Most deaths related to abortion occur in the developing world

BMJ 1999; 318 doi: (Published 05 June 1999) Cite this as: BMJ 1999;318:1509
  1. James Ciment
  1. New York

Of the 50 million abortions performed annually around the world, 40%are unsafe, with at least 90%of the medically perilous procedures occurring in developing countries, according to a recent book published by the World Health Organisation.

Abortion in the Developing World notes that some 30 million abortions are performed in the developing world annually, or roughly 60%of the global total. In addition, over 95%of deaths related to abortion, or about 70000 annually, occur in the developing world.

Based on case studies and statistical evidence gathered in countries as diverse as Mexico, China, Mauritius, and Cuba, the study noted that the deaths were caused less by inadequate health care than by social and legal considerations. For example, abortion was illegal in 94%of the developing countries studied, making it necessary for women to seek illegal help.

“Unsafe abortion is a major public health problem,” said J Khanna, a spokesperson for the WHO. “WHO conducted this study to learn the determinants of the problem—that is, what leads women to resort to abortion.”

Perhaps the most surprising of the book's findings are the similarities between countries with strong family planning programmes and those with weak or non-existent programmes. The proportion of women who were using contraception when they became pregnant was similar in both types of country. For example, about 25%of women seeking an abortion in the Dominican Republic—a country with little family planning—were using contraceptives when they became unintentionally pregnant, while only a third of those in China—where contraceptives are widely available—were using them at this time. The authors conclude that the failure to use contraceptives may be because of the “negative perception of contraceptives, especially hormonal ones,” which women believed had side effects and were unsafe. (See 1526

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