Abortion rates are at an all-time low in developed countries, but not in developing countries, where rates have remained level over the past two decades. 

That’s the key finding from a new study published Wednesday in The Lancet by researchers at the World Health Organization (WHO) and the New York-based Guttmacher Institute.

The study, which analyzed abortion data for every country and major territory in the world between 1990 and 2014, also found that restrictive abortion laws do not limit the number of these procedures. In fact, abortion rates in regions of the world where the procedure is outlawed are similar to those in regions where it’s legal. 

What’s more, in the countries where abortion is illegal, the procedures often occur under conditions that put the mother’s health and life at risk.

“In developed countries, the continued fall in abortion rates is largely due to increased use of modern contraception that has given women greater control over the timing and number of children they want,” explains Gilda Sedgh, a research scientist at the Guttmacher Institute and the study’s lead author, in a released statement. “In developing countries, however, family planning services do not seem to be keeping up with the increasing desire for smaller families.  More than 80 percent of unintended pregnancies are experienced by women with an unmet need for modern methods of contraception, and many unwanted pregnancies end in abortion.”

That need to limit unintended pregnancies seems particularly strong among married women. For here’s another interesting finding from the study: Globally, married women obtain the vast majority — 73 percent — of abortions.

Breaking down the numbers

For the study, Sedgh and her colleagues used various sources of abortion data, including nationally representative surveys, official statistics, and published and unpublished studies. They then fed that data into a statistical model, which enabled them to estimate levels and trends in the incidence of abortion for various regions and sub-regions of the world in five-year periods from 1990 through 2014.

It is the most comprehensive look at abortion data since 2008. 

The data revealed that, globally, about one in four pregnancies — an estimated 56 million pregnancies in all — end in abortion each year. About 90 percent of those abortions occur in developing countries.

Here are some of the other specific findings from the study:

• In the developed world, the abortion rate declined 41 percent between 1990-1994 and 2010-2014, from 46 to 27 abortions per 1,000 women aged 15-44 years.
• Much of that decline was driven by a 52 percent drop in the abortion rate (88 to 42 per 1,000 women) in Eastern Europe, where modern contraception methods have become much more widely available during the last two decades. But the rates also fell by 31 percent in Southern Europe (38 to 26), by 18 percent in Northern Europe (22 to 18) and by 28 percent in North America (25 to 17).
• By comparison, the abortion rate in the developing world remained essentially unchanged between 1990-1994 and 2010-2014, dropping a non-statistically significant two points, from 39 to 37 abortions per 1,000 women aged 15-44.
• In developed countries, the proportion of pregnancies that ended in abortion was 39 percent in 1990-1994 and 28 percent in 2010-2014 — a decline of 28 percent. In developing countries, however, the proportion increased 14 percent, from 21 percent in 1990-1994 to 24 percent two decades later.
• Overall, 28 percent of pregnancies in 2010-2014 ended in abortion. In Latin America, however, where abortion laws are highly restrictive, one in three pregnancies (32 percent) ended in abortion during that time period — higher than in any other region of the world.
• In the 53 countries where abortion is illegal — or permitted only to save a woman’s life — the rate was 37 per 1,000 women in 2010-2014. That compares with 34 per 1,000 women in countries where the procedure is legally available on request — only an 8 percent difference.

Putting women at risk

“The obvious interpretation” of those last statistics “is that criminalizing abortion does not prevent it but, rather, drives women to seek illegal services or methods,” writes Diana Greene Foster of the Bixby Center for Global Reproductive Health at the University of California, San Francisco, in an editorial that accompanies the study. “But this simple story overlooks the many women who, in the absence of safe legal services, carry unwanted pregnancies to term — about half the women denied legal abortions in small studies in Tunisia, South Africa and Nepal.

“The similarity of abortion rates across legal settings for abortion does not reflect a one-for-one exchange of illegal abortion for legal abortion,” she explains. “Women who live in countries where abortion is illegal often have little access to the whole range of family planning services, including contraceptive supplies, counseling, information, and safe abortion. As a consequence of increased rates of unintended pregnancy and unsafe abortion, such women face an increased risk of maternal mortality and bear children that they are not ready to care for and often cannot afford.”

Needed: more reproductive services

The statistics from other studies on how many women find their lives in jeopardy due to an inability to access effective contraception and safe abortion services is staggering: An estimated 6 to 9 million women in the developing world were treated for complications from unsafe abortions in 2012, and each year as many as 40 percent of women who need such care do not receive it.

Abortion may be on the decline globally, but the rates are still far too high. And, as this study’s findings make clear, the answer to bringing those rates down is not to criminalize or restrict women’s access to the procedure.

Instead, write the study’s authors, these new findings “underscore that investments are needed to meet women’s and couples’ contraceptive needs and ensure access to safe abortion care, especially in the developing world, where abortion rates are high and many abortions are unsafe.”  

FYI: You’ll find an abstract of the study on the Lancet’s website, but the full study is, unfortunately, behind a paywall.