Implications for U.S. policy from new evidence on global abortion trends

A new report from the Guttmacher Institute has major implications for U.S. policy, highlighting the urgency for boosting U.S. international family planning assistance and the need for the United States to be more engaged in mitigating the impact of unsafe abortion.

The report, published on October 13, shows positive global trends in increased contraceptive use, lower unintended pregnancy rates and declining abortion numbers, but also demonstrates that unsafe abortion remains a critical global health challenge. According to “Abortion Worldwide: A Decade of Uneven Progress,” both the developed and the developing world saw overall improvements. However, developed regions saw the greatest progress, while improvement varied widely in the developing world, with Africa lagging behind all other regions.

Increases in global contraceptive use have contributed to a decrease in the number of unintended pregnancies and abortions, which declined from 45.5 million procedures in 1995 to 41.6 million in 2003. This decline in worldwide abortion occurred alongside a global trend toward liberalizing abortion laws, with 19 countries significantly reducing abortion restrictions since 1997, and only 3 countries substantially increasing legal restrictions.

The report finds that while the incidence of abortion is closely related to that of unintended pregnancy, it does not correlate with abortion’s legal status. Indeed, abortion occurs at roughly equal rates in regions where it is broadly legal and in regions where it is highly restricted. The key difference is safety—illegal, clandestine abortions cause significant harm to women, especially in developing countries. Unsafe abortion causes 70,000 deaths each year and 5 million women are treated for severe complications resulting from unsafe abortion. Another 3 million women with serious complications go untreated.

In essence, the report provides new proof that abortion legality has much more to do with safety than incidence. Abortion rates correspond mostly to the rates of unintended pregnancy, which in turn correspond closely to rates of contraceptive use.  Where abortion remains severely restricted, it happens about as often as where it isn’t—but it accounts for high rates of maternal death and disability and huge costs to already strained health systems in developing countries. 

The report’s findings are an urgent call to action, and the United States is well-positioned to be a leader in helping to prevent unintended pregnancies and unsafe abortions worldwide. The Obama administration deserves praise for reprioritizing international family planning assistance by rescinding the anti-family planning Mexico City Policy (also known as the Global Gag Rule) and for restoring U.S. funding to UNFPA. The administration likewise deserves credit for making unintended pregnancy prevention one of four pillars of its soon-to-be-released Global Health Initiative. And the new administration and Congress already have begun making up for lost time and have committed important increases in funding for international family planning services despite the tough fiscal environment.

But these positive steps are not enough. Deaths from unsafe abortion are utterly preventable and there is much more the United States can do to avert death and suffering among millions of women, their children and their families:

• The U.S. Congress should increase foreign aid to international family planning programs beyond current proposed increases. U.S. advocates have called for U.S. family planning assistance to be doubled, to at least $1 billion annually. A recently released report by five former directors of the Population and Reproductive Health Program of the U.S. Agency for International Development (USAID) goes even further, recommending that funding for USAID’s population budget be set at $1.2 billion—and raised to $1.5 billion by fiscal year 2014.


• Congress should also reexamine restrictive abortion policies. The 1973 Helms amendment bars the U.S. government from paying for safe abortion services overseas (much like the Hyde amendment does domestically). This restriction should be overturned because it is only exacerbating the problem of unsafe abortion and having no effect whatsoever on making abortion less likely. The United Kingdom’s Department for International Development’s position on unsafe abortion shows just how far the United States is lagging behind other nations when it comes in supporting programs that make safe abortion and post-abortion care more accessible globally.


• Until such time as Congress is prepared to confront the Helms amendment ban on providing funding for safe abortion services in the world’s poorest countries, at the very least, the U.S. should work within the existing exceptions under Helms (in cases of rape, incest and danger to the mother’s life) to make safe abortion care available to women who meet these criteria (consistent with local law). The U.S. should also boost programs that aim to prevent the worst consequences of unsafe abortions, by helping to make post-abortion care more widely available to women suffering complications from clandestine procedures.


• Lastly, the Obama administration should return the United States to its traditional role as a strong advocate for family planning at the international level. As part of this overall effort, the United States is recommitting itself to achieving reductions in maternal mortality and broader access to family planning services under the framework agreed during the 1994 International Conference on Population and Development in Cairo as well as under the millennium development goals.

Women are critical to the economic and social development of societies and to the realization of U.S. international development priorities, as well as many, if not most, of the Millennium Development Goals. It’s time for the U.S. to get serious about addressing better access to contraception, unwanted pregnancy and unsafe abortion as the key public health challenges they are.