Addressing unplanned pregnancies can reduce pregnancy and childbirth related deaths.

Every year, of the estimated 210 million women who become pregnant, 80 million of these pregnancies are unplanned, some of these are carried to term, while others end in spontaneous or induced abortions. In East Asia, 39% of the 40 million pregnancies that occur every year are unplanned, and 30% end in abortion. In the rest of Asia, 34% of 83 million pregnancies occurring each year are unplanned and 17% end in abortion. (1) Overall, a third of pregnancies worldwide do not end in motherhood for women. The data calls for a de-linking of the terms pregnancy and motherhood, since so many pregnancies do not result in maternity, and hence the need for strategies that take this fact into account effectively.

Avoiding unplanned pregnancies can reduce the alarmingly high pregnancy and childbirth related deaths in the Asia-Pacific region, where the largest numbers of women continue to die each year in India (136,000); Pakistan (26,000); Bangladesh (16,000); China (11,000); Indonesia (10,000); and Nepal (6,000). (2) A significant proportion these deaths--14% for south-central Asia and 19% for south-eastern Asia--are the result of unsafe abortions. (3) The legal environment around abortion has a significant bearing on women's access to safe abortion services. Moreover, women in all parts of the world, whether young, old, married, unmarried, rich, and poor, have abortions; but often poor, young and unmarried women's access to safe services, even when legally entitled, is grossly limited.

A large proportion of married women in the region report they had a birth sooner than they wished to (a mistimed birth) or at a time when they had wanted no more children (an unwanted birth). The percentage of unplanned births among ever-married women aged 15-49 years is very high in the Philippines (44%); Bangladesh (32%); Thailand (31%); India (21%); and Pakistan (21%). There is also a high unmet need for contraception in Asia--an estimated 63 million women in Asia (except China) have an unmet need for contraception. (4) Unfortunately, information on the unmet need for contraception of single, never married, divorced, separated, and widowed women in most Asia-Pacific countries is unknown. Women unable to access appropriate and comprehensive information about safe sex practices, sexuality and contraceptive choices, along with related services, are denied their basic sexual and reproductive rights. Without information and services, women are more vulnerable to having unplanned pregnancies, which elevates the likelihood of their having an unsafe abortion.

The Cairo Programme of Action calls for prevention of unwanted pregnancies to be given the highest priority and every attempt to be made to eliminate the need for abortion, while still recognising the importance of access to safe abortion services. Advocacy efforts need to be directed towards improving all women's access to affordable and appropriate contraceptive choices, irrespective of their marital status, along with ensuring access to safe abortion services. Thisneeds to be coupled with empowering women to exercise control over when and under what circumstances they will become pregnant.

Endnotes

(1) The Alan Guttmacher Institute. 1999. Sharing Responsibility: Women, Society and Abortion Worldwide. New York, USA: The Alan Guttmacher Institute

(2) Ross, John A.; Winfrey, William L. 2002. "Unmet Need for Contraception in the Developing World and the Former Soviet Union: An Updated Estimate." International Family Planning Perspectives. Vol. 28 (3): 138-143

(3) ARROW. 2005. Monitoring Ten Years of ICPD Implementation: The Way Forward to 2015. Kuala Lumpur, Malaysia: ARROW

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

   Country                   Maternal Mortality Ratio (e)
                             (Maternal deaths per 100,000
                                     live births)

 Bangladesh                               380
  Pakistan                                500
   Nepal                                  740
   India                                  540
  Cambodia                                450
  Laos PDR                                650
  Vietnam                                 130
  Thailand                                44
 Philippines                              200
 Indonesia                                230

   Country            % of unplanned births among women (mistimed
                                  and unwanted birth)
                         (ever-married women, 15-49 years) (f)

 Bangladesh                               32
  Pakistan                                21
   Nepal                                 N/A
   India                                  21
  Cambodia                               N/A
  Laos PDR                               N/A
  Vietnam                                N/A
  Thailand                                31
 Philippines                              44
 Indonesia                                17

   Country                          Unmet need for
                                 contraception (g) (%)

 Bangladesh                               18
  Pakistan                                32
   Nepal                                  28
   India                                  20
  Cambodia                                33
  Laos PDR                                N/A
  Vietnam                                  7
  Thailand                                11
 Philippines                              26
 Indonesia                                14