Such changes in how abortions are carried out require a reconceptualization of safety and its measurement. 2,3 Newly available estimates enable us to assess this issue using a more refined categorization than a simple dichotomy of safe and unsafe. Efforts continue to improve the quality and coverage of care for complications from unsafe procedures. Treating best unsafe abortion has long been recognized as an important way to reduce maternal mortality and lessen the severity of maternal morbidity, and has officially been on the global public health agenda since the Programme of Action of the 1994 cairo International Conference on Population. 4 Despite wide differences among United Nations (UN) member states in their abortion laws, all agreed to improve the access to and quality of postabortion care—an important component of essential emergency obstetric care. Such care saves womens lives, and over the past decade, many countries with highly restrictive laws have nonetheless issued evidence-based postabortion care guidelines. Researchers continue to add to what is known about abortion. In the past decade, they have increased the evidence base on the incidence of abortion, conducted studies in countries where abortion is highly legally restricted, and compiled data for countries where abortion is permitted under broad criteria and good-quality data are available.
Our last overview report, Abortion Worldwide: a decade of Uneven Progress 1 examined abortion during the first decade of the 2000s. During that period, a number of countries changed their abortion law by expanding the grounds under which abortion is legally permitted. This update extends the time frame through 2017, and considers whether the access to and safety of abortion have changed, and the extent to which the practice of abortion aligns with how abortion is permitted by law. In some settings, for example, women may legally qualify for an abortion, but have no real access to safe services; in others, safe procedures may be widely available, despite severe legal restrictions. Elsewhere, backlash against womens legal right to abortion has resulted in the enactment of restrictions and obstacles to timely procedures. Thus, it is crucial to monitor the evolving legal context and how it affects abortion practice, access and safety around the world. One of the most important developments in terms of the safety of abortion is the steady increase in the use of medication abortion, which is likely having an important impact on abortion-related morbidity and mortality. In addition, the advent of medication abortion has profoundly altered the context in which safe abortions are provided and by whom—and these trends are continuing to evolve.
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Other factors are also important drivers of unintended pregnancy and the decision to have an abortion. Some unintended pregnancies result from rape and incest. Other pregnancies become unwanted after changes in life circumstances or because taking a pregnancy to term would have negative consequences on the woman's health and well-being. As a result, abortion writing continues to be part of how women and couples in all contexts manage their fertility and their lives, regardless of the laws in their country. Thus, safe abortion services will always be needed.
Substantial gaps in knowledge about abortion remain, however. To fill such gaps, researchers are developing and applying innovative approaches to better document the incidence of abortion and to better understand its causes, conditions and consequences. This report draws on this growing evidence base to examine the current state of abortion across legal settings and socioeconomic contexts, and considers abortion in light of factors known to influence its safety and incidence. By providing a comprehensive overview of key aspects of abortion—incidence, legal status, service provision and safety—and how they have changed in recent years, the report aims to inform future policies and programs. What has changed in the last decade?
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 womens 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 womens health and chances of survival, and reduce the heavy financial burden of providing postabortion care that poor countries health.
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. Introduction, induced abortion is common across the globe. The vast majority of abortions occur in response to unintended pregnancies, which typically result from ineffective use or nonuse of contraceptives.
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In all developing regions combined (except Eastern Asia an estimated.9 million women are trunk treated annually for such complications; however, reviews 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 1544, respectively, as of 20102014; both values represent significant declines since 19901994. 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.
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 helper 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.
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 womans 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.
Abortion incidence, as of 20102014, an estimated 36 abortions occur each year per 1,000 women aged 1544 in paperless developing regions, compared with 27 in developed regions. The abortion rate declined significantly in developed regions since 19901994; 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. Abortions occur as frequently in the two most-restrictive categories of countries (banned outright or allowed only to save the womans 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, 2024-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., 316 per 1,000 women aged 1519) and have been declining steadily in many of these countries; comparable data are unavailable for developing regions. 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 womans life or protect her health).
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March 2018, report, susheela singh, lisa remez, gilda sedgh, lorraine Kwok andTsuyoshi Onda, published in 2018, Abortion Worldwide: Uneven Progress and Unequal Access provides the most current information on the incidence of abortion and unintended pregnancy worldwide, as well as trends since 1990, as women. It examines laws that regulate abortion and how they have evolved, and the current safety of abortion provision. It documents the barriers women face to preventing unintended pregnancies and obtaining safe abortions, and the impacts of unsafe abortion on womens well-being. This study provides a comprehensive update to findings from the 2009. Abortion Worldwide: a decade of Uneven Progress. Topic, international, 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 internet 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.