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After decade of decline, abortion rates flatten worldwide.

FROM THE LANCET

After nearly a decade of steady decreases in abortion, the global abortion rate has leveled off, according to new research from the World Health Organization and the Guttmacher Institute.

Between 2003 and 2008, the abortion rate worldwide was almost unchanged, going from 29 abortions per 1,000 women aged 15-44 years to 28 abortions per 1,000 women. The slight drop follows years of consistent de-creases in the abortion rate that occurred from 1995 to 2003, when the abortion rate globally fell from 35 to 29 abortions per 1,000 women.

At the same time, the rate of unsafe abortions being performed around the world has increased. The percentage of unsafe abortions rose from 44% in 1995 to 49% in 2008, reported Gilda Sedgh, Sc.D., of the Guttmacher Institute, New York, and her associates.

The definition of unsafe abortion used in the study was "a procedure for termination of an unintended pregnancy done either by people lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both," as established by WHO.

The research was based on an analysis of official statistics, published reports, hospital records, and surveys, and it was published in the Lancet (2012 Jan. 19 [doi: 10.1016/S0140-6736(11)61786-8]).

The leveling off of the abortion rate between 2003 and 2008 was probably due in part to unmet contraception needs in developing countries, according to the study authors. The stall in the abortion rate between 2003 and 2008 coincides with a plateau in contraceptive use that had previously been increasing, Dr. Sedgh said in a press conference.

She emphasized that a greater investment in family planning services will be needed to break the stall in abortion rates and reduce unintended pregnancy rates.

Research does not support the enactment of more restrictive abortion laws, she said, noting that restrictive abortion laws were not associated with lower abortion rates. In fact, the opposite was true. In sub-regions that had more liberal laws governing abortion, the abortion rate was lower. For example, the abortion rate is 32 per 1,000 women in 2008 in Latin America, where abortion is illegal in most cases, compared with 12 per 1,000 in 2008 in Western Europe, where abortion is generally allowed.

The leveling off of the global abortion rate appears to be driven by a similar stall in abortion rates in developing countries. In 2003 and 2008, the abortion rate in the developing world was 29 abortions per 1,000 women in both years. For example, the rate was 29 in Africa in 2003 and 2008, following a steady decline from 33 in 1995.

"A growing proportion of all abortions are taking place in developing countries, where they are generally illegal and unsafe," Dr. Sedgh said. "Thirteen percent of all maternal deaths are attributed to unsafe abortion, and virtually all of these deaths occur in the developing world."

In the developed world, excluding Eastern Europe, the abortion rate dropped somewhat--from 19 per 1,000 women in 2003 to 17 in 2008.

In North America, that rate dropped from 21 in 2003 to 19 in 2008.

The lowest subregional rate worldwide was in Western Europe at 12 abortions per 1,000 women in 2008. In contrast, Eastern Europe had the highest subregional rate at 43 abortions per 1,000 women the same year.

According to the report, the absolute number of abortions was an estimated 45.6 million in 1995, compared with an estimated 41.6 million in 2003 and 43.8 million abortions in 2008.

Although these numbers may be related to population growth, the abortion rate per 1,000 women is not, the researchers said. "About 78% of all abortions took place in the developing world in 1995, and increased to 86% in 2008." The proportion of women of reproductive age who live in the developing world rose from 80% to 84% during the same time period.

"Since 2003, the number of abortions fell by 0.6 million in the developed world, but increased by 2.8 million in developing countries," Dr. Sedgh and her colleagues wrote.

VITALS

Major Finding: The global abortion rate was 28 per 1,000 women aged 15-44 years in 2008, virtually unchanged from the 2003 rate of 29 per 1,000 women. The rate of unsafe abortions performed around the world climbed from 44% in 1995 to 49% in 2008.

Data Source: The researchers used estimates from the United Nations Population Division, as well as other official statistics and nationally representative surveys. Information on unsafe abortions was largely drawn from published studies, hospital records, and surveys of women.

Disclosures: The authors wrote that they had no conflicts of interest. The study was funded by the U.K. Department of International Development, the Dutch Ministry of Foreign Affairs, and the John D. and Catherine T. MacArthur Foundation.
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Title Annotation:WOMEN'S HEALTH
Author:Schneider, Mary Ellen
Publication:Family Practice News
Date:Feb 15, 2012
Words:811
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