ArticlesAbortion incidence between 1990 and 2014: global, regional, and subregional levels and trends
Introduction
Periodic estimates of the incidence of induced abortion (hereafter referred to as abortion) are needed to monitor progress towards reducing the unmet need for effective contraception and the incidence of unintended pregnancy. These estimates can also motivate investments in helping women avoid the recourse to and consequences of unsafe abortion where safe abortion is not available.
However, reliable data for abortion incidence are not consistently available across countries. Past estimates of global abortion incidence relied on available abortion data and on qualitative assessments of exchangeability to make inference to countries and territories lacking data.1, 2, 3 After the last global estimates were made, country-specific estimates of the level of contraceptive use and unmet need for contraception among married women, and the proportions of women who are married, were published.4, 5, 6 These estimates, and their association with abortion incidence,7, 8 make possible a systematic, model-based approach to estimating abortion incidence. This is in line with methods used recently to estimate other global health indicators, such as causes of maternal death9 and the incidence of anaemia10 and maternal and child mortality.11, 12, 13
In this analysis, we aimed to estimate subregional, regional, and global levels and trends in abortion incidence for 1990 to 2014.
Section snippets
Framework
We developed a theoretical framework in which abortion incidence is estimated as the sum of abortions in subgroups of women of reproductive age defined by their marital status and contraceptive need and use. Separately for married and unmarried women, these subgroups are women with an unmet need for any contraception, those using a contraceptive method and expected to experience a method failure, and those classified as not needing contraception (either because they wish to have a child or
Results
We estimated that there were 35 abortions per 1000 women (90% UI 33–44) aged 15–44 years worldwide each year in 2010–14 (table 1; figure 1). This represents a non-significant 5 point decline (−11 to 0) since 1990–94, when the estimated rate was 40 abortions per 1000 women (90% UI 39–48). Because of population growth, the absolute number of abortions increased by 5·9 million (90% UI −1·3 to 15·4), from 50·4 million per year (48·6 to 59·9) in 1990–94 to 56·3 million per year (52·4 to 70·0) in
Discussion
Our findings indicate the abortion rate declined significantly in the developed world, but not in the developing world, between 1990 and 2014. Although it is likely that current numbers and rates of abortion would be even higher in the absence of investments in family planning services in recent decades, the findings suggest that much more investment is needed to meet the demands of the growing population, the increasingly widespread desire for small families, and the growing strength of
References (36)
- et al.
Induced abortion: incidence and trends worldwide from 1995 to 2008
Lancet
(2012) - et al.
Induced abortion: estimated rates and trends worldwide
Lancet
(2007) - et al.
National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis
Lancet
(2013) - et al.
Global causes of maternal death: a WHO systematic analysis
Lancet Glob Health
(2014) - et al.
A systematic analysis of global anaemia burden between 1990 and 2010
Lancet
(2013) - et al.
Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group
Lancet
(2016) - et al.
Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation
Lancet
(2015) - et al.
Estimates of contraceptive failure from the 2002 National Survey of Family Growth
Contraception
(2008) - et al.
The incidence of abortion worldwide
Int Fam Plan Perspec
(1999) Model-based Estimates and Projections of Family Planning Indicators 2015
(2015)
Estimates and Projections of the Number of Women Aged 15-49 Who Are Married or in a Union: 2015 Revision
Relationships between contraception and abortion: a review of the evidence
Int Fam Plan Perspect
Recent trends in abortion and contraception in 12 countries, DHS Analytical Studies
R. Global estimation of child mortality using a Bayesian B-spline bias-reduction method
Ann Appl Stat
Estimating induced abortion rates: a review
Stud Fam Plann
Abortion incidence and access to services in the United States, 2008
Perspect Sex Reprod Health
Disparities in rates of unintended pregnancy in the United States, 1994 and 2001
Perspect Sex Reprod Health
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