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If you want to reduce the number of terminations, the answer isn't banning abortion. It's embracing it.
Anti-abortion activists often claim that banning abortion will necessarily reduce the number of terminations, but the truth isn't that simple. In the Guardian, journalist George Monbiot argued this week that conservatives who seek to block access to abortion are simply shooting themselves in the foot. "There is no association between its legality and its incidence," he writes. "Banning abortion does not stop the practice; it merely makes it more dangerous."
A report from the Lancet, a medical journal, shows that the abortion rate in countries that have banned the practice is actually higher than in countries where women have access to abortion.
The most recent meta-analysis of global trends, published in 2012, discovered that the abortion rate, after a sharp decline between 1995 and 2003, scarcely changed over the following five years. However, the proportion of unsafe abortions rose from 44 percent to 49 percent of overall abortions.
The overall abortion rates showed that there was a sharp rise in unsafe abortions in western Asia (including the Middle East), but that there was no rise in West and Central Africa, and Central and South America—where 100 percent of all abortions performed are already deemed illegal and unsafe. Western Europe has the world's lowest termination rate: 12 a year for every 1,000 women of reproductive age. North America aborts 19 foetuses for every 1,000 women. In South America, where (when the figures were collected) the practice was banned everywhere, the rate was 32. In eastern Africa, it was 38.
According to the World Health Organization, about 22 million unsafe abortions are performed every year. This means they are performed by persons lacking the necessary skills or in an environment lacking the minimal medical standards. The WHO estimates that 47,000 women and girls die every year and another 5 million sustain disabilities due to unsafe abortion.
Dr Sally Sheldon, a professor of law at Kent Law School specializing in the legal regulation of gender, says that she is "fully convinced" by the findings. "Liberal abortion laws tend to be found in countries with better sex education and better access to contraception, so it makes perfect sense for those countries also to have lower abortion rates than countries without those things," she says.
Unexpectedly, Eastern Europe had the world's highest abortion rate of 43 per 1,000 women. Under communism, abortion was the only available form of medical birth control. The rate has fallen from 90 per 1,000 since 1995, as contraception has become easier to obtain.
But there's still a long way to go. "Where there are restrictive laws, women will still do that but they will have less good access to safe abortion," Dr Sheldon continues. "Those who are serious about reducing abortion rates need to focus on reducing rates of unwanted pregnancy. The technology for very safe, very effective abortions already exists— particularly in the form of abortion pills. What needs to be done is to make sure that women can access it (and accurate information). The removal of restrictive laws is part of that process."
Dr Sheldon's views are in line with the report suggesting that measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are "crucial steps" toward achieving the Millennium Development Goals.
Sarah Shaw, a policy advisor at Marie Stopes International, has seen how women and girls are vulnerable to unsafe abortions first hand. The organization provides women with a range of sexual and reproductive health services across 37 countries, including access to safe abortion services (where legal) and post-abortion care. "In Zimbabwe, although only 3 percent of abortions there are illegal and unsafe, those pregnant are required to have 3 references letters by a doctor and a referral from the court," she says. "This means that girls are required to report the rape in order to access a safe abortion through the legal system."
Sometimes things go wrong; that's why there is a universal right to abortion.
She cites a hospital visit last year to the outskirts of the Zimbabwean capital Harare, where she met many vulnerable girls who were attempting to access an unsafe abortion. "Every woman there was pregnant, waiting to get access to a termination," she says, adding that the exact location and its operations cannot be disclosed in fear of reprisals. "Girls were simply not being prioritised. Once you get past 14 weeks, it's too late—but the authorities lacked awareness."
But in countries where abortion is illegal, it's often difficult to get the full picture of the consequences of unsafe abortions because of the problems within recording data. "We're really hampered with data. Those with weak policy on abortion have less data than those who do," Shaw explains. "There is not a huge amount of data on unsafe DIY abortions, even though it's likely those who undergo it are going to end up in hospital. She, or the provider who gave her pills, would have broken the law—it will never go reported."
In order to reverse the trend of unsafe abortions, Shaw hopes that she will be able to bring more cases forward to the authorities around the world. "Civil servants need to realize that the power is in their hands. They just need to be moved by hearing those stories in person."
"Sometimes things go wrong; that's why there is a universal right to abortion. The need is never going to go away. There will always be a demand for it, so it's important to ensure that there is safe access both during and after the ordeal."
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