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Abstract Each year, nearly 22 million women worldwide have an unsafe abortion, almost all of which occur in developing countries. This paper estimates the incidence and rates of unsafe abortion by five-year age groups among women aged 15–44 years in developing country regions in 2008. Forty-one per cent of unsafe abortions in developing regions are among young women aged 15–24 years, 15% among those aged 15–19 years and 26% among those aged 20–24 years. Among the 3.2 million unsafe abortions in young women 15–19 years old, almost 50% are in the Africa region. 22% of all unsafe abortions in Africa compared to 11% of those in Asia (excluding Eastern Asia) and 16% of those in Latin America and the Caribbean are among adolescents aged 15–19 years. The number of adolescent women globally is approaching 300 million. Adolescents suffer the most from the negative consequences of unsafe abortion. Efforts are urgently needed to provide contraceptive information and services to adolescents, who have a high unmet need for family planning, and to women of all ages, with interventions tailored by age group. Efforts to make abortion safe in developing countries are also urgently needed.

During the early 1990s, global health experts developed a new model of emergency obstetric care: post-abortion care or PAC. In developing countries with restrictive abortion laws and where NGOs relied on US family planning aid, PAC offered an apolitical approach to addressing the consequences of unsafe abortion. In Dying to Count , Siri Suh traces how national and global population politics collide in Senegal as health workers, health officials, and NGO workers strive to demonstrate PAC’s effectiveness in the absence of rigorous statistical evidence that the intervention reduces maternal mortality. Suh argues that pragmatically assembled PAC data convey commitments to maternal mortality reduction goals while obscuring the frequency of unsafe abortion and the inadequate care women with complications are likely to receive if they manage to reach a hospital. At a moment when African women face the highest risk worldwide of death from complications related to pregnancy, birth, or abortion, Suh’s ethnography of PAC in Senegal makes a critical contribution to studies of global health, population and development, African studies, and reproductive justice.  

Background Unsafe abortion remains a critical global health issue, particularly affecting women in low and middle-income countries including Rwanda. In Africa, 99% of abortions are unsafe. Between 2019 and 2023, there has been a reported increased of abortion-related hospitalizations at Remera Rukoma Hospital (RRH), highlighting an urgent need for investigation. Therefore, this study was conducted to determine the prevalence and factors associated with unsafe abortion among women of reproductive age attending RRH. Methods This cross-sectional study was conducted among 384 women of reproductive age (15–49 years) attending at RRH in Rwanda. The sample size was obtained using the Cochrane formula and systematic random sampling. Data analysis utilized SPSS Version25, employing descriptive statistics, bivariate and multivariate analyses to determine the factors associated with unsafe abortion at 95% CI, and p-value < 0.05 was considered statistically significant. Results The majority of participants were married (51.8%), Catholic (32.8%), attained primary education (35.4%), and were housewives (42.2%). The prevalence of unsafe abortion was 35.2%. Multivariate analysis showed unsafe abortion was higher than twice among women married before 18 years (aOR = 2.277, 95% CI: 1.247–4.157, p  = 0.007), those with 3 sexual partners in the last 12 months (aOR = 2.285, 95% CI: 1.031–5.066, p  = 0.042). Women who experienced gender-based violence had higher odds of engaging in unsafe abortion (aOR = 1.965, 95% CI: 1.128–3.424, p  = 0.017). Conclusion This study revealed unsafe abortion as a significant health concern among women of reproductive age, with over one-third of participants reporting unsafe abortions. Early marriage before 18 years, multiple sexual partners, and gender-based violence emerged as key factors associated with unsafe abortion practices. Addressing this issue requires a multifaceted approach, community education, and targeted initiatives to combat gender-based violence and early marriage in Rwanda.

Globally, 19 million women are estimated to undergo unsafe abortions each year. Age patterns of unsafe abortion are critical for tailoring effective interventions to prevent unsafe abortion and for providing post-abortion care. This paper estimates the incidence and the rate of unsafe abortion among women aged 15–44 in the Africa, Asia (excluding Eastern Asia), and Latin America/Caribbean regions, where a woman is likely to have close to one unsafe abortion by age 44. For developing regions as a whole, two-thirds of unsafe abortions occur among women aged 15–30 and 14% among women under age 20. The age pattern of unsafe abortions differs markedly between regions, however. Almost 60% of unsafe abortions in Africa are among women under age 25 and almost 80% are among women under 30. In Asia 30% of unsafe abortions are in women under 25 and 60% in women under 30. In Latin America and the Caribbean, women aged 20–29 account for more than half of unsafe abortions with almost 70% in women under 30. Over 40% of unsafe abortions among adolescents in the developing world occur in Africa, where one in four unsafe abortions takes place during adolescence. Young (under age 25) women in Africa, those over age 25 in Asia and women aged 20–35 years in Latin America and the Caribbean are in the greatest need of interventions to prevent unsafe abortion and good quality post-abortion care. On estime que, chaque année, 19 millions de femmes subissent un avortement à risque dans le monde. Pour intervenir efficacement, il faut connaître la ventilation des avortements par groupes d'âge. L'article évalue l'incidence et le taux d'avortement à risque chez les femmes de 15 à 44 ans en Afrique, en Asie (sauf l'Asie de l'Est), en Amérique latine et aux Caraïbes, régions où une femme aura subi près d'un avortement à risque avant 44 ans. Les deux tiers des avortements à risque concernent des femmes de 15 à 30 ans et de 14% des moins de 20 ans. Néanmoins, les âges diffèrent selon les régions. En Afrique, près de 60% des avortements à risque se produisent chez des femmes de moins de 25 ans et près de 80% chez les moins de 30 ans. En Amérique latine et aux Caraïbes, les femmes âgées de 20 à 29 ans représentent plus de la moitié des avortements à risque, avec près de 70% chez les moins de 30 ans. Plus de 40% des avortements à risque chez les adolescentes de pays en développement se produisent en Afrique, où un avortement à risque sur quatre est pratiqué sur une adolescente. En Afrique, les interventions doivent se centrer sur les femmes de moins de 25 ans, en Asie sur les plus de 25 ans, et en Amérique latine et aux Caraïbes, sur les femmes de 20 à 35 ans. Se estima que, a nivel mundial,cada año aproximadamente 19 millones de mujeres se someten a abortos. Los patrones de edad del aborto inseguro son fundamentales para adaptar las intervenciones de manera eficaz. En este artículo se calcula la incidencia y tasa de abortos inseguros en las mujeres de 15 a 44 años de edad en África, Asia (excluida Asia Oriental), Latinoamérica y el Caribe, donde es probable que cada mujer experimente un aborto inseguro antes de cumplir 44 años. Dos terceras partes de los abortos inseguros ocurren entre las mujeres de 15 a 30 años, y el 14% entre las menores de 20 años. No obstante, el patrón de edades de los abortos inseguros difiere marcadamente entre regiones. Casi el 60% de los abortos inseguros en África ocurre entre las mujeres menores de 25 años, y casi el 80% entre aquéllas menores de 30. En Asia, el 30% de abortos inseguros ocurre entre las mujeres menores de 25 y el 60% entre aquéllas menores de 30. En Latinoamérica y el Caribe, casi la mitad de los abortos inseguros se presentan en mujeres de 20 a 29 años; casi el 70% son menores de 30. Más del 40% de los abortos inseguros entre las adolescentes en los países en desarrollo ocurren en África, donde uno de cuatro abortos inseguros ocurre entre las adolescentes. Para las políticas y los programas, las intervenciones en África deben centrarse en aquéllas menores de 25; en Asia, en las mayores de 25; y en Latinoamérica y el Caribe, en las de 20 a 35 años.

Background Unsafe abortion remains a significant cause of maternal morbidity and mortality in many African countries, including Nigeria. This study aims to fill gaps in understanding of how abortion safety has evolved since previous estimates. The study also offers new insight on pregnant people’s experiences along the abortion care trajectory and how sociodemographic factors correlate with these experiences and the overall safety of abortion. Methods Data presented are drawn from a larger study that was conducted in Lagos and Abuja, Nigeria in 2023 using a total market assessment approach. This analysis drew exclusively on data from a quantitative survey of women of reproductive age with a 5-year history of induced abortion(s). Abortion safety was operationalised based on two dimensions in line with a previous analysis of population-based survey data from Nigeria: [1] whether the method(s) used included any non-recommended methods and [2] whether the source(s) used were clinical or non-clinical. We combined source and method information to categorize a woman’s abortion into one of four safety categories. Analyses include frequencies of abortion safety and experiences along the abortion care trajectory, as well as bivariate and multivariate assessments of sociodemographic and reproductive history correlates. Results Two hundred women completed the survey of which 197 reported their abortion method and were included in this analysis. Almost half (44.7%) of respondents’ reported abortions were categorised as most unsafe involving non-recommended methods and non-clinical source(s). Those living in rural areas and those living in severe poverty were significantly more likely to have had the most unsafe abortions. Those living in poverty were also at increased likelihood of being unable to access an abortion from their preferred source and of experiencing any complications. Conclusion These findings confirm that unsafe abortion in Nigeria is a public health concern and an issue of social inequity. Efforts to improve equitable access to safe, high-quality and client-centred services are needed. National health policies must address both the legal and practical barriers to safe abortion access. Ensuring expanded access to in-facility surgical procedures and post-abortion care is critical for management of complications from continued unsafe abortion. Simultaneously, harm reduction efforts - including increasing awareness of quality medication abortion drugs for safer self-induction and training lower-cadre providers on the medical management of abortion - can help mitigate the toll of abortion-related morbidity and mortality.

Background Abortion is one of the leading causes of maternal death in low- and middle-income countries. In Nepal, abortion is reported to be the third leading cause of maternal death. We aimed to investigate the prevalence and factors associated with abortion and unsafe abortion in Nepal. Methods This study is based on a nationally representative sample of the Nepal Demographic and Health Survey 2011. Women who had ever had a terminated pregnancy ( n  = 2395) were studied. The survey elicited information on the most recent abortion. Unsafe abortion was defined according to the providers of abortion services. Binary logistic regression was used to calculate odds ratios (ORs) and 95% Confidence Intervals (CIs) of abortions and unsafe abortions due to demographic, socio-economic and lifestyle-related characteristics. The interaction of the reason for abortion with age and educational status in predicting unsafe abortion was calculated using the predictive margins and their 95% CI. Results The five-year prevalence of abortion was 21.1% among women of reproductive age who ever had a terminated pregnancy and 16.0% of total abortions were unsafe. Women of Buddhist religion (OR 2.15; 95% CI 1.04, 4.44), those who were literate (secondary level education OR 1.69; 95% CI 1.22, 2.34), those who knew about legal abortion (OR 1.88; 95% CI 1.41, 2.52) and those who were aware of safe places for abortion services (OR 4.96; 95% CI 3.04, 8.09) were more likely to undergo an abortion. Likewise, women in age group 25–34 years (OR 0.43; 95% CI 0.19, 0.97) and those who were in the richest wealth quintile (OR 0.10; 95% CI 0.04, 0.25) were less likely to undergo an unsafe abortion. Educated women of 25–34 years reporting “health risk” as the reason for abortion had a decidedly lower probability (< 10.0%) than the others of going through the unsafe abortion. Conclusions The prevalence of abortion in Nepal remains high. Education, religion, age, knowledge about legal abortion and safe places to undergo abortion were the major decisive factors associated with abortion. Young, poorest and uneducated women were more likely to undergo unsafe abortions. Therefore, intervention studies among these target groups are warranted.

Unsafe abortion and associated morbidity and mortality in women are completely avoidable. This paper reports on an analysis of the association between legal grounds for abortion in national laws and unsafe abortion, drawing on an unpublished study and using estimates of the incidence of and mortality from unsafe abortion using information from the sources used to estimate the incidence of unsafe abortion and associated mortality in 2000. Although legal grounds alone may not reflect the way in which the law is applied, nor the quality of services offered, a clear pattern was found in more than 160 countries indicating that where legislation allows abortion on broad indications, there is a lower incidence of unsafe abortion and much lower mortality from unsafe abortions, as compared to legislation that greatly restricts abortion. The data also show that most abortions become safe mainly or only where women's reasons for abortion, and the legal grounds for abortion coincide. This is a compelling public health argument for making abortion legal on the broadest possible grounds. A wide range of actions have formed part of national campaigns for safe, legal abortion over the past century, covering law reform, provision of safe services, ensuring quality of care, training for providers and information and support for women. Safe abortion is an essential health service for women, as essential for sexual and reproductive health as safe contraception, and safe pregnancy and delivery care. In spite of sometimes powerful opposition and terrible setbacks, the public health imperative is gaining ground in many parts of the globe. Les avortements à risque et la morbidité et mortalité qu'ils entraînent ne sont pas une fatalité. Cet article analyse l'association entre les indications légales de l'avortement dans les législations nationales et les avortements à risque, se fondant sur une étude non publiée des estimations de l'incidence des avortements à risque et de la mortalité qu'ils provoquent. Si les motifs légaux ne peuvent seuls refléter la manière dont la loi est appliquée, pas plus que la qualité des services proposés, un modèle a clairement été observé dans plus de 160 pays: les législations prévoyant de nombreuses indications pour l'avortement vont de pair avec une incidence inférieure d'avortements à risque et une mortalité liée nettement plus faible que les législations restrictives. La plupart des avortements deviennent sûrs lorsque les raisons qui poussent les femmes à avorter coïncident avec les motifs légaux d'avortement. C'est là un argument de poids pour légaliser l'avortement le plus largement possible. Au siècle dernier, les campagnes nationales ont utilisé des mesures très variées pour légaliser et médicaliser l'avortement, notamment réformer la législation, garantir des services sûrs et la qualité des soins, former les prestataires, informer et soutenir les femmes. Des avortements sans risque constituent un service de santé essentiel pour les femmes, aussi essentiel pour leur santé génésique qu'une contraception et des soins obstétriques adaptés. Malgré une opposition parfois puissante et de terribles revers, cet impératif de santé publique gagne du terrain dans de nombreuses régions du globe. El aborto inseguro y la morbimortalidad materna atribuible a éste son completamente evitables. En este artículo se informa acerca de un análisis de la asociación entre las causales del aborto permitidas por las leyes nacionales y el aborto inseguro, basado en un estudio inédito cálculos de la incidencia de la mortalidad atribuible al aborto inseguro. Aunque las causales legales por sí solas no reflejan la forma en que se aplica la ley, o la calidad de los servicios prestados, se encontró un patrón concreto en más de 160 países, que indica que en los lugares donde la ley de aborto es más liberal, se observa una menor incidencia de aborto inseguro y una tasa mucho más baja de mortalidad debido a éste. Por tanto, la mayoría de los abortos son seguros principalmente cuando coinciden los motivos de las mujeres para interrumpir el embarazo y las causales legales para ello. Éste es un argumento convincente para legalizar el aborto bajo las causales más amplias posibles. En el último siglo se han tomado diversas y numerosas medidas a nivel nacional en pro del aborto legal y seguro, tales como la reforma de leyes, la prestación de servicios seguros, la garantía de la calidad de la atención, la capacitación de los profesionales de la salud y el suministro de información y apoyo para las mujeres. El aborto seguro es tan esencial para la salud sexual y reproductiva de las mujeres como la anticoncepción segura y la atención segura durante el embarazo y el parto. Pese a la oposición, a veces poderosa, y a terribles contratiempos, el imperativo en salud pública está ganando terreno en muchas partes del mundo.

In July 2012, in Dar es Salaam, Tanzania, more than 35 obstetrician/gynecologists, nurse-midwives and public health professionals working in Africa recommitted to and reinvigorated their efforts towards achieving Millennium Development Goal (MDG) 5 at a Regional Experts' Summit. During the weeklong conference convened to explore the myriad factors contributing to maternal mortality in the 12 African countries represented, the experts identified solutions that exist today, and that can be made available on a large scale to confront preventable maternal deaths. One such solution, misoprostol, is a simple and effective medicine that can contribute significantly to our efforts to reduce maternal mortality.

Background Unsafe abortions are a leading cause of maternal mortality. This study aimed to conduct a legislative analysis and scoping review to i) describe the abortion laws in Papua New Guinea (PNG), Fiji, Vanuatu, Solomon Islands, and Samoa, ii) identify what safe and unsafe abortion practices and services are available in these countries, and iii) understand women's experiences of accessing these services. Methods Abortion law data for these five countries were extracted and examined from the Global Abortion Policies Database. A scoping review identified relevant peer-reviewed and grey literature. Studies from all years and all languages were eligible. A systematic search was conducted on 1 December 2024 using Medline (Ovid), Embase (Ovid), and CINAHL (EBSCO) databases. Additionally, we hand-searched Google Scholar and the websites and databases of organisations focused on sexual and reproductive health (SRH) in the selected Pacific Island countries. Two independent reviewers screened studies for eligibility using Covidence software. An expert advisory group of Pacific Islander clinicians guided this review. Results The legislative analysis revealed that abortion laws are generally unclear and restrictive in all five countries. Fiji has the most legal grounds for abortion (five), while Vanuatu has the fewest (one). In all five countries, abortion law specifies penalties (imprisonment) for women, providers, and anyone assisting with abortion. The scoping review included 17 articles: 10 from PNG, three from Vanuatu, one from the Solomon Islands, one from Fiji, and two from the Pacific Islands. Studies discussed various abortion strategies and experiences of post-abortion care, but none discussed safe abortion care. Misoprostol use was widely documented to induce abortion. Unsafe abortion methods included using various physical means and consuming traditional herbs. Women lacked control over abortion decision-making and described their experiences seeking post-abortion care for complications. Conclusion We found limited evidence surrounding safe abortion services in these five countries. Future research should examine what optimal safe abortion care may look like within these countries’ health systems. Concerted advocacy is necessary to drive legislative reform, dismantle barriers, and create an enabling environment for safe abortion services, thereby facilitating the achievement of SRH and rights. Key messages What is already known on this topic Unsafe abortions are a preventable cause of maternal mortality. They occur most frequently in low- and middle-income countries where abortion laws are often restrictive and access to safe abortion services is limited. What this study adds In this scoping review, no studies discussed safe abortion services. Studies identified focused on unsafe abortion and were predominantly based in Papua New Guinea. In the Pacific Island countries, abortion laws are unclear or restrictive and comprehensive abortion care, including safe abortion services for all legal indications and all components of post-abortion care, is limited. Consequently, women turn to unsafe abortion methods such as using physical means and consuming traditional herbs. Additionally, clandestine use of misoprostol, sometimes with inaccurate guidance, has been documented. How this study might affect research, practice, or policy Advocacy efforts are needed to decriminalise abortion so that women can openly and safely access comprehensive abortion care.

Introduction Over 60% of unplanned pregnancies end up in abortion and an estimated 45% of these abortions are unsafe, contributing for 13% of all maternal death globally. This study aimed to determine the prevalence and factors associated with unsafe abortion among married women admitted to the gynecological ward at Lira Regional Referral Hospital, a public facility in Lira City, Northern Uganda. Methodology We conducted a cross-sectional study among married women admitted with abortion to the gynecological ward at Lira Regional Referral Hospital, Lira City, Northern Uganda from December 2022 to April 2023. We used a consecutive sampling technique to recruit 368 participants. We collected quantitative data using an interviewer-administered questionnaire, and we analyzed descriptive statistics using Statistical Package for Social Sciences version 29.0. We obtained ethical approval from the Gulu University Research Ethics Committee and Lira Regional Referral Hospital’s administration. We gained informed consent from the study participants. Results 203 (55.2%) of the respondents were aged 15–24 years, 160 (43.5%) were from a rural setting, 158 (42.9%) were Protestants by religion, 338 (91.8%) were Lango by tribe, 111 (30.2%) were peasants, and 229 (62.2%) had primary level of education. 176 (47.8%) respondents had unsafe abortions, while 192 (52.2%) had safe abortions. Respondents who were aged 15–24 years were less likely to have unsafe abortion (AOR: 0.685, 95% CI: 0.454–0.725, P  = 0.020) compared to respondents aged > 34 years. Respondents who were from rural settings were more likely to have unsafe abortion AOR: 2.559, 95% CI: 1.453–4.505, P  = 0.001) compared to those who were urban settings. Respondents who had monthly income of < 100,000 shillings (AOR: 2.677, 95% CI: 1.426–5.023, P  = 0.002), 100,000–250,000 shillings (AOR: 2.854, 95% CI: 1.463–5.567, P  = 0.002), and 250,000–500,000 shillings (AOR: 2.306, 95% CI: 1.031–5.158, P  = 0.042) were more likely to have unsafe abortions compared to those who had total monthly income of > 500,000 shillings. Conclusions There was a high prevalence of unsafe abortion in this study. Older age, coming from rural settings, and low monthly income were significantly associated with unsafe abortion practices. The Ministry of Health should launch a national campaign to educate the public about the risks of unsafe abortion and the availability of sexual and reproductive health services, such as family planning services, to prevent unsafe abortion from unplanned pregnancies.