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Unsafe abortion

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An unsafe abortion has been defined by the World Health Organization (WHO) as the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both.[1] In 2017, WHO, in collaboration with Guttmacher Institute, further refined the definition of unsafe abortion to create a distinction between less safe and least safe abortion.[2] Less safe abortion is abortion performed by a trained provider utilizing an outdated method of abortion, or a safe method of abortion utilized without adequate information or support from a trained individual; least safe abortion is abortion performed by untrained individuals using dangerous methods, such as insertion of foreign bodies into the uterus.[2] Of the 25.1 million unsafe abortions that occur every year, 17.1 million are less safe and 8 million are least safe.[2] Most unsafe abortions (97%) occur in the developing world, and unsafe abortion is more common where abortion is highly restricted or banned altogether.[2]

Worldwide, between 22,800 and 31,000 women die annually from unsafe abortion,[3] accounting for at least 8% of maternal deaths.[4] Around 7 million women receive health facility treatment for complications arising from unsafe abortion,[5] the cost of this care is estimated at US$232 million dollars in the developing world alone.[6]

Overview

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Using data from 2010-14, WHO estimates that there are 55.7 million abortions worldwide each year; of these, approximately 55%, or 31 million, were safe, 31% were less safe, and 14% were least safe.[2] Of the 25.1 million unsafe abortions that occur each year, 97% are in developing countries.[2] At least 22,800 women die annually as a result of complications of unsafe abortion; and between two million and seven million women each year survive unsafe abortion but sustain long-term morbidity. The WHO reports that in developed regions, nearly all abortions (92%) are safe, whereas in developing countries, more than half (55%) are unsafe. According to WHO statistics, the risk rate for unsafe abortion is 1/270; according to other sources, unsafe abortion is responsible for at least 8% of maternal deaths.[7][8] The British Medical Bulletin reported in 2003 that 70,000 women a year die from unsafe abortion.[9] Incidence of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".[10][11]

An article pre-printed by the World Health Organization called safe, legal abortion a "fundamental right of women, irrespective of where they live" and unsafe abortion a "silent pandemic".[10] The article states "ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative." It also states "access to safe abortion improves women’s health, and vice versa, as documented in Romania during the regime of President Nicolae Ceaușescu" and "legalisation of abortion on request is a necessary but insufficient step toward improving women’s health" citing that in some countries, such as India where abortion has been legal for decades, access to competent care remains restricted because of other barriers. WHO’s Global Strategy on Reproductive Health, adopted by the World Health Assembly in May 2004, noted: "As a preventable cause of maternal mortality and morbidity, unsafe abortion must be dealt with as part of the MDG on improving maternal health and other international development goals and targets."[12] The WHO's Development and Research Training in Human Reproduction (HRP), whose research concerns people's sexual and reproductive health and lives,[13] has an overall strategy to combat unsafe abortion that comprises four interrelated activities:[12]

  • to collate, synthesize and generate scientifically sound evidence on unsafe abortion prevalence and practices;
  • to develop improved technologies and implement interventions to make abortion safer;
  • to translate evidence into norms, tools and guidelines;
  • and to assist in the development of programmes and policies that reduce unsafe abortion and improve access to safe abortion and highquality postabortion care

A 2007 study published in The Lancet found that, although the global rate of abortion declined from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions performed in 2003. It also concluded that, while the overall incidence of abortion in both developed and developing countries is approximately equal, unsafe abortion occurs more often in less-developed nations.[14]

According to a new study in The Lancet that focused on data from 2010 to 2014, nearly 55 million pregnancies are terminated early and of that 55 million, nearly half, 25.5 million are deemed as unsafe.[15] The World Health Organization and the Guttmacher Institute in New York, stresses the need for access to a safe abortion for all women and that unsafe methods must be replaced. Africa, Asia and Latin America account for almost 97 percent of them of unsafe abortions. These regions are often poorer and underdeveloped and lack the access to safe abortion methods. Out of all abortions in these regions only 25% are considered safe. In developed countries these numbers improve drastically. Nearly all abortions in North America (99%) are considered safe. Overall nearly 88% of abortions in developed countries were actually considered safe, with the number of safe abortions in Europe slightly lower.

Conflating illegal and unsafe abortion

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Unsafe abortions often occur where abortion is illegal.[16] However, the prevalence of unsafe abortion may also be determined by other factors, such as whether it occurs in a developing country that has a low level of competent medical care.[17]

Unsafe abortions sometimes occur where abortion is legal, and safe abortions sometimes occur where abortion is illegal.[18] Legalization is not always followed by elimination of unsafe abortion.[19][20] Affordable safe services may be unavailable despite legality, and conversely, women may be able to afford medically competent services despite illegality.[21]

When abortion is illegal, that generally contributes to the prevalence of unsafe abortion, but it is not the only contributor. In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.[22]


Illegality of abortion contributes to maternal mortality, but that contribution is not as great as it once was, due to medical advances including penicillin and the birth control pill.[23]

Frequency by continent

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  1. ^ Safe Abortion: Technical and Policy Guidance for Health Systems, page 12 (World Health Organization 2003): "a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skill or in an environment lacking the minimum medical standards, or both."
  2. ^ a b c d e f Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A, Sedgh G, Singh S, Bankole A, Popinchalk A, Bearak J, Kang Z, Alkema L (November 2017). "Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model". Lancet. 390 (10110): 2372–2381. doi:10.1016/S0140-6736(17)31794-4. PMC 5711001. PMID 28964589.
  3. ^ Singh, S; Remez, L; Sedgh, G; Kwok, L; Onda, T (2018). Abortion Worldwide 2017: Uneven Progress and Unequal Access. New York: Guttmacher Institute.{{cite book}}: CS1 maint: url-status (link)
  4. ^ Say, Lale; Chou, Doris; Gemmill, Alison; Tunçalp, Özge; Moller, Ann-Beth; Daniels, Jane; Gülmezoglu, A Metin; Temmerman, Marleen; Alkema, Leontine (2014). "Global causes of maternal death: a WHO systematic analysis". The Lancet Global Health. 2 (6): e323–e333. doi:10.1016/S2214-109X(14)70227-X.
  5. ^ Singh, S; Maddow-Zimet, I (2016). "Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries". BJOG: An International Journal of Obstetrics & Gynaecology. 123 (9): 1489–1498. doi:10.1111/1471-0528.13552. PMC 4767687. PMID 26287503.{{cite journal}}: CS1 maint: PMC format (link)
  6. ^ Singh, S; Maddow-Zimet, I (2016). "Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries". BJOG: An International Journal of Obstetrics & Gynaecology. 123 (9): 1489–1498. doi:10.1111/1471-0528.13552. PMC 4767687. PMID 26287503.{{cite journal}}: CS1 maint: PMC format (link)
  7. ^ Nour NM (2008). "An Introduction to Maternal Mortality". Reviews in Ob Gyn. 1: 77–81.
  8. ^ "Induced Abortion Worldwide". Guttmacher Institute. 2018. Retrieved 2019-09-11.
  9. ^ Grimes DA (2003-12-01). "Unsafe Abortion: The Silent Scourge". British Medical Bulletin. 67 (1): 99–113. doi:10.1093/bmb/ldg002. PMID 14711757. Retrieved 2012-11-03.
  10. ^ a b Grimes DA. "Unsafe Abortion - The Preventable Pandemic*". Retrieved 2010-01-16.
  11. ^ Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM (June 1997). "Women's hidden transcripts about abortion in Brazil". Social Science & Medicine. 44 (12): 1833–45. doi:10.1016/s0277-9536(96)00293-6. PMID 9194245.
  12. ^ a b "Preventing unsafe abortion". WHO. Retrieved 2014-03-28.
  13. ^ "New findings from the WHO Multicountry Survey on Maternal and Newborn Health". WHO. Retrieved 2014-03-28.
  14. ^ Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH (October 2007). "Induced abortion: estimated rates and trends worldwide". Lancet. 370 (9595): 1338–45. CiteSeerX 10.1.1.454.4197. doi:10.1016/S0140-6736(07)61575-X. PMID 17933648.
  15. ^ Welch, A. (2017, September 27). Report finds nearly half of all abortions worldwide are unsafe. Retrieved December 05, 2017, from https://www.cbsnews.com/news/report-finds-nearly-half-of-all-abortions-worldwide-are-unsafe/
  16. ^ Rosenthal E (October 2007). "Legal or Not, Abortion Rates Compare". New York Times. Retrieved 2009-06-30.
  17. ^ Chaudhuri, S.K. Practice Of Fertility Control: A Comprehensive Manual, 7th Edition, page 259 (Elsevier India, 2007).
  18. ^ Faúndes, Aníbal and Barzelatto, José. The Human Drama of Abortion: a Global Search for Consensus, page 21 (Vanderbilt University Press 2006).
  19. ^ Blas, Erik et al. Equity, social determinants and public health programmes, pages 182-183 (World Health Organization 2010).
  20. ^ "Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003" (PDF). World Health Organization. 2007. Retrieved March 7, 2011. In several countries, the legalization of abortion has not been followed by elimination of unsafe abortion.
  21. ^ Safe Abortion: Technical and Policy Guidance for Health Systems, page 15 (World Health Organization 2003).
  22. ^ Singh, Susheela et al. Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health (New York: Guttmacher Institute and United Nations Population Fund 2009): "If women’s contraceptive needs were addressed...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "Facts on Investing in Family Planning and Maternal and Newborn Health Archived 2012-03-24 at the Wayback Machine" (Guttmacher Institute 2010).
  23. ^ "Abortion Distortions: Senators from both sides make false claims about Roe v. Wade" Archived 2011-07-26 at the Wayback Machine, FactCheck.org (2005-08-22): "Sen. Boxer claimed that overturning Roe v. Wade would cost the lives of more than 5,000 pregnant women a year. That might have been true before the invention of penicillin and the birth control pill, but it's not true now. The best evidence indicates that the annual deaths from illegal abortions would number in the hundreds, not thousands."
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