Voluntary termination of pregnancy is the subject of ideological debate as well as health policies. Demographer Agnès Guillaume, co-author with Clémentine Rossier of an extensive review of the subject*, sheds light on the right, access to and practice of abortion in the world today.
How is access to abortion progressing across the world?
Agnès Guillaume : In most countries, little progress has been made in this respect. For example, in 1996, elective abortion was legal in three out of 53 African countries. 22 years later, there are only six. These are low figures. However, marginal progress has been achieved in this continent, as well as in Latin America: some conservative countries are enhancing access conditions by permitting abortion in cases of rape, foetal abnormalities, or by changing from allowing abortion only to save the woman’s life?On which there is a consensus just about everywhere to allowing it to safeguard her health.
On a global scale there are movements in the opposite direction, making it difficult to identify an overall trend. Several Latin American countries made progress towards access to abortion, while others were moving backwards. But beyond formal legislation, the question arises as to actual access. In some countries, abortion is possible in cases of rape but requires so many authorisations that this right is more theoretical than practical.
Is there a divide between countries in this regard?
A. G.: There is a clear contrast between developed and developing countries. Laws are far more permissive in the former: 70% of developed countries permit elective abortion, while this is only the case in 16% of developing countries, and 4% of the least developed countries. In concrete terms, this means that 80% of women of reproductive age have access to abortion in developed countries, unrestricted except for the adherence to legal deadlines, compared with only 6% in the least developed countries. The enjoyment of this right is therefore very unequal depending on the region. And because of this restricted access, women who have abortions face criminal penalties and are exposed to health risks.
And yet, paradoxically, abortion is often more frequent in countries where it is not allowed, as reproductive health programmes are generally less developed and access to contraception is more limited, leading to a larger number of unwanted pregnancies. Thus, the rate of abortion – legal or illegal – amounts to 44 per 1000 women per year in Latin America, compared with 34 in Africa and only 16 in Western Europe where it is permitted almost everywhere.
What makes medical abortion?By taking misoprostol and/or mifepristone depending on the country and the legal situation revolutionary?
A. G.: This technique has really made a difference, in countries where abortion is permitted as well as in those where it is not. It replaces the invasive techniques or high-risk traditional methods used previously. It eliminates the need for a sophisticated medical platform, avoids hospitalisation and diminishes the potential reluctance of medical staff as it is less taxing than surgical techniques. It has become the main method used in countries where it is legal. More importantly, in situations where legal access to abortion is restricted, this method, especially with the use of misoprostol instead of artisanal techniques, means that women can have an abortion with a reduced risk. Therefore it largely contributes to limiting the morbidity and mortality associated with clandestine abortions. Consequently, many NGOs focus their action on its dissemination throughout the world and advice on how to use it.
* Guillaume A. & Rossier C., L’avortement dans le monde. État des lieux des législations, mesures, tendances et conséquences, Population , n°2 2018.