Unsafe Abortion

Unsafe abortion causes approximately 47,000 maternal deaths and high levels of morbidity every year. In settings where abortion is legally restricted or access to safe services is limited, women with unwanted pregnancies often resort to unsafe abortions and subsequently require urgent medical attention to treat incomplete abortions or severe complications such as bleeding or infection. Too many women who seek unsafe abortions have inadequate access to family planing and other reproductive health services that can help women avoid unintended pregnancies.

Postabortion care is a multi-pronged strategy to prevent deaths and injury from unsafe abortion. Both treatment of complications and provision of family planning to prevent future unwanted pregnancies are key components.

 General Resources | Training Resources | Studies & Assessments

General Resources

Safe Abortion: Technical and Policy Guidance for Health Systems, second edition
World Health Organization, 2012
This publication is a comprehensive technical document detailing WHO guidelines for providing safe abortions and post-abortion care (PAC).  It includes guidance for implementing these evidence-based best practices at all levels of the health system from the community to tertiary institutions.  A set of recommendations for navigating political and legal barriers to safe abortion services and postabortion care are also proposed.  This is a valuable tool for Ministries of Health, service providers, and NGOs and other international organizations.

Unsafe Abortion Incidence and Mortality: Global and regional levels in 2008 and trends during 1990-2008
World Health Organization, 2012
This document provides a comprehensive overview of the incidence of unsafe abortion and burden of maternal morality that is related to complications from unsafe abortion.  The data are presented globally, by continent, and regionally.  The publication also highlights noteworthy trends in the data and the potential global implications of these findings.

The World’s Abortion Laws Map
Center for Reproductive Rights, 2012
This interactive map summarizes the current abortion policies from each country.  Countries with restrictive abortion laws often have a large unmet need for PAC; this tool is valuable for identifying such countries and informing the reproductive health community of potential abortion policy barriers.

Abortion Worldwide (Video)
Guttmacher Institute, 2012
Of the estimated 40 million abortions that take place annually in developing country, many are unsafe and can result in serious maternal complications or death.  This short video presents the latest global statistics and evidence around abortion.  It is an advocacy tool to bring attention to the underlying causes of abortion worldwide, the scope of unsafe abortion, and approaches and strategies for addressing the root causes of unsafe abortion to reduce the incidence of and complications related to unsafe abortion.

Legalization alone does not guarantee availability of safe abortion services.
Guttmacher Institute, 2012
A new report examines the implementation and impact of abortion law reform in six settings—Cambodia, Colombia, Ethiopia, Mexico City, Nepal and South Africa—and finds that expanding access to legal abortion does not in itself guarantee a decline in unsafe procedures and need for PAC. While law reform is a positive step toward improving women’s health, little comprehensive information has been available until now on how laws legalizing abortion have been implemented and what impact they have on the provision of abortion services and women’s health.
Read the full news release here.
View the brief here.
Read the full report here.

In Brief Fact Sheet: Facts on Induced Abortion Worldwide
Guttmacher Institute and World Health Organization (WHO), 2012
Published by the WHO and Guttmacher, this fact sheet containts data on worldwide incidence and trends of abortion together with a breakdown of regional incidence and trends. It looks at abortion law and the consequences of unsafe abortion.

Unsafe Abortion: The Missing Link in Global Efforts to Improve Maternal Health
Sneha Barot, Guttmacher Institute, 2011
This policy brief illustrates the importance of focusing on unsafe abortion as a priority area for improving maternal survival.  The policies and programs of DFID and other European donors are identified as successful models for integrating unsafe abortion into comprehensive maternal health efforts that can inform future policies and programs.

New Estimates and Trends Regarding Unsafe Abortion Mortality
Elisabeth Ahman & Iqbal H. Shah., International Journal of Gynecology and Obstetrics
This article presents the latest estimates for maternal mortality related to unsafe abortion and a description of the methods used to calculate the estimates.  The data are stratified by region and include the number of maternal deaths attributable to unsafe abortion, the unsafe abortion mortality ratio (number of maternal deaths related to unsafe abortion per 100,000 live births), and the risk of death associated with unsafe abortion.

Unintended Pregnancy and Induced Abortion in Colombia: Causes and Consequences
Guttmacher Institute, 2011.  Available in Spanish.
According to the report released by the Guttmacher Institute and Fundación Oriéntame, 400,412 induced abortions were performed in Colombia in 2008, an increase from 288,400 in 1989. However, the abortion rate has not changed substantially over the past two decades; rather, the increase in procedures mostly reflects the growing number of women of reproductive age. Despite a 2006 court ruling that allowed access to legal abortion under certain circumstances, virtually all abortions in Colombia – at least 99.9% – are illegal procedures.
Read fact sheet on unintended pregnancy and induced abortion in Colombia here.

The UN Speaks Out: Women Must Have the Right to Health, the Right to Decide.
Center for Reproductive Rights, 2011
What does it mean for women to have a right to health? The Center for Reproductive Rights speaks with Anand Grover, UN Special Rapporteur on the right to health, about the role reproductive choice can play in saving the lives of thousands of women every year.

In brief: Facts on unintended pregnancy and abortion in Ethiopia
Guttmacher Institute and Ipas, 2010
This factsheet delivers information regarding unintended pregnancy and abortion in Ethiopia, including facts about abortion incidence, postabortion care, consequences of unsafe abortion and the implications of these realities.

Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth edition
World Health Organization, 2008
This document includes the most recent WHO estimates of unsafe abortion incidence and related maternal mortality worldwide.  The implications that abortion policies, health systems, and other barriers have on incidence of unsafe abortion and associated mortality are described.  This is a resource for policymakers, clinicians, and program managers.  It is useful for understanding the scope and health consequences of unsafe abortion and can be used for assessing the need for PAC services in specific regions.

Training Resources

Resources to come.  If you have any resources you would like to share, please email info@pac-consortium.org.

Studies & Assessments

Measuring Unsafe Abortion-Related Mortality: A Systematic Review of the Existing Methods
Gerdts C, Vohra D, Ahern J. (2013). PLoS ONE 8(1): e53346.

This systematic review assessed the methodologies used in peer-reviewed literature to estimate maternal deaths resulting from unsafe abortion.  The findings of this study suggest that existing data on the burden of mortality resulting from unsafe abortion is of low quality.  The authors state it is plausible that the current estimates of unsafe abortion are low, as studies with more rigorous methods generally reported higher estimates of deaths than poorer quality studies.

Harm reduction, human rights, and access to information on safe abortion
Erdman J, 2012
The author argues that self-administration of misoprostol for termination of a pregnancy is an effective harm reduction strategy to reduce the complications related to unsafe abortion. It is stated in the article that misoprostol use for this indication meets the “three core principles of harm reduction”: the intervention aims to decrease health-related risks, it is grounded in the framework of human rights, and supported by scientific evidence. In the November 2012 issue of Medical Abortion Matters, Ipas published the article “Harm reduction: a novel approach to addressing unsafe abortion” that provides commentary on the Erdman article.

An unequal burden: Risk factors for severe complications following unsafe abortion in Tigray, Ethiopia
Gerdts C., Prata M., Gessessew A
In Tigray, Ethiopia, women seen for treatment of incomplete abortion at lower level health facilities, including health centers and health posts, were significantly more like to experience a complication.  Married women and women with higher parity also had increased odds of seeking treatment for incomplete. This study highlights the need for safe abortion services a mid- and low-level health facilities.

The health system cost of postabortion care in Ethiopia
Vlassoff M., Fetters T, Kumbi S, Singh S., 2012
In this article, the authors state that 42% of pregnancies in Ethiopia in 2008 were unplanned, which resulted in 380,200 induced abortions that were largely performed under unsafe conditions.  In the cost analysis performed, the authors found postabortion care to be a relatively expensive reproductive health service.  However, when the comprehensive Five Essential Elements of PAC approach for postabortion care is employed, the costs resulting from complications due to unsafe abortion will be reduced.

Long-term Worldwide Decline in Abortions has Stalled. Plateau Coincides with Slowdown in What Had Been a Steady Increase in Contraceptive Use

Guttamacher Institute and WHO, January 2012
The Guttmacher Institute and the World Health Organization (WHO) released a report titled Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008, which is a follow-up to an earlier study that focused on data from 1995 to 2003. The study found that, after a period of substantial decline, the global abortion rate has stalled. This plateau coincides with a slowdown, as documented by the UN, in contraceptive uptake. The researchers also found that nearly half of all abortions worldwide were unsafe, with most occurring in the developing world. Moreover, the study found that restrictive abortion laws are not associated with lower rates of abortion.
Full report: Induced abortion: incidence and trends worldwide from 1995 to 2008

Confronting the challenge of unsafe second-trimester abortion
L.H. Harris, D. Grossman, 2011
This special article for IJGO highlights the need to address the issue of unsafe second-trimester abortion.  Although a minority of abortions occur during the second-trimester, the risk of serious complications and maternal morality are higher in the second-trimester.  The authors discuss strategies  for reducing unsafe second-trimester abortion.

Exploring the pathways of unsafe abortion: A prospective study of abortion clients in selected hospitals of Madhya Pradesh, India.
S.K. Banerjee; K. Andersen Clark, 2009
The Government of Madhya Pradesh collaborated with Ipas to conduct a study titled Exploring the Pathways of Unsafe Abortion: A Prospective Study of Abortion Clients in Selected Hospitals of Madhya Pradesh, India. The study, launched in 10 selected secondary and tertiary hospitals of Madhya Pradesh, holistically looked at the causal routes or pathways of unsafe abortions through in-depth interviews of 381 women identified with postabortion complications.

Unsafe abortion and abortion care in Khartoum, Sudan
J. Kinaro; T.E. Ali; R. Schlangen; J. Mack
Reproductive Health Matters, Nov 2009; 17(34): 71-7.
Unsafe abortion in Sudan results in significant morbidity and mortality. This study of treatment for complications of unsafe abortion in five hospitals in Khartoum, Sudan, included a review of hospital records and a survey of 726 patients seeking abortion-related care from 27 October 2007 to 31 January 2008, an interview of a provider of PAC and focus group discussions with community leaders. Findings demonstrate enormous unmet need for safe abortion services. Mid-level providers should be trained in safe abortion care and PAC to make these services accessible to a wider community in Sudan. Guidelines should be developed on quality of care and should mandate the use of manual vacuum aspiration or misoprostol for medical abortion instead of D&C.