Incidence and Trends Southern Africa, rates are close to the and Cape Verde, Mozambique, South ■■ During 2010–2014, an estimated 8.3 regional average of 34 per 1,000. Africa and Tunisia allow pregnancy million induced abortions occurred termination without restriction as to each year in Africa. This number ■■ The proportion of pregnancies reason, but with gestational limits. represents an increase from 4.6 million ending in abortion ranges from 12% annually during 1990–1994, mainly in Western Africa to 23% and 24% Unsafe Abortion and Its because of an increase in the number in Northern and Southern Africa, Consequences of women of childbearing age. respectively. It is 13% and 14% in ■■ Although induced abortion is medi- Middle and Eastern Africa, respectively. cally safe when done in accordance ■■ The annual rate of abortion, estimated with recommended guidelines, many at 34 procedures per 1,000 women Legal Status of Abortion women undergo unsafe procedures of childbearing age (i.e., those 15–44 ■■ As of 2015, an estimated 90% of that put their well-being at risk. years old), remained more or less women of childbearing age in Africa constant over the same period. live in countries with restrictive abor- ■■ Where abortion is restricted, women tion laws (i.e., countries falling into the often resort to clandestine procedures, ■■ The abortion rate is roughly 26 for first four categories in Table 2). Even which are often unsafe—performed married women and 36 for unmarried where the law allows abortion under by individuals lacking the necessary women. limited circumstances, it is likely that skills or in an environment lacking the few women in these countries are able minimal medical standards, or both. ■■ The proportion of pregnancies ending to navigate the processes required to in abortion, estimated at 15% in obtain a safe, legal procedure. ■■ Almost all abortion-related deaths 2010–2014, also changed little since worldwide occur in developing 1990–1994. ■■ Abortion is not permitted for any countries, with the highest number reason in 12 out of 54 African occurring in Africa. In the poorest ■■ The annual rate of abortion varies countries. countries, women have the fewest slightly by region, ranging from 38 resources to pay for safe procedures. per 1,000 women of childbearing age ■■ Five countries in Africa have relatively They are also the most likely to in Northern Africa to 31 per 1,000 in liberal abortion laws: Zambia permits experience complications related to Western Africa. In Eastern, Middle and abortion on socioeconomic grounds, unsafe abortions.
■■ In Africa, according to the most recent TABLE 1: NUMBERS AND RATES estimates, at least 9% of maternal deaths (16,000) annually were due to Regional and subregional estimates of induced abortion, unsafe abortion. Africa, 1990–1994 and 2010–2014 ■■ Region No. of abortions % of pregnancies About 1.6 million women in the region and subregion (millions) Abortion rate† ending in abortion are treated annually for complications from unsafe abortion. 1990–1994 2010–2014 1990–1994 2010–2014 2010–2014
Africa 4.6 8.3* 33 34 15 ■■ The most common complications Eastern Africa 1.4 2.7* 32 34 14 from unsafe abortion are incomplete abortion, excessive blood loss and Middle Africa 0.5 1.0* 32 35 13 infection. Less common but very Northern Africa 1.3 1.9 40 38 23 serious complications include septic Southern Africa 0.3 0.5 32 35 24 shock, perforation of internal organs Western Africa 1.1 2.2* 28 31 12 and inflammation of the peritoneum.
*Difference between 2010–2014 and 1990–1994 is statistically significant. †Abortions per 1,000 women aged 15–44. SOURCE: Sedgh G et al., Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends, The Lancet, 2016, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30380-4/abstract.
MAY 2016 TABLE 2: LEGALITY OF ABORTION, 2016 SOURCES Most data in this fact sheet Countries in Africa can be classified into six categories, according are from Sedgh G et al., to the reasons for which abortion is legally permitted. Abortion incidence between 1990 and 2014: global, Reason Countries regional, and subregional levels and trends, The Lancet, Prohibited altogether, or no Angola, Central African Republic, Congo (Brazzaville), Democratic 2016, http://www.thelancet. explicit legal exception to save Republic of the Congo, Egypt, Gabon, Guinea-Bissau, the life of a woman Madagascar, Mauritania, São Tomé and Principe, Senegal com/journals/lancet/article/ PIIS0140-6736(16)30380-4/ To save the life of a woman Côte d’Ivoire, Libya (e), Malawi, Mali (a,b), Nigeria, South Sudan, Sudan abstract, and Sedgh G et al., (a), Tanzania, Uganda Induced abortion: incidence and To preserve physical health Benin (a,b,c), Burkina Faso (a,b,c), Burundi, Cameroon (a), Chad (c), trends worldwide from 1995 (and to save a woman’s life)* Comoros, Djibouti, Equatorial Guinea (e,f), Eritrea (a,b), Ethiopia (a,b,c,d), to 2008, The Lancet, 2012, Guinea (a,b,c), Kenya, Lesotho (a,b,c), Morocco (f), Niger (c), Rwanda 379(9816):625–632. Additional (a,b,d), Togo (a,b,c), Zimbabwe (a,b,c) resources can be found in the To preserve mental health (and Algeria, Botswana (a,b,c), The Gambia, Ghana (a,b,c,d), Liberia (a,b,c), fully annotated version available all of the above reasons) Mauritius (a,b,c,e), Namibia (a,b,c), Seychelles (a,b,c,d), Sierra Leone, at https://www.guttmacher.org/ Swaziland (a,b,c) fact-sheet/facts-abortion-africa. Socioeconomic reasons (and Zambia (c) all of the above reasons) The study on which this fact Without restriction as to reason Cape Verde, Mozambique, South Africa, Tunisia sheet is based was made *Includes countries with laws that refer simply to “health” or “therapeutic” indications, which may be interpreted more broadly than physical possible by grants from the UK health. NOTES: Some countries also allow abortion in cases of (a) rape, (b) incest, (c) fetal impairment or (d) other grounds. Some restrict Government, the Norwegian abortion by requiring (e) parental or (f) spousal authorization. Countries that allow abortion on socioeconomic grounds or without restriction as to reason have gestational age limits (generally the first trimester); abortions may be permissible after the specified gestational age, but Agency for Development only on prescribed grounds. SOURCE: Center for Reproductive Rights (CRR), The World’s Abortion Laws 2016, New York: CRR, 2016. Cooperation and the Dutch Ministry of Foreign Affairs. The findings and conclusions contained within do not ■■ Many women experiencing Recommendations to safe abortion services necessarily reflect the positions complications do not receive ■■ Most women undergoing should be improved for and policies of the donors. the treatment they need abortion do so because women who meet legal and some suffer long-lasting they became pregnant criteria. health effects, such as when they did not intend chronic pain, inflammation to. Because contraceptive ■■ A liberal abortion law does of the reproductive tract and use is the surest way to not ensure the safety infertility. prevent unintended preg- of abortions. Service nancy among sexually active guidelines must be written ■■ Unsafe abortion has couples, programs and poli- and disseminated, providers negative consequences cies that improve women’s must be trained, and beyond its immediate and men’s knowledge governments must be effects on women’s health. of, access to and use of committed to ensuring that For example, complications contraceptive methods are safe abortions are available from unsafe abortion critical in reducing the need within the bounds of the may reduce women’s for abortion. law. productivity, increasing the economic burden on ■■ To reduce the high levels poor families, and result of morbidity and mortality in considerable costs to that result from unsafe already struggling public abortion, the provision of health systems. postabortion care should be improved and expanded. ■■ The extent to which misoprostol, with or without ■■ To reduce the number of Good reproductive mifepristone, is used to clandestine procedures, the health policy starts with induce nonsurgical abortions grounds for legal abortion credible research in Africa is not known. The in the region should be sale of misoprostol has broadened, and access 125 Maiden Lane increased in some African New York, NY 10038, USA 212.248.1111 countries in recent years. [email protected] www.guttmacher.org
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