Abortion Worldwide 2017—Executive Summary

The situation of induced abortion has changed markedly over the past few decades. This report provides updated information on the incidence of abortion worldwide, the laws that regulate abortion and the safety of its provision. It also looks at unintended pregnancy, its relationship to abortion, and the impact that both have on women and couples who increasingly want smaller families and more control over the timing of their births.

Abortion incidence

• As of 2010–2014, an estimated 36 abortions occur each year per 1,000 women aged 15–44 in developing regions, compared with 27 in developed regions. The abortion rate declined significantly in developed regions since 1990–1994; however, no significant change occurred in developing regions.
• By far, the steepest decline in abortion rates occurred in Eastern Europe, where use of effective contraceptives increased dramatically; the abortion rate also declined significantly in the developing subregion of Central Asia. Both subregions are made up of former Soviet Bloc states where the availability of modern contraceptives increased sharply after political independence—exemplifying how abortion goes down when use of effective contraceptives goes up.
• Abortions occur as frequently in the two most-restrictive categories of countries (banned outright or allowed only to save the woman’s life) as in the least-restrictive category (allowed without restriction as to reason)—37 and 34 per 1,000 women, respectively.
• In much of the world, 20–24-year-old women tend to have the highest abortion rate of any age-group, and the bulk of abortions are accounted for by women in their twenties.
• Adolescent abortion rates in countries in developed regions are fairly low (e.g., 3–16 per 1,000 women aged 15–19) and have been declining steadily in many of these countries; comparable data are unavailable for developing regions.

Abortion law

• Laws fall along a continuum from outright prohibition to allowing abortion without restriction as to reason. As of 2017, 42% of women of reproductive age live in the 125 countries where abortion is highly restricted (prohibited altogether, or allowed only to save a woman’s life or protect her health).
• The vast majority (93%) of countries with such highly restrictive laws are in developing regions. In contrast, broadly liberal laws are found in nearly all countries in Europe and Northern America, as well as in several countries in Asia.
• Nonetheless, some countries with broadly liberal laws have increasingly added restrictions that chip away at access to legal procedures; these include the United States and several countries in the former Soviet Bloc or zone of influence.
• Since 2000, 28 countries changed their abortion law—all but one expanding legal grounds to allow abortions to protect a woman’s health, for socioeconomic reasons or without restriction as to reason. Moreover, 24 added at least one of three additional grounds: in cases of rape or incest, or when the fetus is diagnosed with a grave anomaly.
• Implementing access under expanded legal grounds can take many years; however, with political will, change can be achieved much more quickly.

Abortion safety

• The development and application of clinical guidelines and standards have likely facilitated the provision of safe abortion. Furthermore, the reach of safe services has been extended by allowing trained, midlevel health professionals to provide abortion in many countries.
• In highly restrictive contexts, clandestine abortions are now safer because fewer occur by dangerous and invasive methods. Women increasingly use medication abortion methods—primarily the drug misoprostol alone, as it is typically more available in these contexts than the method of mifepristone and misoprostol combined.
• As access to health care overall improves and national governments increasingly prioritize implementing World Health Organization (WHO) guidelines, access to quality postabortion care also improves. The combined result of these trends and safer procedures means that fewer women are dying from unsafe abortion.
• Of all abortions, an estimated 55% are safe (i.e., done using a recommended method and by an appropriately trained provider); 31% are less safe (meet either method or provider criterion); and 14% are least safe (meet neither criterion). The more restrictive the legal setting, the higher the proportion of abortions that are least safe—ranging from less than 1% in the least-restrictive countries to 31% in the most-restrictive countries.
• Unsafe abortions occur overwhelmingly in developing regions, where countries that highly restrict abortion are concentrated. But even where abortion is broadly legal, inadequate provision of affordable services can limit access to safe services. In addition, persistent stigma can affect the willingness of providers to offer abortions, and can lead women to prioritize secrecy over safety.
• In 14 developing countries where unsafe abortion is prevalent, 40% of women who have an abortion develop complications that require medical attention. In all developing regions combined (except Eastern Asia), an estimated 6.9 million women are treated annually for such complications; however, many more who need treatment do not get timely care.                                                        

Unintended pregnancy

• The vast majority of abortions result from unintended pregnancies. The estimated unintended pregnancy rates in developed and developing regions are 45 and 65 per 1,000 women aged 15–44, respectively, as of 2010–2014; both values represent significant declines since 1990–1994. Current rates are highest in Latin America and the Caribbean (96 per 1,000) and Africa (89 per 1,000).
• Globally, 56% of unintended pregnancies end in induced abortion; regionally, this proportion ranges from 36% in Northern America to 70% in Europe.
• To act on their growing preferences for smaller families and for better control over the timing of their births, women need improved access to modern contraceptives.
• Levels of unmet need for modern contraception are much higher among single, sexually active women than among in-union women because stigma continues to impede single women—especially adolescents—from getting contraceptive counseling and services.

The path toward safer abortions is clear: The benefits of expanding legal grounds for abortion begin to accrue as soon as women no longer have to risk their health by resorting to clandestine abortion. Although legality is the first step toward safer abortion, legal reform is not enough in itself. It must be accompanied by political will and full implementation of the law so that all women—despite inability to pay or reluctance to face social stigma—can seek out a legal, safe abortion.

Legality alone does not guarantee access, and vigilance is required to prevent backsliding where onerous restrictions that are not based on safety erode the availability of safe and legal abortion services. Highly restrictive laws do not eliminate the practice of abortion, but make those that do occur more likely to be unsafe. In these countries, improving the quality and coverage of postabortion care—which all countries accept as an essential reproductive health service that they must provide—is crucial to saving lives and protecting women’s health.

Where abortion is highly restricted, accurate information on how to safely use misoprostol alone should be widely conveyed to help make clandestine abortions safer, improve women’s health and chances of survival, and reduce the heavy financial burden of providing postabortion care that poor countries’ health budgets must absorb. Where abortion is legal, it is important to ensure that women can choose between equally safe methods of surgery or medication.

In countries that highly restrict abortion, preventing unintended pregnancy goes a long way toward preventing unsafe abortion. Moreover, ensuring that women and couples who desire to avoid pregnancy can use effective contraceptives if they want to is key to keeping women and children healthy. Deciding when and how many children to have is a fundamental human right, the benefits of which reverberate at every level—each individual woman, her family and society as a whole.