Women in poorest countries at greater risk of unintended pregnancy and lack access to safe and legal abortion care services

New estimates, published in The Lancet Global Health, and jointly authored by the Guttmacher Institute and HRP, show a worldwide decline in unintended pregnancies since 1990-1994. Over the same period, the proportion
of unintended pregnancies ending in abortion has increased. 

These findings suggest that over the past 30 years, more women and individuals than ever before have been able to limit or space their pregnancies. This is possibly thanks to improved access to a choice of contraception,
in addition to, and as part of, comprehensive sexual and reproductive health services including safe abortion care to the full extent of the law. 

The new study looks at the incidence of unintended pregnancy and abortion by income, region, and the legal status of abortion from 1990 to 2019.

“The substantial declines in unintended pregnancies and in abortion rates in some regions of the world is welcome news, reflecting important gains in access to effective, safe, acceptable and affordable sexual and reproductive health services,” says Bela Ganatra, Head of Preventing Unsafe Abortion Unit and Scientist at HRP.

Poorest women at greatest risk

Despite progress, approximately 214 million women of reproductive age who want to avoid pregnancy are not using a modern contraceptive method, so are much less able to decide if, how many, and when to have children. The new estimates
show that between 2015 and 2019, almost half of all pregnancies were unintended. 

What is more, women living in the poorest regions were nearly three times as likely to face unintended pregnancies than those in the wealthiest regions.

 

Higher rates of abortion in countries with more legal restrictions 

The highest rates of abortion were found in countries with the most legal restrictions. In high-income countries where abortion is broadly legal (the term “broadly legal” means that abortion is available on request
or on broad socioeconomic grounds) there were 11 abortions per 1 000 women of reproductive age, compared with 32 abortions per 1 000 in high-income countries with more legal restrictions to access.  

Abortion rates were highest in low-income countries with the most legal restrictions to abortion care. There was also an increase – of 12% – in the number of abortions in countries with legal restrictions on the procedure,
whilst it declined slightly in countries where abortion is broadly legal. 

Women living in countries with more legal restrictions for accessing abortion care, also faced significantly higher rates of unintended pregnancies. This suggests they are less able to access contraception alongside broader sexual
and reproductive health services for preventing unintended pregnancies – likely explaining the higher number of abortions in these countries.   

New methodology to improve understanding 

This study uses an updated, more comprehensive methodology, in which for the first time the worldwide number of pregnancies was estimated, followed by an estimation of how many of those pregnancies were unintended and how many ended in abortion. These
numbers were broken down by country income status, Sustainable Development Goal region and legal status. 

Countries were considered to have restrictive abortion laws if the procedure is completely prohibited, available only to save a woman’s life or available to preserve her health. The study found similar abortion rates irrespective of the type
of legal restriction. 

High-quality reproductive health care essential for health, safety and wellbeing 

Sexual and reproductive health care is an essential part of universal health coverage. This includes services to help prevent unintended pregnancy, through provision of comprehensive sexuality education and a choice of effective and affordable modern
contraceptive methods, and access to safe abortion care and post abortion care to the full extent of the law. 

These services are essential to fulfilling the global commitments in the Sustainable Development Goal of ensuring universal access to sexual and reproductive health care, reducing the number of maternal deaths and ending discrimination against women
and girls. 

Read the journal article.

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