Unsafe abortions – by untrained providers or procedures that deviate from the norm – are commonplace worldwide, with especially high rates in developing countries, according to a new report published by the World Health Organisation (WHO) and the Guttmacher Institute.

“There is room everywhere to move forward safer abortions,” said WHO’s Dr Bela Ganatra, a scientist at the department of reproductive health and research at the WHO and one of the report’s authors.

It was estimated that out of the 56 million abortions that take place every year, globally, approximately 25 million are unsafe. Source: WHO/Guttmacher Institute
It was estimated that out of the 56 million abortions that take place every year, globally, approximately 25 million are unsafe. Source: WHO/Guttmacher Institute

Approximately 45% of an estimated 55.7 million abortions that occur globally each year between 2010 and 2014 were performed unsafely, putting women at risk of severe complications – which could sometimes be fatal.

The study, which was published in The Lancet on 27 September, involved 150 pieces of data from 61 countries – collected from previous surveys and studies, bibliographic databases, and ministries of health or national statistical organisations.

Study is first of its kind

Statistics of Global abortion data from 2010 to 2014. Photo credit: Megan Thielking/STAT. Source: Global, Regional and Subregional Classification of Abortions by Safety, 2010-14. Source: The Lancet
Statistics of Global abortion data from 2010 to 2014. Photo credit: Megan Thielking/STAT. Source: Global, Regional and Subregional Classification of Abortions by Safety, 2010-14. Source: The Lancet

Using the information, the researchers divided abortions into three categories: safe, less safe and least safe.

Less safe abortions account for 30.7% of the total and are either performed using the drug misoprostol without professional support, or are undertaken by trained personnel using outdated methods, such as scraping out the lining of the uterus with a surgical tool.

Least safe abortions, which account for eight million of the total, were either performed by untrained individuals using dangerous methods or in an environment that does not achieve the hygienic standards expected, or both. Unsafe abortions of both types can lead to fatal complications.

Study figures also reveal that approximately 88% of abortions performed in developed countries are safe; whereas in developing nations in which 62 countries have either banned or only allowed abortions where they are necessary to save a women's life, barely 25% were safe.

Staggering statistics vary across different countries

"It was striking to note that among the unsafe abortions, the vast majority (abortions) 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%)," remarks Dr Ganatra.

"It is important to note that women undergoing abortions in Africa had the highest risk of dying from a least safe abortion," she adds.

In many countries in Africa, less than 15% met minimal medical standards. China on the other hand, had high levels of safe abortions, similar to developed nations. Unfortunately, in South-Central Asia, less than one in two abortions were safe.

"Evidence shows that the same disparities exist within countries as well – between rural and urban, rich and poor," highlights Dr Ganatra. On the other hand, Nepal, Ethiopia and Uruguay were examples of developing nations that had good access to safe abortions. The researchers are aware that numbers are likely underestimated.

Approximately 45% of an estimated 55.7 million abortions that occur globally each year between 2010 and 2014 were performed unsafely. Source: CNN/WHO/Guttmacher Institute
Approximately 45% of an estimated 55.7 million abortions that occur globally each year between 2010 and 2014 were performed unsafely. Source: CNN/WHO/Guttmacher Institute


Access to safe abortions – a public health issue

"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," says Dr Lisa Haddad, an associate professor in the department of gynaecology and obstetrics at Emory University School of Medicine.

"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," elaborates Haddad, who is not involved in the study.

The findings have demonstrated a strong correlation between abortion laws and safety. "The highest proportions of safe abortions were seen in countries with less restrictive laws, high economic development and well-developed infrastructures," points out Ganatra. Yet, the positive findings in the developed nations does not mean there is no room for improvement.

“How were women treated when they accessed these services? What are the barriers to getting those services?” asks Ganatra.

She believes that change should span public policy, medical training, and health care access because “making safe abortion accessible is simple: It’s a primary care-level intervention. The technology and science is basic. It’s not resource-intensive,” she adds.

Legal change is demanded in the UK

The Royal College of Obstetricians and Gynaecologists (RCOG) in Britain have expounded on this idea, by voting to support the decriminalisation of abortion in the UK.

Currently, Britain is under the Offences Against the Persons Act of 1861 in which, if a woman who undergoes an abortion without obtaining the legal approval of two doctors or buys abortion pills online – she can be sentenced to life imprisonment.

“We believe the procedure should be subjected to regulatory and professional standards, in line with other medical procedures, rather than criminal sanctions,” the RCOG said.

However, many are critical of the suggestion because they believe it will breach doctors’ ethical duty to not harm patients. Dr Kiran Eyre, a member of the BMA’s south-east coast regional council, shares, “abortion is undeniably a controversial topic; but, at present, the legal position is a fair compromise in a challenging ethical field. Radically changing our laws, which should strive to protect both the viable foetus and mother, is a dangerous step towards undermining both how we value human life and how we treat our patients.” MIMS

Read more:
Will BMA’s proposal to “decriminalise abortion-on-demand” go through; how will it affect Malaysian laws?
Malaysian doctor urges law amendment amidst rising teenage pregnancy issues
The battle for abortion pills in America

Sources:
https://www.theguardian.com/world/2017/sep/22/abortion-decriminalise-crime-britain-childbirth-doctors
https://www.statnews.com/2017/09/27/abortion-safety-worldwide/
http://edition.cnn.com/2017/09/27/health/abortion-safety-global-study/index.html https://www.afp.com/en/news/15/nearly-half-abortions-unsafe-study