safe, legal, and rare? an update on abortion around the world

Caitlin Gerdts, PhD, MHS

UCLA Fielding School of Public Health, Bixby Lecture

November 26, 2012

Safe, Legal, and Rare? An update on abortion around the world

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 2

Women all over the World have Abortions for Similar Reasons

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 3

The Decline in Global Abortion Rates has Stalled

World Developing countries

Developed countries

0

10

20

30

40

35 34

39

29 2925

28 29

24

1995 2003 2008

Abortions per 1,000 women aged 15–44

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 4

Stall in global abortion decline coincides with plateau in contraceptive use

0

20

40

60

80

100

0

10

20

30

40

50

60

Abortions per 1,000 women 15-44

Contraceptive prevalence (%)

Contraceptive prevalence (%) Abortion rate

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 5

The abortion rate is lower in developed countries than in developing countries

1995 2000 2005 20100

10

20

30

40

50

20

19 17

39

25 24

34 2929

Developing countriesDeveloped countriesDeveloped countries*

Abortions per 1,000 women aged 15–44

www.guttmacher.org*Excluding Eastern Europe

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 6

Is Abortion Safe?

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 7

When performed in safe, sterile conditions…

…abortion is safer than taking a dose of penicillin.

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 8

When performed in unsafe or unsterile conditions…

• Maternal Morbidity

• Maternal Mortality

• Strains on Health Systems

• Strains on Families

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 9

Disproportionate Impact of Unsafe Abortion

“Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.”

-Iqbal Shah, WHO

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 10

An increasing proportion of abortion are unsafe

World Developing countries Developed countries0

20

40

60

80

100

4454

9

4755

7

4956

6

1995 2003 2008

% of abortions that are unsafe

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 11

By the WHO definition, virtually all Abortions in Latin America and Africa are Unsafe

% of abortions

Africa Latin America

Asia Oceania Europe North America

0

20

40

60

80

100

97 95

40

15 9

Unsafe Safe

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 12

Deaths from Unsafe Abortion are Highest in Africa

Devel-oped

regions

Develop-ing re-gions

Africa Asia Latin America & Car-ibbean

0

100

200

300

400

500

600

700

10

350

650

300

50

Deaths per 100,000 unsafe abortions, 2003

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 13

Is Abortion Legal?

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 14

Most women live in countries where abortion is restricted

This is a slide to use for large images where you want to eliminate everything else but a two-line

title and caption. It’s based on the last slide master.

26%

10%

3%21%

41%

Prohibited altogether or only to save life

Physical Health

Mental Health

Socioeconomic

Without restriction

Global Abortion Legality

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 16

Consequences of restricting contraception and legal abortion in Romania

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 17

Disproportionate Impact of Unsafe Abortion

“Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.”

-Iqbal Shah, WHO

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 18

Abortion law reforms in developing countries have been followed by declines in morbidity and mortality

• South Africa (1997): Annual number of abortion-related deaths decreased by 91% after the law was liberalized.

• Nepal (2002): Abortion-related complications as a proportion of all of maternal illnesses decreased by 48% in a study of facilities in eight districts.

• Ethiopia (2005): Abortion complications per 100,000 live births (at one large hospital) decreased by about 70%.

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 19

Should Abortion be Rare?

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 20

Impact of contraception on reducing the number of abortions

141 million

45 million

14 million

Without modern methods

Current use

If unmet need were met

Estimated number of induced abortions

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 21

Focus on Rare Abortion Increases Stigma

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 22

Global Turnaway Study

www.indiegogo.com/theglobalturnawaystudy

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 23

Global Turnaway Study aim

To describe the mental health, physical health

and socioeconomic consequences of

receiving a legal abortion compared to being

denied a legal abortion in multiple geographic,

cultural, and legal settings.

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 24

Global Turnaway Study groups

4 6 8 10 12 14 16 18 20 22 24 26 28 …

Site A Gestational age limit = 12

4 6 8 10 12 14 16 18 20 22 24 26 28 …

Site B Gestational age limit = 20

Abortion comparison Turnaway

Safe, Legal, and

Rare? An update

on abortion

Caitlin Gerdts, PhD,

MHS

November 2009 | Slide 25

References

■ Weitz, T. Rethinking the Mantra that Abortion Should be “Safe, Legal, and Rare

■ Singh S, Sedgh G, Hussain R. Unintended Pregnancy: Worldwide Levels, Trends and Outcomes. Studies in Family Planning. Dec 2010;41(4).

■ WHO. The prevention and management of unsafe abortion. Report of a technical working group. Geneva: World Health Organization, 1992 (WHO/MSM/92.5).

■ Fawcus SR. Maternal mortality and unsafe abortion. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008; 22(3).

■ The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society & Abortion Worldwide, New York: AGI, 1999

■ Sedgh G, Henshaw S, Singh S, Ahman E, Shah I. Induced Abortion: estimated rates and trends worldwide. Lancet. 2007; 370.

■ Sedgh G, Singh S, Shah I, Ahman E, Henshaw S, Bankole A. Induced Abortion: incidence and trends worldwide from 1995-2008. Lancet. 2012; 379.

■ Adler AJ, Filippi V, Thomas S, Ronsmans C. Quantifying the global burden of morbidity due to unsafe abortion: Magnitude in hospital-based studies and methodological issues. International Journal of Gynecology and Obstetrics. 2012.

■ Adler AJ, Filippi V, Thomas S, Ronsmans C. Incidence of severe acute maternal morbidity associated with abortion: a systematic review. Tropical Medicine and International Health. 2011.

■ WHO. Unsafe Abortion: Global and Regional Estimates of Incidence of Unsafe Abortion and Associated Mortality. Geneva: World Health Organization, 2007.

■ Gipson J, Koenig M, Hindin M. The effects of unintended pregnancy on infant, child and parental health: a review of the literature. Studies in Family Planning. 2008; 39(1): 18-38.

■ Brown S, Eisenberg L (eds). The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academic Press.

■ Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Population Studies. 2003; 51(1): 77-93.

Caitlin Gerdts, PhD, MHS

gerdtsc@obgyn.ucsf.edu

UCLA Fielding School of Public Health

November 26, 2012

Thank you