Global Abortion Rate Stabilizes, but Unsafe Procedures Remain the Norm in Developing Countries

Article excerpt

The worldwide abortion rate was essentially stable between 2003 and 2008, after having declined during the previous eight years, a new analysis indicates. (1) About 44 million abortions were performed in 2008, which translates to 28 per 1,000 women of reproductive age, a rate only slightly lower than that five years earlier (29 per 1,000). More than four-fifths of these abortions took place in developing countries, where more than half (56%) of abortions were unsafe.

The new study was a sequel to prior analyses that estimated worldwide abortion statistics for 1995 and 2003. The researchers estimated numbers and rates of abortion by country and region, and compared the findings to those for the earlier years. They obtained data from a variety of sources, assessed its quality and made adjustments as needed to compensate for shortcomings.

As in the prior analyses, the researchers generally considered abortions unsafe if they were performed in a country with highly restrictive abortion laws, or if they were done in a country with less restrictive laws but did not meet the country's legal requirements. Safe abortions were those that. met legal requirements in a country where abortion was allowed on request or on socioeconomic grounds, or where, if laws were interpreted liberally, abortion was legal to preserve a woman's physical or mental health. However, the researchers deviated from these classifications when called for by empirical evidence; for example, although abortion is broadly legal in India, many pregnancies are terminated by unauthorized providers and categorized as unsafe.

In two-thirds of the countries with liberal abortion laws, formal abortion statistics were available. These data were used unaltered if experts familiar with the country considered the statistics at least 95% complete; if the data did not meet this threshold, the number of abortions was increased by 5-154% (mean, 26%) to yield a more accurate estimate. Similarly, adjustments for underreporting were made to data from countries whose only abortion estimates were from national surveys. If no official statistics, survey data or estimates were available, the investigators assigned estimated rates on the basis of the country's fertility and contraceptive rates and other factors.

For countries with restrictive abortion laws, the investigators used data from official sources, nongovernmental organizations, databases and experts, giving preference to estimates published in peer-reviewed journals. In some cases, numbers and rates were estimated using data on the number of women who received medical treatment for abortion complications and the estimated proportion of abortion recipients who required treatment for complications. In other cases, survey-based data were used and adjusted for under-reporting. For some countries (most of them small), the investigators generated national estimates by extrapolating from subnational data, or by assuming that rates mirrored those of countries that were nearby or had similar abortion laws, fertility rates and levels of contraceptive use.

Overall, an estimated 44 million abortions were performed in 2008, slightly more than in 2003 (42 million) but fewer than in 1995 (46 million). …