Abortion: why the world needs to have a new conversation

You’re about to read something unusual. An article on abortion without controversy, political statements or hyperbole from either end of the political spectrum. Just the facts – seven of them – courtesy of new reports released in the last few weeks by a distinguished medical journal, The Lancet, the Guttmacher Institute, and rarely cited data from the superb Global Burden of Disease (GBD).

Here we go.

#1. Globally, an estimated 56 million abortions are occuring each year, 36 million in Asia, 8 million in Africa, 6.5 million in Latin America, 4.4 million in Europe, and 1.2 million in North America (Sedgh et al, Lancet 2016).

#2. There are 35 abortions per 1,000 women aged 15 to 44, but the rate is higher in the Carribbean (65), South America (47), Eastern Europe (42) and Northern Africa (38), and lower in Oceania (19), Western/Northern Europe (18) and North America (17). While abortion rates are falling in higher income regions, they are static or rising in lower income regions (Sedgh et al, Lancet 2016).

#3. The proportion of pregnancies ending in abortion also varies widely, from 39% in the Caribbean and 38% in Eastern Europe, to 28% in Asia and 15% in Africa. The global average is 25% (Sedgh et al, Lancet 2016).

#4. About half of all pregnancies among adolescent women aged 15 to 19 living in lower income regions are unplanned, with more than half ending in abortion. Adolescents are more likely to resort to unsafe abortions and delay seeking medical care (Guttmacher 2016).

#5. The rate of abortion in countries that restrict access is actually higher (37%) than in countries that allow abortion on request (34%), indicating that legal restrictions are a blunt instrument to reduce abortion rates  (Sedgh et al, Lancet 2016).

#6. Death from abortion is now the second leading cause of death in pregnancy and childbirth (the first is hemorrhage), claiming an estimated 44,000 of 293,000 maternal deaths in 2013 (Global Burden of Disease 2013).  Among women aged 20 to 24 abortion complications are now the tenth leading cause of all deaths, claiming as many lives as malaria (Mokdad et al, Lancet 2016).

#7. Meeting all unmet need for modern contraception would avert 24 million abortions among women, 3.2 million among adolescent women aged 15 to 19, every year (Guttmacher 2014 and 2016).

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Here’s the most important takeout from this new data. The high death toll from abortion means that the world cannot achieve the new global goal to reduce maternal mortality without specifically targeting abortion. This new goal – called Sustainable Development Goal 3.1 – requires that the world reduce deaths in pregnancy and childbirth to 70 for every 100,000 births (the current rate is 216).  All 193 governments have already signed up to achieve this by 2030.  Further, as  abortion complications are among the top ten killers of women aged 20 to 24, the new Global Strategy for Women’s, Children’s and Adolescents’ Health cannnot be fully implemented without prioritizing safe abortion. This is why the world needs to have a new conversation about abortion. The good news is the conversation has already begun.  It was started at the Women Deliver Copenhagen Conference  earlier this year when Richard Horton, Marleen Temmerman, Nozer Sheriar and Imane Khachani showed the world a way forward. Now it needs to be continued. There is certainly no lack of appropriate platforms. The powerful maternal survival, growing contraception and emerging youth empowerment movements all have a stake in reducing demand for, and deaths from, abortion. But none moreso than the movement to end maternal deaths. All of the committed individuals and organizations who are responsible for delivering on this promise to women need to ask themselves the question:  How can an effective strategy to end deaths in pregnancy and childbirth by 2030, exclude the second leading cause of death?