Unsafe Abortions Still Take Their Toll

Abortion is a very tricky issue. It's tricky morally, it's tricky legally and it's tricky politically. But here's one thing that isn't tricky: 70,000 women are dying every year from unsafe abortions. And the vast majority of them are poor.

A recent study by the Guttmacher Institute in New York shows that while the total number of abortions in recent years has fallen across the globe, that drop relates mainly to legal abortions and is due largely to changes in Eastern European laws.

According to the report, 41.6 million pregnancies were terminated worldwide in 2003, compared with 45.5 million in 1995. But in 2003 (the latest year for which the institute had reliable data), 19.7 million abortions performed were unsafe, clandestine abortions. Those numbers have hardly changed at all from 1995, when there were 19.9 million such abortions. Not surprisingly, the lion's share of unsafe abortions occur in poor, developing countries with restrictive abortion laws.

The study looks mainly at the health care costs arising from unsafe abortions in such countries. Of the 19 million unsafe abortions that occur in developing countries every year, an estimated 5 million women are treated for the resulting serious medical complications. The health system costs of post-abortion care in Latin America and Africa combined ranges from $159 million to $333 million per year.

But the study also looks at other costs that arise from allowing unsafe abortions to flourish. Globally,15 percent to 25 percent of women who need hospital-based care for complications from unsafe abortions never receive it. And an unknown number of women suffer lifelong medical and psychological complications; 70,000 die.

The bottom line? Making abortions illegal and unsafe does nothing to prevent abortion. It simply costs money and lives.

So, what can be done to change these trends?

In a word: contraception.

The percentage of married women using contraception increased from 54 in 1990 to 63 in 2003 around the globe as availability of contraceptives increased. Contraceptive use increased in every major region, but still lagged noticeably in Africa, where it is used by only 28 percent of married women, compared with at least 68 percent in other major regions.

At the same time, social attitudes towards abortion have also changed, prompting a relaxation of more restrictive laws. It's a simple fact that abortions worldwide are declining even as more countries liberalize their abortion laws. Since 1997, only three countries -- Poland, Nicaragua and El Salvador -- substantially increased restrictions on abortion, while laws were eased significantly in 19 countries and regions. But 40 percent of the world's women continue to live in countries with highly restrictive abortion laws, virtually all of them in the developing world.

The Guttmacher Report ends by encouraging governments to focus on strategies like contraception and family planning that prevent unwanted pregnancies in the first place. It also urges expanded access to safe and legal abortions, and adequate post-abortion health care.

But that's a hard sell in some corners of the Earth. President Obama recently rescinded the "global gag rule" put into effect under the Bush administration, which prevented federal funds going to organizations abroad that offer abortions or counsel about abortions. That's the good news. But you also have governments like Nicaragua's present one, which cave on this issue under electoral pressure from the religious right, leading to allegations of human rights abuses.

For anyone out there who's still on the fence about this issue (all two of you!), I'd urge you to see a superb Romanian film that flew underneath the radar in the U.S. when it was released a few years back. It's titled "Four Months, Three Weeks, and Two Days." Although fundamentally a parable about the real and psychological horrors of living under authoritarian rule, it's also about the real and psychological horrors of having an unsafe, illegal abortion.

We can and will disagree on many things surrounding the abortion debate. That's appropriate and fair. But let's not ally ourselves with the Ceausescus of this world.