NEW YORK – Increased contraceptive use has led to fewer abortions worldwide, but deaths from unsafe abortion remain a severe problem, killing 70,000 women a year, a research institute reported Tuesday in a major global survey.
More than half the deaths, about 38,000, are in sub-Saharan Africa, which was singled out as the region with by far the lowest rates of contraceptive use and the highest rates of unintended pregnancies.
The report, three years in the making, was compiled by the New York-based Guttmacher Institute, which supports abortion rights and is a leading source of data on abortion-related trends. Researchers examined data from individual countries and multinational organizations.
The institute's president, Sharon Camp, said she was heartened by the overall trends since Guttmacher conducted a similar survey in 1999, yet expressed concern about the gap revealed in the new report.
"In almost all developed countries, abortion is safe and legal," she said. "But in much of the developing world, abortion remains highly restricted, and unsafe abortion is common and continues to damage women's health and threaten their survival."
The report calls for further easing of developing nations' abortion laws, a move criticized by Deirdre McQuade, a policy director with the U.S. Conference of Catholic Bishops' Secretariat for Pro-Life Activities.
"We need to be much more creative in assisting women with supportive services so they don't need to resort to the unnatural act of abortion," she said.
Guttmacher estimated previously that the number of abortions worldwide fell from 45.5 million in 1995 to 41.6 million in 2003 — the latest year for which global figures were available.
A key reason for that drop, the new report said, was that the portion of married women using contraception increased from 54 percent in 1990 to 63 percent in 2003 as availability increased and social mores changed. Guttmacher's researchers said contraceptive use had increased in every major region, but still lagged badly in Africa — used by only 28 percent of married women there, compared with at least 68 percent in other major regions.
The report notes that abortions worldwide are declining even as more countries liberalize their abortion laws. Since 1997, it said, only three countries — Poland, Nicaragua and El Salvador — substantially increased restrictions on abortion, while laws were eased significantly in 19 countries and regions, including Cambodia, Nepal and Mexico City.
Despite this trend, the report said 40 percent of the world's women live in countries with highly restrictive abortion laws, virtually all of them in the developing world. This category includes 92 percent of the women in Africa and 97 percent in Latin America, it said.
The survey concluded that abortion occurs at roughly equal rates in countries where it is legal and where it is highly restricted. The key difference, according to the report, is the high rate of deaths and medical complications from unsafe clandestine abortions in the restrictive countries.
"Legal restrictions do not stop abortion from happening. They just make the procedure dangerous," Camp said. "Too many women are maimed or killed each year because they lack legal abortion access."
In one example, the report told of a Nigerian woman named Victoria who first tried to induce an abortion by drinking an herbal concoction, then consulted a traditional healer who inserted leaves in her vagina that caused internal injuries.
The report estimated that 19.7 million of the 41.6 million abortions in 2003 were unsafe — either self-induced, performed by unskilled practitioners or carried out in unhygienic surroundings.
"Almost all of them occurred in less developed countries with restrictive abortion laws," said the report, which estimated that — beyond the tens of thousands of women killed annually from unsafe abortions — another 8 million women suffer complications because of them.
The report makes three major recommendations:
—Expand access to modern contraceptives and improve family planning services.
—Expand access to legal abortion and ensure that safe, legal abortion services are available to women in need.
—Improve the coverage and quality of post-abortion care, which would reduce maternal death and complications from unsafe abortion.
Camp, in an interview, said sub-Saharan Africa is the area of greatest concern to Guttmacher and like-minded groups. The status of women remains low in many of those countries, she said, while political and religious conservatives block efforts to liberalize abortion laws.
Although the Vatican remains officially opposed to use of contraceptives, Camp said her institute had detected a shift in approach.
"The Catholic Church has informally at least stopped fighting against contraception to the degree it once did and put more of its energies into fighting abortion," she said. "On the ground there are priests and nuns who refer people to family planning services."
McQuade, of the Catholic Bishops Conference, said any priest or nun making such referrals was veering from church policy. She contended that use of artificial contraception could increase a women's health risks and said they would fare better using natural family planning methods approved by the church.
Overall, the report is "a good news/bad news story," said Susan Cohen, the Guttmacher Institute's director of government affairs, who hailed the decline in abortions and unintended pregnancies.
"The bad news is that where most of the poor women live, throughout the developing world, unsafe abortion remains high, and women are dying as a result of it," she said. "It's so preventable, and that's the tragedy."