Almost half of all abortions performed worldwide are unsafe, according to World Health Organisation

There are nearly 56 million abortions every year in the world and almost half of them are unsafe, according to a major piece of research from the World Health Organisation (WHO).

The study found that there were 55.7 million abortions every year between 2010 and 2014 worldwide, and of them 17.1 million were unsafe because the woman was taking pills alone or was with a trained helper but using a method of abortion that is no longer considered best practice.

But a further 8 million abortions, categorised as “least safe” in the study, involved desperate and dangerous backstreet measures, from swallowing toxic substances to inserting wires to try to bring about a miscarriage.

The highest levels of unsafe abortions were in Africa, where only about one in four are safe and as a result abortion deaths are high.

The new figures, from the WHO with the Guttmacher Institute, are published in The Lancet medical journal at a time when international family planning organisations are deeply concerned over cuts to their budgets announced by the Trump administration in the US.

Experts say the proposed cuts, together with the reimposition of the restrictive Mexico City policy (also known as the Global Gag rule) which forbids US federal funds to any organisation that counsels women on abortion, can only make things worse.

The study finds that there are fewer abortions in places where abortion is safest, such as in northern Europe and northern America where women can get contraception easily. The authors explain that most countries in those two regions “have less restrictive laws on abortion, high contraceptive use, high economic development, high levels of gender equality, and well developed health infrastructures”.

Lead author Dr Bela Gunatra, from the WHO, said their work showed “the persistence of inequalities by geography, by income, by levels of development ... that’s the real tragedy that these findings point to.

“Safe abortion is a very safe procedure. It can be provided at primary health care level. It isn’t even necessary that it has to be a procedure. Now you can use tablets. There is nothing that requires this to be highly resourced.

“It is not science that is holding back the progress but barriers in terms of stigma and law.”

In Latin America, where many countries have a ban on abortion in nearly all circumstances, women have resorted to misoprostol, a tablet which they can access online, ideally taken with mifepristone as well.

“It is a very safe method that women are taking into their own hands,” said Gunatra.

If they access the pills through a telemedicine service such as Women on Web which gives them information and support, the study classifies this as safe abortion, she said. But there are large numbers of women obtaining the pills online who do not have help, and those would be less safe.

The availability of the tablets is an improvement, said Gunatra.

“At least it is moving away from the means that led to death,” she said. “But at the same time, not dying is not enough.”

Deaths are highest in west and central Africa, at around 450 per 100,000 abortions, although the study authors warn that the mortality estimates are based on data from different time periods. They say women may die as a result of more serious complications because of the dangerous methods used to bring about an abortion – and their health services may then not have the skills or resources to treat them.

Gilda Sedgh, the Guttmacher Institute’s lead on the study, said it had not been long enough since the re-imposition of the Global Gag rule by President Trump on his first day in office to assess the impact. But there had been some research on the effects of its imposition during other Republican administrations, which had stripped funds from organisations such as the International Planned Parenthood Federation.

“There was no evidence that the Gag rule resulted in a decrease in the incidence of abortion,” she said. A couple of studies in Sub-Saharan Africa had suggested it led to an increase as a result of the shrinking of contraception provision by NGOs.

“Looking forward we can only predict, based on the past, that that’s how it might play out,” she said.

Gunatra said their findings “call for the need to ensure access to safe abortions to the full extent of the law, particularly in low income regions of the world, and efforts are needed to replace the use of unsafe methods with safe methods. Increasing the availability, accessibility and affordability of contraception can reduce the incidence of unintended pregnancies, and therefore abortions, but it is essential to combine this strategy with interventions to ensure access to safe abortions.”