Abortion rates have declined significantly over the last 25 years in developed countries and are at a historic low. But in developing countries, where many abortions are unsafe, rates have remained level, highlighting the urgent need for better access to modern contraception (eg, hormonal pill, implants, IUDs) to reduce unwanted pregnancies and abortions.
The new global and regional estimates of abortion incidence from the Guttmacher Institute and WHO, published in The Lancet, also suggest that restrictive abortion laws do not limit the number of abortions. Indeed, in countries where abortion is strongly legally restricted 1, and often performed under unsafe conditions, the incidence of abortion is estimated to be as high as the incidence in countries where it is legal.
“In developed countries, the continued fall in abortion rates is largely due to increased use of modern contraception that has given women greater control over the timing and number of children they want”, explains lead author Dr Gilda Sedgh at the Guttmacher Institute, New York, USA. “In developing countries, however, family planning services do not seem to be keeping up with the increasing desire for smaller families. More than 80% of unintended pregnancies are experienced by women with an unmet need for modern methods of contraception, and many unwanted pregnancies end in abortion.”2
The study used abortion data from nationally representative surveys, official statistics, and other published and unpublished studies, along with information on the level of unmet need for contraception and the prevalence of contraceptive use, by type of method. The researchers used a statistical model to estimate levels and trends in abortion incidence for all major world regions and subregions from 1990 to 2014.
Between 1990 and 2014, the developed world’s annual abortion rate per 1000 women of childbearing age (15-44 years) dropped from 46 to 27, mainly as a result of the rate in Eastern Europe more than halving (88 per 1000 women to 42) as modern contraceptive methods became more widely available. However, in the developing world the abortion rate has remained virtually unchanged, declining from 39 to just 37 (table 1). Worldwide, on average 56 million abortions took place each year in 2010-2014.
Over the last 25 years, Eastern Europe has seen the biggest drop in abortion rates (88 to 42 per 1000 women), but rates also fell in Southern Europe (38 to 26), Northern Europe (22 to 18), and North America (25 to 17). The overall abortion rate in Africa, where the vast majority of abortions are illegal, remained virtually unchanged – 33 abortions per 1000 women in 1990-94 to 34 per 1000 in 2014.
The estimated worldwide proportion of pregnancies that end in abortion has been fairly stable over time, with the world average in 2010-14 being one in four (25%). In developed countries, abortion has declined as a proportion of all pregnancies from 39% in 1990-94 to 28% in 2010-14, whereas in developing countries it increased from 21% of pregnancies in 1990-94 to 24% in 2010-14. In Latin America, a region with highly restrictive abortion laws, one in three pregnancies (32%) ended in abortion in 2010-2014, higher than any other region (table 3).