Millions of women and girls worldwide experience unintended pregnancy each year. With improved access to sexual and reproductive health services, however, the number of unintended pregnancies worldwide has fallen since 1990–1994.
A new study published today in Lancet Global Health also reveals, however, that more than half of unintended pregnancies (61%) end in abortion. Abortions occur in all countries, even in those with restrictive abortion laws. In fact, over the past three decades, the proportion of unintended pregnancies ending in abortion has increased in countries where more legal restrictions are in place, and where it may be harder to access safe and appropriate contraception.
"The findings of this study show a clear need for a comprehensive approach to sexual and reproductive health and rights, including access to safe and legal abortion, which is critical to ensuring reproductive autonomy," says Herminia Palacio, President and CEO of the Guttmacher Institute.
Authored by researchers at the Guttmacher Institute and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), the study looks at the incidence of unintended pregnancy and abortion from 1990 to 2019.
Unintended pregnancies declining, but women in poorest countries face greatest risks
Worldwide, since 1990, as access to contraceptives has increased, the rate of unintended pregnancy has fallen. In 2015–2019, there were 121 million unintended pregnancies annually, corresponding to a global rate of 64 per 1,000 women aged 15–49. This is a decline from 79 per 1,000 women in 1990–1994.
But progress is not uniform. Women in the poorest countries were nearly three times as likely to face unintended pregnancies as those in the wealthiest countries, revealing major and persistent inequities in access to sexual and reproductive health care.
Sixty–one percent of unintended pregnancies (73.3 million) ended in abortion between 2015 and 2019, corresponding to a global rate of 39 per 1,000 women aged 15–49. Abortion rates and trends varied across regions. The most significant decline was in Europe and North America, where the abortion rate fell by 63% between the periods 1990–1994 and 2015–2019.
"The substantial declines in unintended pregnancies and in abortion rates in some regions of the world is welcome news, reflecting important gains in access to effective, safe, acceptable and affordable sexual and reproductive health services," says Bela Ganatra, Head of Preventing Unsafe Abortion Unit and Scientist at HRP.
Abortion occurs across countries, both where it is legal and where it is restricted
Over the same period, in countries with legal restrictions on the procedure, the abortion rate increased by 12%. However, in countries where it is broadly legal, there was a slight decline. Generally speaking, abortion rates were similar (40 and 36 per 1,000 women, respectively) in countries where abortion is broadly legal and in those where it is restricted - underscoring that women seek abortion when experiencing unintended pregnancy, regardless of its legal status.
Income is another important factor. When considering law and income together, the report shows that abortion rates are lowest in high-income countries where abortion is broadly legal—11 per 1,000 women of reproductive age, compared with 32 per 1,000 in high-income countries where it is not. Among low- and middle-income countries, irrespective of legal status, the abortion rate ranges from 34 to 48.
This highlights the importance of access to contraception. Data are limited, but the higher number of abortions in low- and middle-income countries is likely explained by a lack of access to a range of contraceptive options that are affordable and acceptable—in addition to, and as part of, broader sexual and reproductive health services; essential for ensuring women and individuals are able to plan and space their pregnancies.
Evidence from an earlier study shows that abortions that occur in legally restrictive settings are more likely to be unsafe than those in less restrictive ones. This exposes women to increased risk of physical and mental conditions including infection, hemorrhage, internal injury and psychological trauma. Unsafe abortions contribute to between 5% and 13% of all deaths during pregnancy and childbirth, amounting to between 22,800 and 59,280 deaths each year.
"Imposing legal restrictions to prevent or impede access to abortion does not reduce the number of individuals seeking out those services, but it certainly does increase the risk of unnecessary physical and emotional harm, and may result in legal sanctions and financial hardship, as well," says Zara Ahmed, Associate Director of Federal Issues at Guttmacher.
Across countries of all income levels, those with restrictions on abortion also face substantially higher rates of unintended pregnancy, suggesting a broader lack of access to family planning and other essential reproductive health services than in other countries.
High-quality reproductive health care essential for health, safety and well-being
"Unintended pregnancy and abortion are reproductive health experiences shared by millions of people every year in every part of the world, irrespective of personal status or circumstances," says Jonathan Bearak, lead author of the study and Senior Research Scientist at Guttmacher. "What differs are the obstacles people face—legal, social, economic or other—in exercising their reproductive autonomy."
Sexual and reproductive health care is essential for universal health coverage and for fulfilling global commitments of the Sustainable Development Goals to ensure universal access to sexual and reproductive health care services, to reduce the number of maternal deaths and to end discrimination against women and girls.
To help countries achieve these goals, the Guttmacher-Lancet Commission on Sexual and Reproductive Health—an international group of multidisciplinary experts—has recommended a comprehensive package of essential sexual and reproductive health services, including effective contraception and safe abortion care, for inclusion in national health systems.
Notes for editors
Abortion and Unintended Pregnancy Worldwide is an established study of the incidence of abortion and unintended pregnancy globally and by region.
In 2020, the study uses an updated, more comprehensive methodology, in which for the first time the worldwide number of pregnancies was estimated, followed by an estimation of how many of those pregnancies were unintended and how many ended in abortion. These numbers are broken down by country income status, Sustainable Development Goal region and legal status.
Countries were considered to have restrictive abortion laws if the procedure is completely prohibited, available only to save a woman’s life or available to preserve her health. The study found similar abortion rates irrespective of the type of legal restriction. "Broadly legal" indicates that abortion is available on request or on broad socioeconomic grounds.
About Guttmacher
The Guttmacher Institute is a leading research and policy organization committed to advancing sexual and reproductive health and rights in the United States and globally.
About HRP
HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction) is the main instrument within the United Nations system for research in human reproduction, bringing together policy-makers, scientists, health care providers, clinicians, consumers and community representatives to identify and address priorities for research to improve sexual and reproductive health.