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Home , Algeria, Unsafe abortion

FACT SHEET in

Incidence and trends ■■ The proportion of all in abortion for health and socioeconomic ■■ During 2010–2014, an estimated 8.2 Africa ending in abortion each year, reasons, whereas , South million induced occurred estimated at 15% in 2010–2014, has Africa and permit abortion with- each year in Africa. This number rep- changed little since 1990–1994. out restriction as to reason, with gesta- resents an increase from 4.6 million tional limits. annually during 1990–1994, mainly ■■ The proportion of pregnancies end- because of an increase in the number ing in abortion ranges from 12% in Unsafe abortion and its of women of reproductive age. Western Africa to 24% in Southern consequences Africa; rates in Middle, Eastern and ■■ Induced abortion is medically safe ■■ The annual rate of abortion for the Northern Africa are 13%, 14% and when WHO-recommended methods region is an estimated 34 per 1,000 23%, respectively. are used by trained persons, less safe women of reproductive age (15–44), when only one of those two criteria and remained more or less constant Legal status of abortion is met, and least safe when neither is between 1990–1994 and 2010–2014. ■■ An estimated 93% of women of repro- met. Many undergo ductive age in Africa live in countries unsafe (i.e., less safe or least safe) ■■ The regional abortion rate is roughly 26 with restrictive abortion laws (i.e., procedures that put their well-being per 1,000 for married women and 36 countries in the first four categories at risk. per 1,000 for unmarried women. in Table 2). Even in countries where the law allows abortion under limited ■■ During 2010–2014, an average of ■■ As of 2010–2014, the annual abor- circumstances, it is likely that few about one in four abortions in Africa tion rate varies slightly by subregion, women are able to obtain a safe, legal were safe. Of those that were unsafe, ranging from 31 per 1,000 women of procedure. the majority fell into the least-safe reproductive age in Western Africa to category. 38 per 1,000 in Northern Africa; rates ■■ Abortion is not permitted for any rea- in Eastern, Middle and Southern Africa son in 10 out of 54 African countries. ■■ In 2012, nearly seven per 1,000 are close to the regional average of 34 women of reproductive age in Africa per 1,000. ■■ Four countries in Africa have relatively were treated for complications from liberal abortion laws: permits unsafe abortion. In all, about 1.6 million women in the region are treated for such complications each year. TABLE 1: RATES AND PERCENTAGES ■■ Africa is the region with the high- Regional and subregional estimates of induced abortion, est number of abortion-related deaths. Africa, 1990–1994 and 2010–2014 In 2014, at least 9% of maternal deaths (or 16,000 deaths) in Africa were from Region % of all pregnancies and subregion Abortion rate* ending in abortion unsafe abortion. 1990–1994 2010–2014 2010–2014 ■■ The most common complications Africa 33 34 15 from unsafe abortion are incomplete Eastern Africa 32 34 14 abortion, excessive blood loss and infection. Middle Africa 32 35 13

Northern Africa 41 38 23 ■■ The poorest women with the few- Southern Africa 32 34 24 est resources are the most likely to experience complications from unsafe Western Africa 28 31 12 abortion. *Abortions per 1,000 women aged 15–44. Note: None of the differences between 1990–1994 and 2010–2014 are statistically significant.

MARCH 2018 TABLE 2: LEGALITY OF ABORTION, 2017 SOURCES Most data in this fact sheet Countries in Africa can be classified into six categories, according can be found in: Singh S to the reasons for which abortion is legally permitted. et al., Abortion Worldwide 2017: Uneven Progress and Reason Countries Unequal Access, New York: Guttmacher Institute, 2018; Prohibited altogether, (no , Congo-, Congo-, , , - explicit legal exception) , , , São Tomé and Príncipe, special tabulations of updated data from Sedgh G et al., Abortion incidence between To save life of Côte d’Ivoire, , , (a,b), , , South , 1990 and 2014: global, Sudan (a), , regional, and subregional levels To save life of woman/ (a,b,c), (a,b,c), , (a), Cen. African and trends, Lancet, 2016, preserve physical health* (a,b,c), (c), , , (d,e), 388(10041):258–267; Ganatra (a,b,c), Guinea (a,b,c), , (a,b,c), (e), B et al., Global, regional, and (c), (a,b,c), (a,b,c), (a,b,c) subregional classification of To save life of woman/preserve Algeria, (a,b,c), (a,b), Gambia, (a,b,c), abortions by safety, 2010–14: physical or mental health (a,b,c), (a,b,c,d), (a,b,c), (a,b,c), estimates from a Bayesian (a,b,c), , Swaziland (a,b,c) hierarchical model, Lancet, To save life of woman/preserve Zambia (c) 2017, 390(10110):2372–2381; physical or mental health/socio- and Bearak J et al., Global, economic reasons regional, and subregional Without restriction as to reason Cape Verde, , Tunisia trends in unintended and its outcomes from 1990 *Includes countries with laws that refer simply to “health” or “therapeutic” indications, which may be interpreted more broadly than physical to 2014: estimates from a health. Notes: Some countries also allow abortion in cases of (a) , (b) incest, (c) fetal anomaly. Some restrict abortion by requiring (d) parental or (e) spousal authorization. Countries that allow abortion without restriction as to reason have gestational age limits (generally the Bayesian hierarchical model, first trimester); for legal abortions in categories 2 through 5, gestational age limits differ by prescribed grounds. Lancet Global Health, 2018, 6(4):e380–e389. Additional resources can be found in the ■■ Unsafe abortion has nega- ■■ Most women who have an ■■ The grounds for legal abor- fully annotated version available tive consequences beyond abortion do so because they tion in the region should at https://www.guttmacher.org/ its immediate effects on become pregnant when be broadened and access fact-sheet/abortion-africa. individual women’s health. they do not intend to. As of to safe abortion services Treating complications 2010–2014, the unintended improved to reduce the increases the economic pregnancy rate in Africa number of clandestine pro- burden on poor families and as a whole is 89 per 1,000 cedures and the negative incurs considerable costs women aged 15–44; in consequences that often to already struggling public Eastern Africa, the rate is result. health systems. 112 per 1,000 women. ■■ Liberal abortion laws alone ■■ The extent to which miso- ■■ An estimated 21.6 million do not ensure the safety of prostol is used to induce unintended pregnancies abortions. Service provision abortions in Africa is not occur each year in Africa; guidelines must be adopted known; however, the sale of of these, nearly four in 10 and disseminated, provid- has increased (38%) end in abortion. ers must be trained, and in some African countries in governments must be com- recent years. Recommendations mitted to ensuring that safe ■■ Programs and policies that abortions are available. improve women’s and and unmet need men’s knowledge of, access ■■ As of 2017, about 58 mil- to and use of contraceptive lion women of reproductive methods must be imple- age in Africa have an unmet mented to reduce unin- need for modern contracep- tended pregnancies—and Good reproductive tion—that is, they want to the abortions or unplanned health policy starts with avoid a pregnancy but are births that often follow. credible research either not practicing contra- 125 Maiden Lane ■■ ception or are using tradi- The provision and quality New York, NY 10038, USA tional methods, which are of postabortion care should 212.248.1111 less effective than modern be improved and expanded [email protected] methods. to reduce illness and death from unsafe abortion. www.guttmacher.org

MARCH 2018