- Melissa L Gilliam, MD, MPH
Melissa L Gilliam, MD, MPH
- Professor, Obstetrics and Gynecology
- Professor, Pediatrics
- Vice Provost, Academic Leadership, Advancement, and Diversity
- The University of Chicago
- Sadia Haider, MD, MPH
Sadia Haider, MD, MPH
- Associate Professor, Obstetrics and Gynecology
- Chief, Section of Family Planning and Contraceptive Research
- The University of Chicago
Approximately 213 million pregnancies occur worldwide each year and 42 million of these pregnancies end in abortion . Approximately 22 million of these abortions are "safe" and the other 20 million are "unsafe"  (see 'Definition of safe and unsafe abortion' below). Unsafe abortion is a major factor in maternal morbidity and mortality and accounts for about 4.7 to 13.2 percent of maternal deaths worldwide each year . Women in developing countries were treated for complications related to unsafe abortion at an estimated rate of 6.9 per 1000 women, or 7.4 per 1000 women when countries where abortion is legal and widely accessible were excluded . Additionally, one in eight pregnancy-related deaths are the result of unsafe abortion . Unsafe abortion has large economic costs, as well, since the incomplete procedure creates a need for hospital care.
The risk of complications and death from unsafe abortion is inversely related to the provider’s skill, conditions for performing the procedure, and availability of appropriate equipment. Some unsafe abortions are self-induced; the consequences in these cases also depend on whether the woman seeks medical care. Social stigma, legal threats, and fear can prevent women from accessing post-abortion care, which is a critical aspect of saving lives .
In 2000, 189 nations pledged to free people from extreme poverty and multiple deprivations. This pledge became the eight Millennium Development Goals, which are :
●End poverty and hunger
●Universal educationTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann 2014; 45:301.
- World Health Organization, Department of Reproductive Health and Research. Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2008, 6, WHO, Geneva 2011.
- Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2:e323.
- Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG 2016; 123:1489.
- Harris LH. Stigma and abortion complications in the United States. Obstet Gynecol 2012; 120:1472.
- http://www.un.org/millenniumgoals/bkgd.shtml (Accessed on July 16, 2012).
- Prata N, Sreenivas A, Vahidnia F, Potts M. Saving maternal lives in resource-poor settings: facing reality. Health Policy 2009; 89:131.
- Fawcus SR. Maternal mortality and unsafe abortion. Best Pract Res Clin Obstet Gynaecol 2008; 22:533.
- Hessini L, Brookman-Amissah E, Crane BB. Global policy change and women's access to safe abortion: the impact of the World Health Organization's guidance in Africa. Afr J Reprod Health 2006; 10:14.
- Sing S, Wulf D, Hussain R, et al. Abortion Worldwide: A Decade of Uneven Progress, Guttmacher Institute, New York 2009.
- Malarcher S, Olson LG, Hearst N.. Unintended pregnancy and pregnancy outcome: equity and social determinants.. In: Equity, social determinants and public health programmes., Blas E, Kurup AS (Eds), World Health Organization, Geneva 2010. p.177.
- Sundaram A, Juarez F, Bankole A, Singh S. Factors associated with abortion-seeking and obtaining a safe abortion in Ghana. Stud Fam Plann 2012; 43:273.
- Grimes DA. Unsafe abortion: the silent scourge. Br Med Bull 2003; 67:99.
- Grimes DA, Benson J, Singh S, et al. Unsafe abortion: the preventable pandemic. Lancet 2006; 368:1908.
- Sharing Responsibility: Women, Society & Abortion Worldwide, The Alan Guttmacher Institute, New York 1999.
- Bury L, Aliaga Bruch S, Machicao Barbery X, Garcia Pimentel F. Hidden realities: What women do when they want to terminate an unwanted pregnancy in Bolivia. Int J Gynaecol Obstet 2012; 118 Suppl 1:S4.
- Burnhill MS. Treatment of women who have undergone chemically induced abortions. J Reprod Med 1985; 30:610.
- Ugboma HA, Akani CI. Abdominal massage: another cause of maternal mortality. Niger J Med 2004; 13:259.
- Costa SH. Commercial availability of misoprostol and induced abortion in Brazil. Int J Gynaecol Obstet 1998; 63 Suppl 1:S131.
- Faúndes A, Santos LC, Carvalho M, Gras C. Post-abortion complications after interruption of pregnancy with misoprostol. Adv Contracept 1996; 12:1.
- Prada E, Singh S, Villarreal C. Health consequences of unsafe abortion in Colombia, 1989-2008. Int J Gynaecol Obstet 2012; 118 Suppl 2:S92.
- Hyman A, Blanchard K, Coeytaux F, et al. Misoprostol in women's hands: a harm reduction strategy for unsafe abortion. Contraception 2013; 87:128.
- Austin J, Ford MD, Rouse A, Hanna E. Acute intravaginal misoprostol toxicity with fetal demise. J Emerg Med 1997; 15:61.
- Bentov Y, Sheiner E, Katz M. Misoprostol overdose during the first trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 115:108.
- Barros JG, Reis I, Graça LM. Acute misoprostol toxicity during the first trimester of pregnancy. Int J Gynaecol Obstet 2011; 113:157.
- Henriques A, Lourenço AV, Ribeirinho A, et al. Maternal death related to misoprostol overdose. Obstet Gynecol 2007; 109:489.
- Singh S. Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. Lancet 2006; 368:1887.
- Adler AJ, Filippi V, Thomas SL, Ronsmans C. Quantifying the global burden of morbidity due to unsafe abortion: magnitude in hospital-based studies and methodological issues. Int J Gynaecol Obstet 2012; 118 Suppl 2:S65.
- Gerdts C, Vohra D, Ahern J. Measuring unsafe abortion-related mortality: a systematic review of the existing methods. PLoS One 2013; 8:e53346.
- Ibrahim IA, Onwudiegwu U. Sociodemographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: a four-year review. West Indian Med J 2012; 61:163.
- Ness RB, Trautmann G, Richter HE, et al. Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial. Obstet Gynecol 2005; 106:573.
- Bond GR, Van Zee A. Overdosage of misoprostol in pregnancy. Am J Obstet Gynecol 1994; 171:561.
- Graber DJ, Meier KH. Acute misoprostol toxicity. Ann Emerg Med 1991; 20:549.
- Faúndes A. Strategies for the prevention of unsafe abortion. Int J Gynaecol Obstet 2012; 119 Suppl 1:S68.
- International Federation of Gynecology and Obstetrics, International Confederation of Midwives, International Council of Nurses, United States Agency for International Development. FIGO Consensus Statement. Family planning: a key component of post abortion care. October 8, 2009. http://www.figo.org/news/figo-consensus-statementfamily- planning-key-component-post-abortion-care (Accessed on February 18, 2014).
- International Federation of Gynecology and Obstetrics. Consensus statement on uterine evacuation. Uterine evacuation: use vacuum aspiration or medications, not sharp curettage. July 12, 2011. http://www.figo.org/news/new-downloaduterineevacuation-figo-consensus-statement-003824 (Accessed on February 18, 2014).
- Cleland J, Conde-Agudelo A, Peterson H, et al. Contraception and health. Lancet 2012; 380:149.
- Westoff CF, Recent trends in abortion and contraception in 12 countries, DHS Analytical Studies, Princeton, NJ, USA: Office of Population Research, Princeton University; and Calverton, MD, USA: ORC Macro, 2005, No. 8.
- Stephenson P, Wagner M, Badea M, Serbanescu F. Commentary: the public health consequences of restricted induced abortion--lessons from Romania. Am J Public Health 1992; 82:1328.
- Tripney J, Kwan I, Bird KS. Postabortion family planning counseling and services for women in low-income countries: a systematic review. Contraception 2013; 87:17.
- Goodman S, Hendlish SK, Reeves MF, Foster-Rosales A. Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion. Contraception 2008; 78:143.
- Heikinheimo O, Gissler M, Suhonen S. Can the outcome of the next pregnancy be predicted at the time of induced abortion? Hum Reprod 2009; 24:820.
- Cates W Jr, Rochat RW, Grimes DA, Tyler CW Jr. Legalized abortion: effect on national trends of maternal and abortion-related mortality (1940 through 1976). Am J Obstet Gynecol 1978; 132:211.
- Hossain A, Maddow-Zimet I, Singh S, Remez L. Menstrual regulation, unsafe abortion, and maternal health in Bangladesh. Issues Brief (Alan Guttmacher Inst) 2012; :1.
- Pallitto CC, García-Moreno C, Jansen HA, et al. Intimate partner violence, abortion, and unintended pregnancy: results from the WHO Multi-country Study on Women's Health and Domestic Violence. Int J Gynaecol Obstet 2013; 120:3.
- DEFINITION OF SAFE AND UNSAFE ABORTION
- PREVALENCE AND EPIDEMIOLOGY OF UNSAFE ABORTION
- PROVIDERS AND PERFORMANCE OF UNSAFE ABORTION
- Incomplete abortion
- Chemical burns or drug toxicity
- Failed procedure
- GENERAL APPROACH
- MANAGEMENT OF COMPLICATIONS
- EVIDENCE-BASED RESOURCES
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS