Given the global priority in reducing maternal mortality, how is it possible that 13% of maternal deaths still result from unsafe, yet preventable abortions?
The statistics on unsafe abortions are mind-blowing. WHO estimated that approximately 21.6 million women underwent unsafe abortions in 2008, with almost all taking place in developing countries that prohibit legal abortion. From these, approximately 47,000 women died and 5 million women suffered long-term health complications. The burden is especially high in sub-Saharan Africa where abortion is mostly restricted by law and the death rate due to unsafe abortion is more than 800 times higher than the death rate from legal abortions in the United States.
Consistent with the desire of women all over the world to have smaller families, the WHO has found that many are likely to seek abortion when faced with unwanted pregnancy. It is therefore not surprising that women will choose a number of desperate ways to terminate pregnancy in the absence of access to safe abortion. Many resort to horrifying measures, such as using objects (like roots, twigs, or hangers), ingesting toxic substances (like turpentine or bleach), or using direct force to the abdomen. Some women simply subject themselves to the knives of improperly trained professionals, risking deadly internal cuts and infections. Even after enduring these unthinkable procedures, some women die because of the failure to seek timely help for abortion complications.
The cost of unsafe abortions goes far beyond lost lives and lost family earning potential. WHO estimates that 5 million women require medical care from complications of unsafe abortions, placing high costs on families and health care systems. In one study, the cost of complications from unsafe abortions was estimated at around $490 million, roughly half the amount spent on all obstetric emergencies. Each year, unsafe abortions leave 220,000 children motherless.
Unlike so many other global health problems, the answers to this crisis are straightforward and inexpensive. As the WHO and other authorities have noted, abortion is generally unsafe in countries where abortion is illegal and safe in countries where abortion is legal. As a result, liberalizing abortion laws has proven to greatly reduce unnecessary abortion deaths, as was the case in Romania and South Africa after they relaxed anti-abortion laws. Where countries fail to liberalize laws on their own, the burden rests squarely with international organizations and global health donors, including governments like our own, to pressure those governments to liberalize their abortion laws, perhaps under threat of linking funds for family planning to safe access to abortion.
In addition, alternative safe abortion methods are available and should be encouraged as ways to reduce maternal mortality, especially in countries where abortion is either illegal or difficult to access. For example, the WHO has recognized that safe abortion can be provided by trained mid-level medical providers. Similarly, other medical options exist, such as misoprostal, a safe relatively inexpensive drug for terminating pregnancies up to 12 weeks. Finally, unsafe abortions result directly from unwanted pregnancies. Therefore, efforts to confront the crisis must also include greater access to contraception and family planning services to prevent unwanted pregnancy in the first place. Providing contraceptive services is far more cost-effective in the long run, typically amounting to only a fraction of the cost of abortion complications.
If the global community is really serious about reducing maternal mortality, it must galvanize countries, especially in the developing world, to liberalize restrictive abortion laws and implement other critical steps to reduce the 13% of preventable deaths from unsafe abortions.
Sedgh G., Henshaw S, Singh S, et. al., Induced Abortion: Rates and Trends Worldwide, The Lancet, Vol. 370 Issue 9595, 13 October 2007.
Vlassoff M. et. al., Estimates of Health Care System Costs of Unsafe Abortion In Africa and Latin America, International Perspectives on Sexual and Reproductive Health, Volume 35, No. 3, September 2009.
WHO, Unsafe Abortion, Global and Regional Estimates Of The Incidence Of Unsafe Abortion And Associated Mortality In 2008 (Sixth Edition).
WHO, Safe Abortion: Technical and Policy Guidance For Health System 2003.