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Young people ages 10-24 account for 27 percent of the world’s population totaling at 1.7 billion. Worldwide, approximately 16 million women and girls ages 15 to 19 give birth each year, accounting for approximately 11 percent of all births worldwide. For these young women, complications from pregnancy and childbirth are the leading cause of death, and unsafe abortion is a major contributor to this mortality. Unsafe abortion can also result in lasting and devastating consequences, including, sepsis, perforation of the uterus or intestines, hemorrhage, chronic pelvic infection, and infertility.
Deaths due to unsafe abortion are on the decline, but the proportion of women dying from unsafe abortion globally remains the same
- According to the World Health Organization, deaths from unsafe abortion worldwide have dropped from 69,000 in 1990 to 47,000 in 2008. 
- Parallel to this decline, there has also been a one-third decline in maternal mortality from 546,000 deaths in 1990 to 358,000 in 2008. 
- Despite the decline in the number of deaths due to unsafe abortion, the proportion of women dying from unsafe abortion has remained the same at approximately 13 percent of all maternal deaths. 
- The number of unsafe abortions increased from 19.7 million in 2003 to 21.6 million in 2008 while the unsafe abortion rate remains unchanged at about 14 unsafe abortions per 1,000 women aged 15-44 years. 
- This increase in the number of unsafe abortions without a corresponding increase in the rate is mainly due to the growing population for women of reproductive age.
Young women account for a significant proportion of unsafe abortions worldwide
- According to the most recent data available from 2003, almost 14 percent of all unsafe abortions in developing countries were among women under 20 years of age.
- In developing countries, two in five unsafe abortions occur among women under age 25, and about one in seven women who have unsafe abortions is under 20.
- The proportion of women aged 15–19 in Africa who have had an unsafe abortion is higher than in any other region. 
- Almost 60 percent of unsafe abortions in Africa are among women aged less than 25 years and almost 80 percent are among women below 30. 
- In Asia, 30 percent of unsafe abortions are among women under 25 years of age and 60 percent are in women under 30. 
- In Latin America and the Caribbean, women aged 20–29 years account for more than half of all unsafe abortions, with almost 70 percent of unsafe abortions being carried out on women below 30. 
* Unsafe abortion is defined by the World Health Organization as abortion “a procedure for terminating an unintended pregnancy carried out by either persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.”
Even where abortion is legal, millions of women across the world, especially young women, face barriers to access
- Many women, especially adolescents and poor women cannot afford to access safe abortion. 
- Access to safe services may be geographically inaccessible and also limited by shortages of trained providers. 
- In many societies, the stigma associated with abortion may discourage otherwise trained and capable doctors from providing safe abortion services. 
- Marginalized populations (young people, women living with HIV, minorities, and others) may face stigma and discrimination when attempting to seek safe abortion services, resulting in denial of care or required authorization by a third party even if not needed by law. 
- Gestational limits, the need for parental or spousal consent, and mandatory waiting periods or counseling may also act as a barrier to accessing safe abortion services. 
- Confusion about the legality of abortion and whether it is legal for minors to engage in sexual intercourse can deter some adolescents from seeking safe abortion services, even if legal and available.
While more young women are using contraception around the world, there is still a tremendous unmet need for contraception and young women experience higher failure rates than older women.
Contraception Among Young Women: Unmet Need Around the World
- Around the world, 215 million women of reproductive age have an unmet need for contraception – they do not wish to have children, but are not currently using contraception.
- In some regions of the world, women ages 15-19 are two times more likely to have an unmet need for contraception than women in their 20’s.
- Young women ages 15-24 have the highest unmet need for contraception in sub-Saharan Africa, followed by Latin America and the Caribbean and South and South East Asia. 
- Rates of contraceptive use among both married and unmarried adolescents are still quite low. Contraceptive use among women ages 15-19 ranges from 20-28 percent across sub-Saharan Africa, Latin America and the Caribbean, and former Soviet Asia.
- In Africa, 20-35 percent of unmarried and married sexually active women aged 15-19 reported using contraception in nine countries in contrast with Namibia, where contraceptive prevalence reached 40 percent. 
- The lowest levels of contraceptive use in Africa occurred in five countries, including Chad, Eritrea, Mali, Niger and Senegal. 
- Current use of contraceptives is higher among sexually active, unmarried adolescents than among married youth (for example, 38 percent vs. 60 percent in Kazakhstan, and 4 percent vs. 45 percent in Nigeria). 
- In almost every country, a greater proportion of 15–19-year-olds than of women aged 20–49 reported experiencing a contraceptive failure within a year of starting method use. 
- On average, contraceptive failure rates for adolescents were about 25 percent higher than those for older women. 
- This difference is likely due to several factors, including that adolescents tend to use less effective methods than older women (especially in countries where a substantial proportion of older women are sterilized), use methods less effectively, and are more fecund.
- Unintended pregnancies account for 48 percent of all pregnancies in Southeast Asia, 44 percent in Western Asia, and 33-38 percent in Central Asia.
- Each year, there are an estimated 2.7 million unintended pregnancies among adolescent women living in South Central and Southeast Asia. 
- 93 percent of unintended pregnancies in South Central and Southeast Asia experienced by adolescent women occur among those who are using traditional or no contraceptive methods. 
- Almost all unintended adolescent pregnancies in South Central and Southeast Asia occur among married women. 
- In 2008, there were an estimated 10.8 million unsafe abortions in Asia. 
- There were a total of 6.8 million unsafe abortions in South-Central Asia, 3.1 million in South-Eastern Asia, and 830,000 in Western Asia in 2008. 
- Due to the sheer size of Asia’s population, the region accounts for 45.7 percent of all unsafe abortions among women aged 15-24 that occur yearly in the developing world.
- According to the World Health Organization, 12 percent of maternal deaths in the region are the result of unsafe abortion. 
- In the region, 2.3 million women are hospitalized each year due to complications of unsafe abortion. 
- Abortion laws vary greatly across the region, with some countries outlawing abortion entirely, some allowing abortion only to save the life of the mother, and others allowing abortion with no restrictions related to reason. 
- Almost all abortions performed in East Asia are safe, and more than half of all the safe abortions performed in the entire Asia region in 2003 occurred in China, where abortion is broadly legal and largely accessible. 
- However, even in countries where abortion is broadly legal, many women still undergo unsafe abortion due to lack of access, shortage of doctors, poor healthcare facilities, and inadequate training of medical professionals. 
In Asia, young women experience unintended pregnancy and unsafe abortion, and access to safe and legal abortion varies across the region.
- Each year, there are an estimated 2.2 million unintended pregnancies among adolescents in sub-Saharan Africa. 
- Almost 54 percent of unintended adolescent pregnancies in sub-Saharan Africa occur among married women. 
- Ninety-two percent of unintended pregnancies experienced by adolescent women in sub-Saharan Africa occur among those who are using traditional or no contraceptive methods. 
- In 2008, there were an estimated 5.5 million unsafe abortions in sub-Saharan Africa. 
- There were a total of 2.4 million unsafe abortions in Eastern Africa, 1.8 million in Western Africa, 930,000 in Middle Africa, and 120,000 in Southern Africa. 
- In sub-Saharan Africa, women under age 25 account for 60 percent of all unsafe abortions.
- According to the World Health Organization, 14 percent of maternal deaths in Africa (including Northern Africa) are the result of unsafe abortion. 
- It is estimated that in several African countries, up to 70 percent of all women who receive treatment for complications of abortion are less than 20 years of age.
- While generally restrictive, abortion laws vary across the region with countries in Southern Africa having the least restrictive laws relative to Middle Africa, which has the most restrictive laws. 
- Since 1997, the grounds on which abortion may be legally performed were broadened in Benin, Chad, Ethiopia, Guinea, Mali, Niger, Swaziland, and Togo.
Across sub-Saharan Africa, unintended pregnancy persists among adolescents, the majority of women undergoing unsafe abortion are young women, and abortion laws are restrictive but vary across the region.
Latin America and the Caribbean
- Each year, there are an estimated 1.2 million unintended pregnancies among adolescent women living in Latin America and the Caribbean. 
- About 51 percent of unintended adolescent pregnancies in Latin America and the Caribbean occur among married women. 
- The majority of unintended pregnancies among adolescent women in the region, 83 percent, occur among those using no contraception or traditional contraception. 
- Of the 4.1 million abortions performed in 2003, almost all of them were unsafe.
- In 2008, there were an estimated 4.2 million unsafe abortions in Latin America and the Caribbean. 
- There were a total of 2.9 million unsafe abortions in South America, 1 million in Central America, and 170,000 in the Caribbean. 
- According to the World Health Organization, 12 percent of maternal deaths in the region are the result of unsafe abortion. 
- In Latin America, between 10 and 21 percent of hospitalizations for complications arising from unsafe abortion occurred among adolescents, and one-third of adolescents hospitalized for abortion complications suffered sepsis.
- In Peru, one-third of the women hospitalized for abortion complications were between 15 and 24 years old.
- In Chile and Argentina, unsafe abortion was the cause of more than one-third of the maternal deaths among adolescents. 
- The Latin America and Caribbean region has generally restrictive laws on abortion, particularly in South and Central America. 
- Since 1997, the grounds on which abortion may be legally performed were broadened in Colombia, Saint Lucia, and the Mexico Federal District in Mexico. In contrast, El Salvador and Nicaragua changed their already restrictive laws to prohibit abortion entirely. 
Almost all abortions performed in the Latin America and the Caribbean region are unsafe, abortion laws are generally restrictive, and adolescents account for a substantial proportion of women suffering or dying from related complications.
The Middle East and North Africa
- In the region, 41 percent of all pregnancies are unintended.
- In the region, 36 percent of women who reported wanting to avoid a pregnancy were not using a modern contraceptive method, and these women accounted for 82 percent of all unintended pregnancies. 
- Young married women typically do not start using contraception until after they have their first child. 
- Married women ages 15 to 19 are less likely to use modern contraception than married women ages 20-24.
- In Arab countries, 1 in 6 pregnancies ends in abortion, which is almost always illegal and unsafe. 
- Tunisia and Turkey are the only countries in the region where abortion is legal on request. In most other countries, abortion is only legal to save the woman’s life or protect her health. 
- Annually, there are about 1.6 million unsafe abortions in Arab countries, and about 680,000 women require medical care for complications of unsafe abortion. 
In the Middle East and North Africa, unintended pregnancy is prevalent and most abortions are illegal and unsafe.
- Abortion rates in Eastern Europe fell by more than 50 percent between 1995 and 2003, due primarily to increased access to quality modern contraception throughout the region. 
- There were an estimated 360,000 unsafe abortions in Eastern Europe in 2008. 
- Unsafe abortion is still a problem, with 5 unsafe abortions/1,000 women aged 15-44. 
- Though abortion has been broadly legal in Eastern Europe since the 1950s, unsafe abortions continue to occur, due to an unmet need for family planning and the expense of abortion. 
- During the Soviet Union, abortion was the primary method of family planning for most couples, since it was extremely difficult to obtain modern contraceptives, while relatively easy to access abortion services. Abortion rates remain high in this region compared to the rest of Europe. 
In Eastern Europe, abortion is broadly legal and the region has experienced the most significant drop in abortion rates worldwide due to increased contraceptive use.
- The lowest abortion rate in the world is in Western Europe, with 12 abortions per 1,000 women aged 15-44. 
- The incidence of unsafe abortion in Western Europe is negligible. 
- Much of the low rates of abortion in Western Europe can be attributed to high levels of contraceptive access. 
- Young people throughout the region generally have access to free or low-cost contraception and receive comprehensive sexuality education, and adults view adolescent sexuality as normal and healthy.
- As a result of comprehensive sexuality education, access to contraception and society’s open attitudes to teen and young adult sexuality, teen pregnancy rates in Western Europe are some of the world’s lowest, such as 14.1, 18.8, and 25.7 teen pregnancies/1,000 women aged 15-44 in the Netherlands, Germany, and France, respectively. 
- Abortion is broadly legal in Western Europe, with only Ireland outlawing abortion in all cases except to save the life of the mother.
Unsafe abortion is negligible in Western Europe and the region has the lowest abortion rate in the world.
- In the United States, 82 percent of the approximately 750,000 teen pregnancies that occur each year are unintended, and more than one-quarter of those pregnancies end in abortion.
- Pregnancy rates among adolescent women in the U.S. are twice as high as those in neighboring Canada. 
- Approximately 1.5 million abortions take place in Northern America each year. 
- About three in ten of all American women 15-44 will have an abortion in their lifetime.
- Women in their twenties account for more than half of all abortions in the U.S. with women aged 20–24 accounting for 33 percent of all abortions and women aged 25-29 accounting for 24 percent. 
- According to the World Health Organization, the incidence of unsafe abortion in North America is negligible.
- In Canada, abortion services are legal without restriction. 
- In the United States, abortion services are legal but with increasing state-level barriers in the form of parental consent laws, required waiting periods, gestational limits, ultrasound laws, and clinic regulations that limited access to providers that offer abortion services, among others.
In North America, teen pregnancy persists in parts of the region, unsafe abortion is negligible, and while abortion is legal and safe, it is increasingly less accessible in parts of the United States.
Conflict Zones and War Settings
- Adolescents who are faced with poverty or separation from their families or communities as a result of an emergency situation are at risk of sexual violence.
- Adolescent survivors of sexual violence are at risk of physical injury, STIs including HIV, unwanted pregnancy and unsafe abortion. 
- Half of internally displaced women in Sierra Leone who had direct contact with combatants were victims of sexual violence.
- Half a million women were sexually assaulted during the 1994 Rwandan genocide. 
- In the Balkans, in Bosnia and Herzegovina up to 50,000 women of all ethnic groups were raped. 
- Wartime sexual violence and rape often results in coercive pregnancies, forced motherhood and unsafe abortion. 
- For many women in conflict situations who want to terminate a pregnancy, unsafe abortion is their only option. 
- About 25 to 50 percent of all maternal deaths in refugee situations are related to unsafe abortion.
- Conflict zones and war settings often experience a breakdown in public health services due to scarcity of money and resources. This scarcity results in little to no access to birth control, and pregnancy-related care.
- The introduction of technology and training to perform safe abortions in refugee camps and host communities could greatly improve the health and wellbeing of displaced communities. Such training has already been introduced and used in refugee and other humanitarian relief settings, including Sudan, Ethiopia, Thailand, Kenya and Pakistan.
Unsafe abortions are common in conflict zones and war settings and young women are at particular risk due to sexual violence and coercion.
Abortion Laws Around the World
- Globally, 60 percent of women of reproductive age (15-44) live in countries where abortion is broadly legal. 
- The remaining 40 percent live in places where abortion is highly restricted, which are almost entirely in the developing world. 
- Among women of reproductive age, 92 percent in Africa and 97 percent in Latin America live under severely restrictive abortion laws. 
- In 32 countries, abortion is not legally permitted on any grounds. 
- In 36 countries, abortion is permitted when a woman’s life is threatened. 
- A further 59 countries allow abortion to save a woman’s life, to preserve her physical health, and to protect her mental health. 
- Fourteen countries, including India, permit abortion on all the previously mentioned grounds, in addition to socioeconomic grounds. 
- Lastly, a total of 56 countries and territories allow abortion without restriction to reason. 
Globally, abortion laws are immensely varied based on the grounds for which abortion is permitted, which ranges from no grounds to some, such as to save a woman’s life, to preserve physical health, to preserve mental health, in the case of rape or incest, in the case of fetal impairment, for economic or social reasons, and without restriction as to reason.
Irrespective of legal conditions, women all over the world, including young women, are highly likely to have an abortion when faced with an unplanned pregnancy. Abortion prevalence is higher where the unmet need for family planning is high, contraceptive prevalence is low, and less-effective contraceptive methods prevail. Where abortion laws are the least restrictive there is no or very little evidence of unsafe abortion, while legal restrictions increase the percentage of unlawful and unsafe procedures. Unsafe abortion, in turn, puts all women, including young women, at risk of maternal death and morbidity. Quality sexuality education, family planning and reproductive health services, and access to quality contraceptive commodities in combination with less restrictive abortion laws are urgently needed to reduce unintended pregnancy, unsafe abortion, and associated maternal mortality and morbidity among youth.
Written by Liz Bayer, Nicole Cheetham, and Sarah Robbins, International Division
Advocates for Youth © October 2011
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