Legal or not, abortion rates similar
By Elisabeth Rosenthal
Published: Thursday, October 11, 2007
ROME, — A comprehensive global study of abortion has concluded that abortion rates are similar in countries where it is legal and those where it is not, suggesting that outlawing the procedure does little to deter women seeking it.
Moreover, the researchers found that abortion was safe in countries where it was legal, but dangerous in countries where it was outlawed and performed clandestinely. Globally, abortion accounts for 13 percent of women's deaths during pregnancy and childbirth, and there are 31 abortions for every 100 live births, the study said.
The results of the study, a collaboration between scientists from the World Health Organization in Geneva and the Guttmacher Institute in New York, a reproductive rights group, are being published Friday in the journal Lancet.
"We now have a global picture of induced abortion in the world, covering both countries where it is legal and countries where laws are very restrictive," Dr. Paul Van Look, director of the WHO Department of Reproductive Health and Research, said in a telephone interview. "What we see is that the law does not influence a woman's decision to have an abortion. If there's an unplanned pregnancy, it does not matter if the law is restrictive or liberal."
But the legal status of abortion did greatly affect the dangers involved, the researchers said. "Generally, where abortion is legal it will be provided in a safe manner," Van Look said. "And the opposite is also true: where it is illegal, it is likely to be unsafe, performed under unsafe conditions by poorly trained providers."
The data also suggested that the best way to reduce abortion rates was not to make abortion illegal but to make contraception more widely available, said Sharon Camp, chief executive of the Guttmacher Institute.
In Eastern Europe, where contraceptive choices have broadened since the fall of Communism, the study found that abortion rates have decreased by 50 percent, although they are still relatively high compared with those in Western Europe. "In the past we didn't have this kind of data to draw on," Camp said. "Contraception is often the missing element" where abortion rates are high, she said.
Anti-abortion groups criticized the research, saying that the scientists had jumped to conclusions from imperfect tallies, often estimates of abortion rates in countries where the procedure was illegal. "These numbers are not definitive and very susceptible to interpretation according to the agenda of the people who are organizing the data," said Randall O'Bannon, director of education and research at the National Right to Life Educational Trust Fund in Washington.
He said that the major reason women die in the developing world is that hospitals and health systems lack good doctors and medicines. "They have equated the word 'safe' with 'legal' and 'unsafe' with 'illegal,' which gives you the illusion that to deal with serious medical system problems you just make abortion legal," he said.
The study indicated that about 20 million abortions that would be considered unsafe are performed each year and that 67,000 women die as a result of complications from those abortions, most in countries where abortion is illegal.
The researchers used national data for 2003 from countries where abortion was legal and therefore tallied. WHO scientists estimated abortion rates from countries where it was outlawed, using data on hospital admissions for abortion complications, interviews with local family planning experts and surveys of women in those countries.
The wealth of information that comes out of the study provides some striking lessons, the researchers said. In Uganda, where abortion is illegal and sex education programs focus only on abstinence, the estimated abortion rate was 54 per 1,000 women in 2003, more than twice the rate in the United States, 21 per 1,000 in that year. The lowest rate, 12 per 1,000, was in Western Europe, with legal abortion and widely available contraception.
The Bush administration's multibillion-dollar campaign against HIV/AIDS in Africa has directed money to programs that promote abstinence before marriage, and to condoms only as a last resort. It has prohibited the use of American money to support overseas family planning groups that provide abortions or promote abortion as a method of family planning.
Worldwide, the annual number of abortions appeared to have declined between 1995, the last year such a broad study was conducted, and 2003, from an estimated 46 million to 42 million, the study concluded. The 1995 study, by the Guttmacher Institute, had far less data on countries where abortion was illegal.
Some countries, like South Africa, have undergone substantial transitions in abortion laws in that time. The procedure was made legal in South Africa in 1996, leading to a 90 percent decrease in mortality among women who had abortions, some studies have found.
Abortion is illegal in most of Africa, though. It is the second-leading cause of death among women admitted to hospitals in Ethiopia, its Health Ministry has said. It is the cause of 13 percent of maternal deaths at hospitals in Nigeria, recent studies have found.