Why Are We Not Talking About Unsafe Abortion?

By Ruby Warnock


Increasing access to safe and legal abortion, as a part of access to comprehensive reproductive health care services, is an essential global health issue. A leading cause of maternal morbidity and mortality, the vast majority, 97%, of unsafe abortions occur in developing countries where abortions tend to be the most legally restricted [1]. The World Health Organization defines unsafe abortion as “a procedure to terminate an unintended pregnancy undertaken either by individuals lacking the necessary skills or in an environment that does not meet basic medical standards, or both,” [2]. Globally, pregnant people are highly likely to have an induced abortion when experiencing an unplanned pregnancy – regardless of the legal conditions [2]. For many pregnant people, mostly those in developing counties, abortion is legally restricted, and for many other pregnant people access to safe abortion services is insufficient even when abortion is legal – both cases lead to unsafe abortion outcomes [3]. Unsafe abortion is an entirely preventable epidemic, and the evidence shows legal restrictions on abortion do not decrease abortion rates, they simply makes the procedure unsafe and present an undue burden for pregnant people, their families, communities and societies as a whole [3, 4, 5]. Unintended pregnancy is a complex issue often leading to abortion as the pregnancy outcome. People faced with terminating a pregnancy should not have to endure the risks associated with unsafe abortion.

The issue of unsafe abortion and the resulting sequelae is especially poignant when, here in the United States, many States have enacted prohibitively restrictive abortion laws in recent years, restricting access to safe abortion for those who need it most [6, 7].  When abortions become legally restricted, those with adequate financial resources are often able to obtain safe abortions, and those lacking resources are forced to seek unsafe abortions, and suffer the consequences [4]. The burden of unsafe abortion rests with the most resource poor populations, the people who most need access to safe and legal abortion.

It is important to note, legalizing abortion does not necessitate safe abortion.  Unsafe abortions remain the norm in Colombia despite a 2006 decision by Colombia’s high court to liberalize abortion laws in the country [8]. The limited effect of liberalizing abortion laws can often be attributed to lack of awareness regarding the laws by the public and by clinicians [8]. Raising awareness regarding the consequences of unsafe abortion, along with the legal status of abortion procedures will aid in the increase of safe and legal abortions globally.

Policy change is not an easy feat.  Health policy decisions are complex and involve input from competing interests, values, and financial concerns along with the epidemiologic data [9]. This is to say, policy-making surrounding complex ethical issues rarely follows a purely evidence-based approach.  In those countries with severe legal restrictions on abortion, countless lives would be saved by liberalizing restrictive abortion laws.

Regardless of one’s personal beliefs surrounding abortion, it is irresponsible of policy makers, health care providers and public health practitioners to allow abortion to remain unsafe in any circumstance.  Restricting access to abortion does not mean abortions stop – we know this.  It is time to implement evidence based policy decisions regarding abortion and reproductive health care.  Millions of lives are at stake, the choice is clear; it is the responsibility of those passionate about human rights to fight for safe and equal access to a full spectrum of reproductive health care options, including access to safe and legal abortion.  This is not an issue exclusively experienced by those in the developing world, as we continue to limit access to reproductive health care in the United States we will continue to see unnecessary death and disability of those experiencing unwanted pregnancies. It is time to pay attention to the facts and move toward a world where people have autonomy over their bodies and where they are granted the ability to make their own decisions regarding their health and wellbeing.  Decisions regarding health care should be left between an individual and the individual’s health care provider.  It is not the business of policy makers to dictate what people cannot do with their bodies. It is essential we fight as hard as we can for a full spectrum of reproductive rights, or we will face a situation where only those who have the resources to do so can have autonomy over their reproductive health, and the rest of us will be forced to pursue unsafe and illegal options.


1.            Grimes, D.A., et al., Unsafe abortion: the preventable pandemic. The Lancet, 2006. 368(9550): p. 1908-1919.

2.            WHO, Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008, 2011, World Health Organization: Geneva.

3.            Singh, S., Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. The Lancet, 2006. 368(9550): p. 1887-1892.

4.            Lane, S.D., J. Madut Jok, and M.T. El-Mouelhy, Buying safety: the economics of reproductive risk and abortion in Egypt. Social Science & Medicine, 1998. 47(8): p. 1089-1099.

5.            Singh, S., et al., Abortion Worldwide: A Decade of Uneven Progress. 2009.

6.            Gold, R.B., Lessons from Before Roe: Will Past be Prologue? Guttmacher Report on Public Policy, 2003. 6(1).

7.            Gold, R.B. and E. Nash, TRAP Laws Gain Political Traction While Abortion Clinics—and the Women They Serve—Pay the Price. Guttmacher Policy Review, 2013. 16(2).

8.            Moloney, A., Unsafe abortions common in Colombia despite law change. The Lancet, 2009. 373(9663): p. 534.

9.            Keefe, R.H., S.D. Lane, and H.J. Swarts, From the bottom up: tracing the impact of four health-based social movements on health and social policies. Journal of Health & Social Policy, 2006. 21(3): p. 55-69.

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