Unsafe abortions are on the rise across the world, according to a new global analysis by the Guttmacher Institute and the World Health Organization. And, after a period of significant decline in the global abortion rate as a whole, researchers found that those numbers had begun to plateau.
From 2003 to 2008, the abortion rate per 1,000 women of childbearing age (15 to 44) changed slightly, from 29 to 28 per 1,000. women But the proportion of unsafe abortions that took place across the world rose 44 percent in 1995 to 49 percent in 2008.
"The stall in the abortion rate coincides with a plateau in the level of contraceptive use, which had been increasing in prior years," said Dr. Gilda Sedgh, lead author of the study and senior researcher at the Guttmacher Institute in New York. "Before the abortion rate stalled, it was declining, and contraceptive use was increasing. Also more abortions are unsafe because a growing proportion of abortions are taking place in the developing world."
Researchers defined unsafe abortion according to the WHO description when analyzing data. The WHO considers an abortion unsafe when a procedure for terminating pregnancy is performed by a person who is lacking the necessary skills or in an environment that does not conform to minimal medical standards.
Scientists based the data on national surveys, official statistics, hospital records and research papers from across the globe.
Despite the decline in the overall abortion rate, the number of abortions increased, from 41.6 million in 2003 to 43.8 million in 2008 because of an increasing global population, according to the report.
While almost all reported abortions were deemed safe in North America and Europe, nearly all abortions (97 percent) in Africa were considered unsafe in 2008. Nearly all abortions were performed under safe conditions in East Asia, but 65 percent were considered unsafe across south central Asia.
Over the past three decades, about 20 percent of all pregnancies around the world have ended in abortion, according to the research.
"What we clearly know is that making abortion less available does not make it performed less often," said Dr. Lauren Streicher, assistant clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. "It's just more unsafe. Condemning abortion is a cruel and failed strategy."
Even in the U.S., where abortion is currently legal, Streicher said access can be limited based on someone's insurance plan and where they live.
"Fifty percent of undesired pregnancies are due to failed contraception," said Streicher. "Of those unplanned pregnancies, 50 percent resolve in abortion, so the need for abortion is always going to be there. By criminalizing it, you're just increasing the amount of women who have poor and dangerous outcomes.
While some countries have decreased their restrictions on abortion, others have increased barriers to safe abortion through more restrictive laws, unwillingness to train providers, increasing the cost of obtaining safe services and validating abortion stigmatization through perpetuation of cultural and societal norms, said Dr. Eva Lathrop, assistant professor of family planning, obstetrics and gynecology and global health at Emory University Schools of Medicine and Public Health.
Researchers said it appears that family planning programs across the globe have not kept pace with the demand, which has continued to increase because of population growth and as more couple want smaller families.
Experts said the key to keeping women safe requires an improvement in the availability of a full range of contraceptive methods to allow women to choose the method that is best for them. Very few countries have complete bans on abortions, but women and families are often unclear of those laws, so public health advocates and policymakers must provide more education that is readily available to women, health care providers and society as a whole.
"When women are dying from unsafe abortions, their families crumble," said Lathrop. "The health of a society can be measured by the health of the women who are the backbone of that society, and when unsafe abortion rates are high, it is a general indication that the public health system is broken.
"Abortion is the single most important global public health issue, and the single most divisive, yet it needn't be," said Lathrop. "It is time that global leaders have an ethical and open conversation addressing access to abortion as a human right and make swift policy changes towards destigmatisation and legalisation of abortion."