CoChat
Sign Up
Cited by 94Reproductive Health and ContraceptionGlobal Maternal and Child HealthInternational Human Rights and Reproductive Law

Unsafe abortion and postabortion care - an overview

Open access
RASCH, VIBEKE·2011·Acta Obstetricia et Gynecologica Scandinavica
DOI 10.1111/j.1600-0412.2011.01165.x
Open this paper in CoChat — free accountOpen PDF

Abstract

Forty per cent of the world's women are living in countries with restrictive abortion laws, which prohibit abortion or only allow abortion to protect a woman's life or her physical or mental health. In countries where abortion is restricted, women have to resort to clandestine interventions to have an unwanted pregnancy terminated. As a consequence, high rates of unsafe abortion are seen, such as in Sub-Saharan Africa where unsafe abortion occurs at rates of 18-39 per 1 000 women. The circumstances under which women obtain unsafe abortion vary and depend on traditional methods known and types of providers present. Health professionals are prone to use instrumental procedures to induce the abortion, whereas traditional providers often make a brew of herbs to be drunk in one or more doses. In countries with restrictive abortion laws, high rates of maternal death must be expected, and globally an estimated 66 500 women die every year as a result of unsafe abortions. In addition, a far larger number of women experience short- and long-term health consequences. To address the harmful health consequences of unsafe abortion, a postabortion care model has been developed and implemented with success in many countries where women do not have legal access to abortion. Postabortion care focuses on treatment of incomplete abortion and provision of postabortion contraceptive services. To enhance women's access to postabortion care, focus is increasingly being placed on upgrading midlevel providers to provide emergency treatment as well as implementing misoprostol as a treatment strategy for complications after unsafe abortion.

AI snapshot

Written from the paper’s full text.

TL;DR

This overview reviews global evidence on unsafe abortion, its legal and provider contexts, health consequences, and postabortion care. It argues that restrictive abortion laws do not lower abortion incidence but increase unsafe abortion, while postabortion care—especially MVA, misoprostol, and contraceptive services—can reduce harm where legal abortion is inaccessible.

Key findings

  • Around 40% of women of childbearing age live in countries with highly restrictive abortion laws; 26% of the world’s population lives in 68 countries where abortion is prohibited or allowed only to save a woman’s life. Unsafe abortion accounts for 13% of all maternal deaths, and an estimated 66,500 women die yearly from unsafe abortion.
  • Unsafe abortion rates vary widely: 18–39 per 1,000 women in Sub-Saharan Africa, 16–33 in Latin America and the Caribbean, 9–28 in Asia, and 12–17 in western and northern Europe where abortion is broadly permitted. In Uganda the estimated rate is 54; in Mexico 33 in 2006; in Guatemala 24; in the Philippines 27 overall, with 52 in metropolitan Manila and 17 in rural areas; in Pakistan 29, or about 37% of all pregnancies.
  • Providers and methods differ by setting: in Pakistan 80% of terminations were by health professionals, in Burkina Faso 61%, while in Tanzania 60% of urban and 47% of rural women had self-induced or used traditional providers. Traditional providers often use herbal brews or cassava sticks; health professionals more often use instrumental or surgical procedures, and misoprostol is increasingly used clandestinely.
  • Postabortion care includes emergency treatment, contraceptive counseling/services, and linkage to other reproductive health services. MVA efficacy was 94.7% among 245 patients in a Scottish study; postabortion contraceptive acceptance was 97.4% in Brazil and 42% in Cambodia. In 2005, about eight million women developed complications from unsafe abortion, but only about five million received treatment: 2.3 million in Asia, 1.7 million in Africa, and 1.0 million in Latin America and the Caribbean.

Methods

  • The paper is a narrative overview, not a rigorous systematic review; the author states the topic was not considered appropriate for one because of the legal circumstances surrounding unsafe abortion.
  • A systematic PubMed search covering January 2005 to October 2010 used terms such as “clandestine abortion,” “unsafe abortion rate,” “unsafe abortion provider,” “unsafe abortion method,” “unsafe abortion deaths,” “unsafe abortion complications,” “postabortion contraception,” “incomplete abortion misoprostol,” and “abortion manual vacuum aspiration.”
  • The search identified 746 publications; 404 duplicates were excluded, leaving 342 assessed, of which 186 were excluded for language, second-trimester focus, or not being scientific articles. Reference lists yielded nine additional publications, giving 166 for initial review; after methodological quality assessment, the final review was based on 67 publications considered high scientific standard and highly relevant.

Limitations

  • The paper states that unsafe abortion rates are based on estimates and should be considered approximate; women and providers are reluctant to report abortion, and governments do not collect data on abortions outside the legal health system.
  • Health-consequence data come mainly from women hospitalized with abortion complications, so they miss women who have clandestine abortions without complications and women who have complications but obtain no care. Classification based on infection/sepsis or trauma plus unplanned pregnancy may misclassify spontaneous abortions, especially where febrile diseases such as malaria are common; empathetic interviews are suggested as a better alternative.
  • Evident from the text: the review is not systematic, identified hardly any randomized controlled trials, excluded non-English publications, and combined studies using different denominators (women aged 15–44 vs 15–49), which the author believes still yields comparable figures but may affect reported rates.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/j.1600-0412.2011.01165.x

Cites

77 of 77 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

29 of 93 cited sources checked · 11 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    In Mexico, the abortion rate was 33 per 1000 women in 2006.

    “For example, in Mexico, where abortion is only legally available to preserve physical health, the abortion rate was 33 in 2006 (8).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Juarez, 2008, Estimates of induced abortion in Mexico: what's changed between 1990 and 2006?, Int Fam Plan Perspect. source
  • Premisecitation

    In Tanzania, traditional providers often make a brew of herbs and roots from local plants soaked in water, to be drunk in one or more doses.

    “For instance, in Tanzania it has been documented that traditional providers often make a brew of herbs and roots from local plants soaked in water, to be drunk in one or more doses (16).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] Rasch, 2009, Unsafe abortion in urban and rural Tanzania: method, provider and consequences, Trop Med Int Health. source

      The Abortion procedure section (page not available in our copy) reports that traditional healers sometimes instructed women to prepare herbal tea and drink a large amount to induce abortion. It does not say that providers made the brew themselves, that roots were soaked in water, or that it was drunk in one or more doses. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Premisecitation

    Another common method used by traditional healers is to induce abortion by inserting a cassava stick in the uterine cervix.

    “Another common method used by traditional healers is to induce the abortion by inserting a cassava stick in the uterine cervix (16,18).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [16] Rasch, 2009, Unsafe abortion in urban and rural Tanzania: method, provider and consequences, Trop Med Int Health. source

      The Abortion procedure section reports that traditional healers used herbs to induce abortion, sometimes placing pounded herbs in the vagina; it also reports use of roots. It does not identify a cassava stick, describe insertion into the uterine cervix, or establish that this specific method was common. Page numbers are unavailable in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [18] Dahlback, 2010, Pregnancy loss: spontaneous and induced abortions among young women in Lusaka, Zambia, Cult Health Sex. source
  • Premisecitation

    In a Tanzanian study of 469 women admitted with complications after unsafe abortion, 60% of urban women and 47% of rural women had either induced the abortion themselves or resorted to traditional providers.

    “As documented in a Tanzanian study conducted among 469 women admitted with complications after an unsafe abortion, 60% of urban women and 47% of rural women had either induced the abortion themselves or had resorted to traditional providers (16).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] Rasch, 2009, Unsafe abortion in urban and rural Tanzania: method, provider and consequences, Trop Med Int Health. source

      The Abortion procedure section (page unavailable) reports that an unskilled provider induced the abortion for 60% of urban women, but 46%, not 47%, of rural women. Its definition also includes friends and family members alongside the woman herself and traditional healers, so the claim narrows the provider categories counted. The provider table accounts for 469 women with identified unsafe induced abortions. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
  • Premisecitation

    In Uganda, the estimated rate of unsafe abortion is 54 per 1000 women.

    “In Uganda, where abortion is only legally available to save the life of a woman, the estimated rate of unsafe abortion is 54 (7).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] Singh, 2005, The incidence of induced abortion in Uganda, Int Fam Plan Perspect. source

      The Abortion Incidence section (Table 5, p. 187) estimates 54 induced abortions per 1,000 women aged 15–49 in 2003. The paper says abortions often occur under unsafe conditions and legal abortions are very rare, but it does not identify 54 as a rate specifically for unsafe abortions. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • May combine two claims. 41
  • Classified as probably not a substantial claim. 23
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    In the Philippines, unsafe abortion rates are 52 in metropolitan Manila and 17 in more rural parts.

    “However, great differences between urban and rural Philippines have been documented, with unsafe abortion rates of 52 in metropolitan Manila and 17 in more rural parts of the country (10).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Juarez, 2005, The incidence of induced abortion in the Philippines: current level and recent trends, Int Fam Plan Perspect. source

      The Abortion Incidence in 2000 section reports 52 induced abortions per 1,000 women in Manila and 17 in Visayas, a less urban region. But 17 is not the rate for all more rural parts: the paper reports 18 in Mindanao and 27 in the rest of Luzon. It reports these as induced-abortion rates, not specifically unsafe-abortion rates; page numbers are unavailable in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In Guatemala, unsafe abortions occur at a rate of 24 per 1000 women, and there is one abortion for every six births.

    “Likewise, in Guatemala, although law permits induced abortion only to save a woman's life, unsafe abortions occur at a rate of 24, and there is one abortion for every six births (9).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] Singh, 2006, Induced abortion and unintended pregnancy in Guatemala, Int Fam Plan Perspect. source

      The Abortion Incidence section estimates 24 induced abortions per 1,000 women aged 15–49 and approximately one induced abortion for every six births. The Discussion describes abortion provision in Guatemala as very unsafe, but the paper does not identify the 24-per-1,000 figure specifically as a rate of unsafe abortions; it is the estimated rate of all induced abortions. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In a Nigerian survey, 90% of 323 interviewed doctors stated they were frequently attended by pregnant women requesting a clandestine induced abortion, and 24% reported they did terminate unwanted pregnancies when requested.

    “More specifically, 90% of 323 Nigerian doctors interviewed stated they were frequently attended by pregnant women who requested a clandestine induced abortion and 24% reported that they did terminate unwanted pregnancies when requested to do so by the women (15).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Okonofua, 2005, Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria, Acta Obstet Gynecol Scand. source

      The ‘Attitudes towards unwanted pregnancies and abortion complications’ section reports that 90% of the 323 surveyed private practitioners saw women requesting induced abortion and that 24% said they terminated unwanted pregnancies on request. It does not establish that the requested abortions were clandestine; that qualifier is unsupported. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In the Philippines, 473,400 women had an unsafe abortion in 2000 and the unsafe abortion rate was 27 per 1000 women.

    “For instance, in the Philippines, where abortion is prohibited altogether, 473 400 women had an unsafe abortion in 2000 and the rate of unsafe abortion was reported to be 27 (10).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Juarez, 2005, The incidence of induced abortion in the Philippines: current level and recent trends, Int Fam Plan Perspect. source

      The Abortion Incidence in 2000 section reports 473,400 induced abortions and a rate of 27 per 1,000 women aged 15–44 per year. But the paper describes its estimate as covering abortions “safe or unsafe”; it does not say that all 473,400 were unsafe abortions or give 27 as an unsafe-abortion rate. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    If a qualified person trained in surgical procedures performs the abortion, they may use vacuum aspiration or dilatation and curettage.

    “If it is a qualified person who has received training in surgical procedures, he or she may use either vacuum aspiration or dilatation and curettage to terminate the pregnancy (16,20).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [16] Rasch, 2009, Unsafe abortion in urban and rural Tanzania: method, provider and consequences, Trop Med Int Health. source

      The Discussion identifies manual vacuum aspiration and dilatation and curettage as procedures considered safe and contrasts access to practitioners with abortions performed by unskilled providers. It does not state that providers trained in surgical procedures use either method, so the training qualification is not supported by our copy. No page number is available for the passage. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [20] Dahlbäck, 2007, Unsafe induced abortions among adolescent girls in Lusaka, Health Care Women Int. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Although liberalization of abortion laws and regulations has taken place worldwide, restrictions have also increased, and Poland and Lithuania are examples of countries that have taken a conservative path on abortion.

    “However, although liberalization of abortion laws and regulations has taken place all over the world, restrictions have also increased, and Poland and Lithuania are examples of countries which have taken a conservative path on abortion.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [56] Rahman, 1998, A global review of laws on induced abortion, 1985-1997, Int Fam Plann Persp. source
    • cites [55] Boland, 2008, Developments in laws on induced abortion: 1998-2007, Int Fam Plan Perspect. source

      The Liberalizing Trend section (page unavailable) explicitly reports worldwide liberalization alongside increased restrictions in some regions. It describes Lithuania’s abortion law as liberal while noting efforts to restrict it; the Human Rights section identifies a draft restrictive law. The International Legal Developments section reports a Polish case involving denial of access to an abortion, but the paper does not characterize Poland and Lithuania as countries that have taken a conservative path. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In Ethiopia, the law was changed in 2005, but the expansion of safe abortion services has only progressed slowly.

    “In Ethiopia, the law was changed in 2005, but the expansion of safe abortion services has only progressed slowly (59).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [59] Singh, 2010, The estimated incidence of induced abortion in Ethiopia, 2008, Int Perspect Sex Reprod Health. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Lithuania, a draft law, not yet passed, bans abortion except when the mother's health is in danger or if she conceived during sexual molestation.

    “In Lithuania, a draft law, which has not yet been passed, bans abortion except in cases where the mother's health is in danger or if she conceived the child during sexual molestation (55).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [55] Boland, 2008, Developments in laws on induced abortion: 1998-2007, Int Fam Plan Perspect. source

      The Human Rights section describes a Lithuanian draft law restricting access to abortion, and the Liberalizing Trend section treats restrictions in Lithuania as a proposed change to its existing liberal law. Neither passage specifies exceptions for danger to the mother's health or pregnancy resulting from sexual molestation. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The majority of Nigerian physicians considered abstinence from premarital sex and contraceptive use as the most effective strategies for reducing abortion-related deaths, whereas liberalization of the abortion law was not deemed effective.

    “The majority considered abstinence from premarital sex and contraceptive use as the most effective strategies for reducing abortion-related deaths, whereas a liberalization of the abortion law was not deemed effective.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [57] Okonta, 2010, Liberalization of abortion and reduction of abortion related morbidity and mortality in Nigeria, Acta Obstet Gynecol Scand. source

      The Abstract says most surveyed physicians favored premarital abstinence and contraceptive use, while the Results rank legal liberalization fourth among five strategies. But the claim overstates their view of liberalization: the Abstract says it was not considered *very* effective, and the Results say 50.8% believed it would significantly reduce maternal mortality. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisenone given

    The circumstances under which women obtain unsafe abortion vary and depend on traditional methods known, types of providers present, and availability of trained health professionals willing to perform abortion despite illegality.

    “The circumstances under which women obtain unsafe abortion vary from one setting to another and depend on the traditional methods known, the types of providers present and the availability of trained health professionals who are willing to perform abortion despite the intervention being illegal.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In Pakistan, an estimated 890,000 unsafe abortions are performed annually, equal to an annual rate of 29 per 1000 women or about 37% of all pregnancies.

    “Hence, it has been estimated that 890 000 unsafe abortions are performed annually in Pakistan, being equal to an annual rate of 29 or about 37% of all pregnancies (11).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Sathar, 2007, Estimating the incidence of abortion in Pakistan, Stud Fam Plann. source

  • May combine two claims.

    Premisecitation

    In Latin America and the Caribbean, the vast majority of abortions are performed unsafely, with estimated unsafe abortion rates of 16-33 per 1000 women.

    “In Latin America and the Caribbean, the vast majority of abortions are, like in Africa, performed unsafely, and the estimated rates of unsafe abortion are 16-33 (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Singh, 2009

  • May combine two claims.

    Interpretationreasoning

    Legal restrictions do not lower the incidence of abortion but rather increase the risk of unsafe abortion.

    “The above documented rates of unsafe abortion clearly illustrate that legal restrictions do not lower the incidence of abortion but rather increase the risk of unsafe abortion.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Africa, almost all abortions are performed unsafely and unsafe abortion rates vary from 18 to 39 per 1000 women, highest in Eastern Africa and lowest in Southern and Northern Africa.

    “In Africa, where abortion is restricted in most countries, almost all abortions are performed unsafely and the rates of unsafe abortion vary from 18 to 39, being highest in Eastern Africa and lowest in Southern and Northern Africa (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Singh, 2009

  • May combine two claims.

    Premisecitation

    In Guatemala, 49% of women resort to traditional providers for abortion, whereas in Mexico only 14% do.

    “More specifically, in Guatemala, a poor and mainly rural country, the use of traditional providers is high (49%), whereas in Mexico, a more affluent country, only 14% of the women resort to traditional providers to have an abortion (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Singh, 2009

  • May combine two claims.

    Premisecitation

    In the Caribbean, the unsafe abortion rate is estimated to be 16 per 1000 women, reflecting that safe legal abortion is available in Cuba.

    “In comparison, in the Caribbean, the unsafe abortion rate is estimated to be only 16, reflecting that safe legal abortion is available in Cuba and therefore a comparatively lower number of women in this subregion have to resort to clandestine interventions (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Singh, 2009

  • May combine two claims.

    Premisecitation

    High abortion rates prevail in countries where abortion is legally restricted, whereas comparatively lower abortion rates of 12-17 per 1000 women have been reported in western and northern Europe, where abortion is permitted on broad grounds.

    “Hence, high abortion rates prevail in countries where the procedure is legally restricted, whereas comparatively lower abortion rates of 12-17 have been reported in, for example, western and northern Europe, where abortion is permitted on broad grounds (12).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Sedgh, 2007, Induced abortion: estimated rates and trends worldwide, Lancet. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    In countries where restrictive abortion laws prevail, high rates of unsafe abortion must be expected.

    “In countries where restrictive abortion laws prevail, high rates of unsafe abortion must be expected.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The main barriers to MVA access in Ghana were government restriction on procurement, high cost of equipment, limited access to MVA training, and lack of priority when facilities for access to funds were limited.

    “The main barriers reported were government restriction on procurement, high cost of equipment, limited access to MVA training and lack of priority when facilities for access to funds were limited (38).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Graff, 2009, Barriers to sustainable MVA supply in Ghana: challenges for the low-volume, low-income providers, Afr J Reprod Health.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The vast majority of abortion-related deaths occur in Sub-Saharan Africa (about 36,000) and south Central Asia (about 28,400), whereas the number is negligible in southern and western Europe, North America, and China.

    “The vast majority of abortion-related deaths occur in Sub-Saharan Africa (about 36 000) and south Central Asia (about 28 400), whereas the number is negligible in southern and western Europe, North America and China (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] World Health Organization (WHO), 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    A systematic search in PubMed covering January 2005 to October 2010 was performed to identify publications on unsafe abortion rates, methods, health consequences, and postabortion care.

    “However, a systematic search in PubMed, covering January 2005 to October 2010, was performed to identify publications on unsafe abortion rates, unsafe abortion methods, health consequences and postabortion care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Owing to stigma, women keep their pregnancy to themselves and only confide in close relatives and friends who may help by guiding them to obtain a clandestine abortion.

    “Owing to stigma associated with an unsafe abortion, women keep their pregnancy to themselves and only confide in close relatives and friends who may help by guiding them as to where to obtain a clandestine abortion (19,22,23).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [19] Hill, 2009, The context of informal abortions in rural Ghana, J Womens Health (Larchmt) source
    • cites [22] Kinaro, 2009, Unsafe abortion and abortion care in Khartoum, Sudan, Reprod Health Matters. source
    • cites [23] Rossier, 2007, Abortion: an open secret? Abortion and social network involvement in Burkina Faso, Reprod Health Matters. source

  • May combine two claims.

    Premisecitation

    Women often try sequential abortion methods, starting with cheaper and less effective methods provided by traditional healers, and if these fail, resort to harsher and more expensive methods.

    “Women often try sequential abortion methods to terminate their pregnancy, starting with cheaper and less effective methods provided by traditional healers and if these attempts fail, the women resort to harsher and more expensive methods (4,19).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Singh, 2009
    • cites [19] Hill, 2009, The context of informal abortions in rural Ghana, J Womens Health (Larchmt) source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The postabortion care model lists three essential elements: emergency treatment for complications of spontaneous or induced abortion; postabortion family planning counseling and services; and linkage between emergency care and other reproductive health services.

    “The model lists three essential elements: (1) emergency treatment for complications of spontaneous or induced abortion; (2) postabortion family planning counseling and services; and (3) linkage between emergency care and other reproductive health services, such as management of sexually transmitted diseases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Curtis, 2007, Meeting health care needs of women experiencing complications of miscarriage and unsafe abortion: USAID's postabortion care program, J Midwifery Womens Health. source

  • May combine two claims.

    Premisecitation

    The sustainability of MVA has been questioned, and a 2007 situation analysis in Ghana revealed that despite consensus about the serious need for MVA, the country lacked sustainable access to MVA.

    “However, the sustainability of the procedure has been questioned, and a situation analysis conducted in Ghana in 2007 revealed that despite consensus about the serious need for MVA in Ghana, the country lacked sustainable access to MVA (38).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Graff, 2009, Barriers to sustainable MVA supply in Ghana: challenges for the low-volume, low-income providers, Afr J Reprod Health.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The final review was based on 67 publications considered to be of high scientific standard and high relevance for the topic studied.

    “Based on this assessment, it was decided to base the final review on 67 publications considered to be of high scientific standard as well as of high relevance for the topic studied.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Estimates suggest that around 1.7 million women develop secondary infertility each year as a consequence of badly performed abortions, and more than three million annually experience reproductive tract infections that become chronic conditions.

    “Estimates based on the limited available data suggest that around 1.7 million women develop secondary infertility each year as a consequence of badly performed abortions, and more than three million annually experience reproductive tract infections that become chronic conditions (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] World Health Organization (WHO), 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Malawi, unsafe abortion has been documented to be responsible for 48/204 (24%) of all maternal deaths.

    “and in Malawi unsafe abortion has been documented to be responsible for 48/204 (24%) of all maternal deaths (29).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Lema, 2005, Maternal mortality at the Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi, East Afr Med J. source

  • May combine two claims.

    Premisecitation

    A meta-analysis found no significant difference in complete abortion rate and participants' satisfaction between MVA and electric vacuum aspiration.

    “There was no significant difference in complete abortion rate and participants' satisfaction, whereas the operation time was shorter for electric vacuum aspiration (36).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Wen, 2008, Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review, BJOG. source

  • May combine two claims.

    Premisenone given

    Despite misoprostol being on the WHO list of essential medicines since 2005, the drug is still not available in many countries.

    “However, despite misoprostol being on the list of essential medicines of the World Health Organization since 2005, the drug is still not available in many countries.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Less common but very serious complications of unsafe abortion include septic shock, renal failure, perforation of the intestines, and peritonitis.

    “Less common but very serious complications are septic shock, renal failure, perforation of the intestines and peritonitis (31).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Gebreselassie, 2005, The magnitude of abortion complications in Kenya, BJOG. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The reported figures from Tanzania and Nigeria are in accordance with the global estimate of unsafe abortion accounting for 13% of all maternal deaths.

    “The reported figures from Tanzania and Nigeria are in accordance with the global estimate of unsafe abortion accounting for 13% of all maternal deaths (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] World Health Organization (WHO), 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Nigeria, 12-13% of maternal deaths have been reported to be due to unsafe abortion.

    “while in Nigeria 12-13% of maternal deaths have been reported to be due to unsafe abortion (25,26).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] Nwogu-Ikojo, 2007, Abortion-related mortality in a tertiary medical centre in Enugu, Nigeria, J Obstet Gynaecol. source
    • cites [26] Kigbu, 2009, Review of maternal deaths from unsafe abortion in Jos, Nigeria, Niger J Med.

  • May combine two claims.

    Premisenone given

    Chronic pain, inflammation of the reproductive tract, and pelvic inflammatory disease, which may lead to secondary infertility, are other common complications of unsafe abortion.

    “Chronic pain, inflammation of the reproductive tract and pelvic inflammatory disease, which may lead to secondary infertility, are other common complications.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The topic of this article was not considered appropriate for a rigorous systematic review owing to the legal circumstances surrounding unsafe abortion.

    “Owing to the legal circumstances surrounding unsafe abortion, the topic of this article was not considered appropriate for a rigorous systematic review.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    While law change is a prerequisite if women are to be guaranteed access to safe abortion services, that in itself is not enough.

    “While law change is a prerequisite if women are to be guaranteed access to safe abortion services, that in itself is not enough.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A Columbian survey from 2007 revealed that while 85% of gynecologists favored the new abortion law, only a third were prepared to perform a legal abortion under any circumstances and only 38% of those said they would be willing to recommend a colleague who does practise abortion.

    “A Columbian survey from 2007 has further revealed that while 85% of gynecologists favored the new abortion law, only a third were prepared to perform a legal abortion under any circumstances and only 38% of those said they would be willing to recommend a colleague who does practise abortion (58).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Moloney, 2009, Unsafe abortions common in Colombia despite law change, Lancet. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In 2005, about eight million women developed complications from unsafe abortions, but only about five million received treatment in hospitals and other health facilities: 2.3 million in Asia, 1.7 million in Africa and 1.0 million in Latin America and the Caribbean.

    “In 2005, about eight million women developed complications from unsafe abortions, but only about five million received treatment in hospitals and other health facilities, 2.3 million in Asia, 1.7 million in Africa and 1.0 million in Latin America and the Caribbean (65).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Singh, 2006, Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries, Lancet. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Poland, the abortion law was revised in 1993 to permit abortion only when a pregnancy threatens the woman's life or health, and a more liberal law enacted in 1996 was overturned by the Constitutional Court in 1997.

    “In Poland, the abortion law was revised in 1993 to permit abortion only when a pregnancy threatens the woman's life or health and a more liberal law enacted in 1996 was overturned by the Constitutional Court in 1997 (56).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Rahman, 1998, A global review of laws on induced abortion, 1985-1997, Int Fam Plann Persp. source

  • May combine two claims.

    Study design and conductcitation

    This approach does not cover women who have abortions in clandestine circumstances but experience no complications, nor women who experience complications but obtain no care.

    “An inherent weakness of this approach is that it does not cover women who have abortions in clandestine circumstances but experience no complications, nor does it cover women who experience complications but obtain no care (4).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Singh, 2009

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Consideration of the possibilities of failed abortion attempts must be seen within the context of the more serious health risks which women may encounter if they instead resort to unsafe abortion methods.

    “However, consideration of the possibilities of failed abortion attempts must be seen within the context of the more serious health risks which the women may encounter if they instead have to resort to unsafe abortion methods.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In Columbia, the high court partly depenalized abortion in 2006; government figures from 2009 show less than 3,000 legal abortions were performed, while between 320,000 and 450,000 backstreet abortions are estimated to take place every year.

    “In Columbia, the high court partly depenalized abortion in 2006; however, government figures from 2009 show that less than 3 000 legal abortions were performed, while between 320 000 and 450 000 backstreet abortions are estimated to take place every year (58).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Moloney, 2009, Unsafe abortions common in Colombia despite law change, Lancet. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    There is great space for further advancing women's access to postabortion care.

    “Hence, there is great space for further advancing women's access to postabortion care.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Interpretationreasoning

    As a consequence of surgical treatment being mainly offered at secondary and tertiary facilities and doctors often being the only permitted providers, the service is often difficult to access for women living in remote rural areas.

    “As a consequence, the service is often difficult to access for women living in remote rural areas.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Surgical treatment for incomplete abortion is mainly offered at secondary and tertiary health facilities, and doctors are often the only health professionals permitted to provide treatment for incomplete abortions.

  • May combine two claims.

    Interpretationreasoning

    Columbia, Ethiopia and Cambodia are examples of countries where although legal reform took place some years ago, social norms regarding abortion are only beginning to change and consequently many unsafe abortions are still taking place.

    “Columbia, Ethiopia and Cambodia are examples of countries where although legal reform took place some years ago, social norms regarding abortion are only beginning to change and consequently many unsafe abortions are still taking place.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The findings from this overview indicate that achievements have been made during the past years.

    “The findings from this overview indicate that achievements have been made during the past years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    40% of the world's population are still living in countries where abortion is only available to save a woman's life or to protect her physical or mental health, and many women who experience abortion complications are still lacking access to comprehensive postabortion care.

    “However, 40% of the world's population are still living in countries where abortion is only available to save a woman's life or to protect her physical or mental health, and many women who experience abortion complications are still lacking access to comprehensive postabortion care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    An alternative and perhaps more trustworthy approach would be to identify women through an empathetic interview, which has proved to be an improvement of the clinical approach.

    “An alternative and perhaps more trustworthy approach would be to identify the women through an empathetic interview, which has proved to be an improvement of the clinical approach (54).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Rasch, 2000, Self-reports of induced abortion: an empathetic setting can improve the quality of data, Am J Public Health. source

  • May combine two claims.

    Study design and conductcitation

    Although the quality of methods used to estimate unsafe abortion rates has improved and estimates are believed to have become more reliable, the reported figures should be considered with some caution.

    “Although the quality of the methods used to estimate unsafe abortion rates have improved and it is believed that the estimates have become more reliable (4), the reported figures should be considered with some caution.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Singh, 2009

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    A number of countries have liberalized their abortion laws, and comprehensive postabortion care programs have been implemented in countries where restrictive abortion laws prevail.

    “A number of countries have liberalized their abortion laws, and comprehensive postabortion care programs have been implemented in countries where restrictive abortion laws prevail.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The best way to reduce the health burden associated with unsafe abortion is a legal change of restrictive abortion laws which prevail worldwide.

    “The best way to reduce the health burden associated with unsafe abortion is a legal change of restrictive abortion laws which prevail worldwide.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Pervasive stigma against abortion, as well as a lack of knowledge that abortion is legal, keeps women from opting for safe legal abortion.

    “Pervasive stigma against abortion, as well as a lack of knowledge that abortion is legal, keeps women from opting for safe legal abortion (62).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] deRoubaix, 2007, Ten years hence-has the South African choice on Termination of Pregnancy Act, Act 92 of 1996, realised its aims? A moral-critical evaluation, Med Law.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Women with financial means can always find a way to travel or find a doctor who will provide a safe legal/illegal abortion, whereas women who live in poverty have a greater risk of resorting to unsafe abortion.

    “Women with financial means can always find a way to travel or find a doctor who will be able to provide a safe legal/illegal abortion, whereas women who live in poverty have a greater risk of resorting to unsafe abortion.”
    Quote in the paperNot a substantial claim
53 of 53

  • The paper relies on this without support.

    Women's self-reports of outcomes after self-administered mifepristone and misoprostol for early abortion are accurate.

    “A review of the women's reports of the telecommunication service and the consequences experienced through self-administration of mifepristone and misoprostol for early abortion have recently been conducted among 249 women who had received the service.”

  • The paper relies on this without support.

    Assessing the magnitude of the problem of unsafe abortion and its consequences is one of the least documented reproductive health problems and is difficult to document.

    “Assessing the magnitude of the problem of unsafe abortion and its consequences is one of the least documented reproductive health problems and, not coincidentally, it is difficult to document.”

  • The paper relies on this without support.

    Women who have experienced unsafe abortion and abortion providers are reluctant to report having had or performed an abortion.

    “Women who have experienced unsafe abortion as well as the abortion providers are reluctant to report having had or having performed an abortion.”

  • The paper relies on this without support.

    Governments do not collect data on abortions performed outside the legal health system.

    “In addition, governments do not collect data on abortions performed outside the legal health system.”

  • The authors state this as an assumption.

    Infection risk is much higher after an induced than after a spontaneous abortion.

    “However, the use of sepsis as a criterion for classifying an abortion as induced depends on the assumption that infection risk is much higher after an induced than after a spontaneous abortion.”

  • The paper relies on this without support.

    Surgical treatment for incomplete abortion is mainly offered at secondary and tertiary health facilities, and doctors are often the only health professionals permitted to provide treatment for incomplete abortions.

    “Surgical treatment for incomplete abortion is mainly offered at secondary and tertiary health facilities, and doctors are often the only health professionals permitted to provide treatment for incomplete abortions.”

  • The paper relies on this without support.

    During the past two decades, misoprostol has increasingly been used for medical abortion, especially in Latin America, where the drug's availability in pharmacies has greatly improved access to a safe method of abortion.

    “Hence, during the past two decades misoprostol has increasingly been used for medical abortion, especially in Latin America, where the drug's availability in pharmacies has greatly improved access to a safe method of abortion.”

  • The paper relies on this without support.

    More recently, misoprostol has also become available in developing countries such as Cambodia, India, Nepal, South Africa, Tunisia, Vietnam and Zambia.

    “More recently, the drug has also become available in developing countries, such as Cambodia, India, Nepal, South Africa, Tunisia, Vietnam and Zambia.”

  • The paper relies on this without support.

    Most unsafe abortions are consequences of unplanned and unwanted pregnancies.

    “Finally, as most unsafe abortions are consequences of unplanned and unwanted pregnancies, access to highly effective contraceptive methods should be advanced globally.”

  • The paper relies on this without support.

    Among women in low-income countries, the proportion of spontaneous abortions that result in localized infection or sepsis is unknown.

    “Among women in low-income countries, the proportion of spontaneous abortions that result in localized infection or sepsis is unknown.”
10 of 10

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. World Health Organization (WHO), 2007, Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003

Cited by

Sorted by citations

Related

Authors
RASCH, V.
Affiliations
Odense University Hospital (DK)
Corresponding author
RASCH, VIBEKE
ORCID
RASCH, VIBEKE
Venue
Acta Obstetricia et Gynecologica Scandinavica
Publisher
Wiley
Published
2011-05-25
Volume
90
Issue
7
Pages
692-700
ISSN
0001-6349 (ISSN-L)
DOI
10.1111/j.1600-0412.2011.01165.x
OpenAlex
W2098840754
Semantic Scholar
eb56bb3e170a6e481b1c70d48b6e8d8c475d73ab
Cited by
94
References
68
Citations by year
2026: 5 · 2025: 4 · 2024: 12 · 2023: 11 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 6 · 2017: 3 · 2016: 8 · 2015: 9 · 2014: 14 · 2013: 7 · 2012: 2
FWCI
6.75
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1 (tdm, 1560 d)
Locations
  • Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
Keywords
unsafe abortion, post-abortion care, restrictive abortion laws, illegal abortion, maternal mortality, incomplete abortion, post-abortion contraception, mid-level providers, misoprostol, sub-Saharan Africa
MeSH terms
Abortion, Illegal, Abortion, Criminal, Abortion, Induced, Adolescent, Adult, Aftercare, Cultural Characteristics, Developing Countries, Female, Health Policy, Humans, Malawi, Maternal Mortality, Middle Aged, Nigeria, Pregnancy, Pregnancy, Unwanted, Socioeconomic Factors, Women's Health, Africa South of the Sahara, Risk Assessment, Needs Assessment, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-19.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-19.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review