So do you want the good news, or the bad news? OK-, first good: According to a major just-released report (PDF) from the Guttmacher Institute, increased use of contraception has helped decrease unintended pregnancy worldwide. (Globally, the percentage of married and of sexually active single women of childbearing age with access to contraception has increased from 54 percent in 1990 to 63 percent in 2003.) Abortions, ergo, are down as well, from an estimated 45.5 million procedures in 1995 to 41.6 million in 2003. In Eastern Europe, where a decade ago abortion was commonly, and infamously, used to limit or space births, the abortion rate was so high it threw off the curve. Now, abortion in that region has dropped by a whopping 50 percent, thanks to the wider availability of actual birth control.
But. To put a not-so-fine point on it, when we say abortions are down, we mean certain abortions are down. The estimated number of unsafe abortions actually “changed little” during the same period, says the study. Ditto the rate of unsafe abortion: from 15 in 1,000 to … 14 in 1,000. Yes, that’s the bad news. In fact, the study found (again), abortion occurs at about the same rate in places where it’s legal and in places where it’s restricted.
In other words: Bans do nothing. Except kill women. (Making their success rate, and irony factor, analogous to that of a virginity pledge.) Specifically: About 70,000 women die each year of complications from unsafe abortion, an estimate that — should it sound familiar — has hardly changed in 10 years. An estimated 8 million women per year experience complications requiring medical treatment. (Only 5 million receive that treatment. Even when quality post-abortion care is available, the study says, “distance, cost and the stigma often associated with Abortion can discourage women from seeking treatment.”) Another new Guttmacher study also found that “the costs of treating medical complications from unsafe abortion constitute a significant financial burden on public health care systems in the developing world.” (Treating complications from unsafe abortion costs Africa and Latin America alone up to $280 million each year.)
Let’s put it this way: Because of death — wholly preventable death — by unsafe abortion, an estimated quarter million children grow up without a mother. “Restrictive abortion laws are an unacceptable infringement of women’s human rights and of medical ethics,” says the study. “Eliminating unsafe abortion and providing access to safe abortion would reduce ill health, death and lost years of productivity among women, and avert the financial burden of treating related health complications. Achieving these goals would lead to enormous individual and societal benefits — for women, their families and countries as a whole.” File all that under What More Data Could You Possibly Need? (Or, depending on your mood, under “How Dare You Call Abortion a ‘Convenience’”?)
“The progress made during the past decade in increasing contraceptive use and reducing the need for abortion is fundamentally good news — the world is moving in the right direction,” added Sharon Camp, president and CEO of the Guttmacher Institute, in a statement. “And yet, we still have two widely disparate realities. In almost all developed countries, abortion is safe and legal. But in much of the developing world, abortion remains highly restricted, and unsafe abortion is common and continues to damage women’s health and threaten their survival.”
Eighty-six percent of reproductive-age women in the developing world live under highly restrictive abortion laws, according to the study.
(And in the U.S., 87 percent of counties, as we know, have no abortion provider. Yet the number of abortions here is among the highest in the developed world, according to the study. Guttmacher blames this in part on inconsistencies in, cough cough, insurance coverage of contraceptives.)
So there’s much to be done both at home and abroad. “The findings are an urgent call to action for governments around the world, including the United States, which is well-positioned to be a leader in helping prevent unintended pregnancies and unsafe abortions worldwide,” study co-author Gilda Sedgh, ScD, told Broadsheet. “The Obama administration has already reprioritized international family planning assistance by removing funding restrictions — i.e., the Global Gag Rule and funding for UNFPA. The administration and Congress have also proposed funding increases for international family planning services despite the tough fiscal environment.”
The findings also support increasing foreign aid to international family planning programs and reexamining restrictive policies such as the 1973 Helms Amendment, which is like the Hyde Amendment with a Eurail pass. (The Helms bars the U.S. from paying for safe abortion services overseas.)
“Our findings demonstrate that restricting access to safe abortion does not reduce the number of abortions performed, but rather increases the number of complications and deaths that women suffer as a result of the induced abortions they procure. U.S. policies are more likely to succeed in preserving the health of women if they are aimed at ensuring that safe services are available,” said Sedgh.
We also need to ask: How safe is “safe”? What kind of access do women have to abortion worldwide? We know well that here, states throw up cruel, specious roadblocks that severely limit access to a legal medical procedure — one that becomes less safe as it is delayed. Likewise, in countries such as India and South Africa, the study notes, abortion is broadly available, but “access to services provided by qualified personnel is uneven.”
This study is a reminder — one we should hardly need — that global maternal health is global health. Even, literally, the health of the planet. A recent editorial in the Lancet queried why so few countries have realized the role that contraceptives and family planning — as population control — could play in limiting the effects of global warming.
All the more reason — as if more were required — to keep these people out of, well, everything.