8. 36% the world’s population live where abortion is very restricted Maximum Criteria* * Each includes more restrictive criteria Source: Center for Reproductive Rights, 2006
9. Most countries with legal abortion are in developed regions ██ Legal on request ██ Legal for health, mental health, socio-economic factors ██ Legal for health, mental health
10. Women are as likely to have abortions, whether the law is restrictive or not Abortion rates per 1000 women aged 15 – 44
11. Almost half of the 42 million abortions in 2003 are unsafe % of all abortions
12. Restricting contraception and legal abortion in Romania resulted in increased maternal and abortion-related deaths Contraception/ Abortion liberalized Contraception/Abortion restricted Source: UNDP, UNFPA, WHO, World Bank
20. The Method ’ s Approach Number of Induced Abortions in a Country Abortions Treated in Hospital Abortions Not Reaching Hospital (safe and unsafe) Data: Num. women treated for hosp comp due to abort Source: Hospital Data Data: 1/ Prop. of women having an abort. who are hospitalized Source: Health Professional Survey
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24. HFS provides estimated number of women who obtain treatment in hospital/facility for complications. HPS provides estimate of multiplier = (1/[Proportion hospitalized among all women who obtain induced abortions): e.g. (1/.25) = multiplier of 4 Estimated total number of induced abortions = # treated in facilities * multiplier Estimate A Estimate B Directly measurable Steps in the calculation Some of these complications are due to induced abortions.
25. 110,000 women hospitalized for post-abortion complications in 2003 Some women experience no complications or do not obtain hospital treatment An estimated 300,000 induced abortions Subtract an estimated 25,000 miscarriages Multiply by 3.5 Findings: Example of Uganda 85,000 cases of complications were due to induced abortions
33. Magnitude of Unsafe Abortion Complications treated in Hospitals Country, date Number of women Annual rate of complications per 1000 women Guatemala, 2003 21600 8.6 Nigeria, 1996 142,200 6.1 Pakistan, 2002 197,000 7.0 Peru, 1998 50,000 8.6 Philippines, 2000 78,150 4.4 Uganda, 2002 85,000 16.4
39. More than one-third of all pregnancies in developing countries each year are unintended, and 19% end in abortion pregnancies in developing countries (182 million)
40. Most unintended pregnancies occur among women who were not using any contraceptive Modern method No method Traditional method Unintended pregnancies in developing countries, by women’s contraceptive use
41. More than 100 million married women have an unmet need for contraception Guttmacher Institute Number (in millions) and % distribution of married women with unmet need 60 (56%) 29 (27%) 7 (7%) 9 (8%) 3 (3%)
42. Reasons for not using contraception compared: results for 55 countries % of married women 15-49 reporting each problem
43. The relative importance of some reasons has changed over time Guttmacher Institute % of married women 15-49 with unmet need 1986-1989 2002-2005
44. Abortion levels and trends are strongly linked to modern contraceptive use Index of changes in rates, Russian Federation
Unsafe abortion has a significant negative impact on women’s health and survival, particularly in the developing world. Most of us do not have to be convinced of that fact. Particularly those of us who have lived and worked in developing countries. What we are still trying hard to do is to document more accurately the nature and extent of this impact. This has not proven to be an easy task given that abortion is both legally restricted and highly stigmatized in most of the developing world. Unsafe abortion is highly common in environments where the procedure is highly restricted and stigmatized. Yet, thanks to the unrelenting efforts of some organizations and individuals, we now have fairly reasonable knowledge of not only the incidence of unsafe abortion but also its determinants and consequences. With this information we are in a better position today to help decision makers to find solutions. This presentation provides some key findings in the literature on unsafe abortion and its consequences.