In 2012, an estimated 6.9 million women in developing regions were treated for complications resulting from unsafe abortion, according to new research by Susheela Singh and Isaac Maddow-Zimet of the Guttmacher Institute. Their article, "Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012," published today in BJOG: An International Journal of Obstetrics & Gynaecology, highlights two alarming realities: the very large number of women who experience complications from unsafe abortions and the significant costs that women, their households and governments incur as a result of treating these complications.

Using data from 26 countries, the researchers estimated that seven out of every 1,000 women aged 15–44 in developing regions were treated for complications resulting from unsafe procedures. Because many women who experience complications do not receive medical care for them, the actual number of women injured by unsafe procedures is likely far greater. Previous research has estimated that around 40% of women requiring treatment do not receive the care they need.

In countries where abortion is illegal or highly restricted, the procedure is often carried out under clandestine conditions that jeopardize women’s health and lives. If a woman’s health is compromised, she may also experience severe financial burdens associated with missing work or receiving medical care. In addition, health systems in developing regions spend a significant portion of their already stretched health care budgets—an estimated total of $232 million each year—on postabortion care.

A previous Guttmacher study estimated that five million women in developing regions were treated in health facilities for complications of unsafe abortion in 2005, at a rate of six per 1,000 women aged 15–44. The new study, however, uses more comprehensive data than was previously available, including new data on private sector services. The expanded scope of the current research likely accounts for the higher rate estimated for 2012.

Estimates of the treatment rate for abortion complications in Latin America show a 31% decline between 2005 and 2012, from 7.7 per 1,000 women to 5.3 per 1,000. Because the estimates for the two years are comparable in terms of countries covered and the types of data available—and access to postabortion care in Latin America is unlikely to have declined over the past decade—the researchers believe this trend may reflect a decline in complications from clandestine procedures in the region.

"It is possible that there has been a real drop in complications from clandestine abortions in Latin America," says Susheela Singh, vice president for research at the Guttmacher Institute and lead author of the study. "The specific causes of this decline are uncertain, but it is possible that increased use of misoprostol—a drug used to end pregnancy—played a role."

The researchers recommend expanding the provision of high-quality postabortion care to ensure women who need treatment are able to receive it. The researchers also urge that family planning services, including counseling and provision of a wide range of contraceptive methods, be included as a key component of postabortion care. Doing so would reduce the incidence of unintended pregnancy, which is the root cause of most abortions. They also note that improved access to safe abortion services would decrease the number of women harmed by complications from unsafe, clandestine procedures.