The largest, most comprehensive global study of abortion ever undertaken has concluded that abortion rates are similar in countries where it is legal and those where it is not, suggesting that outlawing the procedure does little to deter women.
Moreover, the authors found that abortion was a very safe procedure for women in countries where it is legal, but extremely dangerous for women in countries where it is outlawed and performed underground. The procedure accounts for 13 percent of deaths during pregnancy and childbirth, globally.
The massive survey, a collaboration between scientists from the World Health Organization in Geneva and the Alan Guttmacher Institute in New York, is being published today in the journal The Lancet.
"We now have a global picture of induced abortion in the world, covering both countries where it is legal and countries where laws are very restrictive," said Paul Van Look, director of the WHO department of reproductive health and research, in an interview. "What we see is that the law does not influence a woman's decision to have an abortion. If there's an unplanned pregnancy it does not matter if the law is restrictive or liberal."
But the legal status of abortion did dramatically affect the dangers involved, the scientists said. Van Look said: "Generally where abortion is legal it will be provided in a safe manner. And the opposite is also true: Where it is illegal it is likely to be unsafe, performed under unsafe conditions by poorly trained providers."
The data also suggested that the best way to lower abortion rates was to make contraception more widely available, rather than placing legal curbs on abortion, said Sharon Camp, chief executive of the Guttmacher Institute, a reproductive rights group. In Eastern Europe, where contraceptive choices have broadened since the fall of communism, the survey found that abortion rates have plummeted by 50 percent in countries like Hungary, although they are still relatively high compared with Western Europe. "In the past we didn't have this kind of data to draw on," Camp said, adding that "contraception is often the missing element."
Groups that oppose abortion criticized the research, saying that the scientists had jumped to conclusions from imperfect tallies, often estimates of abortion rates in countries where the procedure is illegal. "These numbers are not definitive and very susceptible to interpretation according to the agenda of the people who are organizing the data," said Randall O'Bannon, director of education and research at the National Right to Life Educational Trust Fund in Washington.
He said that the major reason women patients die in the developing world is that hospitals and health systems lack good doctors and medicines. "They have equated the word 'safe' with 'legal' and 'unsafe' with 'illegal,' which gives you the illusion that to deal with serious medical system problems you just make abortion legal."
According to the new study, there are about 20 million "unsafe" abortions performed each year and 67,000 women die as a result of complications from the procedure, most in countries where abortion is illegal.
The researchers relied on national data from countries where the procedure is legal and therefore tallied. In a massive effort, WHO scientists estimated abortion rates from countries where it is outlawed, using data on hospital admissions for abortion complications, interviews with local family planning specialists, and surveys of women.
In Uganda, where abortion is illegal and sex education programs focus on abstinence only, the estimated abortion rate was 54 per 1,000 women in 2003, more than twice the rate in the United States, 21 per 1,000 in that year. The lowest rate, 12 per 1,000, is in Western Europe, where abortion is legal and contraception is widely available.