The high cost of unsafe abortion

Every eight minutes a woman dies somewhere in a developing country due to complications from an unsafe abortion. She most likely had little money or support to obtain safe services. She probably first tried to induce a termination herself. Failing that she would have turned to an unskilled, but relatively inexpensive, provider.

The cost of unsafe abortion-relatedill-health and death was the subject of a technical meeting held at theInstitute of Development Studies (UK) on 18th and 19thApril 2007. It was funded by the Hewlett Foundation and brought togetherexperts on unsafe abortion and economists specialising in costing methods. Themeeting reviewed recent work estimating the cost of unsafe abortion to thehealth sector. Participants also discussed the economic costs to healthsystems, individuals and households, and the links between unsafe abortion andpoverty. This issue of id21 health focus highlights the findings reviewed atthe meeting and points to important lessons for decision-makers.

Unsafe abortion carried out by individualslacking the necessary skills and/or in unhygienic conditions, is a major globalpublic health problem. The practice occurs where abortion is legallyrestricted, and where access to safe services is inadequate although the lawmay broadly permit the procedure. Unsafe abortion causes death and ill healthin women, and burdens households, health systems and society.

Each year, there are an estimated 19million unsafe abortions worldwide, most in low-income countries. About 5.2million of these women are hospitalised for serious complications, while anunknown but possibly equal number of women suffer similarly seriouscomplications but cannot obtain treatment. As a result, around 68,000 women dieeach year, making unsafe abortion a significant cause of maternal mortality. Thisnumber has remained unchanged since 1990.

In 2000, the consequences of unsafeabortion were greater in Africa than in Asia and Latin America.  In Africa, 709 women die per 100,000 unsafeabortions, compared to 324 in Asia and 100 in Latin America. Nearly half of alldeaths due to unsafe abortion occur in Africa, although Africa accounts for only13 percent of all women of reproductive age in developing countries.  

In recent years, countries such as Nepalhave responded by liberalising their abortion law. When accompanied by expandedaccess to safe services, as in South Africa, this greatly reduces complicationsand deaths from unsafe abortion. Another promising trend is the increased useof new drugs such as mifepristone and misoprostol - the 'abortion pill' - invery early pregnancy. These are an effective alternative to surgery and furtherreduce the risk and severity of complications.

Key policy lessons that emerged from theworkshop include:

• Women need better access tocontraceptive information and services to reduce unintended pregnancies and abortion (unsafeand safe). 
• Where the law broadly permitsabortion, safe services need to be expanded so that women do not need to resortto unsafe methods.
• Where the law is highlyrestricted, access to services for permitted criteria should be provided. Advocacyshould highlight the unacceptable cost of unsafe abortion and the benefits of expandingthe criteria for legal abortion.
• The quality and coverage ofpost-abortion care in developing countries need urgent improvement.