Unsafe abortion: The global public health challenge

Each year throughout the world, approximately 205 million women become pregnant and some 133 million of them deliver live-born infants [1]. Among the remaining 72 million pregnancies, 30 million end in stillbirth or spontaneous abortion and 42 million end in induced abortion. An estimated 22 million induced abortions occur within the national legal systems; another 20 million take place outside this context and by unsafe methods or in suboptimal or unsafe circumstances. When faced with unwanted or unintended pregnancies, women resort to induced abortion irrespective of legal restrictions. In contrast to other medical conditions, ideologies and laws restrict access to safe abortion services, especially in developing countries and among the poorest of poor countries. Information on the incidence of induced abortion, whether legal and safe or illegal and unsafe, is crucial for identifying policy and programmatic needs aimed at reducing unintended pregnancy and addressing its consequences. Understanding the magnitude of unsafe abortion and related mortality and morbidity is critical to addressing this major yet much neglected public health problem. This chapter focuses on induced unsafe abortions, which carry greater risks than those performed under legal conditions. It provides the latest estimates of the magnitude of the problem including rates, trends, and differentials in unsafe abortion. The links between contraceptive prevalence, unmet need for family planning, and unsafe abortion are described, as well as the mortality and morbidity as a result of unsafe abortion. The chapter concentrates on developing countries, where 97% of unsafe abortions and nearly all related deaths occur. Finally, the chapter describes the international discourse on addressing unsafe abortion.