ArticlesInduced abortion: estimated rates and trends worldwide
Introduction
Induced abortion is one of the greatest human rights dilemmas of our time. The need for scientific and objective information on the matter is therefore imperative. However, because of the sensitive nature of the topic, data sources are limited and accurate information on the occurrence of induced abortion is difficult to obtain.
The distinction between safe and unsafe abortion is crucial because each has different public-health implications. Safe abortion has few health consequences, whereas unsafe abortions are a threat to women's health and survival.1, 2, 3, 4, 5 WHO is involved in efforts to improve maternal health and reduce maternal mortality in 63 priority countries.5 The UN Millennium Development Goals, adopted by 189 nations, include the goal of improving maternal health and the specific target of reducing the maternal mortality ratio by three-quarters between 1990 and 2015.6 Unsafe abortion is a major cause of maternal mortality, and measuring its incidence is important for monitoring progress on this goal. Unsafe abortion also has other consequences, including economic costs to health systems and families, stigmatisation, and psychosocial effects on women.
All abortions, whether safe or unsafe, are a compelling indicator of the incidence of unintended pregnancies, and information on abortion rates can affect the allocation of resources by national authorities, donor nations, and international agencies for contraceptive services and supplies.
This Article presents new estimates of the incidence of induced abortion worldwide, by region, and according to the safety of the procedure, for 2003, the most recent year for which worldwide estimates could be made. We define safe and unsafe abortion and indicate how these definitions intersect with abortion laws and regulations. This work is the product of a comprehensive review of the evidence and systematic methods of estimation, and represents the first known worldwide assessment of abortion incidence since 1995, when estimates were originally developed. It used methods similar to those used in 1995, and we assessed trends in safe and unsafe abortion since that time.
Section snippets
Data sources
For estimation purposes, safe abortions were defined as those that meet legal requirements in countries in which abortion is legally permitted under a broad range of criteria. Unsafe abortion is defined by WHO as any procedure to terminate an unintended pregnancy done either by people lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both (panel 1).6 These include abortions in countries with restrictive abortion laws, as well as abortions
Results
An estimated 42 million induced abortions occurred in 2003, compared with the 1995 estimate of 46 million (table 1). The abortion rate (yearly number of induced abortions per 1000 women aged 15–44 years) worldwide was 29 in 2003, down from 35 in 1995. The total abortion rate, which can be interpreted as the number of abortions a woman will have if current rates prevail throughout her reproductive lifetime, was 1·1 in 1995 and 0·9 in 2003. An assessment of trends between 1995 and 2003 should
Discussion
The findings presented here provide new estimates of abortion incidence at the worldwide and regional levels, which had not been updated since 1995. In the face of a dearth of information for many countries, particularly those in which abortion laws are highly restrictive, this study drew on all available sources of information and used systematic and consistent methods to estimate abortion incidence. Information on abortion rates and trends has important implications for stakeholders in many
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