Legal Abortion Worldwide in 2008: Levels and Recent Trends

CONTEXT: Periodic assessments of abortion incidence are essential for monitoring trends in unintended pregnancy and gaps in contraceptive services and use. METHODS: Statistics and estimates of legal induced abortions in 2008 were compiled for 64 of the 77 countries in which legal abortion is generally available; these 64 are home to 98% of women aged 15-44 who live in the countries eligible for inclusion. Data sources included reports or completed questionnaires from national statistical offices and nationally representative surveys. The completeness of official figures was assessed by in-country and regional experts. Trends since 1996 and 2003 were examined. RESULTS: Of the 77 countries with liberal abortion laws, 36 are in the developing world. In 2008, abortion rates in the 25 countries with complete records--all of which were developed--ranged from seven (Germany and Switzerland) to 30 (Estonia) per 1,000 women aged 15-44.Abortion rates declined in most of the 20 countries with consistently reliable information on trends between 1996 and 2008; declines were generally steeper than increases, although the pace of decline slowed after 2003.The highest observed abortion rates were in developing countries with incomplete estimates. For most developing countries that had liberal laws, the reported abortion rates were incomplete and varied widely. CONCLUSIONS: High abortion rates in some countries, and small increases in rates in others, indicate a great need for more effective family planning services for these populations. Reliable data collection systems, needed to ensure that trends can be effectively monitored, are lacking in many countries. International Perspectives on Sexual and Reproductive Health, 2011, 37(2):84-94, doi: 10.1363/3708411 The incidence of induced abortion is an important indicator of the frequency with which women experience unintended pregnancies, and it can point to gaps in contraceptive services and effective contraceptive use. Periodic assessments of abortion incidence are therefore essential for monitoring trends in these critical aspects of the wellbeing of women and couples. However, documentation of this incidence is often unavailable or incomplete, in part because of the sensitive nature of abortion. Although it is extremely difficult to obtain reliable counts of the numbers of procedures performed in countries that have highly restrictive abortion laws, abortion data collection systems or other means of abortion estimation are in place in most countries that have liberal laws. This review presents the most recent available official statistics and national estimates of the level of abortion in all countries and major territories where legal abortion was generally available in 2008--settings where abortion was legal without restriction as to reason or on socioeconomic grounds; or where abortion was legal to preserve a woman's physical or mental health, if the law was interpreted liberally. A recent analysis estimated that about 60% of women of childbearing age live in countries with liberal abortion laws.(1) Another 3% live in countries whose abortion laws are interpreted liberally such that legal abortion is generally available. The quality of abortion statistics varies greatly, and the completeness of the statistics depends on such factors as whether abortion reporting is voluntary or required by law; whether medication abortions are reliably reported; whether clinicians face consequences for failure to report abortions, such as lack of reimbursement for services rendered; whether reporting systems include services provided in the private sector (and, if not, the proportion of abortions performed in the private sector); and whether abortion stigma negatively influences reporting. The completeness of reporting can change over time if circumstances that influence reporting change. In our analyses, we assess the completeness of abortion reports and whether the quality of reporting has changed substantially over time. …