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Caitlin Gerdts, PhD, MHS. UCLA Fielding School of Public Health, Bixby Lecture November 26, 2012. Safe, Legal, and Rare? A n update on abortion a round the world. Women all over the World have Abortions for Similar R easons. The Decline in Global Abortion Rates has Stalled.

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slide1
Caitlin Gerdts, PhD, MHS

UCLA Fielding School of Public Health, Bixby Lecture

November 26, 2012

Safe, Legal, and Rare?

An update on abortion around the world

the decline in global abortion rates has stalled
The Decline in Global Abortion Rates has Stalled

Abortions per 1,000 women aged 15–44

stall in global abortion decline coincides with plateau in contraceptive use
Stall in global abortion decline coincides with plateau in contraceptive use

Contraceptive prevalence (%)

Abortion rate

the abortion rate is lower in developed countries than in developing countries
The abortion rate is lower in developed countries than in developing countries

Abortions per 1,000 women aged 15–44

*Excluding Eastern Europe

www.guttmacher.org

when performed in safe sterile conditions
When performed in safe, sterile conditions…

…abortion is safer than taking a dose of penicillin.

when performed in unsafe or unsterile conditions
When performed in unsafe or unsterile conditions…
  • Maternal Morbidity
  • Maternal Mortality
  • Strains on Health Systems
  • Strains on Families
disproportionate impact of unsafe abortion
Disproportionate Impact of Unsafe Abortion

“Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.”

-Iqbal Shah, WHO

by the who definition virtually all abortions in latin america and africa are unsafe
By the WHO definition, virtually all Abortions in Latin America and Africa are Unsafe

% of abortions

deaths from unsafe a bortion are highest in africa
Deaths from Unsafe Abortion are Highest in Africa

Deaths per 100,000 unsafe abortions, 2003

most women live in countries where abortion is restricted
Most women live in countries where abortion is restricted

This is a slide to use for large images where you want to eliminate everything else but a two-line title and caption. It’s based on the last slide master.

disproportionate impact of unsafe abortion1
Disproportionate Impact of Unsafe Abortion

“Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.”

-Iqbal Shah, WHO

slide18
Abortion law reforms in developing countries have been followed by declines in morbidity and mortality

South Africa (1997): Annual number of abortion-related deaths decreased by 91% after the law was liberalized.

Nepal (2002): Abortion-related complications as a proportion of all of maternal illnesses decreased by 48% in a study of facilities in eight districts.

Ethiopia (2005): Abortion complications per 100,000 live births (at one large hospital) decreased by about 70%.

impact of contraception on reducing the number of abortions
Impact of contraception on reducing the number of abortions

Estimated number of induced abortions

141 million

Without modern methods

45 million

Current use

14 million

If unmet need were met

global turnaway study
Global Turnaway Study

www.indiegogo.com/theglobalturnawaystudy

global turnaway study aim
Global TurnawayStudy aim

To describe the mental health, physical health and socioeconomic consequences of receiving a legal abortion compared to being denied a legal abortion in multiple geographic, cultural, and legal settings.

global turnaway s tudy groups
Global Turnaway Study groups

Abortion comparison

Turnaway

Site A

Gestational age limit = 12

4 6 8 10 12 14 16 18 20 22 24 26 28 …

Site B

Gestational age limit = 20

4 6 8 10 12 14 16 18 20 22 24 26 28 …

references
References
  • Weitz, T. Rethinking the Mantra that Abortion Should be “Safe, Legal, and Rare
  • Singh S, Sedgh G, Hussain R. Unintended Pregnancy: Worldwide Levels, Trends and Outcomes. Studies in Family Planning. Dec 2010;41(4).
  • WHO. The prevention and management of unsafe abortion. Report of a technical working group. Geneva: World Health Organization, 1992 (WHO/MSM/92.5).
  • Fawcus SR. Maternal mortality and unsafe abortion. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008; 22(3).
  • The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society & Abortion Worldwide, New York: AGI, 1999
  • Sedgh G, Henshaw S, Singh S, Ahman E, Shah I. Induced Abortion: estimated rates and trends worldwide. Lancet. 2007; 370.
  • Sedgh G, Singh S, Shah I, Ahman E, Henshaw S, Bankole A. Induced Abortion: incidence and trends worldwide from 1995-2008. Lancet. 2012; 379.
  • Adler AJ, Filippi V, Thomas S, Ronsmans C. Quantifying the global burden of morbidity due to unsafe abortion: Magnitude in hospital-based studies and methodological issues. International Journal of Gynecology and Obstetrics. 2012.
  • Adler AJ, Filippi V, Thomas S, Ronsmans C. Incidence of severe acute maternal morbidity associated with abortion: a systematic review. Tropical Medicine and International Health. 2011.
  • WHO. Unsafe Abortion: Global and Regional Estimates of Incidence of Unsafe Abortion and Associated Mortality. Geneva: World Health Organization, 2007.
  • Gipson J, Koenig M, Hindin M. The effects of unintended pregnancy on infant, child and parental health: a review of the literature. Studies in Family Planning. 2008; 39(1): 18-38.
  • Brown S, Eisenberg L (eds). The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academic Press.
  • Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Population Studies. 2003; 51(1): 77-93.
slide26
Caitlin Gerdts, PhD, MHS

[email protected]

UCLA Fielding School of Public Health

November 26, 2012

Thank you

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