Unintended pregnancies ending in abortion have gone up and it’s higher in countries with restrictions: Study

Women in the poorest countries were nearly three times as likely to face unintended pregnancies as those in the wealthiest countries


                            Unintended pregnancies ending in abortion have gone up and it’s higher in countries with restrictions: Study
(Getty Images)

The proportion of unintended pregnancies ending in abortion has increased globally between 1990-94 and 2015-19, even though there has been a worldwide decline in unintended pregnancies, according to researchers. As a result, the global average abortion rate in 2015-19 was roughly equal to the estimates for 1990-94, say experts from Guttmacher Institute, US, the World Health Organization (WHO), and the University of Massachusetts, US. 

Researchers found that the number of unintended pregnancies has gone down due to improved access to sexual and reproductive health services, but many of these unintended pregnancies end in abortion. In 2015-19, there were 121 million unintended pregnancies annually, corresponding to a global rate of 64 unintended pregnancies per 1,000 women aged 15-49 years. In comparison, the global annual unintended pregnancy rate in 1990-94 was 79 pregnancies per 1000 women aged between 15-49 years, says the study.

The analysis reveals that in 2015-19, there were 73.3 million abortions each year on average, which corresponded to a global annual rate of 39 abortions per 1,000 women aged 15-49 years. These estimates reflect that 61% of unintended pregnancies ended in abortion. “The proportion of unintended pregnancies that ended in abortion increased 18% (uncertainty interval or UI 12-26) over the 30-year period from 51% (48-54) to 61% (58-63) in 2015-19,” write authors in the analysis published in The Lancet Global Health.

The team did not find any evidence that abortion rates were lower in settings where abortion was restricted. In countries where abortion was legally restricted, the proportion of unintended pregnancies ending in abortion increased compared with the proportion for 1990-94. As such, individuals with unintended pregnancies relied on abortion services even in settings where abortion was restricted, potentially facing legal and physical risks for doing so, say researchers.

The study also suggests that people in high-income countries have better access to sexual and reproductive healthcare than those in low-income countries. The average annual unintended pregnancy rate in high-income countries was 34 pregnancies per 1,000 women aged 15-49 years compared with 66 pregnancies per 1,000 women aged 15-49 years in middle-income countries. In low-income countries, the average annual unintended pregnancy rate was 93 pregnancies per 1,000 women aged 15-49 years. “Since 1990-94, the unintended pregnancy rate declined among all income groups. High-income and middle-income countries experienced a decline of 21% for high-income countries and 13-28% for middle-income countries, followed by a decline of 18% in low-income countries,” write authors.  

Abortion rates and trends varied across regions. The most significant decline was in Europe and North America, where the abortion rate fell by 63% between the periods 1990–1994 and 2015–2019. 

Unintended pregnancy and abortion rates, and percentage of unintended pregnancies ending in abortion, 2015–19 (The Lancet Global Health)

Women in poorest countries face the greatest risks

The new study looked at the incidence of unintended pregnancy and abortion by income, region, and the legal status of abortion from 1990 to 2019. The researchers found that progress has not been uniform. Women in the poorest countries were nearly three times as likely to face unintended pregnancies as those in the wealthiest countries, revealing major and persistent inequities in access to sexual and reproductive healthcare.

The analysis shows that approximately 214 million women of reproductive age, in developing regions, who want to avoid pregnancy are not using a modern contraceptive method, so are much less able to decide if, how many, and when to have children. 

Abortion also occurs in nations with restrictive laws

Abortions occur in all countries, even in those with restrictive abortion laws. Over the past three decades, the proportion of unintended pregnancies ending in abortion has increased in countries where more legal restrictions are in place, and where it may be harder to access safe and appropriate contraception. “This finding points to the need for research to understand how individuals obtain abortions, particularly in legally restrictive settings, the safety of abortions in these settings, and the consequences of unsafe abortion on health and wellbeing. Other aspects of people’s wellbeing, including their experience of mistreatment and stigma, also warrant further study,” the authors write.

High-income countries where abortion is broadly legal – implying that abortion is available on request or on broad socioeconomic grounds – had the lowest unintended pregnancy rate, abortion rate, and proportion of unintended pregnancies ending in abortion. The analysis shows that in high-income countries, where abortion is broadly legal, there were 11 abortions per 1,000 women of reproductive age, compared with 32 abortions per 1,000 in high-income countries with more legal restrictions to access. 

(Getty Images)

Among low and middle-income countries, irrespective of legal status, the abortion rate ranges from 34 to 48. Abortion rates were highest in low-income countries with the most legal restrictions on abortion care. “High-income countries where abortion is broadly legal had the lowest annual average rate of unintended pregnancy at 30 pregnancies per 1,000 women aged between 15 and 49 years. The highest rate was 101 unintended pregnancies per 1,000 women aged between 15-49 years in low-income countries with restrictive abortion laws,” shows analysis.

There was also an increase – of 12% – in the number of abortions in countries with legal restrictions on the procedure, while it declined slightly in countries where abortion is broadly legal. Generally speaking, abortion rates were similar (40 and 36 per 1,000 women, respectively) in countries where abortion is broadly legal and in those where it is restricted, underscoring that women seek abortion when experiencing an unintended pregnancy, regardless of its legal status.

“Women living in countries with more legal restrictions for accessing abortion care faced significantly higher rates of unintended pregnancies. This suggests they are less able to access contraception alongside broader sexual and reproductive health services for preventing unintended pregnancies — likely explaining the higher number of abortions in these countries,” say experts.

High-quality reproductive healthcare is critical

The findings highlight the need for continued commitment and investment to ensure access to the full spectrum of quality comprehensive sexual and reproductive healthcare, say experts.

The researchers emphasize that sexual and reproductive healthcare is an essential part of universal health coverage. This includes services to help prevent unintended pregnancy through the provision of comprehensive sexuality education and a choice of effective and affordable modern contraceptive methods, as well as access to safe abortion care and post-abortion care to the full extent of the law.

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