But the rate of unsafe abortions remains high, especially in the developing world, according to Gilda Sedgh, Sc.D., of the Guttmacher Institute and colleagues at the institute and the World Health Organization.
In the U.S. and Canada, there were an estimated 1.5 million abortions in both 1995 and 2003, but the abortion rate fell slightly, from 2.2% to 2.1%, the investigators reported in the Oct. 13 issue of The Lancet.
The abortion rate is defined as the annual number of abortions per 1,000 women between the ages of 15 and 44. Expressed as a percentage, the worldwide rate was 2.9% in 2003, down from 3.5% in 1995, the researchers said.
The U.S. abortion rate is middle-of-the-road, Dr. Sedgh and colleagues found, tucked between a low of 1.4% for Western Europe (including countries such as Austria, Belgium, France, and Germany) and a high of 4.4% for Eastern Europe (including such former Soviet bloc countries as Belarus, Hungary, Poland, and Ukraine).
All told, the researchers found, there were 6.6 million abortions in the developed world in 2003, for an abortion rate of 2.6%. In the developing countries, the corresponding figures were 35 million and 2.9%.
Although the overall rates are similar between the developed and developing nations, "unsafe abortion is concentrated in developing countries," the investigators wrote.
In the developed world, they said, 92% of abortions were deemed safe. In the U.S., for example, fewer than three women of every thousand having an abortion suffer a complication that requires hospital admission.
But worldwide, almost half of all abortions in 2003 were unsafe, including 38% of abortions in Asia, 94% in Latin America and the Caribbean, and 98% in Africa.
The study shows that "abortion is a universal phenomenon," regardless of the legal or cultural situation, said David Grimes, M.D., an expert in abortion epidemiology at the University of North Carolina in Chapel Hill.
The differing abortion rates around the world, Dr. Grimes said, "largely reflect access to safe and affordable and acceptable contraception" -- where contraception is widely available, abortion rates tend to be low.
For example, Dr. Sedgh and colleagues noted, the rate in Eastern Europe was 4.4% in 2003 -- but that's down from 9% in 1995.
The reason? The former Soviet Union restricted access to contraception, but offered abortion at little or no cost, the researchers said. Now, access to contraception has improved, so abortions are down. But the relatively high abortion rate "suggests the need for continued improvements," they said.
Dr. Grimes, who was not involved in the research, said the findings show that some progress has been made. "But the important public health message here is that about half of all abortions worldwide are unsafe," he said, "and the suffering that stems from that is prodigious."
Dr. Grimes's view was echoed by Beth Fredrick, executive vice-president of the New York-based International Women's Health Coalition.
Writing in a comment accompanying the article in The Lancet, she said, "the continuing high incidence of unsafe abortion in developing countries represents a public-health crisis and a human-rights atrocity."
She called on the U.S. government to lift the "global gag rule" that requires any foreign groups getting U.S. governmental assistance for family planning to deny women information about legal abortion or where safe services can be obtained.
"This policy has very real detrimental effects on public health," she said, "and should be unanimously rejected."
The researchers also calculated an "abortion ratio" -- the proportion of abortions to live births. Overall, there were 31 abortions for every 100 live births in 2003; the ratio was highest in Eastern Europe, where there were 105 abortions for every 100 births.
In the U.S. and Canada, the ratio was 33, the researchers found.
|The study was supported by the World Health Organization and the World Bank. The researchers said they had no conflict of interest.|
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco
The LancetSource Reference: Sedgh G et al. "Induced abortion: estimated rates and trends worldwide."
Lancet 2007; 370: 1338-45.
The LancetSource Reference: Fredrick B. "Eliminating unsafe abortion worldwide." Lancet 2007; 370: 1295-97.