Recent Trends in Abortion Rates Worldwide. (RESEARCH NOTE).(Statistical Data Included)

Context: Legal abortion rates vary widely among countries with nonrestrictive laws. Data on trends in legal induced abortion may provide insight for policymakers into factors that influence rates of legal induced abortion and the levels of abortion that might be achievable in their own countries and in other parts of the world.

Methods: Numbers of le gal induced abortions were estimated for 54 countries from official statistics or other national data. Abortion rates per 1,000 women aged 15-44 were calculated for the years 1975 through 1996.

Results: The most striking recent trend is a sharp decline in abortion incidence in Eastern and Central Europe and the successor states to the Soviet Union. For example, rates fell by 28-4 7% in the four former Soviet states with reasonably complete data (Belarus, Estonia, Kazakhstan and Latvia), and by 18-65% in six states with less-complete reporting. Similar patterns were seen in such nations as Bulgaria, Hungary and the Czech and Slovak Republics. Rates have also declined in several other developed countries: Since 1975, the abortion rate in such countries as Denmark, Finland, Italy and Japan has dropped by 40-50%. In only a few developed countries (among them Canada, New Zealand and Scotland) have abortion rates shown an increase overtime. In the few developing countries with reliable data, some (China, South Korea, Tunisia and Turkey) have experienced a declining abortion rate, while others (such as Cuba and Vietnam) have seen increases in levels of abortion.

Conclusions: In developed countries with high abortion rates, use of abortion is likely to fail rapidly when a range of contraceptive methods become widely available and effectively used. Legalization of abortion and access to abortion services do not lead to increased reliance on abortion for fertility control in the long term; in developed countries with these conditions, the predominant trend in abortion rates has been downward.

Legal abortion rates vary widely among countries with nonrestrictive laws.(1) In 1995-1996, rates ranged from a low of seven abortions per 1,000 women aged 15-44 in Belgium and the Netherlands to a high of at least 83 per 1,000 in Vietnam. Some developed countries have rates close to that in Vietnam, a developing country; for example, the rate is at least 78 per 1,000 in Romania and 68 per 1,000 in the Russian Federation.(2)

Perhaps the most important factors affecting the abortion rate are the strength of motivation to have a small family and control the timing of births, and the extent of effective use of contraceptives. Although it is the policy of most countries to encourage contraceptive use, not all have provided support or allocated the necessary resources to family planning services. As a result, lack of access to contraceptive services and supplies can be an important barrier to the use of family planning. Negative attitudes toward various contraceptive methods may also impede change. In addition, it may be difficult in some countries for health systems accustomed to providing abortion services to shift to an emphasis on contraception. Finally, some countries with high abortion rates are said to have an "abortion culture," implying that reliance on abortion will be slow to change, regardless of contraceptive availability.

If a country's birthrate remains stable, a declining trend in the abortion rate suggests success in substituting contraception for abortion. Information on trends is important for understanding policies concerning abortion and contraception and perhaps the factors that impede the success of these policies. Recent experience also sheds light on the speed with which abortion rates can change and the level of abortion that a country can reasonably hope to achieve.