Induced Abortion: Incidence and Trends Worldwide From 1995 to 2008

Women whose abortions performed according to medical guidelines are at very low risk of complications. A significant proportion of women with unsafe abortions, however, are at substantial risk of morbidity and death. Unintended pregnancies occur in all societies, and women determined to avoid an unplanned birth will seek unsafe abortions if they have no access to a safe abortion. There are significant regional and global differences in the incidence of safe and unsafe abortions and in laws restricting abortion. It is controversial whether restrictive abortion laws prevent women from obtaining abortions and are effective in reducing rates of abortion. Monitoring of global abortion trends is critical to assess the progress toward reduction of maternal mortality and achieving universal access to family planning. This study was designed to investigate the global incidence of safe and unsafe abortions in 2008, and to compare 2008 abortion rates with those in 1995 and 2003, the only other years when similar assessments were conducted. Another aim of the study was to investigate the association between the incidence of abortion and the legal status of abortion in the world's subregions. The definition of unsafe abortion established by the World Health Organization was used. Information used to estimate the incidence of safe abortions was obtained largely from official statistics and nationally representative surveys of women. The sources of information for estimates of the incidence of unsafe abortions were primarily published studies, hospital records, and surveys of women. Adjustments and projections were made to correct for data that were misreported, incomplete, or from earlier years by using additional sources and approaches. Trends for the incidence of abortion were estimated using rates developed for 1995, 2003, and 2008 with the same methodology. Linear regression models were used to examine the association between the legal status of abortion and the abortion rate across subregions of the world in 2008. Abortion rates were expressed as the numbers of abortions for every 1000 women aged 15 to 44 years. There was no difference in abortion rates in the world's 18 subregions with access to legal abortion between 2003 and 2008; the rate was 29 and 28 per 1000 women, respectively. The stable rates during these years were preceded by a period of substantial decline from 35 abortions per 1000 women in 1995. Between 1995 and 2003, the average annual global decline in the rate was nearly 2.4% compared with a decline of only 0.3% between 2003 and 2008. Between 1995 and 2008, the proportion of unsafe abortions increased from 45% to 49%. In 2008, about 1 in 5 pregnancies ended in abortion. The abortion rate was lower in subregions with liberal abortion laws than in subregions with restrictive laws (P < 0.05). These findings show that restrictive abortion laws do not reduce rates of the procedure. The increased abortion rates among women living under restrictive laws expose them to unsafe abortions and increased risk of morbidity and death. Critical measures to reduce maternal mortality include universal access to reproductive health through availability of family planning services, with effective use of contraceptives, safe abortion services, and postabortion care.