Global Pandemic Of Unsafe Abortion Highlighted In Landmark Series In The Lancet

Worldwide, approximately eight women die every hour because of complications of unsafe abortion. In an article published this week by The Lancet exploring causes and consequences of unsafe abortion, the authors write that "ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative."[1]

Titled "Unsafe abortion: The preventable pandemic," the article is authored by David A. Grimes, MD, of the University of North Carolina Medical School; Janie Benson, DrPH, and Bela Ganatra, MD, both of Ipas; and other noted experts in obstetrics-gynecology or international public health. It is featured in a special series of articles on sexual and reproductive health released online in November. The Lancet held a press briefing this morning in London, chaired by Editor Richard Horton, to launch the landmark series.

Commenting on the pandemic, Dr. Janie Benson, Vice President for Research and Evaluation at Ipas, an international organization committed to reproductive health and rights, stated, "As with other serious threats to public health, whether in the developing world or elsewhere, the problem of unsafe abortion should be approached by using evidence-based solutions." She went on to note that "after decades of public-health research on the subject, the clear and incontrovertible evidence shows that when abortion is made legal, safe and easily accessible, women's health rapidly improves." Dr. Horton, writing in a comment introducing the special series, asserts that both the journal and the World Health Organization, which provided support for the special series, back this conclusion.[2]

The article reviews evidence from numerous countries demonstrating that legally restricting abortion does not reduce the overall number of abortions, but does, often dramatically, increase the rates of maternal death and injury from unsafe abortion. Conversely, areas in which abortion and contraception services are widely accessible have among the very lowest overall abortion rates in the world.

By definition, unsafe abortions are those "done by individuals without the requisite skills, or in an environment below medical standards." Approximately 19-20 million such abortions occur annually, almost all in developing countries.

Approximately a quarter of the world's population lives in countries in which abortion is legally permitted under no or nearly no circumstances. And, consequently, the silent, preventable pandemic of unsafe abortion persists. The authors thus conclude that the root causes of maternal deaths and injuries from unsafe abortion are "apathy and disdain toward women."

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[1] Grimes, David A., Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E. Okonofua, Iqbal H. Shah. 2006. Unsafe abortion: The preventable pandemic. Lancet, Sexual and reproductive health series (4), pp. 65-76, published online November 1.

[2] Horton, Richard. 2006. Reviving reproductive health [Comment]. Lancet, Sexual and reproductive health series, p. 1; published online November 1.

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