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Cited by 769Reproductive Health and ContraceptionInternational Human Rights and Reproductive LawGlobal Maternal and Child Health

Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends

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Sedgh, Gilda, Bearak, Jonathan, Singh, Susheela, Bankole, Akinrinola, Popinchalk, Anna, Ganatra, Bela, Rossier, Clémentine, Gerdts, Caitlin +4 more·2016·The Lancet
DOI 10.1016/s0140-6736(16)30380-4PMC PMC5498988
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Abstract

Background Information about the incidence of induced abortion is needed to motivate and inform efforts to help women avoid unintended pregnancies and to monitor progress toward that end. We estimate subregional, regional, and global levels and trends in abortion incidence for 1990 to 2014, and abortion rates in subgroups of women. We use the results to estimate the proportion of pregnancies that end in abortion and examine whether abortion rates vary in countries grouped by the legal status of abortion.Methods We requested abortion data from government agencies and compiled data from international sources and nationally representative studies. With data for 1069 country-years, we estimated incidence using a Bayesian hierarchical time series model whereby the overall abortion rate is a function of the modelled rates in subgroups of women of reproductive age defined by their marital status and contraceptive need and use, and the sizes of these subgroups.Findings We estimated that 35 abortions (90% uncertainty interval [UI] 33 to 44) occurred annually per 1000 women aged 15-44 years worldwide in 2010-14, which was 5 points less than 40 (39-48) in 1990-94 (90% UI for decline -11 to 0). Because of population growth, the annual number of abortions worldwide increased by 5.9 million (90% UI -1.3 to 15.4), from 50.4 million in 1990-94 (48.6 to 59.9) to 56.3 million (52.4 to 70.0) in 2010-14. In the developed world, the abortion rate declined 19 points (-26 to -14), from 46 (41 to 59) to 27 (24 to 37). In the developing world, we found a non-significant 2 point decline (90% UI -9 to 4) in the rate from 39 (37 to 47) to 37 (34 to 46). Some 25% (90% UI 23 to 29) of pregnancies ended in abortion in 2010-14. Globally, 73% (90% UI 59 to 82) of abortions were obtained by married women in 2010-14 compared with 27% (18 to 41) obtained by unmarried women. We did not observe an association between the abortion rates for 2010-14 and the grounds under which abortion is legally allowed.Interpretation Abortion rates have declined significantly since 1990 in the developed world but not in the developing world. Ensuring access to sexual and reproductive health care could help millions of women avoid unintended pregnancies and ensure access to safe abortion.Funding UK Government, Dutch Ministry of Foreign Affairs, Norwegian Agency for Development Cooperation, The David and Lucile Packard Foundation, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

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  • These results are similar to findings by Sedgh et al. and Awoyemi et al. that married women were less likely to demand abortion compared to unmarried women.

    “These results are similar to Sedgh et al. [40] and Awoyemi et al. [28] findings which showed that married women were less likely to demand abortion, compared to women who were not married.”

    From Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique (2020) · cites this paper as [40]

    The Results report the opposite global comparison for 2010–14: 36 abortions per 1,000 married women versus 25 per 1,000 unmarried women. The paper notes regional exceptions in sub-Saharan Africa and North America, but it does not report a general finding that married women were less likely to seek abortion; it estimates abortion incidence, not demand. (LLM, conf=0.88)

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  • There is no association between the legal status of abortion and total abortion rates.

    “While there is no association found between the legal status of abortion and total abortion rates,7”

    From Advocating safe abortion: outcomes of a multi‐country needs assessment on the potential role of national societies of obstetrics and gynecology (2020) · cites this paper as [7]

  • A brisk 20 minute walk each day could be enough to reduce an individual's risk of early death.

    “Even a modest increase in physical activity could have significant health benefits: a brisk 20 minute walk each day could be enough to reduce an individual's risk of early death.257”

    From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [257]

    The Results and Discussion address abortion incidence and reproductive health, not the effects of walking on mortality. Searches for a brisk 20-minute walk and for physical activity, walking, and premature death found no passage addressing the claim. (LLM, conf=0.79)

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Research works printed but not linked: 3

  1. [16]Singh S Prada E Juarez F The abortion incidence complications method: a quantitative technique Methodologies for estimating abortion incidence and abortion-related morbidity: a review New York Guttmacher Institute 2010 71 98
  2. [27]Jejeebhoy SJ Women’s education, autonomy and reproductive behavior Oxford Clarendon Press 1995
  3. [33]WHO Safe abortion: technical and policy guidance for health systems 2 http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/ accessed May 3, 2016 23700650

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Authors
Sedgh, G., Bearak, J., Singh, S., Bankole, A., Popinchalk, A., Ganatra, B., Rossier, C., Gerdts, C., Tunçalp, Ö., Johnson, B. R., Johnston, H. B., & Alkema, L.
Affiliations
  • Guttmacher Institute (US)
  • World Health Organization (CH)
  • University of Geneva (CH)
  • Ibis Reproductive Health (US)
  • University of Massachusetts Amherst (US)
Corresponding author
Sedgh, Gilda
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2016-07
Volume
388
Issue
10041
Pages
258-267
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(16)30380-4
PMC
PMC5498988
OpenAlex
W2393388559
Cited by
766
References
32
Citations by year
2026: 33 · 2025: 47 · 2024: 35 · 2023: 68 · 2022: 74 · 2021: 100 · 2020: 143 · 2019: 102 · 2018: 90 · 2017: 52 · 2016: 19 · 2015: 1 · 2013: 1
FWCI
86.94
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Archined (submittedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Funders
  • World Health Organization
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD074034)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
abortion, abortion incidence, unintended pregnancy, abortion rates, legal status of abortion, marital status, contraceptive use, contraceptive needs, global trends, developed and developing countries, women of reproductive age, pregnancy outcomes, family planning, reproductive health
MeSH terms
Abortion, Induced, Adolescent, Adult, Bayes Theorem, Developing Countries, Female, Humans, Pregnancy, Marital Status, Developed Countries, Young Adult

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