|Press Release WHO/28
17 May 1999
ABORTION IN THE DEVELOPING WORLD
Out of nearly 50 million abortions performed in the world each year (30 million of them in developing countries), 20 million are unsafe, according to a World Health Organization (WHO) publication "Abortion in the Developing World"1 .
Close to 90%of all unsafe abortions take place in developing countries. In 94% of these countries, induced abortion is restricted by law. The risk of dying from an unsafe abortion in a developing country is 1 in 250 procedures, while in developed countries it is 1 in 3,700 procedures.
Induced abortions, especially in countries where the practice is restricted by law, continue to be a major reproductive health problem. Some 70 000 women die each year as a result of unsafe abortion. Many more women survive the experience only to suffer throughout the rest of their lives from infertility, chronic morbidity and permanent physical impairment.
A strong motivation to seek an abortion rests on the widespread desire for smaller families, the need to control the timing of births and the failure or inconsistent use of contraception. Poor access to family planning services, shifts from rural to urban settings, poverty and hardship, increase in non-marital sexual activity, adolescent sexuality coupled with unprotected sex, all contribute to the continuing practice of abortion in the developing world.
The case studies included in the book and conducted in countries as far apart as Mexico and Mauritius, China and Cuba suggest that the relationship between contraceptive needs and induced abortion remains, for the most part, unexplored territory in reproductive health research. For most women in the developing world, where abortion is usually restricted and unsafe, contraception would seem to offer a better fertility regulation option. Yet the research findings indicate the extensive use of induced abortion even in countries with good family planning services.
Induced abortion exists everywhere, both in countries where family planning programmes are strong as well as where they are weak or non-existent. Often enough, it occurs within marriage to limit family size. Thus, in the Nepal study, unplanned pregnancy accounted for 95% of induced abortion but the majority of women were not using contraception.
In the Dominican Republic scarcely 25% of women were using a contraceptive method when they became pregnant unintentionally. Even in China, where contraception is easily and widely available, non-use of contraception is a primary reported reason for unwanted pregnancy and abortion. However, contraceptive failure can go as high as 37% (China), as the reported reason for abortion. In the Cuba study, three out of every four women who had had an abortion in the last 12 months reported using a modern method of contraceptive at the time they were surveyed.
Based on several studies, researchers concluded that non-use and low continuation of use of modern contraceptive methods among the women who had an abortion in developing countries resulted from the women's negative perception of contraceptives, especially hormonal ones, which they felt had side effects and lacked in safety.
Whatever the complexities of the relationship between contraception and abortion, all the studies call for general improvement in the quality of reproductive health services as a way to reduce the recourse to abortion. There is an urgent need to make available a wider range of contraceptive methods to allow users greater freedom to choose what suits their needs best. Ensuring longer continuation of use is one way of lowering abortion risks among women who do not want to become pregnant.
Abortion continues to be a very controversial and complex issue given its political, religious, ethical and health dimensions which often lead to heated debates in public forums. The book sheds new light on the reality of abortion which varies dramatically in different social, legal and political contexts.
For further information, journalists can contact Mr Valery Abramov, Office of Press and Public Relations, WHO, Geneva. Telephone (+41 22) 791 25 43; Fax (+41 22 ) 791 48 58. E-Mail: email@example.com
All WHO Press Releases, Fact Sheets and Features as well as other informationon this subject can be obtained on the Internet on the WHO home page http://www.who.int/