin American and the Caribbean were using contraceptives in 2003, only 28% of married African women were doing so. Nearly one in four married women in Africa had an unmet need for contraception in 2002–2007, compared with 10–13% of their counterparts in Asia and in Latin America and the Caribbean.

“The evidence is strong and growing that empowering women with the means to decide for themselves when to become pregnant and how many children to have significantly lowers unintended pregnancy rates and thereby reduces the need for abortion,” adds Dr. Camp.

“Addressing the unmet need for contraception, which remains very high in many parts of world, is critical in promoting the well-being of women and their families. This is especially true in those parts of the developing world where modern contraceptive use is still low and mortality related to clandestine and unsafe abortion is high.”

The new report makes three key recommendations:
Expand access to modern contraceptives and improve family planning services.

Expand access to legal abortion and ensure that safe and legal abortion services are available to women in need.

Improve the coverage and quality of postabortion care, which would reduce maternal death and complications from unsafe abortion.

“The gains we’ve seen are modest in relation to what we can achieve. Investing in family planning is essential—far too many women lack access to contraception, putting them at risk,” notes Dr. Camp. “Legal restrictions do not stop abortion from happening, they just make the procedure dangerous. Too many women are maimed or killed each year because they lack legal abortion access.”

“Abortion Worldwide: A Decade of Uneven Progress” was authored by Susheela Singh, Deirdre Wulf, Rubina Hussain, Akinrinola Bankole and Gilda Sedgh.