Abortion rates drop dramatically – but only in rich countries

Karen McVeigh
Protestors take part in the Rally for Choice march in Belfast, Northern Ireland. Abortion remains illegal there, allowed only to save the woman’s life. Photograph: Charles McQuillan/Getty Images

Rates of abortion have dropped significantly across the world in the past quarter-century, but the decline has been predominantly in the developed world, according to a report.

Evidence gathered by the US-based Guttmacher Institute, a research and advocacy group for reproductive health, suggests the procedure, which kills tens of thousands of women every year, has become safer in many parts of the world.

However, the authors said they were concerned about the higher rates of abortion, particularly unsafe abortion, occurring “overwhelmingly” in developing countries.

In 2014, at least 22,800 women died from complications of unsafe terminations.

Globally, the rate of abortion fell between 1990-94 and 2010-2014, from 46 to 27 per 1,000 women of reproductive age. But in developing countries, the abortion rates declined from 39 to just 36 in the same period.

Latin America and the Caribbean has the highest annual rate of abortion of any world region, with 44 per 1,000 women of reproductive age, compared with 36 in Asia, 34 in Africa, and 17 in northern America.

Unsafe abortions occur in developing countries where restrictions are concentrated and also where there is inadequate provision, even when legal, the study found.

“Legal restrictions do not eliminate abortion,” the report said. “Rather they increase the likelihood that abortions will be done unsafely, as they compel women to seek clandestine procedures. Indeed, abortion tends to be safer in countries where it is broadly legal and in countries with a high national income.”

Across the world, researchers said the fall in abortion rates was driven by improved contraceptive use. The steepest decline occurred in eastern Europe, where use of effective contraception increased dramatically. They also declined in the sub-region of central Asia: former Soviet bloc states where availability of contraceptives increased sharply after political independence.

“Improved contraception use and, in turn, declines in unintended pregnancy rates are the likely driver behind the worldwide decline in abortion rates,” said Susheela Singh, vice president for international research at the GI. “Most women who have an abortion do so because they did not intend to become pregnant in the first place. Meeting the need for contraception is critical to bringing down rates even further.”

In the 14 developing countries where unsafe abortion is prevalent, 40% of women seeking a termination develop complications that require medical attention.

Marjorie Newman-Williams, vice president for external affairs at Marie Stopes International, said: “At a time when we see several governments around the world trying to increase restrictions on women’s access to safe abortion, and in some cases even to contraception, this report is a beacon of common sense. Restricting abortion does not stop women from having them. All it does is drive women to desperate measures, putting their health and lives at risk. Every day, 130 women die as a result of an unsafe procedure.

“It is vital on this issue that governments are led by the evidence rather than resorting to well-trodden myths and prejudices. Giving people the power to decide the size of their family is an essential component of development, lifting families out of poverty and strengthening security and resilience. Countries can only benefit by accepting that this need exists and providing safe, quality services to meet it.”

The report found that abortions occur as frequently in the two most restrictive categories of countries – such as Malta, where it is banned outright, or Ireland, where it is allowed only to save the woman’s life – as it does in the least restrictive category, where it is allowed no matter what the reason.

Of the 56 million abortions that occurred annually between 2010 and 2014, an estimated 55% were deemed “safe”: done by a trained practitioner and by a recommended method. Just over 30% were “less safe”, where only one of these conditions was met, and 14% were “least safe”, when neither was met, according to the report.

The safety of abortion procedures has improved because of advances in clinical guidelines and broadening legality in a number of countries, the study said. In addition, where abortion laws are highly restrictive, the increased use of the drug misoprostol has also improved safety.

It concluded: “Even when used by an untrained person, misoprostol is still safer than traditional methods of clandestine abortion that are considered the least safe, such as inserting sharp objects into the uterus or ingesting toxic substances.”

Improved contraceptive use meant that across the world the number of unwanted pregnancies dropped substantially, it said.

“It is good news that the unplanned pregnancy rate has declined worldwide,” said Gilda Sedgh, one of the report’s authors. “But it is not good news that there are wide differences across the world between developing and developed countries.”

As of 2017, 42% of women of reproductive age live in the 125 countries where abortion is highly restricted (either prohibited altogether or allowed only to save a woman’s life or protect her health).

In South Africa, where abortion became legal in 1997, the number of women who died from complications after unsafe terminations in public facilities dropped by 90% in three years.