October 14, 2009 — Increased contraception use has contributed to a decline in global abortion rates, but unsafe abortions continue to kill 70,000 women and girls annually, according to a report issued Tuesday by the Guttmacher Institute, Reuters reports. The number of abortions decreased from about 45.5 million in 1995 to 41.6 million in 2003, a period during which many countries relaxed restrictions on the procedure, the report said (Kelland, Reuters, 10/13). The global abortion rate declined from 35 abortions for every 1,000 women of reproductive age -- ages 15 to 44 -- in 1995 to 29 per 1,000 women of reproductive age in 2003, according to the report (Feldmann, Christian Science Monitor, 10/13). In addition to the thousands of deaths from unsafe abortions, five million women experience complications from unsafe procedures each year, including about three million who go untreated (Guttmacher Institute release, 10/13).
The report found that nearly 20 million unsafe abortions are performed each year, mostly in low-income countries by untrained traditional healers or by the women themselves through drugs or herbal potions. Sharon Camp, president of Guttmacher, said it is "significant and tragic" that the rate of unsafe abortion has not declined, despite the decrease in overall abortion rates. She added, "Too many women are maimed or killed each year because they lack legal abortion access."
According to the report, 40% of women live in nations with highly restrictive abortion laws (Reuters, 10/13). The report found that 19 countries have "significantly reduced restrictions in their abortion laws" since 1997, and three countries have "substantially increased legal restrictions," the Christian Science Monitor reports. Ninety-two percent of women in Africa live under highly restrictive abortion laws, while the figure is 97% in Latin America, the Monitor reports (Christian Science Monitor, 10/13).
"In almost all developed countries, abortion is safe and legal," Camp said, adding that "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" (Crary, AP/San Francisco Chronicle, 10/14). She said that legal restrictions "do not stop abortion from happening, they just make the procedure dangerous" (Reuters, 10/13). The report found that abortion rates were roughly the same in countries where the procedure is legal and those where it is highly restricted. The difference between such countries is the high rates of death and medical complications from unsafe abortion procedures, according to the report (AP/San Francisco Chronicle, 10/14).
The report said that a major reason for the decline in overall abortion rates was increased use of contraceptives by married women. In 2003, 63% of married women were using contraception, compared with 54% in 1990. The greatest gains in contraception use occurred in the developed world, while Africa had the least gains of all developing areas. For example, one in four married women in sub-Saharan Africa has an unmet need for contraception. Some women who would use contraception do not have access, while others choose not to use it because they are concerned about side effects. Gilda Sedgh, a senior researcher at Guttmacher and co-author of the study, said that such concerns have been "increasing in prevalence as a reason for non-use," adding that women have become more aware about family planning over the past few decades but "concern with the methods themselves has increased as an obstacle." Sedgh said the solution is access to high-quality family planning programs offering a range of contraceptive methods and information about true side effects (Christian Science Monitor, 10/13).
According to the report, health care for women treated for unsafe abortions in developing countries costs an estimated $500 million. The researchers said that improving access to contraception could help reduce the costs of treating unsafe abortions. For example, a recent study found that the cost of treating complications from unsafe abortions in Nigeria was about $19 million. However, it would cost about $4.8 million to provide contraception to people who wanted it, Reuters reports.
The Guttmacher researchers said preventing the need for abortion entirely is not realistic, but more access to contraception and less restrictive abortion laws could dramatically reduce the number of unsafe abortions. Camp said, "Women will continue to seek abortion whether it is safe or not as long as the unmet need for contraception remains high." She added, "With sufficient political will, we can ensure that no woman has to die in order to end a pregnancy she neither wanted nor planned for" (Reuters, 10/13).
In addition to expanded access to family planning services, modern contraceptives and legal abortion, the report recommends improving the coverage and quality of post-abortion care, which the authors said would reduce maternal deaths and complications from unsafe procedures (AP/San Francisco Chronicle, 10/14).
NPR's "Morning Edition" on Wednesday reported on the findings. The segment includes comments from Susan Cohen of Guttmacher and Colin Mason of the antiabortion-rights Population Research Institute (Wilson, "Morning Edition," NPR, 10/14).