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Lancet. 1996 Jun 15;347(9016):1663-8.

Abortion and fertility regulation.

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School of Public Health, University of Michigan, USA.

Erratum in

  • Lancet 1996 Jul 6;348(9019):68.


To achieve their desired fertility, women use a combination of contraception and abortion, and some societies also place constraints on marriage and sexual activity. The degree to which these means are adopted varies considerably, but for the foreseeable future abortion will remain an important element of fertility regulation. Globally, complications of unsafe abortion affect hundreds of thousands of women each year, and account for as many as 100,000 deaths annually (about two in ten maternal deaths), mainly in poor countries, where abortion typically remains illegal. Access to safe abortion is both essential and technically feasible and should be provided in combination with good quality family planning services.


This article presents a review of abortion-related issues that suggests that worldwide abortion will remain a form of fertility regulation. It is estimated that about 2 in 10 maternal deaths occur worldwide due to unsafe abortion practices, which are mostly in developing countries and in countries where abortion is illegal. The 1994 International Conference on Population and Development was the first forum to focus in a global way on the serious health threat to women from unsafe abortion. In the US, about 60% of all pregnancies are unwanted or mistimed and about 50% are aborted. In most European countries, about 66% of women had at least one unintended pregnancy. The annual worldwide abortion rate is estimated to range from 32 abortions/1000 women to 46/1000 women aged 15-44 years. In most developed countries the abortion rate varies from 1 to 30/1000. The Netherlands has the lowest rate (5/1000) and the most liberal abortion laws. The former USSR has the highest rate (112/1000), although some central regions of European Russia have a higher rate of 186/1000. Variation in abortion rates by country can be accounted for by contraceptive prevalence and use-effectiveness, prevailing fertility preferences, laws and policies relating to abortion and contraception, and the relationship between abortion and contraception. Contraceptive usage is a key factor. For example, in the US, 7% of sexually active women aged 15-44 years, who were not using contraception nor seeking to become pregnant, accounted for 53% of unintended pregnancies. Developing countries shifting from high to low fertility may experience a rise in abortions. Where contraceptives are unavailable to adolescents, abortion rates are high and increasing. Women seek abortion for many reasons. Abortion laws vary widely by country. Vacuum aspiration is considered the safest, simplest, and most medically and economically effective way of inducing first-trimester abortions or treating incomplete abortions. The issue of abortion is complicated by political, religious, and moral concerns.

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