New estimates point to global decline in the number of women dying from unsafe abortion

Friday, May 23, 2014

New reports from the United Nations and other organizations suggest a pronounced decline in maternal mortality worldwide and indicate that global efforts to reduce deaths of women from unsafe abortion are beginning to work.

One of the new reports, backed by the World Health Organization (WHO) and other UN agencies, is Trends in Maternal Mortality: 1990 – 2013. The UN interagency report documents an estimated 45 percent overall decline in maternal deaths worldwide, from about 523,000 in 1990 to an estimated 289,000 in 2013.  It does not provide estimates for the number of deaths due to abortion or other causes. 

At about the same time, WHO researchers published in The Lancet a new analysis of global causes of maternal death during the period 2003-2009, based on multiple studies and data sources in 115 countries. The analysis concludes that unsafe abortion accounted for about 8 percent of global maternal deaths during that time—a far lower percentage than previous estimates.

“It is tempting to apply this percentage to the new interagency global maternal mortality figure to obtain a new estimate of annual maternal deaths due to abortion,” says Dr. Janie Benson, Ipas Vice President for Research and Evaluation. “But such a calculation is inadvisable, because these two research efforts are based on different methodologies and focus on different time periods.”

WHO has periodically published specific abortion-related mortality estimates by region, based on systematic review of studies focused on abortion. The last such estimates, published in 2011 for the year 2008, suggested that approximately 47,000 women die every year from unsafe abortion globally. 

“We are encouraged by new studies suggesting that the number of women dying is probably significantly lower now than in 2008,” says Dr. Barbara Crane, Ipas Executive Vice President for Technical Leadership and Advocacy. “We believe that the regional and global estimates published in 2011 are the most robust, however, and should continue to be cited until updated estimates are available.

“Moreover, we know that progress has been greater in some countries and regions than in others.  Women in sub-Saharan Africa and South-Central Asia—particularly young women—remain at highest risk of unintended pregnancy and unsafe abortion.”

New estimates were also released recently in The Lancet by the Institute for Health Metrics and Evaluation (IHME), which is based at the University of Washington. IHME researchers estimated a slightly higher level of maternal mortality in 2013 than the UN interagency group—292,982 deaths. The study further estimates that 43,684 women died from abortion-related causes in 2013, or approximately 15 percent of the global total. This figure reflects a significant decrease or no change in every region except sub-Saharan Africa, where abortion-related deaths are estimated by IHME to have increased since 1990.

“It is not surprising to see variations in global and regional estimates,” said Benson. “Reliable data on maternal mortality and its causes are notoriously difficult to obtain. Under-reporting and misclassification particularly affect estimates of abortion incidence and outcomes.” 

Ipas, the Guttmacher Institute and others have addressed data gaps through national-level studies in countries such as Ethiopia, Nigeria, Kenya, Malawi, Uganda, India, and Cambodia. Although available data and estimation methods for abortion mortality and morbidity are improving, resources are still inadequate both for improvements in routine data collection in national health systems and for special studies.

Nevertheless, estimates of an overall decline in abortion-related mortality are consistent with anecdotal observations and with evidence of increasing efforts over the last two decades by governments, civil society and donors to help women prevent and manage unwanted pregnancy safely. Such efforts have included:  

  • expansion of access to effective contraception
  • expansion and improvement of postabortion care and safe abortion to the extent of the law, reaching millions of women
  • increases in the availability of safe, effective technologies for abortion care, including manual vacuum aspiration (MVA) and medical abortion
  • training of tens of thousands of health-care workers in provision of woman-centered abortion care
  • increased focus on informing women and communities about their rights, the availability of safe abortion services, and the dangers of unsafe abortion, and
  • liberalization of  abortion laws and policies in a number of countries in every region.

“While the global trends are encouraging, it is unconscionable in the 21st century that even one woman should die from abortion-related causes anywhere in the world,” says Ipas President and CEO, Elizabeth Maguire. “We have shown that unsafe abortion can be prevented easily and at low cost – if the political will to do so exists.

“Ipas and our partners around the world will continue to accelerate our efforts.  We are hopeful that the post-2015 development framework will facilitate greater attention to this urgent issue by the entire global community.”