Unsafe Abortions Kill 70,000 a Year

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by
The Guardian/UK

Unsafe Abortions Kill 70,000 a Year

Countries with restrictive laws most affected • Global report shows overall fall in terminations

by
Sarah Boseley

A woman in a maternity ward at Makeni hospital in Sierra Leone. A report found only 28% of married African women use contraceptives. (Photograph: Issouf Sanogo)

About 70,000 women die every year and many more suffer harm as a
result of unsafe abortions in countries with restrictive laws on ending
a pregnancy, according to a report.

The total number of abortions
across the globe has fallen, the influential Guttmacher Institute says,
but that drop relates only to legal abortions and is mostly the result
of changes in eastern Europe.

There were 41.6m terminations
worldwide in 2003, compared with 45.5m in 1995. But in 2003, says the
report, 19.7m of these were unsafe, clandestine abortions. The numbers
of those have hardly changed from 1995, when there were 19.9m.

Almost all the unsafe abortions were in less developed countries with restrictive abortion laws.

"Virtually
all abortions in Africa and in Latin America and the Caribbean were
unsafe," says the report. In Asia, safe procedures outnumbered unsafe
because of the large number of legal abortions in China. Most of those
in Europe and almost all in North America were safe.

The figures
are hard to obtain in countries with restrictive laws from hospitals
dealing with women damaged by backstreet or self-induced abortion. But
the institute, which has been monitoring the numbers for many years, is
confident of the picture it paints and hopes it will influence policy
makers.

"Our hope is that the new report will help inform a
public debate in which all too often emotion trumps science," said the
institute president, Dr Sharon Camp.

Fundamental to turning the
tide is preventing unwanted pregnancy, but in many countries there is
little advice on family planning and contraceptive products are in
short supply. "Women will continue to seek abortion whether it is legal
or not as long as the unmet need for contraception remains high," Camp
said. "With sufficient political will we can ensure that no woman has
to die in order to end a pregnancy she neither wanted nor planned for."

The
US has always been the biggest funder of family planning in developing
countries, but a significant amount of it stopped under the presidency
of George Bush, who reinstated a policy known as the "global gag rule"
on arrival in office in January 2001.

It removed funding from any
family planning organisation overseas that had anything to do with
abortion, including counselling. Although European governments,
including the UK, stepped up contributions, funds were short at a time
when more couples were becoming interested in smaller families. "It
really was a lost decade," said Camp.

President Barack Obama has
rescinded the policy and more US funds are expected, but the process of
ordering increased contraceptive supplies from manufacturers and
getting them to where they are needed will take time.

Where
contraceptive use has risen, such as in the former Soviet bloc
countries, abortion rates have invariably fallen. Worldwide, the
unintended pregnancy rate has dropped from 69 for every 1,000 women
aged 15-44 in 1995 to 55 for every 1,000 in 2008. The proportion of
married women using contraception increased from 54% in 1990 to 63% in
2003.

However, only 28% of married African women use contraceptives. Lack of availability is the biggest issue.

The
report points to a global trend towards the liberalisation of abortion
laws, which has allowed women with an unwanted pregnancy to end it
safely. Nineteen countries have relaxed their restrictions since 1997.
But in three countries, Poland, El Salvador and Nicaragua, tougher
legislation has been introduced, the latter two prohibiting abortion
even when the woman's life is at risk.

"We have seen an increase
in women's deaths and teenage suicides in Nicaragua," said Dr Kelly
Culwell, of the International Planned Parenthood Federation at the
report's launch.

Camp deplored the exit of the pharmaceutical
companies from research and development work on contraceptive products.
"There used to be 13 major pharmaceutical companies with full-blown
programmes of contraceptive R&D. Now there are none," she said.

Yet
there was a real need for products women could use if they were having
occasional rather than regular sex apart from the condom, which
requires the consent of the man.

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