Abortion Worldwide 2023: an overview

Abortion has a significant presence in the global reproductive health landscape. According to the World Health Organization (WHO), almost half of all pregnancies – 121 million – are unintended each year. From this number of unintended pregnancies, 6 out of 10 end up in induced abortion [1]. That translates into an estimated 73 million abortions annually, which means that abortion is a widespread medical practice.

Country classifications by income level & abortion rates

The Guttmacher Institute reports that countries with low income have the highest number of unintended pregnancies, with 40% ending in abortion. In general, the relationship between income and unintended pregnancy is negative. While income does play a role in unintended pregnancy rates, it does not make utterly accurate to abortion rates, as the middle-income countries reported the highest number of abortion rates [2].

In countries with higher incomes, reproductive health is much more accessible, as well as contraception and abortion care, which allows people in those countries better access to sexual and reproductive medical care services. Conversely, access and availability to such services in low-income countries are often more limited, leading to more unintended pregnancies and, in turn, more abortions and more underreporting of abortions [3].

Legal Restrictions and abortion rates

Throughout the world, legal restrictions on abortion vary significantly. Abortion is banned in some countries, whereas in others, abortion it’s permitted without restrictions. Despite changing legal restrictions on abortion, the proportion of unintended pregnancies ending in abortion is typically similar among countries with restrictive and more permissive laws; which suggests that even in countries with heavy restrictions, people who need or want to end a pregnancy will find ways to do it. While the number of abortion rates is similar, the numbers of unsafe abortions and complications vary. It is essential to recognize that despite the legal restrictions, abortion rates seem not to be affected. Safe and legal abortion, which is necessary for improving maternal health, is threatened [2][5].

Unsafe abortion rates

Unsafe abortion is a serious public health concern that impacts millions of people around the world. Every year, an estimated 20 million unsafe abortions occur, resulting in approximately 68,000 deaths and 5 million cases of disability [4]. Unsafe abortion is particularly prevalent in countries with restrictive abortion laws, as access to safe, legal abortion services is limited or non-existent.

The maternal mortality ratio – the number of maternal deaths per 100,000 live births – due to complications of unsafe abortion is much higher in regions with restrictive abortion laws compared to areas where access to safe and legal abortion is available. For example, according to a study by the Special program of research of the World Health Organization, the incidence of unsafe abortion is higher in low and middle-income regions: Africa, Asia, and Latin-American.

The State of Abortion Data

The availability and accuracy of data on abortion are critical for public health, policy, and advocacy efforts. Accurate data can help decision-makers better understand the sexual and reproductive health needs of their populations and tailor policies and services accordingly. Unfortunately, legal restrictions and social stigma surrounding abortion mean that reliable data is often difficult to obtain [6].

The disparities of existing data are vast. Europe and Northern America counted most of the data regarding abortion. While in other regions, like Sub-Saharan Africa and Latin America, abortion was available for less than half of the countries. West Asia and North Africa are the regions with more lack of abortion information [6].

While these figures have changed, particularly in regions such as Latin America, where NGOs and local organizations have made substantial efforts to increase the evidence for abortion. There is still a lack of complete and up-to-date abortion data worldwide. A report published by Women Deliver in 2020 indicated that abortion data is lacking regarding the following topics:

• Information on rates of unsafe abortion and post-abortion care outcomes;

• Evidence based on effective approaches to liberalize abortion laws and increase access to safe abortion and post-abortion care in legally restrictive settings and humanitarian settings;

• Investigate the long-term impacts of incarceration due to abortion/restrictive legal frameworks on women’s health, economic opportunities, and societal costs [7].

A lack of data affects the population since there is no evidence to guide decisions regarding healthcare programs and no understanding of the local context. Moreover, data is necessary to inform healthcare providers about their patients’ needs and evaluate their performance. Therefore, a lack of data can have severe implications for public health efforts, leading to inequalities in access to care, poor health outcomes, and the neglect of reproductive and health rights.

This text contains data relating abortion to unintended pregnancies, as the Guttmacher Institute has tried to overcome the challenge of producing abortion data using the variable “unintended pregnancies.” Despite this, it is essential to note that abortions occur during unintended and intended pregnancies.

Sources

[1] World Health Organization. (2021).  Abortion. https://www.who.int/news-room/fact-sheets/detail/abortion. Jan 2, 2023. 

[2] Guttmacher Institute. (2022). Unintended Pregnancy and Abortion Worldwide. guttmacher.org/fact-sheet/induced-abortion-worldwide. Jan 2, 2023. 

[3] Bearak, J; Popinchalk A; Ganatra B; Moller, A; Tunçalp, Ö; Cynthia Beavin, C; Kwok, L; Alkema, L.  (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health.

[4] Haddad, L;  Nour, N. (2009). Unsafe Abortion: Unnecessary Maternal Mortality. Rev Obstet Gynecol. 2009 Spring;2(2):122-6. PMID: 19609407; PMCID: PMC2709326.

[5] Shah,I; Åhman, E. (2009). Unsafe Abortion: Global and Regional Incidence, Trends, Consequences, and Challenges. Women’s Health. 

[6] Popinchalk, A ;  Beavin, C; Bearak, J. (2021) The state of global abortion data: an overview and call to action. Guttmacher Institute. 

[7] Women Deliver. (2020). Advocating for a stronger evidence base for gender equality: an analysis of gender data and knowledge gaps.