As 2015 approaches, concern is growing about whether many developing countries can attain the fifth Millennium Development Goal, which focuses on maternal health. Throughout the developing world, women still die in great numbers from complications of unsafe abortion, from lack of skilled obstetric care and other maternal health services and from limited access to services that would allow them to avoid unwanted and mistimed pregnancies. The articles in this issue of International Perspectives on Sexual and Reproductive Health explore various facets of the circumstances that continue to expose women to these risks.
In the lead article, Elena Prada and colleagues estimate numbers and rates of abortion in Colombia for 2008 [page 114]. Although abortion was made legal under limited circumstances in 2006, just 322 of the estimated 400,400 abortions performed in 2008 were legal Noting that only one in nine of the Colombian health facilities sampled in the study offered legal abortion in 2009 and that the national family planning program has lost momentum in the last decade, the authors warn that unsafe abortion will continue to have a substantial impact on women's health until access to such services is increased.
The latest in a series of studies of family planning program effort conducted since 1972 indicates that on average, programs improved their effort levels slightly between 1999 and 2009 [page 125]. Nevertheless, authors john Ross and Ellen Smith say, the average effort in 2009 was only about half of maximum, and neither scores for service nor those for access to contraceptives reached that level. According to the authors, countries have not yet ensured universal access to a wide range of long-term and short-term methods. They argue that the extent to which women resort to unsafe abortion testifies to the failure of national programs and the private sector to make contraceptive access and information broadly available to the public.
Abortion is severely restricted in Iran, and many women with an unwanted pregnancy resort to an illegal abortion. Using data from the 2009 Tehran Survey of Fertility, Amir Erfani estimates that about 11,500 abortions were performed among married women in the city in 2009 [p. 134]. Fertility-related or socioeconomic reasons were cited by seven in 10 women who reported having an abortion; because danger to the life of the woman or the fetus are the only justifications for legal abortion, this implies that the great majority of the abortions performed were illegal, and presumably unsafe. …