Abortion

One of the Most Preventable Causes of Maternal Death

Unsafe abortion continues to be a serious public health problem worldwide; 98% of abortion-related deaths occur in developing countries where few women can afford or access abortion services. Each year, nearly 20 million women are forced to resort to unsafe abortion. A woman dies every 8 minutes in a developing country due to complications arising from unsafe abortion. Over 50% of these deaths occur in developing parts of Asia, followed closely by developing countries in East and West Africa.

Abortion induced by a skilled provider is one of the safest procedures in contemporary medical practice. Newer technologies such as manual vacuum aspiration (MVA) and medical abortion (accomplished by simply taking a prescribed regimen of misoprostol and mifeprex) make abortion easier to provide. These advances allow for innovation in increasing access to safe abortion within the private sector. For example, midwives or other non-physician health professionals can be trained in these simplified, low-risk procedures.

Private Sector and Safe Abortion

Common Complications of Unsafe Abortion
  • Death
  • Hemorrhage
  • Sepsis
  • Infection of reproductive and genital tract
  • Vaginal and uterine trauma
  • Infertility

For understandable reasons, abortion is a service with high elasticity of demand: people will go to great lengths to find providers, pay huge sums, and risk their lives with illegal providers and unproven methods. One study in Ethiopia found that 10% of women reported providing sex to providers as part of payment for illegal abortions. In India, where abortion on demand is legal but government clinics are few, prices in private clinics regularly exceed one month of salary for low-income families.

The private sector is a major provider of abortion services all around the world because privacy concerns and legal restrictions drive patients to them, and the urgency of need means that abortion provision is highly profitable.

This has made abortion services amenable to interventions that improve markets and increase quality. In many countries NGOs and social franchise programs are making a significant contribution in provision, support, and training related to safe abortion. New technologies, such as Manual Vacuum Aspiration (MVA) have been introduced around the world and are used now in developed country settings such as the UCSF Medical Center. New medicines for morning after or medically induced abortion, including postinor, RU486, and misoprostol, have greatly increased access and reduced risks of 1st trimester abortions and allowed midwives and traditional birth attendants to provide abortion services safely, profitably, and in rural and home-care settings.

Social franchise organizations and a few specialized NGOs train providers in safe abortion services, monitor quality, and are working to adjust incentives for private providers to assure both quality and access to safe abortion care.

Strengths

  • Use of new, safer technologies
  • Improved morbidity and mortality
  • Use of non-physician health providers
  • Broader reach

Weaknesses

  • Illegal or significantly restricted in many countries
  • Social stigma
  • Lack of data for advocacy
  • Privacy and confidentiality issues
  • Discouraging attitude of health providers
Making abortion legal, safe, and accessible does not appreciably increase demand: all it does is turn previously clandestine, unsafe procedures into safe and legal ones.
Grimes et al. Unsafe Abortion: the preventable pandemic. The Lancet 2006; 368:1908-19.
Current Programs and Resources - Abortion