I310 The magnitude and consequences of unsafe abortion globally (original) (raw)
2009, International Journal of Gynecology & Obstetrics
public sentiment may suddenly place reproductive providers in unfamiliar territory, being asked to meet new demands while still learning requisite skills. Instant results are expected by the media. Cooperation from colleagues in regions already providing such services is invaluable. In conclusion, international cooperation and collaboration in obstetrics and gynecology are not simply desirable, but essential. Scientific advances, clinical improvement, and public confidence will proceed only with fluid, multidirectional collaboration.
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*Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening role for the review of the ICPD Action Programme. 4 *Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening role for the review of the ICPD Action Programme. law and thus leaving no option for women other than having an unwanted birth or a clandestine risky abortion. Political and policy barriers continue to hinder legal reforms to permit abortion on request and to make services accessible where countries have reformed the laws. No other issue in reproductive health divides politicians and policy makers as abortion. More recently, the organized opposition to provision of safe abortion and efforts to make its access more restrictive are presenting formidable challenges. Together, these barriers and challenges deprive women from accessing safe abortion and exposing them to unwanted births or to unsafe abortion and its devastating consequences of death and disability. This paper reviews evidence on abortions laws and policies, levels and trends in the incidence of safe and unsafe abortion and of mortality due to unsafe abortion, focusing on changes since 1994 ICPD. Key findings are highlighted before describing data and methods, abortion laws and their implementation and levels and trends in unsafe and safe abortion. This is followed by evidence on levels and trends in unsafe abortion mortality and morbidity, selected case studies of transiting from unsafe to safe abortion and preserving the legal provision of safe abortion, reproductive rights and, finally, a set of recommendations are presented in the concluding section of the paper. Key Findings 1) Globally, the annual number of induced abortions has declined from 46 million in 1995 to 44 million in 2008. This corresponds to a decline in overall abortion rate from 35 to 28 per 1000 women in reproductive age 15-44 years. 2) From 1995 to 2008, the decline in unsafe abortion globally was modest; from 15 to 14 per 1000 women of reproductive age 15-44 years while the rate for safe abortion dropped from 20 to 14 during the same period. 3) Unsafe abortion rate declined in all regions, except in Africa where it remained constant from 1990 to 2008 at a rate of 28 per 1000 women in reproductive age 15-44 years. 4) The number of deaths due to unsafe abortion has declined from 69 000 in 1990 to 47 000 in 2008; corresponding to an annual decline in unsafe abortion-related mortality ratio of 1% in Africa, compared to 4% in Asia and over 6% in Latin America. 5) The case-fatality rate of unsafe abortion has also declined globally at a rate of nearly 3% annually, but remains many times higher than for safe abortion in developed countries. 6) Nearly all unsafe abortions and related mortality occur in developing countries with sub-Saharan Africa accounting for 61% of all deaths due to unsafe abortion. The case fatality rate for Africa was 520 per 100 000 unsafe abortions in 2008. 7) Since ICPD, countries not permitting abortion on any ground have declined from 8% to 3% in 2011 and countries where abortion is permitted on request increased from 22% to 30%. During this period, the number of countries which made grounds for abortion more liberal was much higher (70) than those making the grounds for abortion more restricted (11). 8) Whether legally restricted or not, abortions continue to occur with abortion rates being higher where it is restricted than where it is permitted on request or under broad grounds. 9) Where abortion is legally highly restricted, the incidence of unsafe abortion and related mortality is high. Legal restrictions also result in major inequity in access to safe providers, as women in urban areas and those who can afford to pay can access physicians or travel abroad to procure abortion. 10) Some countries have made major progress in reducing unsafe abortion and the associated burden of mortality and morbidity with concerted efforts, including political will, legal and health system reforms and by applying innovative approaches.
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