Chapter 5. Abortion in practice: Safe and Unsafe conditions for women. (Induced Abortion).

In countries where abortion is broadly legal, services are usually accessible, and the procedure is performed early in pregnancy by skilled practitioners; in these circumstances, abortion-related deaths are rare. Where abortion is generally against the law, well-off women in cities are frequently able to obtain safe abortions, but many of their poor and rural counterparts try to end their own pregnancies or turn to unskilled practitioners. Of the 600,000 women who die each year from pregnancy-related causes, an estimated one in eight die of complications from abortion. Abortion-related deaths are hundreds of times more common in Latin America and Africa than in developed countries. Furthermore, experts believe that about one-third of women undergoing unsafe abortions experience serious complications, yet fewer than half of these women receive hospital treatment. Levels of maternal death and illness due to abortion have fallen dramatically in countries that have liberalized their abortion laws.

Raw numbers reveal little about the general conditions in which women have abortions. A good deal of information is available about the provision of abortion in countries with liberal abortion laws, but for obvious reasons, conditions are far less well documented in countries where the procedure is prohibited or severely restricted (see box on page 39).

Legality and safety usually coincide. But in some countries where abortion is legal, not all procedures are safe, and in many countries where abortion is not legally permitted, it is possible for some women to obtain "safe" services.

In India, for example, where abortion has been allowed for socioeconomic reasons since 1971, around 600,000 legal procedures a year are reported. But many Indian women, especially in rural areas, do not even know that abortion is legal. Furthermore, authorized abortion facilities are inadequate in number, and some health professionals in government facilities treat patients badly, even going so far as to insist that a woman undergoing a legal abortion also have an IUD inserted or be sterilized. As a result, women frequently go outside the authorized system and obtain extralegal abortions, many of which are unsafe. (1)

Making abortion legal, therefore, does not guarantee that services will be easily accessible, of good quality or safe. But neither is it the case that under conditions of illegality, all abortions will be of poor quality and unsafe. Even where abortion is illegal, some physicians offer safe medical pregnancy terminations. Consequently, as the World Health Organization (WHO) notes, "the legality or illegality of.. services may not be the defining factor of their safety." (2)

The WHO defines an unsafe abortion as a "procedure for terminating an unwanted pregnancy [carried out] either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both. (3) Furthermore, the agency points out that even if performed by physicians, abortions carried out in unauthorized facilities or in a country where abortion is illegal place women's health and lives at risk. (4) Thus, the WHO's estimate of almost 20 million unsafe abortions each year--19 million in developing countries, and the remainder mostly in Eastern Europe--includes some procedures performed by trained physicians, even though most of these are technically safe.

When Abortion Is Provided in Safe Conditions, It Poses Little Risk to Women's Health