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In Brief

Facts on Induced Abortion Worldwide

WORLDWIDE INCIDENCE AND TRENDS 78% to 86%, in part because the REGIONAL INCIDENCE AND TRENDS
• After declining substantially between proportion of all women who live in the • The overall abortion rate in Africa,
1995 and 2003, the worldwide abortion developing world increased during this where the vast majority of abortions are
rate stalled between 2003 and 2008. period. illegal and unsafe, showed no decline
between 2003 and 2008, holding at 29
• Between 1995 and 2003, the abortion • Since 2003, the number of abortions abortions per 1,000 women of child-
rate (the number of abortions per 1,000 fell by 600,000 in the developed world bearing age.
women of childbearing age—i.e., those but increased by 2.8 million in the
aged 15–44) for the world overall developing world. In 2008, six million • The Southern Africa subregion,
dropped from 35 to 29. It remained abortions were performed in developed dominated by South Africa, where
virtually unchanged, at 28, in 2008. countries and 38 million in developing abortion was legalized in 1997, has the
countries, a disparity that largely reflects lowest abortion rate of all African
• Nearly half of all abortions worldwide
subregions, at 15 per 1,000 women in
are unsafe, and nearly all unsafe abor- population distribution.
2008. East Africa has the highest rate, at
tions (98%) occur in developing coun-
• A woman’s likelihood of having an 38, followed by Middle Africa at 36, West
tries. In the developing world, 56% of all
abortion is slightly elevated if she lives Africa at 28 and North Africa at 18.
abortions are unsafe, compared with just
in a developing region. In 2008, there
6% in the developed world. • Both the lowest and highest subregional
were 29 abortions per 1,000 women aged
abortion rates are in Europe, where
• The proportion of abortions worldwide 15–44 years in developing countries,
abortion is generally legal under broad
that take place in the developing world compared with 24 per 1,000 in the grounds. In Western Europe, the rate is 12
increased between 1995 and 2008 from developed world. per 1,000 women, while in Eastern Europe
it is 43. The discrepancy in rates between
NUMBERS AND RATES the two regions reflects relatively low
Global and regional estimates of induced abortion, 1995, 2003 and 2008 contraceptive use in Eastern Europe, as
well as a high degree of reliance on
Region No. of abortions (millions) Abortion rate* methods with relatively high user failure
1995 2003 2008 1995 2003 2008 rates, such as the condom, withdrawal
and the rhythm method.
World 45.6 41.6 43.8 35 29 28

Developed countries 10.0 6.6 6.0 39 25 24 • In Europe, 30% of pregnancies end in


Excluding Eastern Europe 3.8 3.5 3.2 20 19 17 abortion. A higher proportion of preg-
Developing countries 35.5 35.0 37.8 34 29 29 nancies end in abortion in Eastern
Excluding China 24.9 26.4 28.6 33 30 29 Europe than in the rest of the region.
Africa 5.0 5.6 6.4 33 29 29
Asia 26.8 25.9 27.3 33 29 28 • In Eastern Europe, the abortion rate
Europe 7.7 4.3 4.2 48 28 27 held steady at 43 per 1,000 women
Latin America 4.2 4.1 4.4 37 31 32
Northern America 1.5 1.5 1.4 22 21 19 between 2003 and 2008, after a period
Oceania 0.1 0.1 0.1 21 18 17 of steep decline between the mid-90s
*Abortions per 1,000 women aged 15–44.
and the early 2000s.
Source: Sedgh G et al., Induced abortion: incidence and trends worldwide from 1995 to 2008, Lancet, 2012, (forthcoming).
• Western Europe, Southern per 1,000 in Western Europe, UNSAFE ABORTION steady decline in abortions
Africa and Northern Europe where abortion is generally • The World Health (partly due to the increasingly
have the lowest abortion rates permitted on broad grounds. Organization defines unsafe widespread use of effective
in the world, at 12, 15 and 17, abortion as a procedure for contraceptives) in countries
respectively. • Where abortion is permitted
terminating a pregnancy that where abortion is legal and safe.
on broad legal grounds, it is
is performed by an individual
• The abortion rate fell in Latin generally safe, and where it is • Worldwide, medication
lacking the necessary skills, or
America from 37 to 31 abor- highly restricted, it is typically abortion (a technique using a
in an environment that does
tions per 1,000 women between unsafe. In developing coun- combination of the drugs
not conform to minimal
1995 and 2003; it has held tries, relatively liberal abortion mifespristone and misoprostol,
medical standards, or both.
fairly steady since, reaching 32 laws are associated with fewer or misoprostol alone) has
in 2008. negative health consequences • Between 1995 and 2008, become more common in both
from unsafe abortion than are the rate of unsafe abortion legal and clandestine proce-
• In Latin America, subregional
highly restrictive laws. worldwide remained essentially dures. Increased use of
abortion rates range from 29 in
unchanged, at 14 abortions per medication abortion has likely
Central America (the subregion • In South Africa, where the
1,000 women aged 15–44. contributed to declines in the
that includes Mexico) to 32 in abortion law was liberalized in
proportion of clandestine
South America and 39 in the 1997, the annual number of • During the same period, the abortions that result in severe
Caribbean. The Caribbean (the abortion-related deaths fell proportion of all abortions that morbidity and maternal death.
subregion that includes Cuba, by 91% between 1994 and were unsafe increased from
where abortions are generally 1998–2001. 44% to 49%. CONSEQUENCES OF
safe) has the lowest proportion UNSAFE ABORTION
of abortions in the region that • In Nepal, where abortion was • In 2008, more than 97% • The estimated annual number
are unsafe (46%), compared made legal on broad grounds of abortions in Africa were of deaths from unsafe abortion
with nearly 100% in Central in 2002, it appears that unsafe. Southern Africa is the declined from 56,000 in 2003 to
and South America. abortion-related complications subregion with the lowest 47,000 in 2008. Complications
are on the decline: A recent proportion of unsafe abortions from unsafe abortion accounted
• In Asia, abortion rates across study in eight districts found (58%). Close to 90% of women for an estimated 13% of all
subregions held steady between that abortion-related complica- in the subregion live in South maternal deaths worldwide in
2003 and 2008, ranging from tions accounted for 54% of Africa, where abortion was both years.
26 per 1,000 in South Central all facility-treated maternal liberalized in 1997.
Asia and Western Asia to 36 per illnesses in 1998, but for only • Declines since 2003 in the
1,000 in Southeastern Asia. • In Latin America, 95% of annual number of deaths from
28% in 2008–2009.
abortions were unsafe, a unsafe abortion, along with
• Abortion incidence appears to • Between 1997 and 2008, proportion that did not change concurrent increases in the
have risen in China since 2003, the grounds on which abortion between 1995 and 2008. annual number of unsafe
after an extended period of may be legally performed were Nearly all safe abortions abortions performed, indicate
decline. Evidence shows that broadened in 17 countries: occurred in the Caribbean, that the risks associated with
this is due to an increase in Benin, Bhutan, Cambodia, primarily in Cuba and several clandestine procedures may be
premarital sexual activity and Chad, Colombia, Ethiopia, other islands where the law is decreasing.
disruptions in access to Guinea, Iran, Mali, Nepal, liberal and safe abortions are
contraceptive services resulting Niger, Portugal, Saint Lucia, accessible. • In the United States, legal
from rapid urbanization. Swaziland, Switzerland, induced abortion results in
• In Asia, the proportion of only 0.6 deaths per 100,000
Thailand and Togo. Mexico City
ABORTION LAW abortions that are unsafe varies procedures. Worldwide, unsafe
and parts of Australia (Capital
• Highly restrictive abortion widely by subregion, from abortion accounts for a death
Territory, Victoria, Tasmania
laws are not associated with virtually none in Eastern Asia to rate that is 350 times higher
and Western Australia) also
lower abortion rates. For 65% in South Central Asia. (220 per 100,000), and, in
liberalized their abortion laws.
example, the abortion rate is Sub-Saharan Africa, the rate is
In contrast, El Salvador and • In Western Asia, the propor-
29 per 1,000 women of 800 times higher, at 460 per
Nicaragua changed their tion of abortions that are
childbearing age in Africa and 100,000.
already restrictive laws to unsafe increased from 34% to
32 per 1,000 in Latin
prohibit abortion entirely, 60% between 2003 and 2008. • Almost all abortion-related
America—regions in which
while Poland withdrew socioe- This increase is likely due to deaths occur in developing
abortion is illegal under most
conomic reasons as a legal improved measurement of countries, with the highest
circumstances in the majority
ground for abortion. unsafe abortions and to a number occurring in Africa.
of countries. The rate is 12

Induced Abortion Worldwide 2 Guttmacher Institute


• Unsafe abortion is a signifi- UNINTENDED PREGNANCY: Most data in this fact sheet is from
cant cause of ill-health among THE ROOT OF ABORTION Sedgh G et al., Induced abortion:
women in the developing • The uptake of modern incidence and trends worldwide
from 1995 to 2008, Lancet, 2012,
world. Estimates for 2005 contraceptive methods
(forthcoming), and the World
indicate that 8.5 million worldwide has slowed in recent Health Organization. Additional
women annually experience years, from an increase of 0.6 sources can be found in the fully
complications from unsafe percentage points per year in annotated version, available at
1990–1999 to an increase of http://www.guttmacher.
abortion that require medical
org/pubs/fb_IAW.html and at
attention, and three million do only 0.1 percentage points per www.who.int/topics/reproductive_
not receive the care they need. year in 2000–2009. In Africa, health/en/.
the annual increase in modern
• Treating medical complications contraceptive use fell from 0.8
from unsafe abortion places a percentage points in 1990–
significant financial burden on 1999 to 0.2 percentage points
public health care systems in in 2000–2009.
the developing world. According
to a 2009 study, the minimum • An estimated 215 million
annual estimated cost of women in the developing world
providing postabortion care in have an unmet need for modern
the developing world is $341 contraceptives, meaning they
million. want to avoid a pregnancy but
are using a low-efficacy
• In developing countries, poor traditional family planning
women have the least access to method or no method.
family planning services and
the fewest resources to pay for • Some 82% of unintended
safe abortion procedures; they pregnancies in developing
are also the most likely to countries occur among women
experience complications who have an unmet need for
related to unsafe abortion. modern contraception.

• Unsafe abortion has signifi- • In the developing world,


cant negative consequences women’s reasons for not using
beyond its immediate effects on contraceptives most commonly
women’s health. For example, include concerns about
complications from unsafe possible side-effects, the belief
abortion may reduce women’s that they are not at risk of
productivity, increasing the getting pregnant, poor access
economic burden on poor to family planning, and their
families; cause maternal deaths partners’ opposition to
that leave children motherless; contraception.
cause long-term health prob-
• Reducing unmet need for
lems, such as infertility; and
modern contraception is an
result in considerable costs to
effective way to prevent
already struggling public health
unintended pregnancies,
systems.
abortions and unplanned births.

Guttmacher Institute 3 Induced Abortion Worldwide


Advancing sexual and reproductive health worldwide
Department of Reproductive
through research, policy analysis and public education
Health and Research
World Health Organization
New York Washington D.C. 1211 Geneva 27
Switzerland
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info@guttmacher.org Tel: 202.296.4012, Fax: 202.223.5756
policyinfo@guttmacher.org
www.guttmacher.org
January 2012