Recent trends in abortion rates worldwide

International Family Planning Perspectives, Mar 1999 by Henshaw, Stanley K, Singh, Susheela, Haas, Taylor

Context: Legal abortion rates vary widely among countries with nonrestrictive laws. Data on trends in legal induced abortion may provide insight for policymakers into factors that influence rates of legal induced abortion and the levels of abortion that might be achievable in their own countries and in other parts of the world.

Methods: Numbers of legal induced abortions were estimated for 54 countries from official statistics or other national data. Abortion rates per 1, 000 women aged 15-44 were calculated for the years 1975 through 1996.

Results: The most striking recent trend is a sharp decline in abortion incidence in Eastern and Central Europe and the successor states to the Soviet Union. For example, rates fell by 28-47% in the four former Soviet states with reasonably complete data (Belarus, Estonia, Kazakhstan and Latvia), and by 18-65% in six states with less-complete reporting. Similar patterns were seen in such nations as Bulgaria, Hungary and the Czech and Slovak Republics. Rates have also declined in several other developed countries: Since 1975, the abortion rate in such countries as Denmark, Finland, Italy and Japan has dropped by 40-50%. In only a few developed countries (among them Canada, New Zealand and Scotland) have abortion rates shown an increase over time. In the few developing countries with reliable data, some (China, South Korea, Tunisia and Turkey) have experienced a declining abortion rate, while others (such as Cuba and Vietnam) have seen increases in levels of abortion.

Conclusions: In developed countries with high abortion rates, use of abortion is likely to fall rapidly when a range of contraceptive methods become widely available and effectively used. Legalization of abortion and access to abortion services do not lead to increased reliance on abortion for fertility control in the long term; in developed countries with these conditions, the predominant trend in abortion rates has been downward.

International Family Planning Perspectives, 1999, 25(1):44-48

Legal abortion rates vary widely among countries with nonrestrictive laws.1 In 1995-1996, rates ranged from a low of seven abortions per 1,000 women aged 15-44 in Belgium and the Netherlands to a high of at least 83 per 1,000 in Vietnam. Some developed countries have rates close to that in Vietnam, a developing country; for example, the rate is at least 78 per 1,000 in Romania and 68 per 1,000 in the Russian Federation.2

Perhaps the most important factors affecting the abortion rate are the strength of motivation to have a small family and control the timing of births, and the extent of effective use of contraceptives. Although it is the policy of most countries to encourage contraceptive use, not all have provided support or allocated the necessary resources to family planning services. As a result, lack of access to contraceptive services and supplies can be an important barrier to the use of family planning. Negative attitudes toward various contraceptive methods may also impede change. In addition, it may be difficult in some countries for health systems accustomed to providing abortion services to shift to an emphasis on contraception. Finally, some countries with high abortion rates are said to have an "abortion culture," implying that reliance on abortion will be slow to change, regardless of contraceptive availability.

If a country's birthrate remains stable, a declining trend in the abortion rate suggests success in substituting contraception for abortion. Information on trends is important for understanding policies concerning abortion and contraception and perhaps the factors that impede the success of these policies. Recent experience also sheds light on the speed with which abortion rates can change and the level of abortion that a country can reasonably hope to achieve.

This article reports trends in legal induced abortion in 54 countries* for the period 1975 to 1996.^ Although the majority of countries with data on the incidence of legal abortion are economically developed, enough information is available on developing countries to provide important insights. We have included data for countries in which abortion reporting is known to be incomplete, because the time trends are often meaningful even if the absolute level of abortion is uncertain.

Methods and Data Sources

Abortion data are generally collected by government agencies that compile statistics from health facilities and physicians who perform abortions. Our aim was to obtain abortion statistics from all countries that had a population of one million or more and where abortion was legal in 1997 under broad conditions^^ or where the law was more restrictive but legal abortion services were widely available. In each country for which we believed data would be available, we contacted the national statistical office or a local informed expert with our request for information and for published reports containing abortion statistics.*

We present abortion rates based on government abortion statistics for 48 countries and taken from other sources for six countries where governmental sources do not exist or where other sources are more complete. For one of the six, Switzerland, the number of abortions was taken from a publication reporting the number in each canton (with estimates for two cantons).3 For the United States, we used data collected through periodic surveys of all abortion providers by The Alan Guttmacher Institute (AGI)4 instead of government statistics (which are incomplete for many states). For France and Italy, we used estimates made by local experts that attempt to correct for underreporting in the official statistics.5