Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model

Abstract

SummaryBackgroundGlobal estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where abortion is legally restricted, and the need to account for the multiple factors that affect abortion safety.MethodsWe used all available empirical data on abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe abortion and WHO guidelines on safe abortion to categorise abortions as safe or unsafe and to further divide unsafe abortions into two categories of less safe and least safe.FindingsOf the 55· 7 million abortions that occurred worldwide each year between 2010–14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9–59·4) were safe, 17·1 million (30·7%, 25·5–35·6) were less safe, and 8·0 million (14·4%, 11·5–18·1) were least safe. Thus, 25·1 million (45·1%, 40·6–50·1) abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws.InterpretationIncreased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates.FundingUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.

Utrygge aborter er svært vanlig i lavinntektsland

“…I en studie som nylig er publisert i tidsskriftet The Lancet, basert på data fra 61 land, ble antall aborter i verden i perioden 2010-14 beregnet til å vaere 55 700 000, altså over 55 millioner (1). Av disse ble ca.…”

Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa

“…The World Health Organization (WHO) estimates that 44 percent (25.1 million) of the approximately 56 million abortions that occurred annually between 2010 and 2014 were unsafe [1]. The proportion of unsafe abortions was higher in countries with restrictive abortion laws, such as in the East, Central, and Southern Africa (ECSA) health community [1].…”

“…The proportion of unsafe abortions was higher in countries with restrictive abortion laws, such as in the East, Central, and Southern Africa (ECSA) health community [1]. Restrictive abortion laws, poverty, gender inequality, and stigmatisation contribute to inequitable and inadequate healthcare access, causing higher proportions of unintended pregnancy and unsafe abortions in ECSA [1,2]. Inadequate access to comprehensive abortion care (CAC) impedes women’s sexual and reproductive health and rights (SRHR).…”

Protective Effect of Taohong Siwu Decoction on Abnormal Uterine Bleeding Induced by Incomplete Medical Abortion in Rats during Early Pregnancy

“…However, one of great side effects of medical abortion is incomplete abortion, which may cause abnormal uterine bleeding (AUB) at any time. 1,2) AUB, affecting up to one-third of women of child bearing age, will interfere with the physical, emotional, and social QOL of women.3,4) Patients with clinically diagnosed AUB were treated by means of medicines or operations. Surgical treatments are suggested in the presence of medical therapies failure, which cause severe anemia, and other accompanying uterine pathology because of the influence on fertility.…”

“…However, one of great side effects of medical abortion is incomplete abortion, which may cause abnormal uterine bleeding (AUB) at any time. 1,2) AUB, affecting up to one-third of women of child bearing age, will interfere with the physical, emotional, and social QOL of women. 3,4) Patients with clinically diagnosed AUB were treated by means of medicines or operations.…”