safe, legal, and rare? an update on abortion around the world
DESCRIPTION
by Caitlin Gerdts, PhD, MHS November 26, 2012TRANSCRIPT
Caitlin Gerdts, PhD, MHS
UCLA Fielding School of Public Health, Bixby Lecture
November 26, 2012
Safe, Legal, and Rare? An update on abortion around the world
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 2
Women all over the World have Abortions for Similar Reasons
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 3
The Decline in Global Abortion Rates has Stalled
World Developing countries
Developed countries
0
10
20
30
40
35 34
39
29 2925
28 29
24
1995 2003 2008
Abortions per 1,000 women aged 15–44
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 4
Stall in global abortion decline coincides with plateau in contraceptive use
0
20
40
60
80
100
0
10
20
30
40
50
60
Abortions per 1,000 women 15-44
Contraceptive prevalence (%)
Contraceptive prevalence (%) Abortion rate
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 5
The abortion rate is lower in developed countries than in developing countries
1995 2000 2005 20100
10
20
30
40
50
20
19 17
39
25 24
34 2929
Developing countriesDeveloped countriesDeveloped countries*
Abortions per 1,000 women aged 15–44
www.guttmacher.org*Excluding Eastern Europe
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 6
Is Abortion Safe?
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 7
When performed in safe, sterile conditions…
…abortion is safer than taking a dose of penicillin.
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 8
When performed in unsafe or unsterile conditions…
• Maternal Morbidity
• Maternal Mortality
• Strains on Health Systems
• Strains on Families
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 9
Disproportionate Impact of Unsafe Abortion
“Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.”
-Iqbal Shah, WHO
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 10
An increasing proportion of abortion are unsafe
World Developing countries Developed countries0
20
40
60
80
100
4454
9
4755
7
4956
6
1995 2003 2008
% of abortions that are unsafe
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 11
By the WHO definition, virtually all Abortions in Latin America and Africa are Unsafe
% of abortions
Africa Latin America
Asia Oceania Europe North America
0
20
40
60
80
100
97 95
40
15 9
Unsafe Safe
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 12
Deaths from Unsafe Abortion are Highest in Africa
Devel-oped
regions
Develop-ing re-gions
Africa Asia Latin America & Car-ibbean
0
100
200
300
400
500
600
700
10
350
650
300
50
Deaths per 100,000 unsafe abortions, 2003
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 13
Is Abortion Legal?
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 14
Most women live in countries where abortion is restricted
This is a slide to use for large images where you want to eliminate everything else but a two-line
title and caption. It’s based on the last slide master.
26%
10%
3%21%
41%
Prohibited altogether or only to save life
Physical Health
Mental Health
Socioeconomic
Without restriction
Global Abortion Legality
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 16
Consequences of restricting contraception and legal abortion in Romania
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 17
Disproportionate Impact of Unsafe Abortion
“Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.”
-Iqbal Shah, WHO
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 18
Abortion law reforms in developing countries have been followed by declines in morbidity and mortality
• South Africa (1997): Annual number of abortion-related deaths decreased by 91% after the law was liberalized.
• Nepal (2002): Abortion-related complications as a proportion of all of maternal illnesses decreased by 48% in a study of facilities in eight districts.
• Ethiopia (2005): Abortion complications per 100,000 live births (at one large hospital) decreased by about 70%.
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 19
Should Abortion be Rare?
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 20
Impact of contraception on reducing the number of abortions
141 million
45 million
14 million
Without modern methods
Current use
If unmet need were met
Estimated number of induced abortions
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 21
Focus on Rare Abortion Increases Stigma
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 22
Global Turnaway Study
www.indiegogo.com/theglobalturnawaystudy
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 23
Global Turnaway Study aim
To describe the mental health, physical health
and socioeconomic consequences of
receiving a legal abortion compared to being
denied a legal abortion in multiple geographic,
cultural, and legal settings.
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 24
Global Turnaway Study groups
4 6 8 10 12 14 16 18 20 22 24 26 28 …
Site A Gestational age limit = 12
4 6 8 10 12 14 16 18 20 22 24 26 28 …
Site B Gestational age limit = 20
Abortion comparison Turnaway
Safe, Legal, and
Rare? An update
on abortion
Caitlin Gerdts, PhD,
MHS
November 2009 | Slide 25
References
■ Weitz, T. Rethinking the Mantra that Abortion Should be “Safe, Legal, and Rare
■ Singh S, Sedgh G, Hussain R. Unintended Pregnancy: Worldwide Levels, Trends and Outcomes. Studies in Family Planning. Dec 2010;41(4).
■ WHO. The prevention and management of unsafe abortion. Report of a technical working group. Geneva: World Health Organization, 1992 (WHO/MSM/92.5).
■ Fawcus SR. Maternal mortality and unsafe abortion. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008; 22(3).
■ The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society & Abortion Worldwide, New York: AGI, 1999
■ Sedgh G, Henshaw S, Singh S, Ahman E, Shah I. Induced Abortion: estimated rates and trends worldwide. Lancet. 2007; 370.
■ Sedgh G, Singh S, Shah I, Ahman E, Henshaw S, Bankole A. Induced Abortion: incidence and trends worldwide from 1995-2008. Lancet. 2012; 379.
■ Adler AJ, Filippi V, Thomas S, Ronsmans C. Quantifying the global burden of morbidity due to unsafe abortion: Magnitude in hospital-based studies and methodological issues. International Journal of Gynecology and Obstetrics. 2012.
■ Adler AJ, Filippi V, Thomas S, Ronsmans C. Incidence of severe acute maternal morbidity associated with abortion: a systematic review. Tropical Medicine and International Health. 2011.
■ WHO. Unsafe Abortion: Global and Regional Estimates of Incidence of Unsafe Abortion and Associated Mortality. Geneva: World Health Organization, 2007.
■ Gipson J, Koenig M, Hindin M. The effects of unintended pregnancy on infant, child and parental health: a review of the literature. Studies in Family Planning. 2008; 39(1): 18-38.
■ Brown S, Eisenberg L (eds). The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academic Press.
■ Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Population Studies. 2003; 51(1): 77-93.
Caitlin Gerdts, PhD, MHS
UCLA Fielding School of Public Health
November 26, 2012
Thank you