Only about half of abortions performed each year from 2010 to 2014 were safe, study says
Findings reveal a disparity, with a higher incidence of unsafe abortions in developing regions
Dr. Lisa Haddad remembers the women’s faces clearly.
Since 2008, the obstetrician-gynecologist has been traveling to sub-Saharan Africa. While working in Zambia, she saw gynecologic units in the hospital filled with women admitted with heavy bleeding or life-threatening infections, she said.
The women often would remain tight-lipped about why they were hemorrhaging, but Haddad said that it was clear to her and the Zambian clinicians what was happening. Some of the women had unsafe abortions and were facing serious complications, she said.
“This is a public health priority and I don’t think it’s been placed on that level and given the attention that it needs,” said Haddad, associate professor in the department of gynecology and obstetrics at Emory University School of Medicine.
A new study finds nearly half of all 55.7 million estimated abortions around the world each year between 2010 and 2014 were performed in an unsafe manner, putting women at risk for serious complications.
The study, published Wednesday in the journal The Lancet, suggests that unsafe abortions are still a major health problem globally, especially in developing countries.
“These are the first global estimates to show the distribution of the abortions across three safety categories,” said Dr. Bela Ganatra, a scientist at the department of reproductive health and research at the World Health Organization and lead author of the study.
“For the first time, we actually tried to determine the conditions under which abortions take place, how, who, where. This allows us to develop a better understanding of actions needed,” she said.
Based on the WHO definition, an unsafe abortion results from a pregnancy that is terminated either by someone who lacks the necessary medical skills or in an environment that does not conform to minimal medical standards, or both.
Unsafe abortions can lead to complications, such as heavy bleeding, infection, damage to genitals or internal organs, or an incomplete abortion, such as when all of the pregnancy tissue is not removed from the uterus, according to WHO.
Complications related to unsafe abortions sometimes can be fatal.
“I think that there’s no question that unsafe abortion continues to be one of the leading causes of maternal mortality and morbidity, and importantly this is preventable,” said Haddad, who was not involved in the new study. Abortions performed by trained providers through evidence-based approaches are safe, she said.
Counting unsafe abortions
The study, conducted by an international team of researchers at WHO and Guttmacher Institute, involved 150 pieces of data from 61 countries on both safe and unsafe abortions performed around the world between 2010 and 2014.
The information was collected from previous surveys and studies, bibliographic databases, and ministries of health or national statistical organizations.
The researchers analyzed the data to determine how many abortions fit within the WHO’s definition of “unsafe.”
They found that, in total, about 55.7 million abortions occurred annually worldwide between 2010 and 2014. Among those abortions, about 25.1 million were performed in unsafe circumstances each year – with about 17.1 million being “less safe” and 8 million being “least safe,” the researchers found.
Overall, almost all abortions in developed countries were deemed safe, whereas roughly half of those in developing countries were safe, according to the findings.
“Among the developed regions, the distributions of abortions across the safety categories were similar with the majority of abortions being performed under safe conditions, except for Eastern Europe, where 14% were less safe,” Ganatra said.
“While both Africa and Latin America had low proportions of abortions that were carried out in safe conditions, it was striking to note that among the unsafe abortions, the vast majority in the Latin America region were performed under less safe conditions (59.7%) while in Africa the majority of unsafe abortions were performed under the least safe conditions (48%),” she said. “It is also important to note that women undergoing abortions in Africa had the highest risk of dying from a least safe abortion.”
Eastern Asia, including China, had a distribution similar to developed regions, Ganatra said. Yet in South-Central Asia, less than one in two abortions were safe.