Worldwide, 25 million unsafe abortions (45% of all abortions) occurred every year between 2010 and 2014, according to a new study by WHO and the Guttmacher Institute published in The Lancet. The majority of unsafe abortions, or 97%, occurred in developing countries in Africa, Asia, and Latin America.
Over half of all estimated unsafe abortions globally were in Asia. 3 out of 4 abortions that occurred in Africa and Latin America were unsafe. The risk of dying from an unsafe abortion was the highest in Africa.
Each year between 4.7 – 13.2 percent of maternal deaths can be attributed to unsafe abortion. Around 7 million women are admitted to hospitals every year in developing countries, as a result of unsafe abortion.
In developed regions, it is estimated that 30 women die for every 100 000 unsafe abortions.
That number rises to 220 deaths per 100 000 unsafe abortions in developing regions and 520 deaths per 100 000 unsafe abortions in sub-Saharan Africa.
The annual cost of treating major complications from unsafe abortion is estimated at US$ 553 million.
Almost every abortion death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion, and timely care for complications.
Abortions are safe if they are done with a method recommended by WHO that is appropriate to the pregnancy duration and if the person providing or supporting the abortion is trained.
Such abortions can be done using tablets (medical abortion) or a simple outpatient procedure.
Unsafe abortion occurs when a pregnancy is terminated either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards or both.
The people, skills, and medical standards considered safe in the provision of induced abortions are different for medical abortion (which is performed with drugs alone), and surgical abortion (which is performed with a manual or electric aspirator). Skills and medical standards required for safe abortion also vary depending upon the duration of the pregnancy and evolving scientific advances.
They are less safe, when done using outdated methods like sharp curettage even if the provider is trained or if women using tablets do not have access to proper information or to a trained person if they need help.
Abortions are dangerous or least safe when they involve ingestion of caustic substances or untrained persons use dangerous methods such as insertion of foreign bodies, or use of traditional concoctions.
Women, including adolescents, with unwanted pregnancies, often resort to unsafe abortion when they cannot access safe abortion.
Barriers to accessing safe abortion include restrictive laws, poor availability of services, high cost, stigma, conscientious objection of health-care providers and unnecessary requirements, such as mandatory waiting periods, mandatory counseling, provision of misleading information, third-party authorization and medically unnecessary tests.
Any woman with an unwanted pregnancy who cannot access safe abortion is at risk of unsafe abortion.
Women living in low-income countries and poor women are more likely to have an unsafe abortion.
Deaths and injuries are higher when unsafe abortion is performed later in pregnancy.
The rate of unsafe abortions is higher where access to effective contraception and safe abortion is limited or unavailable.
Following the unsafe abortion, women may experience a range of harms that affect their quality of life and well-being, with some women experiencing life-threatening complications.
The major life-threatening complications resulting from the least safe abortions are hemorrhage, infection, and injury to the genital tract and internal organs.
Unsafe abortions when performed under least safe conditions can lead to complications such as incomplete abortion (failure to remove or expel all of the pregnancy tissue from the uterus), haemorrhage (heavy bleeding), infection, uterine perforation (caused when the uterus is pierced by a sharp object), damage to the genital tract and internal organs by inserting dangerous objects such as sticks, knitting needles, or broken glass into the vagina or anus.
An accurate initial assessment is essential to ensure appropriate treatment and prompt referral for complications of unsafe abortion.
The critical signs and symptoms of complications that require immediate attention include abnormal vaginal bleeding, abdominal pain, infection and shock (collapse of the circulatory system).
Complications of unsafe abortion can be difficult to diagnose.
For example, a woman with an extra-uterine or ectopic pregnancy (abnormal development of a fertilized egg outside of the uterus) may have symptoms similar to those of incomplete abortion.
It is essential, therefore, for health-care personnel to be prepared to make referrals and arrange transport to a facility where a definitive diagnosis can be made and appropriate care can be delivered quickly.
Complications arising from unsafe abortions and their treatments include Haemorrhage: timely treatment of heavy blood loss is critical, as delays can be fatal.
Infection: treatment with antibiotics along with evacuation of any remaining pregnancy tissue from the uterus as soon as possible.
Injury to the genital tract and/or internal organs: if this is suspected, early referral to an appropriate level of health care is essential.
Health-care providers are obligated to provide life-saving medical care to any woman who suffers abortion-related complications, including treatment of complications from unsafe abortion, regardless of the legal grounds for abortion.
However, in some cases, treatment of abortion complications is administered only on the condition that the woman provides information about the person(s) who performed the illegal abortion.
The practice of extracting confessions from women seeking emergency medical care as a result of illegal abortion puts women’s lives at risk.
The legal requirement for doctors and other health-care personnel to report cases of women who have undergone an abortion delays care and increases the risks to women’s health and lives.
UN human rights standards call on countries to provide immediate and unconditional treatment to anyone seeking emergency medical care.
Unsafe abortion can be prevented through comprehensive sexuality education; prevention of unintended pregnancy through the use of effective contraception, including emergency contraception and provision of safe, legal abortion.
In addition, deaths and disability from unsafe abortion can be reduced through the timely provision of emergency treatment of complications.
WHO provides global technical and policy guidance on the use of contraception to prevent unintended pregnancy, safe abortion, and treatment of complications from unsafe abortion.
In 2012, WHO published updated technical and policy guidance on safe abortion.
Upon request, WHO provides technical support to countries to adopt sexual and reproductive health guidelines in specific contexts and strengthen national policies and programmes related to contraception and safe abortion care.
Ganatra B, Gerdts C, Rossier C, Johnson BR Jr, Tunçalp Ö, Assifi A, Sedgh G, Singh S, Bankole A, Popinchalk A, Bearak J, Kang Z, Alkema L. Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model. Lancet. 2017 Nov 25;390(10110):2372-2381. doi: 10.1016/S0140-6736(17)31794-4.