Abortion rates are similar in countries where the procedure is legal and in countries where it is not, and the number of abortions worldwide is declining due to increased access to contraception, according to a study conducted by the Guttmacher Institute and the World Health Organization and published Oct. 12 in The Lancet, The New York Times reports. The study also found that abortions were “safe in countries where it was legal, but dangerous in countries where it was outlawed and performed clandestinely,” according to the Times.

For the study, Gilda Sedgh of the Guttmacher Institute and colleagues from WHO examined abortion trends from 1995 to 2003 in developed and developing countries where the procedure is legal and prohibited. The researchers used national data for countries where abortion was legal and estimated abortion rates from countries where it is illegal, using data on hospital admissions for abortion complications, interviews with local family planning experts and surveys of women in those countries, the Times reports.

Unsafe abortions tied to poverty

The study found that the number of abortions worldwide has decreased from about 46 million in 1995 to about 42 million in 2003. The majority of abortions, 35 million, occurred in developing countries, and 97 percent of all unsafe abortions — those performed either by people without the necessary skills or in a setting that does not conform to minimum medical standards — were performed in low-income countries, the study found. About 20 million unsafe abortions were performed each year, and about 67,000 women died from complications from those abortions, mostly in countries where the procedure is banned, according to the study.

Regional differences

In Eastern Europe, where contraceptive access has increased in recent years, abortion rates declined by 50 percent, the study found. However, there are 105 abortions per every 100 live births in Eastern Europe, compared with 33 abortions per 100 live births in North America and 17 abortions per 100 live births in Africa, according to the study. The largest number of abortions, 26 million in 2003, occurred in Asia, including about 9 million procedures in China.

In Uganda, where abortion is illegal and sex education programs focus on abstinence, the estimated abortion rate was 54 abortions per 1,000 women in 2003. The rate in the U.S. was 21 per 1,000 women, and in Western Europe, where abortion is legal and contraception is widely available, the abortion rate was 12 per 1,000 women.

Laws vs. women’s decisions

“We now have a global picture of induced abortion in the world, covering both countries where it is legal and countries where laws are very restrictive,” Paul Van Look, director of WHO’s Department of Reproductive Health and Research, said, adding, “What we see is that the law does not influence a woman’s decision to have an abortion. If there’s an unplanned pregnancy, it does not matter if the law is restrictive or liberal.”

Sharon Camp, CEO of the Guttmacher Institute, said the data also suggested that the best way to reduce abortion rates was not to make the procedure illegal but to make contraception more widely available. “Generally, where abortion is legal it will be provided in a safe manner,” Van Look said, adding, “And the opposite is also true: where it is illegal, it is likely to be unsafe, performed under unsafe conditions by poorly trained providers.”

Maternal mortality stillbig problem

In a related Lancet study also published Oct. 12, maternal mortality rates declined less than 1 percent annually between 1990 and 2005, “far below” the 5.5 percent annual decline needed to meet the UN Millennium Development Goals target of reducing the number of women who die during pregnancy and childbirth by three-quarters by 2015, Reuters reports. For the study, researchers used figures from WHO, the World Bank and other nongovernmental organizations to assess maternal mortality trends.

Half of the maternal deaths occurred in sub-Saharan Africa, and the region showed a “particularly small drop” in its maternal mortality rate, BBC News reports.

“The huge difference in risk [between countries] dwarfs differences for other commonly used health indicators, such as the infant mortality rate, and makes it likely that effective interventions to reduce maternal mortality exist but are not being widely implemented,” the researchers said.

— Excerpted from Kaisernetwork.org