Global Illegal Abortion: Where There Is No "Roe": An Examination of the Impact of Illegal Abortion Around the World Issue Brief

Summary

Every day, approximately 186 women die around the world due to complications from unsafe abortion (WHO, 2004a); many of these deaths are in countries where access to abortion is legally restricted. In the United States the future ability of women to access safe, legal abortion is also uncertain, as Roe v. Wade hangs in the balance of new Supreme Court appointments. The experiences of other countries illustrate the potential implications of making abortion illegal in the United States. This issue brief discusses the connection between legal status, access to abortion, and safe abortion around the world. In short, women seek abortion regardless of its legal status, and when abortion is illegal it is more likely to be unsafe and harmful to women's health, lives, families, and communities (WHO, 2004a). As important, it denies women their most fundamental rights to health and to control their own bodies.

Legal Status and Unsafe Abortion

Each year, about 26 million women have legal abortions; 20 million women have abortions in countries where abortion is restricted (for example, allowed only to save the life of the woman) or prohibited by law (AGI, 1999). In developing countries with restrictive laws, wealthier women seek abortions primarily from physicians, but millions of poor women attempt to end their pregnancies by unsafe means (AGI, 1999). The outcomes of complications from an unsafe abortion depend not only on the availability of quality post-abortion services, but also on women's willingness to turn to hospitals in the event of complications, and the readiness of medical staff to extend services. As such, the number of maternal deaths, not abortions, is the most visible consequence of legal restrictions on abortion (WHO, 2004a).

Around the world, 39 percent of women live under restrictive abortion laws: 25 percent of them in places where abortion is permitted only to save a woman's life or is restricted altogether (AGI, 1999). Fourteen percent of the world's women live in countries where some provision is made for preserving the woman's life or health, though the definition of risk to health is diverse (AGI, 1999). In a handful of countries — Chile, El Salvador, the Holy See, and Malta — it is not even allowed to save a woman's life (WHO, 2004a). In only a handful of countries is abortion legal in all circumstances (AGI, 1999; WHO, 1998; WHO, 2004a).

Restrictive abortion laws correspond with higher rates of unsafe abortion. When abortion is performed by qualified care providers using correct techniques and in sanitary conditions, it is a very safe surgical procedure. In the United States, the death rate from abortion is .6 per 100,000 procedures, making it as safe as an injection of penicillin (WHO, 2004a). In developing countries where abortion is illegal or highly restricted, however, the risk of death from an unsafe abortion may be several hundred times higher than an abortion provided under safe conditions (WHO, 2004a).

Latin America provides an illustration of the connection between legal status, unsafe abortion, and the impact on women's health and mortality. Latin America's restrictive abortion laws are associated with some of the world's highest rates of unsafe abortion. An estimated 95 percent of the abortions performed in the region are illegal; the rate of unsafe abortion in the region is 26 unsafe abortions per 1,000 women aged 15 to 49 (Ipas, 2005a). The total number of women hospitalized for treatment of abortion complications is an indicator of the extent to which unsafe abortion endangers their health and lives: five to 10 of every 1,000 women in are hospitalized annually for complications, according to data from six Latin American countries (Ipas, 2005a). Deaths in the region from unsafe abortion are also among the highest in the world: for example, 48 percent of maternal deaths in Uruguay are attributable to unsafe abortion (Ipas, 2005a).

The Impact of Unsafe Abortion

"As a physician in a very long professional career, I have seen many women risk their health and life in order to get an abortion in a country where abortion is against the law."
— Dr. Mahmoud Fathalla, Professor of Obstetrics and Gynecology at Assiut University in Egypt (Ipas, 2005d)

The experience of the United States and countries around the world demonstrates that legal restrictions do not mean that abortion does not happen; it simply is driven under-ground and becomes more dangerous. Unsafe and often ineffective methods include taking various drugs or caustic substances by mouth; inserting objects into the vagina or flushing the vagina with caustic substances (AGI, 1999). Worldwide, in 2000 one in 10 pregnancies ended in an unsafe abortion, according to a World Health Organization study (WHO, 2004a).

Beyond maternal deaths, unsafe abortion can cause serious and long-term damage to women's health, affects their ability to care for their families, affects their productivity inside and outside the home, and strains limited public health resources. Between 10 and 50 percent of women who undergo unsafe abortions need medical care for complications (WHO, 1998).

The most frequent complications are incomplete abortion, sepsis, hemorrhage, and injury, such as puncturing or tearing of the uterus (WHO, 1998). Long-term health problems include chronic pelvic pain, pelvic inflammatory disease, tubal blockage, and secondary infertility (WHO, 1998).

About one-third of women who undergo unsafe abortion experience serious complications, but fewer than half of these women receive hospital treatment (AGI, 1999).

Treatment of abortion-related complications taxes already strained public health systems. Hospitalization, medical care, blood transfusions, and antibiotics and other drugs are among the public health costs of treating complications due to unsafe abortion — an entirely preventable medical crisis. As much as 50 percent of hospital budgets in some developing countries are used to treat complications of unsafe abortion (WHO, 1998).

This damage to women's health and premature loss of their lives, the impact on families and communities, and the cost to overstretched health care systems may be preventable, given that provision of safe abortion is possible if political commitment and supportive policies are in place (Ipas, 2005b).

Legal Abortion Is a Key Factor in Reducing the Incidence of Unsafe Abortion

"Unless governments act to make abortion legal and accessible, women's lives will continue to be endangered."
— Leila Hessini, Senior Policy Advisor for Ipas, an international nongovernmental organization working on unsafe abortion (Ipas, 2005c).

The experience of other countries demonstrates that the incidence of unsafe abortion is affected by legal access to safe abortion, as well as the availability and quality of legal abortion services (WHO, 2004a). Legal provisions for abortion make governments — those entities primarily responsible for the protection of human rights — accountable for the availability and accountability of care (IPAS, 2005b).

Changes in abortion law can have dramatic effects on rates of abortion-related deaths. The case of Romania, as described in the box "Case in Point: Romania," illustrates the connection. The experience of the United States prior to the Roe v. Wade Supreme Court decision mirrors that of Romania. In 1965 deaths recorded as due to illegal, unsafe abortion accounted for nearly one-fifth of all maternal deaths (though the actual number is presumed to be much higher). After abortion was legalized and became more accessible, associated death rates plummeted (Gold, 2003).

It is important to note that in order to decrease the incidence of unsafe abortion there must be legal changes as well as corresponding improvements in access to affordable, safe abortion services and contraception in order to address the underlying cause of abortion — unintended pregnancy (Gold, 2003).

Legal Status and Abortion Rates

Contrary to the arguments of abortion opponents, making abortion legal does not appear to increase the incidence of abortion — in fact, the opposite seems to happen. A study by the Alan Guttmacher Institute published in 1999 found that abortion rates are no lower overall in areas where abortion is generally restricted by law (and where many abortions are performed under unsafe conditions) than in areas where abortion is legally permitted (Henshaw, 1999). Some of the lowest abortion rates in the world occur in countries where abortion is legal (e.g., Western Europe) and some of the highest abortion rates occur in countries where abortion is illegal (e.g., Latin America) (Marston, 2003). The study concluded that both developed and developing countries can have low abortion rates. Most countries, however, have moderate to high abortion rates, reflecting lower prevalence and effectiveness of contraceptive use. Stringent legal restrictions do not guarantee a low abortion rate (Henshaw, 1999).

The Netherlands, for example, has a non-restrictive abortion law, widely accessible contraceptives and free abortion services, and the lowest abortion rate in the world (WHO, 1998). Data suggests that an increase in contraceptive use in Mexico and Colombia is associated with an apparent drop in abortion rates in the metropolitan areas of those countries (Henshaw, 1999).

In contrast, countries in Latin America have some of the strictest abortion laws in the world. The vast majority — 95 percent — of abortions in the region are illegal (Henshaw, 1999; Ipas, 2005a). Despite the legal restrictions, many women seek abortions. The estimated rate of abortion is high, ranging from 25.1 per 1,000 women in Mexico to 56.1 per 1,000 women in Peru. Only three countries in the region — Barbados, Guyana, and Cuba — allow legal abortion for a wide range of reasons (Ipas, 2005a).

Global Trends to Change the Legal Status of Abortion

At a time when the United States seems poised on the brink of rolling back women's rights to safe, legal, and accessible abortion, many countries of the world are heading in the opposite direction. Since 1995, 15 countries — including Albania, Ethiopia, South Africa, and Nepal — have changed abortion laws to allow for greater access to legal abortion (CRR, 2005b). Several countries where previously abortion had been legal only to save a woman's life, such as Benin and Burkina Faso, have expanded the legal grounds under which abortion may be attained to include protection of health and in cases of rape, incest, and fetal impairment. Cambodia expanded its legal right to an abortion from restricting it only to save the life of the woman to permitted without restriction as to reason during the first 14 weeks of pregnancy (CRR, 2005a). Other countries have adopted significant, but less dramatic abortion law reforms (CRR, 2005a).

Cited References

Abortion Access Project. (2004, May 6; accessed 2005, August 11). Fact Sheet: The Impact of Illegal Abortion. [Online]. http://www.abortionaccess.org/AAP/publica_resources/fact_sheets/illegalabortion.htm

AGI - Alan Guttmacher Institute. (1999). Facts in Brief: Induced Abortion Worldwide. New York, New York: Alan Guttmacher Institute.

CRR - Center for Reproductive Rights. (2005a, accessed July 14, 2005). As World Eases Restrictions on Abortion, U.S. Becomes More Restrictive, Study Finds. [Online]. www.reproductiverights.org/pr_05_0304abortion.html.

CRR. (2005b, accessed July 19, 2005). Abortion and the Law: Ten Years of Reform. New York, New York: Center for Reproductive Rights. [Online]. www.reproductiverights.org.

Cohen, Susan A. (2003). "Envisioning Life Without Roe: Lessons Without Borders". The Guttmacher Report, 6 (2), 3-5. [Online]. http://www.guttmacher.org/pubs/tgr/06/2/gr060203.html

Gold, Rachel Benson. (2003). "Lessons from Before Roe: Will Past be Prologue?" The Guttmacher Report, 6 (1), 3-5. [Online]. http://www.guttmacher.org/pubs/journals/2900603.html

Henshaw, Stanley K., Susheela Singh and Taylor Haas. (1999). "The Incidence of Abortion Worldwide". International Family Planning Perspectives. 25 (Supplement), 30-38. [Online]. http://www.guttmacher.org/pubs/journals/25s3099.html

Ipas. (2005a). Achieving ICPD Commitments for Abortion Care in Latin America: The Unfinished Agenda. Chapel Hill, North Carolina: Ipas.

Ipas. (2005b). Ensuring Women's Access to Safe Abortion: Essential Strategies for Achieving the Millennium Development Goals. Chapel Hill, North Carolina: Ipas.

Ipas. (2005c, March 7, 2005; accessed July 19, 2005). Panel at Commission on the Status of Women Calls on Nations to Fulfill Beijing Promise to Address Unsafe Abortion. [Online]. http://www.ipas.org/english/pres_room/2005/releases/03072005.asp

Ipas. (2005d, June 16, 2005; accessed July 20, 2005). Egyptian Gynecologist Offers Reflections on Abortion and Moral Values. [Online]. http://www.ipas.org/english/press_room/2005/releases/06162005.asp

Ipas. (1995, accessed July 20, 2005). 10 Ways to Effectively Address Unsafe Abortion.[Online]. http://www.ipas.org/publications/en/10_WAYS_E99_en.pdf

Marston, Cicely and John Cleland. (2003). "Relationship Between Contraception and Abortion: A Review of the Evidence". International Family Planning Perspectives, 29 (1), 6-13. [Online]. http://www.guttmacher.org/pubs/journals/2900603.html

UNFPA. (1994). Programme of Action of the International Conference on Population and Development. [Online]. http://www.unfpa.org/icpd/icpd_poa.htm

United Nations. (1995). Platform for Action of the International Conference on Women.[Online]. http://www.un.org/womenwatch/daw/beijing/platform/plat1.htm

WHO - World Health Organization. (1998; accessed 2005, July 20). "World Health Day Safe Motherhood: Address Unsafe Abortion". [Online]. http://www.who.int/docstore/world-health-day/en/pages1998/whd98_10.html

WHO. (Geneva, 2004a). Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2000, 4th Edition. Geneva, Switzerland: World Health Organization.

WHO. (2004b; accessed 2005,August 16). "Prevention of unsafe abortion". [Online]. http://www.who.int/reproductive-health/unsafe_abortion/index.html

 

Lead Author — Rhonda Schlangen, International Division, Planned Parenthood^® Federation of America

Published: 08.30.05 | Updated: 09.29.06

Published by International Division, Planned Parenthood^® Federation of America

©2006 Planned Parenthood^® Federation of America, Inc.
All rights reserved.


Media Contacts
New York: 212-261-4650
Washington, DC: 202-973-4882

International Division Contact
New York: 212-541-7800