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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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Caitlin gerdts phd mhs

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


Is abortion safe
Is Abortion Safe? developing countries


When performed in safe sterile conditions
When performed in safe, sterile conditions… developing countries

…abortion is safer than taking a dose of penicillin.


When performed in unsafe or unsterile conditions
When performed in unsafe or unsterile conditions… developing countries

  • Maternal Morbidity

  • Maternal Mortality

  • Strains on Health Systems

  • Strains on Families


Disproportionate impact of unsafe abortion
Disproportionate Impact of Unsafe Abortion developing countries

“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


An increasing proportion of abortion are unsafe
An increasing proportion of abortion are unsafe developing countries

% of abortions that are unsafe


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 America and Africa are UnsafeAbortion are Highest in Africa

Deaths per 100,000 unsafe abortions, 2003


Is abortion legal
Is Abortion Legal? America and Africa are Unsafe


Most women live in countries where abortion is restricted
Most women live in countries where abortion is restricted America and Africa are Unsafe

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.


Global abortion legality
Global Abortion Legality America and Africa are Unsafe



Disproportionate impact of unsafe abortion1
Disproportionate Impact of Unsafe Abortion in Romania

“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


Caitlin gerdts phd mhs
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%.


Should abortion be rare
Should Abortion be Rare? followed by declines in morbidity and mortality


Impact of contraception on reducing the number of abortions
Impact of contraception on reducing the number of abortions followed by declines in morbidity and mortality

Estimated number of induced abortions

141 million

Without modern methods

45 million

Current use

14 million

If unmet need were met


Focus on rare abortion increases stigma
Focus on Rare Abortion Increases Stigma followed by declines in morbidity and mortality


Global turnaway study
Global followed by declines in morbidity and mortalityTurnaway Study

www.indiegogo.com/theglobalturnawaystudy


Global turnaway study aim
Global followed by declines in morbidity and mortalityTurnawayStudy 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 followed by declines in morbidity and mortalityTurnaway 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 followed by declines in morbidity and mortality

  • 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.


Caitlin gerdts phd mhs

Caitlin Gerdts, PhD, MHS followed by declines in morbidity and mortality

gerdtsc@obgyn.ucsf.edu

UCLA Fielding School of Public Health

November 26, 2012

Thank you