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World
Health Organisation studies estimate that there were 42 million abortions
in 2003
throughout the world, a decline from 46 million in 1995.
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About 20 Million, or 48%, of these were unsafe - 68 000 women die
and over 5 million women suffer temporary or permanent disability from
unsafe abortions. The large majority of unsafe abortions occur in
developing countries in south-east Asia, Africa and South America. The impact of unsafe abortion extends to the
existing children of these women, who are likely to experience increased
poverty, compromised health and death.
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Women experience unplanned pregnancy for many reasons, including
forced intercourse, difficulties in access to preferred methods of contraception,
incorrect use and inadequate quality of contraceptives,
contraceptive failure, and a lack of empowerment
to achieve control of their sexual and reproductive lives.
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Poverty is a major reason women turn to abortion,
when they consider the financial impact of an unplanned pregnancy.
Health risks to themselves or the fetus are another major
concern, including HIV/AIDS and inadequate
pre- and post-natal care. Inadequate maternal care is prevalent in
developing countries, such as the incidence of
obstetric fistula.
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Relationships and support, size of families and
number of children are also issues. In countries where the infant
mortality rate is high, it is estimated that the ability to be able to
space children two years apart increases the second child's survival
rate by 50%.
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Where abortion law is restrictive, women turn to
clandestine abortions. High death and infection rates reflect
the reliance on unqualified providers. Self-induced methods used
by women to try to abort, include drinking poisonous substances
or high doses of over-the-counter drugs, inserting objects and
substances into the uterus (sticks, wire, bleach)
and physical trauma (punches, falls). These methods often
fail and also cause serious injury.
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In countries where abortion law is restrictive,
large numbers of hospital beds are occupied by women who have
experienced complications from unsafe abortions. Complications
include incomplete abortion, infection, heavy blood loss and cervical
trauma.
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Other impacts of restrictive abortion laws include
corruption of law enforcement (bribes from backyard operators), doctors
working in uncertainty which creates further access issues, and
discrimination (only wealthy women can access safe abortions)
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Where abortion law is not restrictive, women may
still have difficulty in accessing safe abortion, such as in India
where although abortion is fully legal, many rural women and/or women living in poverty cannot
access
a certified clinic facility.
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In some countries where abortion is prohibited by
law, women with sufficient funds travel to an alternate country.
It is estimated that 6000 Irish women access abortion in Britain per
year.
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Legal access to
abortion across the world ranges from unrestricted to totally
restricted. Access also varies across states within countries,
such as in the
USA.
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Countries
that permit abortion on broad social, economic and medical grounds contain
41% of the world's population and include Britain, Canada, China and
South Africa.
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Countries that totally prohibit abortion, or permit
abortion only to save the life of the woman, contain 25% of the world's
population, and include Indonesia, Philippines, Chile, Iran, Ireland,
Sudan, Kenya and Nigeria.
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Some countries
permit abortion for rape or incest.
Often inadequate referral pathways exist to refer a woman
who has been treated for rape to access abortion. With the
underlying societal difficulties in many countries and situations, where
women have poor access to reporting and obtaining treatment for rape,
and little power in
negotiating for safe and consensual sex,
this law does not facilitate access to safe abortion.
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Many countries where abortion is restricted also
require the consent of the husband to the procedure.
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In the
past ten years, many jurisdictions have liberalised
their abortion laws; including South Africa, Switzerland, Cambodia and
Ethiopia. Reforms have also occurred at state level.
Repeated studies (eg. 1975 Population Study following the Menhennit
ruling, Romania data from 1956-1967) show that legalisation impacts more
upon maternal deaths and hospitalisations than the number of abortions.
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Western Europe has the lowest abortion rate in the
world (12 per 1000 women), an area where safe and legal abortions are
readily accessible, contraceptive services are widely available and
contraceptive use is prevalent.
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In April 2007, Mexico City decriminalised
abortion during the first 12 weeks of gestation and reformed its Health
Law to emphasize prevention of unwanted pregnancies through sexuality
education, availability of birth control and abortion services.
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Continued action in reforming restrictive law, social
conditions and reproductive health education is important in
improving women's reproductive health across the world.
Continued research
in reproductive health issues and
advocacy for women's
rights underpins these initiatives.
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It is hoped that wider access to
medical abortion, as
well as antibiotics, will also reduce the number of unsafe abortions.
