Policy Brief

of 11
UNSAFE
ABORTION
The Unique Problem of the
Developing World
Evidence from across the Global South
By Rakib Miah
Abstract
The World Health Organization estimates 21.6 million unsafe abortions occur annually. This exacts
significant human costs in terms of maternal mortality and morbidity, as well as costs to health systems,
economies and human capital. Unsafe abortions, and the subsequent costs, are virtually exclusive
developing world burdens. Moreover, efforts to counter unsafe abortion by developing regions are key in
order to meet the Sustainable Development Goal (3.1) of reducing global maternal mortality from 216 to
70 per 100,000 live births by 2030.
With research from across the Global South, this brief discusses three inter-related causes of unsafe
abortion: (1) restrictive abortion laws, (2) the lack of contraceptive usage, and (3) abortion stigma at the
community-level and in healthcare settings. Based on these causes, and on evidence of existing policies,
to counter unsafe abortion this paper suggests the following policy options: (1) liberalise abortion laws to
provide safe abortion services on the widest grounds possible; (2) increase contraception usage amongst
populations which have an unmet need for family planning services; and (3) tackle abortion stigma
amongst populations, particularly healthcare professionals, through sensitisation and outreach activities,
use of popular media and public platforms and legislation.
Abbreviations List
SDG(s) Sustainable Development Goal(s)
UARMDs Unsafe Abortion Related Maternal Deaths
UARMM Unsafe Abortion and Related Mortality and Morbidity
WHO World Health Organization

of 11
Introduction: the developing
world burden of unsafe
abortion
The World Health Organizaton (WHO) (2011)
estimates 21.6 million unsafe abortions occur
annually (Box. 1 below). For regions affected by
the phenomenon of unsafe abortion, alongside a
gross human cost in mortality and morbidity, there
is a needless (financial) burden on public health
systems, economies and on human capital,
associated with the occurrence of unsafe abortion
(Panel. 1). Indeed, with every unsafe abortion there
is a risk of morbidity and mortality.
As 98% of unsafe abortions occur in developing
regions (ibid.), it follows the costs are also virtually
exclusive developing world burdens. Though, even
within developing regions rates of unsafe abortion
vary widely, as does the rate of unsafe abortion-
related maternal deaths (UARMDs) (Panel. 2;
Winikoff and Sheldon, 2012, p.595).
That said, the salient point which cannot be
understated is that the phenomenon of unsafe
abortion, and consequent human, economic and
financial costs are ‘entirely’ preventable (Faúndes
and Shah, 2015, p.S56). Aside from the known
relative simplicity of preventative measures to
reduce the need for unsafe abortion
(contraception), the technology and knowledge also
exist to safely induce an abortion (Grimes et al.,
2006, p.1908); in fact, one study in the United
States (U.S.) found the risk of a woman dying from
childbirth is approximately 14 times higher than
the risk of dying from abortion (Raymond and
Grimes, 2012). Yet, women in developing regions
continue to die, and suffer morbidity, from unsafe
abortion.
Panel. 1. Consequences of Unsafe Abortion.
Sources: WHO (2011); Singh and Maddow-Zimet (2015); Vlassoff et al. (2008);
Singh et al., (2009); United Nations (2009); Alder et al. (2012).
Panel. 2. Selected Indicators of Unsafe
Abortion in the Developing World.
Sources: WHO (2011); Singh and Maddow-Zimet (2015); Vlassoff et al. (2008);
Singh et al., (2009); United Nations (2009); Alder et al. (2012).
21.6
million unsafe abortions
occur yearly
$500m
is the annual cost to health
systems in developing regions
$400m
annual cost in lost productivity
in developing regions
47,000
women die every year from
unsafe abortion
5 to 7
million women suffer morbidity
annually in developing regions
CONSEQUENCES OF
UNSAFE ABORTION
Consequences of unsafe abortions
are almost exclusively developing
regions burdens
5
million productive life
years lost annually
due to mortality and
morbidity
of global maternal mortality
13%
of global maternal mortality is
due to unsafe abortion
97%
40%
9%
95%
15%
Africa Asia Eastern Europe La1n America and
the Caribbean
Oceania
Es+mated Propor+ons of Unsafe Abor+on and Safe Abor+on by Region, 2008
Safe
Unsafe
30
220
460
160
30 30
400
Developed
Regions
Developing
Regions
Africa Asia Eastern Europe La7n America
and the
Caribbean
Oceania
Es*mated Number of Deaths per 100,000 Unsafe Abor*ons, 2008

of 11
As this brief will discuss, there are three main root
causes of unsafe abortion across developing
regions: restrictive abortion laws, a lack of
contraceptive usage and societal stigma relating to
abortion.
With political will from developing governments
confronted by the public health risk of unsafe
abortion, such root causes can be counteracted so
as to reduce the prevalence of unsafe abortion and
its detrimental consequences. More pertinently,
with the newly established Sustainable
Development Goals (SDGs), action by
governments targeting unsafe abortion should be a
key effort to achieve the SDGs relating to global
(maternal) health (Box. 2).

An unsafe abortion is defined by the WHO (2011, p.02) as a
procedure for terminating an unintended pregnancy that is
‘carried out either by a person lacking the necessary skills, or in an
environment that does not conform to minimal medical standards,
or both’.

An unsafe abortion may be self-induced, carried out by
clandestine medical practitioners outside of prescribed health
facilities, or traditional healers (ibid. p.14). For an abortion to be
“safe” it needs to consist of pre- and post-abortion care which,
along with the actual abortion procedure itself, have to conform
to minimal medical standards as defined by current guidelines
issued by the WHO regarding abortion services (see WHO (2012)
for current guidelines; Ganatra et al., 2014).

Common methods to induce an unsafe abortion, particularly by
those women who self-induce or use traditional healers, include:
oral ingestion of toxic chemical or herbal abortificants, by
inserting foreign bodies into the uterus, or by causing trauma to
the abdomen (Grimes et al., 2006; WHO, 2011; Fawcus, 2008).
Unsurprisingly, then, unsafe abortion is a significant cause of
maternal-mortality and short- and long-term morbidity, including
infertility, chronic pelvic pain, various organ failures and sepsis
(Fawcus, 2008; Vlassof et al., 2008; Alder et al., 2012). The last
inducement method, in particular, involves vigorously pummelling
the woman’s lower abdomen which can cause the ‘uterus to
rupture’ (WHO, 2011, p.14) resulting in death, and is used in
contexts diverse as equatorial Africa and the South Pacific
(Ugboma and Akani, 2004; Grimes et al., 2006) by traditional
healers.
BOXONE
Definition of Unsafe Abortion

BOXTWO
Unsafe Abortion and the SDGs
In September 2015, the Sustainable Development Goals (SDGs), following the Millennium Development Goals (MDGs) between 2000 and 2015,
were adopted by nearly 200 countries to address poverty, food security, climate change and other areas essential to human development
(MacNaughton and Frey, 2016, p.608; Jha et al., 2016; see United Nations, 2015b; 2015c for more information).

In particular, the SDG-3.1 target calls for reducing the global maternal mortality ratio (MMR) from 216 per 100,000 live births in 2015 to less than
70 per 100,000 live births by 2030 (UNICEF, 2016). Considering unsafe abortion currently accounts for 13% of all maternal deaths (WHO, 2011)—
which may be higher in individual developing countries such as India (8-20%) (Armo et al., 2015) and Zambia (30%) (Coast and Murray, 2016)—
reducing entirely preventable unsafe abortions should be a key effort by developing governments for attaining SDG-3.1.

Targeting this preventable cause of maternal mortality in the context of the SDGs is made more so important considering the difficulty in
achieving the MDG-5.A, which called for a 75% reduction in the MMR between 1990 and 2015 (United Nations, 2015b). The international
community failed to achieve this target: analysis by Alkema et al. (2015) shows the MMR reduced by 44% (The Lancet, 2015); to achieve SDG-3.1,
the MMR needs to be reduced by 68% - a slightly lower target than MDG-5.A, but one significantly higher than what has been achieved
historically.

of 11
What are the root causes of
unsafe abortion in the
developing world?
Restrictive Abortion Laws
The first root cause of unsafe abortion and related
mortality and morbidity (UARMM) is restrictive
abortion laws across developing regions (Ahman
and Shah, 2011). Analysis of 165 countries by
Berer (2004) demonstrates unsafe abortion and
UARMDs is highest in countries with restrictive
abortion laws compared to countries with liberal
laws. Figure. 1 below graphically depicts that the
countries with the most restrictive abortion laws—
where abortion is only allowed to save a woman’s
life or it is prohibited altogether—are primarily in
developing regions (Mundigo, 2006, p.54).
Figure. 1. Countries with the Most Restrictive
Abortion Laws.
Source: Centre for Reproductive Rights (2015)
The relationship between UARMM and restrictive
abortion laws is twofold, and both act as significant
determinants of UARMM (Shah and Ahman,
2010). The more restrictive abortion laws: (1) the
less likely public health provisions will exist to aid
women seeking a safe abortion (Faúndes, 2012,
p.S70), especially when the legally-sanctioned
reasons for abortion are narrow, such as only to
preserve a mother’s life. Because of restrictive
abortion laws, women who seek an abortion for
reasons that fall outside of the scope of national
abortion laws are forced to either self-induce or to
use a clandestine provider (Faúndes and Shah,
2015, p.S57; Hosseini-Chavoshi et al., 2012) – that
is, to have an unsafe abortion.
This then produces the second relationship
between UARMM and restrictive abortion laws:
(2) following an unsafe abortion, the risk of
criminalisation for inducing an abortion outside of
the legal remit may discourage women to seek
medical care for post-unsafe abortion
complications (Cohen, 2009).1 In both instances,
women are risking mortality and morbidity.
The support for restrictive abortion laws, tempered
by social and religious norms (Mundigo, 2006),
stems primarily from a fear that liberalising
abortion laws will lead to an increase in women
using abortion to control their fertility (Faúndes,
2012, p.S70). This fear, however, is unfounded
(Box. 3 below).
Indeed, while ethical considerations pertaining to
social and religious norms regarding abortion are,
of course, for individual societies to reconcile, from
a public health perspective the message is clear:
restrictive abortion laws are a strong determinant
of UARMM across developing regions (Grimes et
al., 2006, p.1908).

1 This may partly explain why there are a substantial segment of women
who suffer post-unsafe abortion complications but do not seek medical
care, thereby risking mortality and morbidity. The estimated proportions
of such women regionally (e.g. South-East Asia, 19%) and nationally
(e.g. Guatemala, 20%) are relatively high (Singh et al., 2005; Singh et
al., 2006).

of 11
Lack of Contraceptive Usage
Related to restrictive abortion laws, the second
root cause of UARMM is due to a lack of
contraceptive usage. UARMM results from a want
to terminate a pregnancy that is unintended and
unwanted (Mundigo, 2006, p.50). Considering
developing regions are characterised by restrictive
abortion laws (Shah and Ahman, 2010), in such
contexts, then, for a woman wanting to abort a
pregnancy because it is unintended and
unwanted—which are generally legally prohibited
reasons for abortion—she may resort to unsafely
aborting a pregnancy.
The reasons why pregnancies may be unintended
and unwanted are diverse (Grimes et al., 2006,
p.1909). However, notwithstanding the occurrence
of unintended pregnancies due to sexual violence
(Faúndes and Shah, 2015, p.S56), Bankole et al.
(1999) found 50% or more of women across 20
countries in developing regions gave their desire to
control family size and growth as the most
important reason for wanting an abortion.
Though, unintended and unwanted pregnancies,
and thus unsafe abortions, can to a large extent be
avoided with use of modern contraceptive methods
(Culwell et al., 2010; Fawcus, 2008, p.S38).
However developing regions, which already
experience high rates of unintended pregnancies
(Sedgh et al., 2014, pp.307-308), are overall
characterised by the relatively low prevalence of
contraceptive usage (Box. 4). Consequently,
increasing the contraceptive prevalence across
developing regions is imperative to reducing
UARMM (Benagiano and Pera, 2000).
Abortion Stigma
The third root cause of UARMM is abortion
stigma, which, like support for restrictive abortion
laws, is tempered by social and religious norms
(Mundigo, 2006). Even in contexts where there is
provision of safe abortions services, a critical factor
that may determine usage of such services is
abortion stigma, particularly at the community-
level and in healthcare settings.
Community-Level Stigma
In contexts diverse as Mexico and Malawi,
community-level stigma includes branding women
who abort pregnancies as “sinners” and “evil”

BOXTHREE
Does liberalising abortion laws result
in an increase in abortion rates?
In a May 2016, a joint WHO/Guttmacher Institute study published
in The Lancet found the abortion rate per 1000 women aged 15-44
shows no association with the restrictive/liberal nature of abortion
legislation (Sedgh et al., 2016). For example, the abortion rate for
countries with the most restrictive laws (prohibited altogether or to
save a woman’s life) is 37, while the rate for countries with the
most liberal laws (on request) is 34.

This corroborates previous evidence from liberal abortion countries
which suggests liberalisation is not associated with an increase in
abortion rates (The Alan Guttmacher Institute, 1999, p.28).
Moreover, in some liberal abortion countries, such as the U.S.,
Finland and Denmark, abortion rates are even declining (Peiró et al.,
2012; Gissler et al., 1996; Harper et al., 2005).

BOXFOUR
Low prevalence of contraception
Developing regions are characterised by low prevalence of
contraception usage. Across the least developed countries, for
example, only 40% of married, or in-union, women of reproductive
age use contraceptives (United Nations, 2015a, p.08; Chintsanya,
2013; Palamuleni, 2014); in individual developing countries, like
Sudan, it may be low as 10% (Kinaro et al., 2009); in Sub-Saharan
Africa, it is estimated 1 in 4 women of reproductive age do not use
contraceptives (WHO, 2012).

of 11
(Shellenberg et al., 2011, p.S112; Levandowski et
al., 2012, p.S169) and as violating core societal
values of pro-creation, with abortion resulting in
‘strong community condemnation’ (Sorhaindo et
al., 2014, p.638).
Such stigmatizing behavior can determine
UARMM in two inter-related ways. Community-
level stigma may: firstly, compel women to seek
clandestine abortions, such as self-inducement,
despite (potential or actual) legal provisions for
abortion services, in an effort to avoid ‘revealing
their intention to terminate a pregnancy’
(Sorhaindo et al., 2014, p.623); and, secondly, act
as a disincentive in seeking medical care for post-
unsafe abortion health complications for fear of a
woman’s abortion being revealed (Coast and
Murray, 2016, p.202).
Stigma in Healthcare Settings
Though, community-level stigma affects not only
abortion-seeking women; it can also impact
healthcare professionals. Women may be
compelled to seek a clandestine abortion because,
as in Brazil, medical professionals may refuse to
perform abortion services through morally-based
conscientious objection (Seid et al., 2015) and for
fear of being stigmatised and ostracised (Faúndes et
al., 2013, p.S58); for example, only 2% of Brazilian
physicians in Faúndes et al. (2004)’s study were
willing to provide abortions themselves.
Moreover, Warenius et al. (2006) find nurses-
midwives in Zambia (which has relatively liberal
abortion laws) and Kenya strongly disapprove of
abortion based on religious and ethical reasons
(Koster-Oyekan, 1998; Rogo et al., 1998).
Consequently, such attitudes from healthcare
professionals may, as in South Africa, discourage
women to seek a legally-sanctioned abortion from
public health facilities, due to, in particular, an
‘expected poor quality of service’ (Faúndes and
Shah, 2015, p.S56) and treatment from healthcare
professionals. Therefore, in Kenya and South
Africa, despite a legal entitlement to a public
provision of abortion services, women still
resort to unsafe abortion.
Furthermore, even following an unsafe abortion, if
a woman is to seek medical care from health
complications, anti-abortion attitudes of healthcare
professionals put women in risk of mortality and
morbidity (Box. 5).
Policy Recommendations
The following policy recommendations are
intended to form as the foundations of action,
consisting of inter-related primary interventions by
(primarily) developing governments confronted by
unsafe abortion.

BOXFIVE
Abortion stigma in Gabon
In an analysis of maternal death at Libreville Hospital in Gabon,
Mayi-Tsonga et al. (2009) find healthcare professionals grossly
delayed the care for death-causing abortion-related conditions
compared to other pregnancy-related conditions: the former was
delayed by 23.8 hours, whereas the latter was as low as 1 hour.

The authors note there is a ‘sense’ abortion stigma is responsible
for this mistreatment (ibid., p.68). Indeed, abortion is socially-
rejected in Gabon, particularly by healthcare professionals, and this
a common theme across Sub-Saharan African countries (e.g.
Mngadi et al., 2008). Though, such mistreatment of women
seeking post-abortion care by stigmatizing healthcare professionals
is not excusive to Gabon; it has also been evidenced in, for
example, Argentina (Steele and Chiarotti, 2004).

of 11
ONE POLICY RECOMMENDATION
ONE
LIBERALISE ABORTION LAWS
POLICY IMPLICATIONS
•  Governments should liberalise abortion laws to provide
safe abortion services through public health systems on
the widest grounds possible.
•  In countries diverse as South Africa (Jewkes and Rees, 2005), Romania (The
Lancet, 1995) and Ethiopia (Sedgh et al., 2012), liberalisation of abortion laws has
drastically reduced UARMM.
•  However, research in Ethiopia, India, Cambodia, Colombia, Mexico City and Nepal
suggests the success of liberalising abortion laws on reducing UARMM rests on
increasing public awareness of newly established entitlement to legal abortion
services (Malter, 2012; Grimes, 2003; Seid et al., 2015).
•  Such public information efforts are also key to reduce resistance to liberalisation
by dispelling popular misconceptions regarding abortion (Garcia et al., 2004).
•  Liberalising abortion laws will require investments in the infrastructure and
resources needed to provide safe abortions. However, liberalising abortion does
not ‘appreciably’ increase demand for abortion (Grimes et al., 2006, p.1912),
therefore it should not represent additional burdens on weak public health
systems.
•  Indeed, abortion rates over the long-term may decline, and savings may be made
from treating (reduced) unsafe abortion complications, and ‘net economic gains’
from increased productivity (Faúndes, 2012, p.S70).
•  For countries lacking the financial and/or structural capacity to provide safe
abortion services through public health systems following liberalisation, this
presents a potential target for international donor intervention(s).
•  Governments can seek to partner with the international donor community to
assess the feasibility of third-party provision of abortion services.
TWO POLICY RECOMMENDATION
TWO
INCREASE CONTRACEPTIVE USAGE
POLICY IMPLICATIONS
•  The ‘surest way’ (Norris et al., 2016, p.08) to reduce
UARMM is to prevent unwanted pregnancies.
•  Therefore, governments should work towards increasing
modern contraception usage amongst their populations
(Fawcus, 2008, p.S39) to reduce UARMM.

To do this, governments could:

•  Include sexual and reproductive health classes within
educational curriculums to, for example, discuss
contraception, to dispel misconceptions regarding the
latter and of abortion (Levandowski et al., 2012, p.S169).
•  Distribute free male and female contraceptives.
•  Create networks of community-based local volunteers to
provide family planning services, including distribution of
contraceptives, and family planning and reproductive
health advice.
•  In Bulgaria, Kyrgyzstan, Kazakhstan, Switzerland, Tunisia, Turkey and Uzbekistan
general abortion rates declined as use of modern contraception increased
(Marston and Cleland, 2003).
•  The strategy of creating networks of community volunteers has been used in
Zimbabwe, Peru, Nepal, Columbia and Nigeria to achieve a variety of health
outcomes: ‘A regular client-worker contact can improve the use of
contraception’ (Kabir et al., 2013, p.08).
•  However, no contraceptive method is 100% effective (Grimes et al., 2006, p.1914).
•  The WHO (2012, p.23) estimates even with perfect (i.e. correct and consistent) use
of contraception by women and men, 33 million women worldwide experience
unintended pregnancies annually.
•  This further suggests the need for public provision of liberal abortion services
across developing regions.

of 11
Conclusion
In conclusion, unsafe abortion and its consequent
costs represent an entirely preventable
phenomenon, and is a virtually exclusive
developing world burden. With political will from
developing governments, targeting the three
discussed causes (restrictive abortion laws, a lack of
contraceptive usage, and abortion stigma) can
reduce unsafe abortions. To this end, this brief
recommends three policy options. Indeed, such an
effort by developing governments is key to meeting
the SDG relating to maternal mortality.
Bibliography
Ahman, E. and Shah, H. I. 2011. New estimates and trends regarding unsafe
abortion mortality. International Journal of Gynecology &
Obstetrics. [Online]. 115(2), pp.121-126. [Accessed 23rd April 2016].
Available from:
http://www.sciencedirect.com/science/article/pii/S002072921100377
8
Alkema, A., Chou, C. Dr., Hogan, D., Zhang, S., Moller, B., Gemmill, A., Fat,
M. D., Boerma, T., Termmerman, M. Prof., Mathers, C. and Say, L.
Global, regional, and national levels and trends in maternal mortality
between 1990 and 2015, with scenario-based projections to 2030: a
systematic analysis by the UN Maternal Mortality Estimation Inter-
Agency Group. The Lancet. [Online]. 387(10017), pp.462-474.
[Accessed 29th April 2016]. Available
from:http://www.sciencedirect.com/science/article/pii/S01406736150
08387
Armo, M., Babbar, K., Thakur, H. and Pandey, S. 2015. Maternal morbidity
due to unsafe medical abortion in rural practice is just the tip of the
iceberg: is it really preventable? International Journal of
Reproduction, Contraception, Obstetrics and Gynecology.
[Online]. 4(1), pp.56-60. [Accessed 21st April 2016]. Available from:
http://www.scopemed.org/fulltextpdf.php?mno=172499
Bankole, A., Singh, S. and Haas, T. 2010. Reasons Why Women Have Induced
Abortions: Evidence from 27 Countries. International Perspectives
on Sexual and Reproducitve Health. [Online].24(3), [no page
numbers]. [Accessed 27th April 2016]. Available from:
https://www.guttmacher.org/about/journals/ipsrh/1998/09/reasons-
why-women-have-induced-abortions-evidence-27-countries
Benagiano, G. and Pera, A. 2000. Decreasing the need for abortion: challenges
and constraints. International Journal of Gynecology & Obstetrics.
[Online]. 70(1), pp.35-48. [Accessed 26th April 2016]. Available from:
9
Berer, M. 2004. National Laws and Unsafe Abortion: The Parameters of
Change. Reproductive Health Matters. [Online]. 12(24), pp.01-08.
[Accessed 26th April 2016]. Available from:
1
Calhoun, C. B. 2015. The Myth That Abortion is Safer Than Childbirth:
Through the Looking Glass. Issues in Law & Medicine. [Online].
30(2), pp.209-215. [Accessed 25th April 2016]. Available from:
http://europepmc.org/abstract/med/26710380
Center for Reproductive Rights. 2015. The World's Abortion Laws Map.
[Online]. [Accessed 26th April 2016]. Available from:
THREE POLICY RECOMMENDATION
THREE
REDUCE ABORTION STIGMA
POLICY IMPLICATIONS
•  Governments should work towards reducing abortion
stigma amongst their populations, and particularly
amongst healthcare professionals.

To do this, governments could:

•  Conduct sensitisation and outreach activities to increase
awareness of abortion, the consequences of restrictive
abortion laws and abortion stigma (UARMM), and to
dispel misconceptions regarding abortion.
•  Convey such messages through popular media, including
popular entertainment, to ‘normalise abortion within
public discourse’ (Norris et al., 2011).
•  Create visible public platforms to encourage religious
authorities to engage with the debates surrounding the
liberalisation of abortion and its consequences.
•  Legislate the requirements – in terms of medical
treatment and professional service – of healthcare
professionals vis-à-vis abortion services (Malter, 2012).
•  Changing societal attitudes regarding abortion is, quite obviously, a long-term
investment whose dividends may not materialise in the immediate future.
However, tackling abortion stigma is key to counteracting UARMM.
•  As discussed, even despite liberal abortion laws, women may still seek an unsafe
abortion due to abortion stigma.
•  In Malawi, following sensitisation, health workers reported that they felt their
colleagues treatment of women with post unsafe-abortion complications had
improved (Levandowski et al., 2012, p.S169).

of 11
http://www.reproductiverights.org/document/the-worlds-abortion-
laws-map
Chintsanya, J. 2013. Trends and Correlates of Contraceptive Use among
Married Women in Malawi: Evidence from 2000-2010 Malawi
Demographic and Health Surveys. [Online]. Washington: United
States Agency for International Development. [Accessed 24th April
2016]. Available from:
https://dhsprogram.com/pubs/pdf/WP87/WP87.pdf
Coast, E. and Murray, F. S. 2016. “These things are dangerous”:
Understanding induced abortion trajectories in urban Zambia. Social
Science & Medicine. [Online]. 153(1), pp.201-209. [Accessed 21st
April 2016]. Available from:
6
Cohen, A. S. 2009. Facts and Consequences: Legality, Incidence and Safety of
Abortion Worldwide. Guttmacher Policy Review. [Online]. 12(4),
[no page numbers]. [Accessed 26th April 2016]. Available from:
https://www.guttmacher.org/about/gpr/2009/11/facts-and-
consequences-legality-incidence-and-safety-abortion-worldwide
Culwell, R. K., Vekemans, M., Silva, D. U., Hurwitz, M. and Crane, B. B.
2010. Critical gaps in universal access to reproductive health:
Contraception and prevention of unsafe abortion. International
Journal of Gynecology and Obstetrics. [Online]. 110(1), pp.S13-
S16. [Accessed 27th April 2016]. Available from: http://0-
www.sciencedirect.com.wam.leeds.ac.uk/science/article/pii/S00207292
10001608
Faúndes, A. 2012. Strategies for the prevention of unsafe abortion.
International Journal of Gynecology and Obstetrics. [Online].
119(1), pp.S68-S71. [Accessed 21st April 2016]. Available from:
2
Faúndes, A. and Shah, H. I. 2015. Evidence supporting broader access to safe
legal abortion. International Journal of Gynecology & Obstetrics.
[Online]. 131(1), pp.S56-S59. [Accessed 21st April 2016]. Available
from:
5
Faúndes, A., Duarte, A. G, Neto, A. J. and Sousa, D. H. M. 2004. The Closer
You Are, the Better You Understand: The Reaction of Brazilian
Obstetrician–Gynaecologists to Unwanted Pregnancy. Reproductive
Health Matters. [Online]. 12(34), pp.47-56. [Accessed 27th April
3
Faúndes, A., Duarte, A. G. and Osis, D. J. M. 2013. Conscientious objection or
fear of social stigma and unawareness of ethical obligations.
International Journal of Gynecology & Obstetrics. [Online].
123(3), pp.S57-S59. [Accessed 24th April 2016]. Available from:
X
Fawcus, R. S. 2008. Maternal mortality and unsafe abortion. Best Practice &
Research Clinical Obstetrics & Gynaecology. [Online]. 22(3),
pp.533-548. [Accessed 21st April 2016]. Available from:
http://www.bestpracticeobgyn.com/article/S1521-6934(07)00169-
1/fulltext?mobileUi=0
Ford, L. and Galatsidas, A. 2014. Abortion rights around the world - interactive.
[Online]. The Guardian. 1 October. [Accessed 26th April 2016].
Available from: http://www.theguardian.com/global-development/ng-
interactive/2014/oct/01/-sp-abortion-rights-around-world-interactive
Ganatra, B., Tunçalp, Ö., Johnston, B. H., Johnson, R. B. Jr., Gülmezoglu, M.
A. and Temmerman, M. 2013. From concept to measurement:
operationalising WHO's definition of unsafe abortion. Bull. World
Health Organ. [Online]. 92(155), [no page numbers]. [Accessed 27th
http://www.scielosp.org/pdf/bwho/v92n3/0042-9686-bwho-92-03-
155.pdf
Garcia, G. S., Tatum, C., Becker, D., Swanson, K. A. and Lockwood, K. 2004.
Policy Implications of a National Public Opinion Survey on Abortion in
Mexico. Reproductive Health Matters. [Online]. 12(24, Supplement),
pp.65-74. [Accessed 26th April 2016]. Available from:
4?np=y
Gebreselassie, H., Gallo, F. M., Monyo, A. and Johnson, R. B. 2005. The
magnitude of abortion complications in Kenya. BJOG: An
International Journal of Obstetrics and Gynaecology. [Online].
112(9), pp.1229-1235. [Accessed 24th April 2016]. Available
from:http://onlinelibrary.wiley.com/doi/10.1111/j.1471-
0528.2004.00503.x/abstract;jsessionid=0F57C75ECEB264206DDE7D
5A33F556AC.f02t03
Gissler, M., Ulander, V., Hemmiki, E. and Rasimus, A. 1996. Declining
Induced Abortion Rate in Finland: Data Quality of the Finnish Abortion
Register. International Journal of Epidemiology. [Online]. 25(2),
http://ije.oxfordjournals.org/content/25/2/376
Grimes, A. D. 2003. Unsafe abortion: the silent scourge. British Medical
Bulletin. [Online]. 67(1), pp.99-113. [Accessed 21st November 2016].
Available from: http://bmb.oxfordjournals.org/content/67/1/99.short
Grimes, A. D., Benson, J., Singh, S., Romero, M., Ganatra, B., Okonofua, E. F.
and Shah, H. I. 2006. Unsafe abortion: the preventable pandemic. The
Lancet. [Online]. 368(9550), pp.1908-1919. [Accessed 21st April 2016].
Available from:
6
Harper, C. C., Henderson, T. J. and Darney, D. P. 2005. Abortion in the
United States. Annual Review of Public Health. [Online]. 28(1),
http://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.2
6.021304.144351
Hosseini-Chavoshi, M., Abbasi-Shavazi, J. M., Glazebrook, D. and McDonald,
P. 2012. International Journal of Gynecology & Obstetrics.
[Online]. 118(2), pp.S172-S177. [Accessed 21st April 2016]. Available
from:
6
Hubacher, D. and Trussell, J. 2015. A definition of modern contraceptive
methods. Contraception. [Online]. 92(5), pp.420-421. [Accessed 26th
0
Jewkes, R. and Rees, H. 2005. Dramatic decline in abortion mortality due to the
Choice on Termination of Pregnancy Act. The South African Medical
Journal. [Online]. 95(4), [no page numbers]. [Accessed 26th April
http://www.samj.org.za/index.php/samj/article/view/1609/971
Jha, A., Kickbusch, I., Taylor, P. and Abbasi, K. 2016. Accelerating
achievement of the sustainable development goals. The British
Medical Journal. [Online]. 352(1), Editorial. [Accessed 30th April
2016]. Available from: http://www.bmj.com/content/352/bmj.i409
Kabir, H., Saha, C. N., Oliveras, E. and Gazi, R. 2013. Association of
programmatic factors with low contraceptive prevalence rates in a rural
area of Bangladesh. Reproductive Health. [Online]. 10(31), pp.01-08.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689600/#B31
Kinaro, J., Ali, M. E. T., Schlangen, R. and Mack, J. 2009. Unsafe abortion and
abortion care in Khartoum, Sudan. Reproductive Health Matters.
6
Koster-Oyekan, W. Why resort to illegal abortion in Zambia? Findings of a
community-based study in Western Province. Social Science &
Medicine. [Online]. 46(10), pp.1303-1312. [Accessed 24th April 2016].
Available from:

of 11
2
Levandowski, A. B., Phiri-Kalilani, L., Kachale, F., Awah, P., Kangaude, G.
and Mhango, C. 2012. Investigating social consequences of unwanted
pregnancy and unsafe abortion in Malawi: The role of stigma.
International Journal of Gynecology & Obstetrics. [Online].
118(2), pp.S167-S171. [Accessed 21st April 2016]. Available from:
4
MacNaughton, G. and Frey, F. D. 2016. Decent Work, Human Rights and the
Sustainable Development Goals. Georgetown Journal of
International Law. [Online]. 47(2), pp.607-663. [Accessed 30th April
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2613999
Malter, J. 2012. Making Abortion Services Accessible in the Wake of Legal
Reforms: A Framework and Six Case Studies. [Online]. New York:
Guttmacher Institute. [Accessed 21st April 2016]. Available from:
https://www.guttmacher.org/report/making-abortion-services-
accessible-wake-legal-reforms-framework-and-six-case-studies
Marston, C. and Cleland, J. 2003. Relationships Between Contraception and
Abortion: A Review of the Evidence. International Perspectives on
Sexual and Reproductive Health. [Online]. 29(1), pp.06-13]. [Accessed
29th April 2016]. Available from:
https://www.guttmacher.org/about/journals/ipsrh/2003/03/relations
hips-between-contraception-and-abortion-review-evidence
Mayi-Tsonga, S., Oksana, L., Ndombi, I., Diallo, T., Sousa, D. H. M and
Faúndes, A. 2009. Delay in the provision of adequate care to women
who died from abortion-related complications in the principal maternity
hospital of Gabon. Reproductive Health Matters. [Online]. 17(34),
1
Mngadi, P. T., Faxelid, E., Zwane, T. I., Höjer, B. and Ransjo-Arvidson, B-. A.
2008. Health providers' perceptions of adolescent sexual and
reproductive health care in Swaziland. International Nursing
Review. [Online]. 55(2), pp.148-155. [Accessed 30th April 2016].
Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1466-
7657.2007.00625.x/abstract
Mundigo, I. A. 2006. Determinants of unsafe induced abortion in developing
countries. In: Warriner, K. I. and Shah, H I. eds. Preventing Unsafe
Abortion and its Consequences. [Online]. New York: Guttmacher
Institute. [Accessed 21st April 2016]. Available from:
http://www.who.int/reproductivehealth/publications/unsafe_abortion
/0939253763.pdf?ua=1#page=61
Norris, A., Bessett, D., Steinberg, R. J., Kavanaugh, L. M., Zordo, D. S. and
Becker, D. 2013. Abortion Stigma: A Reconceptualization of
Constituents, Causes, and Consequences. Women's Health Issues.
[Online]. 21(3), pp.S49-S54. [Accessed 30th April 2016]. Available
from: http://www.whijournal.com/article/S1049-3867(11)00033-
8/abstract
Norris, A., Harrington, J. B., Grossman, D., Hemed, M. and Hindin, J. M.
2016. Abortion experiences among Zanzibari women: a chain-referral
sampling study. Reproductive Health. [Online]. 13(23), pp.01-09.
[Accessed 21st April 2016], Available from:
http://link.springer.com/article/10.1186%2Fs12978-016-0129-9
Palamuleni, E. M. 2014. Demographic and Socio-economic Factors Affecting
Contraceptive Use in Malawi. Journal of Human Ecology. [Online].
46(3), pp.331-341. [Accessed 24th April 2016]. Available from:
http://www.krepublishers.com/
Perió, R., Colomer, C., Alvarez-Dardet, C. and Ashton, R. J. 2012. Does the
liberalization of abortion laws increase the number of abortions? The
case study of Spain. The European Journal of Public Health.
[Online]. 11(2), pp.190-194. [Accessed 26th April 2016]. Available
from: http://eurpub.oxfordjournals.org/content/11/2/190.long
Raymond, G. E. and Grimes, A. D. 2012. The Comparative Safety of Legal
Induced Abortion and Childbirth in the United States. Obstetrics &
Gynecology. [Online]. 119(2, Part 1), pp.215-219. [Accessed 28th April
http://www.ncbi.nlm.nih.gov/pubmed/22270271
Rogo, K., Orero, S. and Oguttu, M. 1998. Preventing Unsafe Abortion in
Western Kenya: An Innovative Approach through Private
Physicians. Reproductive Health Matters. [Online]. 6(11),
http://www.jstor.org/
Rowlands, S. 2011. Misinformation on abortion. The European Journal of
Contraception & Reproductive Health Care. [Online]. 16(4),
http://www.tandfonline.com/doi/full/10.3109/13625187.2011.570883
Sebambo, K. 2015. A one-dollar contraceptive designed for the developing
world. [Online]. Design Indaba. 3 November. [Accessed 26th April
2016]. Available from: http://www.designindaba.com/articles/creative-
work/one-dollar-contraceptive-designed-developing-world
Sedgh, G., Filippi, V., Owolabi, O. O., Singh, D. A., Askew, I., Bankole, A.,
Benson, J., Rossier, C., Pembe, B. A., Adewole, I., Ganatra, B. and
MacDonagh, S. 2016. Insights from an expert group meeting on the
definition and measurement of unsafe abortion. International Journal
of Gynecology and Obstetrics. [Online]. Special Article, pp.01-03.
[Accessed 21st April 2016]. Available
from:http://www.sciencedirect.com/science/article/pii/S00207292160
01028
Sedgh, G., Bearak, J., Singh, S., Bankole, A., Popinchalk, A., Ganatra, B.,
Rossier, C., Gerdts, C., Tunçalp, Ö., Johnson, R. B. Jr., Johnston, B. H.
and Alkema, L. 2016. Abortion incidence between 1990 and 2014:
global, regional and subregional levels and trends. The Lancet.
[Online]. In Press, Corrected Proof – Note to Users. [Accessed 12th May
4
Sedgh, G., Singh, S., Shah, H. I., Ahman, E., Stanley, H. K. and Bankole, A.
2012. Induced abortion: incidence and trends worldwide from 1995 to
2008. The Lancet. [Online]. 379(9816), pp.625-632. [Accessed 21st
8
Seid, A., Yeneneh, H., Sende, B., Belete, S., Eshete, H., Fantahun, M., Gizaw,
A. and Yimer, B. 2015. Barriers to access safe abortion services in East
Shoa and Arsi Zones of Oromia Regional State, Ethiopia. Ethiopian
Journal of Health Development. [Online]. 29(1), pp.13-21. [Accessed
21st April 2016]. Available from:
http://ejhd.org/index.php/ejhd/article/view/2/4
Shah, I. and Ahman, E. 2010. Unsafe abortion in 2008: global and regional
levels and trends. Reproductive Health Matters. [Online]. 18(36),
pp.90-101. [Accessed 21st April 2016]. Available from:
2
Shellenberg, M. K., Moore, M. A., Bankole, A., Juarez, F., Omideyi, K, A.,
Palomino, N., Sathar, Z., Singh, S. and Tsui, O. A. Social stigma and
disclosure about induced abortion: Results from an exploratory study.
Global Public Health. [Online]. 6(1), pp.S111-S125. [Accessed 27th
http://www.tandfonline.com/doi/abs/10.1080/17441692.2011.594072
?journalCode=rgph20
Singh, S. and Maddow-Zimet, I. 2015. Facility-based treatment for medical
complications resulting from unsafe pregnancy termination in the
developing world, 2012: a review of evidence from 26 countries. BJOG:
An International Journal of Obstetrics & Gynaecology. [Online].
[no volume number](no issue number), [no page numbers].
http://onlinelibrary.wiley.com/wol1/doi/10.1111/1471-
0528.13552/abstract
Singh, S., Prada, E. and Kestler, E. 2006. Induced Abortion and Unintended
Pregnancy in Guatemala. International Perspectives on Sexual and
Reproductive Health. [Online]. 32(3), pp.136-145. [Accessed 23rd

of 11
https://www.guttmacher.org/about/journals/ipsrh/2006/09/induced-
abortion-and-unintended-pregnancy-guatemala
Singh, S., Prada, E., Mirembe, F. and Kiggundu, C. 2005. The Incidence of
Induced Abortion in Uganda. International Perspectives on Sexual
and Reproductive Health. [Online]. 31(4), pp.183-191. [Accessed
23rd April 2016]. Available from:
https://www.guttmacher.org/about/journals/ipsrh/2005/12/incidence
-induced-abortion-uganda
Sorhaindo, M. A., Juárez-Ramírez, C., Olavarrieta, D. C., Aldaz, E., Piñeros,
M. C. M. and Garcia, S. 2014. Qualitative Evidence on Abortion
Stigma from Mexico City and Five States in Mexico. Women &
Health. [Online]. 54(7), pp.622-640. [Accessed 24th April 2016].
Available from:
http://www.tandfonline.com/doi/abs/10.1080/03630242.2014.919983
Steele, C. and Chiarotti, S. 2004. With Everything Exposed: Cruelty in Post-
Abortion Care in Rosario, Argentina. Reproductive Health Matters.
6
The Alan Guttmacher Institute. 1999. Sharing Responsbility: Women,
Society and Abortion Worldwide. [Online]. New York: The Alan
Guttmacher Institute. [Accessed 26th April 2016]. Available from:
https://www.guttmacher.org/sites/default/files/pdfs/pubs/sharing.pdf
The Lancet. 1995. Abortion: one Romania is enough. The Lancet. [Online].
345(8943), editorial. [Accessed 26th April 2016]. Available from:
2
The Lancet. 2015. Despite substantial progress, the world fell short of the
maternal mortality target in the Millennium Development Goals,
UN report shows. [Online]. [Accessed 29th April 2016]. Available
from:
https://www.sciencedaily.com/releases/2015/11/151113051118.html
Ugboma, H. A. and Akani, C. I. 2004. Abdominal massage: another cause of
maternal mortality. Nigerian Journal of Medicine. [Online]. 13(3),
http://www.ncbi.nlm.nih.gov/pubmed/15532228
UNICEF. 2016. Maternal mortality fell by almost half between 1990 and
2015. [Online]. [Accessed 29th April 2016]. Available from:
http://data.unicef.org/maternal-health/maternal-mortality.html
United Nations. 2009. World Population Prospects: The 2008 Revision.
[Online]. New York: United Nations. [Accessed 21st April 2016].
Available from:
http://www.un.org/esa/population/publications/wpp2008/wpp2008_
highlights.pdf
United Nations. 2015a. Trends in Contraceptive Use Worldwide. [Online].
New York: United Nations, Department of Economic and Social Affairs.
http://www.un.org/en/development/desa/population/publications/pd
f/family/trendsContraceptiveUse2015Report.pdf
United Nations. 2015b. Sustainable Development: Knowledge Platform.
[Online]. [Accessed 29th April 2016]. Available from:
https://sustainabledevelopment.un.org/resourcelibrary
United Nations. 2015c. Transforming Our World: The 2030 Agenda for
Sustainable Development. [Online]. New York: United Nations.
https://sustainabledevelopment.un.org/post2015/transformingourworl
d
Vlassoff, M., Shearer, J., Walker, D. and Lucas, H. 2008. Economic Impact of
Unsafe Abortion-Related Morbidity and Mortality: Evidence and
Estimation Challenges. [Online]. Brighton: Institute of Development
Studies. [Accessed 21st April 2016]. Available from:
https://www.ids.ac.uk/files/dmfile/RR59.pdf
Warenius, U. L., Faxelid, A. E., Chishimba, N. P., Musandu, O. J., Ong'any, A.
A. and Nissen, B-M. E. 2006. Nurse-Midwives' Attitudes towards
Adolescent Sexual and Reproductive Health Needs in Kenya and
Zambia. Reproductive Health Matters. [Online]. 14(27), pp.119-128.
2
Winikoff, B. and Sheldon, R. W. 2012. Abortion: what is the problem? The
Lancet. [Online]. 379(9816), pp.594-596. [Accessed 21st April 2016].
Available from:
5
World Health Organization. 2011. Unsafe abortion: global and regional
estimates of the incidence of unsafe abortion and associated
mortality in 2008. [Online]. Sixth Edition. Geneva: World Health
Organization. [Accessed 21st April 2016]. Avalable
from:http://apps.who.int/iris/bitstream/10665/44529/1/9789241501
118_eng.pdf
World Health Organization. 2012. Safe abortion: technical and policy
guidance for health systems. Second Edition. [Online]. New York:
United Nations. [Accessed 21st April 2016]. Available from:
http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_e
ng.pdf?ua=1

Policy Brief

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Destacado

Destacado (13)

Similar a Policy Brief

Similar a Policy Brief (20)

Policy Brief