An abortion is a medical procedure that terminates a pregnancy. Globally, approximately 73 million induced abortions occur each year. This accounts for 61% of unintended pregnancies and 29% of all pregnancies (1). The World Health Organization (WHO) includes comprehensive abortion care in its list of essential health care services. Abortion is a safe and effective intervention when performed using recommended methods and by trained professionals. In early pregnancy (up to 12 weeks), a medical abortion can be safely self-managed at home with accurate information, quality medication, and support from a trained healthcare worker, if desired.
Comprehensive abortion care encompasses information, abortion management, and post-abortion care, addressing miscarriage, induced abortion, incomplete abortion, and intrauterine fetal demise. This fact sheet will focus on care related to induced abortion.
The Scope of Unsafe Abortions Worldwide
When performed by skilled providers using WHO-recommended methods appropriate for the gestational age, abortion is a safe healthcare intervention (5).
However, barriers to safe, timely, affordable, geographically accessible, respectful, and non-discriminatory abortion care lead to unsafe abortions. Global estimates from 2010-2014 indicate that 45% of induced abortions were unsafe. A third of these unsafe abortions were performed under the least safe conditions – by untrained individuals using dangerous methods. The majority of unsafe abortions occur in Asia, particularly in south and central Asia. In Latin America and Africa, approximately 3 out of 4 abortions are unsafe, with nearly half occurring under the least safe circumstances in Africa (3).
Consequences of Limited Access to Quality Abortion Care
Lack of access to safe, affordable, timely, and respectful abortion care, coupled with abortion-related stigma, poses risks to women’s physical and mental health. It can also violate human rights, including the rights to life, health, scientific progress, reproductive autonomy, and freedom from cruel and degrading treatment.
Studies show that a significant percentage of maternal deaths are linked to abortion outcomes. A review from 2003-12 found that 4.7-13% of maternal deaths were linked to abortive pregnancy outcomes (4), while it is important to note that maternal deaths due to abortion, particularly unsafe abortion, are often underreported because of social stigma.
Deaths from safe abortions are minimal, occurring in less than 1 in 100,000 cases (5). In contrast, regions with high rates of unsafe abortion experience death rates exceeding 200 per 100,000 abortions. Estimates from 2012 indicate that in developing countries, 7 million women are hospitalized annually for complications from unsafe abortions (6).
Physical health risks associated with unsafe abortion include:
- Incomplete abortion (failure to remove all pregnancy tissue)
- Hemorrhage (heavy bleeding)
- Infection
- Uterine perforation (caused by sharp objects)
- Damage to the genital tract and internal organs
Restrictive abortion regulations can cause distress, stigma, and financial burdens, and violate human rights, including the rights to privacy, non-discrimination, and equality. Regulations that require travel for legal care, mandatory counseling, or waiting periods can make abortion inaccessible to women with limited resources (6,8).
Complications from unsafe abortions cost health systems in developing countries an estimated US$553 million per year for post-abortion treatments. Households also experience US$922 million in lost income due to long-term disability related to unsafe abortion (10). Increased access to modern contraception and quality induced abortion could result in significant monetary savings (8,9).
Abortion regulations affect women’s education, labor market participation, and contributions to GDP growth. The legal status of abortion can also influence children’s educational outcomes and future earnings. Legalizing abortion, by reducing unwanted pregnancies and increasing the likelihood of children being born wanted, can lead to greater parental investment in children’s schooling, especially for girls (9).
Strategies for Expanding Access to Quality Abortion Care
Evidence demonstrates that restricting abortion access does not reduce abortion rates (1). However, it significantly affects the safety and dignity of abortions. Countries with highly restrictive abortion laws have significantly higher proportions of unsafe abortions compared to those with less restrictive laws (2).
Barriers to safe abortion include high costs, stigma, and healthcare providers refusing to provide abortions based on personal beliefs. Access is further impeded by restrictive and medically unjustified laws, such as criminalization of abortion, mandatory waiting periods, biased counseling, third-party authorization, and restrictions on healthcare providers or facilities.
Legal, health system, and community-level actions are needed to ensure access to quality abortion care for everyone who needs it. The three cornerstones of an enabling environment for quality comprehensive abortion care are:
- Respect for human rights, including supportive laws and policies
- Availability and accessibility of information
- A supportive, universally accessible, affordable, and well-functioning health system
A well-functioning health system includes:
- Evidence-based policies
- Universal health coverage
- Reliable supply of quality, affordable medical products and equipment
- An adequate number of trained healthcare workers providing abortion care at a reachable distance
- Delivery of abortion care through various approaches, including health facilities, digital interventions, and self-care, allowing for choices based on values, preferences, resources, and context
- Healthcare workers trained to provide safe and respectful abortion care, support informed decision-making, and interpret abortion laws and policies
- Support and protection for healthcare workers from stigma
- Provision of contraception to prevent unintended pregnancies
Availability and accessibility of information requires:
- Evidence-based comprehensive sexuality education
- Accurate, non-biased, and evidence-based information on abortion and contraceptive methods
WHO’s Role in Promoting Safe Abortion
WHO provides global technical and policy guidance on contraception, abortion care information, abortion management (miscarriage, induced abortion, incomplete abortion, and fetal death), and post-abortion care. In 2022, WHO published updated guidelines on abortion care, including recommendations and best practices across law and policy, clinical services, and service delivery.
WHO also maintains the Global Abortion Policies Database, an online resource with information on abortion laws, policies, health standards, and guidelines for all countries.
Upon request, WHO provides technical support to countries to adapt sexual and reproductive health guidelines and strengthen national policies and programs related to contraception and safe abortion care.
WHO is a cosponsor of the HRP (UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), which researches clinical care, abortion regulation, abortion stigma, and community and health systems approaches to quality abortion care. It also monitors the global burden of unsafe abortion and its consequences.
Note: An “unsafe abortion” is defined as a procedure performed by individuals lacking the necessary skills or in environments that do not conform to minimal medical standards. The skills and standards considered safe vary based on the method of abortion (medical or surgical) and the duration of pregnancy. This definition aligns with current WHO technical and policy guidance (2).
References
(1) Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020 Sep; 8(9):e1152-e1161. doi: 10.1016/S2214-109X(20)30315-6.
(2) Ganatra B, Tunçalp Ö, Johnston H, Johnson BR, Gülmezoglu A, Temmerman M. From concept to measurement: Operationalizing WHO’s definition of unsafe abortion. Bull World Health Organ 2014;92:155; 10.2471/BLT.14.136333.
(3) Ganatra B, Gerdts C, Rossier C, Johnson Jr B R, Tuncalp Ö, Assifi A et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017 Sep.
(4) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun; 2(6):e323-33.
(5) Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. 2012 Feb;119(2 Pt 1):215-9. doi: 10.1097/AOG.0b013e31823fe923. PMID: 22270271.
(6) Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG 2015; published online Aug 19. DOI:10.1111/1471-0528.13552.
(7) Coast E, Lattof SR, Meulen Rodgers YV, Moore B, Poss C. The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers. PLoS One. 2021 Jun 9;16(6):e0252005. doi: 10.1371/journal.pone.0252005. PMID: 34106927; PMCID: PMC8189560.
(8) Lattof SR, Coast E, Rodgers YVM, Moore B, Poss C. The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems. PLoS One. 2020 Nov 4;15(11):e0237227. doi: 10.1371/journal.pone.0237227. PMID: 33147223; PMCID: PMC7641432.
(9) Rodgers YVM, Coast E, Lattof SR, Poss C, Moore B. The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes. PLoS One. 2021 May 6;16(5):e0250692. doi: 10.1371/journal.pone.0250692. PMID: 33956826; PMCID: PMC8101771.
(10). Vlassoff et al. Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. Brighton, Institute of Development Studies, 2008 (IDS Research Reports 59).
