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Abortion rates are down globally, but these declines have been mainly driven by decreases in abortion in the developed world, according to a large descriptive analysis of abortion estimates
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Abortion rates are down globally, but these declines have been mainly driven by decreases in abortion in the developed world, according to a large descriptive analysis of abortion estimates.
Of the 56 million abortions estimated annually worldwide, the vast majority (88%) actually take place in the developing world as opposed to the developed world.
The estimated global abortion rate was 35 abortions (90% UI 33-34) per 1,000 women ages 15-44 from 2010-2014. This was a nonsignificant decline of 5 points from 2 decades earlier in 1990-1994, reported Gilda Sedgh, ScD, of the Guttmacher Institute in New York City, and colleagues.
But the majority of these declines came from industrial nations, where the annual abortion rate was down by 19 points to a record low (27 per 1,000 women versus 46 in the earlier period). Abortion rates in the developing world only experienced a nonsignificant 2-point decline (39 to 37), they wrote in The Lancet.
In a conference call with the media, Sedgh said that improvements had been made to the model that researchers used to develop these estimates. She described previous estimates as "conservatively low," and that estimated 44 million abortion figure was likely closer to 52 million abortions in 2008.
"[For this model], we used all the available abortion data, but also information on factors associated with abortion incidence and a statistical, hierarchical time series model to create a more scientifically rigorous approach," said Sedgh, who commented that researchers had previously estimated abortion incidence by using all available abortion data and "making inferences" about missing data from some countries.
An accompanying editorial from Diana Greene Foster, PhD, of the University of California San Francisco, pointed out that reported U.S. abortion rates are half of those indicated by data from abortion providers, and that these new estimates give a sense of "the magnitude of uncertainty" around abortion estimates.
"New estimates might enable researchers to assess the consequences of reproductive health policies such as investments into family planning [programs], [liberalization] of abortion law, availability of safe methods of self-induction with medical abortion, development of new methods of contraception, and new approaches to empowering women to achieve reproductive control," she wrote.
One quarter of all pregnancies worldwide were estimated to end in abortion (25%), but those numbers were drastically different in the developed world compared with the developing world. Examining the number of pregnancies ending in abortion, there was a 11-point decline in the developed world (39% to 28%), but an increase in the developing world (21% to 24%). Married women had the majority of abortions (73%), with single women accounting for only a little over a quarter of abortions worldwide.
Interestingly, there was no significant difference in abortion rates of countries where abortion was prohibited (37 per 1,000 women) or only allowed to save a mother's life compared with countries where it was available upon request (34 per 1,000 women). Sedgh's group estimated that 16 million abortions take place in countries where it is illegal.
They also cited earlier estimates that 40% of women suffering complications from backroom abortions never get treatment -- making the importance of access to safe abortion, quality family planning services and contraception that much more critical, they said.
"Women are having abortions in all parts of the world, whether abortion is legal or not, whether health systems are weak or strong and whether contraceptive prevalence are high or low," said Sedgh on the media call.
Richard Horton, MD, editor-in-chief, The Lancet, also spoke on the call, saying that this data provided a "wake up call" for all governments and agencies worldwide to provide safe abortion services. He said that this issue relates both to maternal mortality -- where abortion is a leading cause.
"Providing safe abortion services is essential if one is going to reduce maternal mortality. Safe abortion services are almost never prioritized – they are hugely stigmatized," said Horton on the call. "If health of women is truly going to be a priority, then provision of these services is indispensable for that vision."
He added that these results would also provide a "special opportunity" to focus on adolescent health and reproductive services and ensure the younger generation has access to quality care.
This research was supported in part by the U.K. government, Dutch Ministry of Foreign Affairs, Norwegian Agency for Development Cooperation, and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
Sedgh and colleagues disclose no conflicts of interest.
Greene Foster discloses no conflicts of interest.
- Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner
The LancetSource Reference: Sedgh G, et al "Abortion incidence between 1990 and 2014: Global, reg