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

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by Caitlin Gerdts, PhD, MHS
November 26, 2012

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

  1. 1. 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
  2. 2. 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
  3. 3. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 3 The Decline in Global Abortion Rates has Stalled 35 34 39 29 29 25 28 29 24 0 10 20 30 40 World Developing countries Developed countries 1995 2003 2008 Abortions per 1,000 women aged 15–44
  4. 4. 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 10 20 30 40 50 60 0 20 40 60 80 100 1980 1985 1990 1995 2000 2005 2010 Abortions per 1,000 women 15-44 Contraceptive prevalence (%) Contraceptive prevalence (%) Abortion rate
  5. 5. 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 34 29 29 39 25 24 20 19 17 0 10 20 30 40 50 1995 2000 2005 2010 Developing countries Developed countries Developed countries* Abortions per 1,000 women aged 15–44 www.guttmacher.org *Excluding Eastern Europe
  6. 6. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 6 Is Abortion Safe?
  7. 7. 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.
  8. 8. 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
  9. 9. 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
  10. 10. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 10 An increasing proportion of abortion are unsafe 44 54 9 47 55 7 49 56 6 0 20 40 60 80 100 World Developing countries Developed countries 1995 2003 2008 % of abortions that are unsafe
  11. 11. 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 97 95 40 15 9 0 20 40 60 80 100 Africa Latin America Asia Oceania Europe North America Unsafe Safe
  12. 12. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 12 Deaths from Unsafe Abortion are Highest in Africa 10 350 650 300 50 0 100 200 300 400 500 600 700 Developed regionsDeveloping regions Africa AsiaLatin America & Caribbean Deaths per 100,000 unsafe abortions, 2003
  13. 13. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 13 Is Abortion Legal?
  14. 14. 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% 40% Prohibited altogether or only to save life Physical Health Mental Health Socioeconomic Without restriction
  15. 15. Global Abortion Legality
  16. 16. 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
  17. 17. 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
  18. 18. 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%.
  19. 19. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 19 Should Abortion be Rare?
  20. 20. 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
  21. 21. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 21 Focus on Rare Abortion Increases Stigma
  22. 22. Safe, Legal, and Rare? An update on abortion Caitlin Gerdts, PhD, MHS November 2009 | Slide 22 Global Turnaway Study www.indiegogo.com/theglobalturnawaystudy
  23. 23. 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.
  24. 24. 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
  25. 25. 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.
  26. 26. Caitlin Gerdts, PhD, MHS gerdtsc@obgyn.ucsf.edu UCLA Fielding School of Public Health November 26, 2012 Thank you

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