Induced abortion accounts for 1 in 8 of approximately maternal deaths that occur annually worldwide. Induced abortion rate can be considered as one of the indicators for assessing availability of the appropriate reproductive health plans for women and identifying needs for appropriate related health policies and programs. Search terms from two categories including abortion and termination of pregnancy were compiled. Meta-analysis was carried out by using OpenMeta software.
Induced abortion rates were calculated based on the random effect model. Overall induced abortion rate was obtained Nation-wide and local rates were obtained Induced abortion is a major public health problem that occurs worldwide whether under the legal restriction or freedom, and it remains as reproductive health concern globally. To eliminate the need for induced abortion is at the core of any effort for preventing this issue. Option with the highest priority is to prevent unwanted pregnancies through promoting reproductive health plans for women of reproductive age.
In case the prevention strategies fail, universal provision of safe abortion services should be put in place. Induced abortion accounts for 1 in 8 of approximately maternal deaths that occur annually worldwide 12.
According to the WHO estimation, each year about 44 million induced abortions occur globally. The induced abortion rate varies considerably. It was approximated 12 per women aged years old in Western Europe, comparing to 43 in Eastern Europe 5. The induced abortion rate is even higher in countries like Uganda, where there were 54 induced abortions per women in 6. Evidence shows the induced abortions are more likely in countries in which abortion is illegal or restricted compared to those liberated 5.
Induced abortion rate can be considered as one of the indicators for assessing availability of the appropriate reproductive health plans for women 5 and to identify needs for appropriate related health policies and programs 1. Aim of this study is to conduct a systematic review and meta-analysis on induced abortion rate worldwide. We compiled search terms from two categories including abortion and termination of pregnancy.
Results from the query were restricted to the publications in English and Farsi. Three reviewers independently screened the titles and abstracts of the retrieved papers to decide if they met the inclusion criteria for the meta-analysis.
Any disagreement was resolved through consultation with the principal researcher. Schedutil android form with predefined items was prepared and used for extracting data from the studies while reviewing the full text of the eligible studies. To be eligible for inclusion, the study had to report the abortion cases per pregnant women.
The data collected for the analysis included: author name, study location, period of study, age range of the participants, the number of induced abortions, sample size, and confidence interval of the study. Studies evaluated as low quality were excluded from the systematic review and meta-analysis. Meta-analysis was carried out by using OpenMeta 8 version A total number of 38 studies were considered as a final list for the systematic review and meta-analysis.
A total number of 67 statistics on induced abortion rate were extracted from the included studies. Sample size of studies was varied ranging from 43 to This variation was due to the various levels of the studies ranging from local level to the global scale.Induced abortion is the intentional termination of a pregnancy before the fetus can live independently. An abortion may be elective based on a woman's personal choice or therapeutic to preserve the health or save the life of a pregnant woman.
An abortion may be performed whenever there is some compelling reason to end a pregnancy. An abortion is termed "induced" to differentiate it from a spontaneous abortion in which the products of conception are lost naturally also called a miscarriage.
An abortion is considered to be elective if a woman chooses to end her pregnancy, and it is not for maternal or fetal health reasons. Some reasons a woman might choose to have an elective abortion are:. A therapeutic abortion is performed in order to preserve the health or save the life of a pregnant woman. A health care provider might recommend a therapeutic abortion if the fetus is diagnosed with significant abnormalities or not expected to live, or if it has died in utero.
Therapeutic abortion may also be used to reduce the number of fetuses if a woman is pregnant with multiples; this procedure is called multifetal pregnancy reduction MFPR. A therapeutic abortion may be indicated if a woman has a pregnancy-related health condition that endangers her life.
Some examples of such conditions include:. Abortion has been a legal procedure in the United States since Since then, more than 39 million abortions have taken place. It is estimated that approximately 1.
Induced abortions terminate approximately half of the estimated three million unplanned pregnancies each year and approximately one-fifth of all pregnancies.
In an estimated 21 out of 1, women aged 15—44 had an abortion. Out of every pregnancies that year that ended in live birth or abortion, approximately 24 were elective terminations. The highest abortion rates in occurred in New Jersey, New York, California, Delaware, Florida, and Nevada greater than 30 per 1, women of reproductive age. In andthe highest percentage of abortions were performed on women between the ages of 20 and 30, with women ages 20—24 having the highest rate 47 per 1, women.
The highest abortion rates occurred among African American women 49 per 1, womenwith Hispanic and Asian women also reporting higher-than-average rates 33 and 31 per 1, women, respectively. The rate was the lowest among white women 13 per 1, women. Abortions are safest when performed within the first six to 10 weeks after the last menstrual period LMP.
Induced Abortion: a Systematic Review and Meta-analysis
This calculation is used by health care providers to determine the stage of pregnancy. Abortions performed between 13 and 24 weeks during the second trimester have a higher rate of complications. Abortions after 24 weeks are extremely rare and are usually limited to situations where the life of the mother is in danger. Although it is safer to have an abortion during the first trimester, some second trimester abortions may be inevitable. The results of genetic testing are often not available until 16 weeks gestation.
In addition, women, especially teens, may not have recognized the pregnancy or come to terms with it emotionally soon enough to have a first trimester abortion. Teens make up the largest group having second trimester abortions.Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus. When deliberate steps are taken to end a pregnancy, it is called an induced abortionor less frequently "induced miscarriage".
The unmodified word abortion generally refers to an induced abortion. When properly done, abortion is one of the safest procedures in medicine  but unsafe abortion is a major cause of maternal deathespecially in the developing world. Historicallyabortions have been attempted using herbal medicinessharp tools, forceful massageor through other traditional methods. In some areas abortion is legal only in specific cases such as rapeproblems with the fetuspovertyrisk to a woman's health, or incest.
An induced abortion may be classified as therapeutic done in response to a health condition of the women or fetus or elective chosen for other reasons. Approximately million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion. The manner selected often depends upon the gestational age of the embryo or fetus, which increases in size as the pregnancy progresses.
Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic abortion when it is performed to save the life of the pregnant woman; to prevent harm to the woman's physical or mental health ; to terminate a pregnancy where indications are that the child will have a significantly increased chance of mortality or morbidity; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.
Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation. Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the s and the antiprogestogen mifepristone also known as RU in the s. The most common early first-trimester medical abortion regimens use mifepristone in combination with misoprostol or sometimes another prostaglandin analog, gemeprost up to 10 weeks 70 days gestational age,   methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.
In very early abortions, up to 7 weeks gestationmedical abortion using a mifepristone—misoprostol combination regimen is considered to be more effective than surgical abortion vacuum aspirationespecially when clinical practice does not include detailed inspection of aspirated tissue.
Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain  France Switzerland and the Nordic countries. Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion.
These techniques can both be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U. EVA can be used later. MVA, also known as "mini-suction" and " menstrual extraction " or EVA can be used in very early pregnancy when cervical dilation may not be required.
The World Health Organization recommends sharp curettage only when suction aspiration is unavailable.
Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia.Abortion is common.
Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period — was 35 abortions per women aged 15—44 yearsfive points less than the rate of 40 for the period — Abortion laws vary around the world but are generally more restrictive in developing countries.
Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity.
While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically in the first trimester, by manual or electric vacuum aspiration or with medication: both are safe and effective.
Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion.
This, together with improved education and other interventions, may succeed in reducing unintended pregnancy. Abortion is common; around one in four women will have an abortion at some time in their lives.
In developing countries, abortion is often unsafe and a significant cause of maternal morbidity and mortality.
Between andinduced abortion was estimated to have been responsible for or 7. Although a simple and safe procedure, abortion remains controversial. Its availability depends not on medical or public health need but on religious, moral and political beliefs.
Abortion is legal on broad grounds in most European countries. Women seeking abortion are not different from those seen daily by reproductive medicine specialists in their clinics, operating theatres and delivery suites.
Healthcare providers working in reproductive medicine should be informed about abortion and abortion care, even if they do not provide it. This article summarizes key points on abortion, its prevalence, availability, methods and safety, on post-abortion care and on efforts at preventing unintended pregnancy. Estimating the incidence of induced abortion is difficult. In countries with liberal abortion laws and reporting requirements, under-reporting is common and the introduction of medical abortion may have further compounded this problem.
In countries with restrictive laws where most induced abortions are performed clandestinely, no centralised registries are available and estimates must be derived indirectly from published studies, hospital records, surveys of women, expert opinion, etc. Almost all the decline occurred in developed regions: from 46 in — to 27 in — In the developing world, the small decline from 39 37—47 to 37 34—46 was not statistically significant.
Rates showed little or no change over the period — in Africa, and they increased in Latin America and decreased in most of Asia. Rates decreased throughout Europe as a whole, from 52 48—64 in — to 30 27—38 in —; in Western Europe, however, the rate increased by five points 1—11 between — and — Table I. Table I Estimated abortion rates per women 15—44 years old, by geographic area and time period.
UI: uncertainty interval. Estimated abortion rates per women 15—44 years old, by geographic area and time period.
In contrast to earlier reports Sedgh et al. Since the mids there has been progress towards liberalized access to abortion. Altogether 56 countries liberalized their laws while eight countries voted on more stringent restrictions.Related to induced abortion: therapeutic abortion.
In the medical sense, this term and the term miscarriage both refer to the termination of pregnancy before the fetus is capable of survival outside the uterus. The term abortion is more commonly used as a synonym for induced abortion, the deliberate interruption of pregnancy, as opposed to miscarriage, which connotes a spontaneous or natural loss of the fetus. Because of this distinction made by the average layperson, care should be exercised in the use of the word abortion when speaking of a spontaneous loss of the fetus.
The technique chosen to terminate pregnancy depends on the stage of pregnancy and the policies of the institution and patient needs. It is rare for a fetus to survive if it weighs less than g, or if the pregnancy is terminated before 20 weeks of gestation.
These factors are, however, difficult to determine with a high degree of accuracy while the fetus is still in utero; survival of the fetus delivered near the end of the second trimester often depends to a great extent on the availability of personnel and equipment capable of supporting life until the infant develops sufficiently.
Viability of the fetus outside the uterus is frequently used as the determining factor in deciding the legality and morality of induced abortion. Whether this is a valid criterion is essentially based on whether one believes that the fetus is human from the moment of conception or that it achieves humanity at some point during physical development.
Those who oppose abortion on moral grounds believe that the fetus is human or potentially human and that destruction of the fetal body is tantamount to murder. Many others have equally strong beliefs that abortion is a woman's right. The liberalization of abortion laws has resulted in a dramatic increase in the number of abortions performed in physicians' offices, clinics, and hospitals. While this has diminished the occurrence of septic abortions performed at the hands of unscrupulous abortionists and has improved the possibility of safe and uneventful physical recovery from an induced abortion, the issue remains controversial and charged with emotion.
The health care provider who strongly objects to abortion is legally and morally free to choose not to participate in the procedure and is advised to avoid situations involving responsibility for the care of patients who have chosen abortion as a means of ending an unwanted pregnancy. Women who have made a decision to have an abortion need a safe, non-judgmental environment to recover physically and emotionally from the procedure. The patient should know that other alternatives are available and that an abortion after 20 weeks is inadvisable for medical and other reasons.
Preabortion counseling in the psychological, religious, and legal aspects of abortion should be readily available, with immediate referral to the proper resources.
Although delay in carrying out the procedure may increase the risk of complications, no patient should be encouraged to go through with an abortion until she has had time and sufficient counseling to reach a rational decision. During postabortion counseling there should be a discussion of various methods of contraception.
The client will need information on the advantages and disadvantages of each method, her responsibilities in preventing future unwanted pregnancies, and available help in initiating and following through on a program of effective contraception.
She should be informed that women who have had two or more abortions run a greatly increased risk of miscarriage or spontaneous abortion in the first six months of subsequent pregnancies.
Patient Care. The type of care required and the complications to be avoided in abortion will depend on the stage of pregnancy at the time of termination and whether the abortion is spontaneous, is induced under sterile conditions, or is performed by an unskilled abortionist or the patient herself.
Many women who choose to have an abortion are anxious and confused about the physical and psychological outcomes of the procedure. Therefore both pre- and postabortion counseling are recommended. In cases of spontaneous or habitual abortion, patient care is directed toward emotional support of the patient and acceptance of her feelings of bitterness, grief, guilt, relief, and other emotions associated with the loss of the fetus.
Data and Statistics
The patient should be able to express her feelings in an open, nonjudgmental, and nonthreatening environment. The most frequent complications are severe hemorrhage and sepsis, and for those who delay seeking medical attention the mortality rate is high. In the United States this definition is confined to the termination of pregnancy before 20 weeks' gestation based upon the date of the first day of the last normal menses.
Chromosomal abnormalities cause at least half of spontaneous abortions. Mentioned in? References in periodicals archive? Angela Lanfranchi, Joel Brind and others have for many years documented the overwhelming evidence from around the world of a direct link between induced abortionand the subsequently higher rate of breast cancer experienced by women who undergo those abortions. Complications: Abortion's Impact on Women.
Previous research has shown that induced abortion is often underreported even in societies in which the procedure is not legally restricted, 8 which may be because some people are not comfortable with the subject and may not answer direct survey questions about it honestly. Results: The mean score of students' attitude towards voluntary induced abortion was Abortionthe expulsion of a fetus from the uterus before it has reached the stage of viability in human beings, usually about the 20th week of gestation.Self-Induced Abortions
An abortion may occur spontaneously, in which case it is also called a miscarriageor it may be brought on purposefully, in which case it is often called an induced abortion. Spontaneous abortions, or miscarriages, occur for many reasons, including disease, trauma, genetic defect, or biochemical incompatibility of mother and fetus. Occasionally a fetus dies in the uterus but fails to be expelled, a condition termed a missed abortion. Induced abortions may be performed for reasons that fall into four general categories: to preserve the life or physical or mental well-being of the mother; to prevent the completion of a pregnancy that has resulted from rape or incest; to prevent the birth of a child with serious deformity, mental deficiencyor genetic abnormality; or to prevent a birth for social or economic reasons such as the extreme youth of the pregnant female or the sorely strained resources of the family unit.
By some definitions, abortions that are performed to preserve the well-being of the female or in cases of rape or incest are therapeutic, or justifiable, abortions. Numerous medical techniques exist for performing abortions. During the first trimester up to about 12 weeks after conceptionendometrial aspirationsuction, or curettage may be used to remove the contents of the uterus. In endometrial aspiration, a thin, flexible tube is inserted up the cervical canal the neck of the womb and then sucks out the lining of the uterus the endometrium by means of an electric pump.
In the related but slightly more onerous procedure known as dilatation and evacuation also called suction curettage, or vacuum curettagethe cervical canal is enlarged by the insertion of a series of metal dilators while the patient is under anesthesiaafter which a rigid suction tube is inserted into the uterus to evacuate its contents. When, in place of suction, a thin metal tool called a curette is used to scrape rather than vacuum out the contents of the uterus, the procedure is called dilatation and curettage.
When combined with dilatation, both evacuation and curettage can be used up to about the 16th week of pregnancy. From 12 to 19 weeks the injection of a saline solution may be used to trigger uterine contractions; alternatively, the administration of prostaglandins by injection, suppository, or other method may be used to induce contractions, but these substances may cause severe side effects.
Hysterotomy, the surgical removal of the uterine contents, may be used during the second trimester or later. In general, the more advanced the pregnancy, the greater the risk to the female of mortality or serious complications following an abortion.
In the late 20th century a new method of induced abortion was discovered that uses the drug RU mifepristonean artificial steroid that is closely related to the contraceptive hormone norethnidrone. RU works by blocking the action of the hormone progesterone, which is needed to support the development of a fertilized egg. When ingested within weeks of conceptionRU effectively triggers the menstrual cycle and flushes the fertilized egg out of the uterus.
Whether and to what extent induced abortions should be permitted, encouraged, or severely repressed is a social issue that has divided theologians, philosophers, and legislators for centuries. Abortion was apparently a common and socially accepted method of family limitation in the Greco-Roman world.
Although Christian theologians early and vehemently condemned abortion, the application of severe criminal sanctions to deter its practice became common only in the 19th century. In the 20th century such sanctions were modified in one way or another in various countries, beginning with the Soviet Union inwith Scandinavian countries in the s, and with Japan and several eastern European countries in the s.
In some countries the unavailability of birth-control devices was a factor in the acceptance of abortion. In the late 20th century China used abortion on a large scale as part of its population-control policy. In the early 21st century some jurisdictions with large Roman Catholic populations, such as Portugal and Mexico Citydecriminalized abortion despite strong opposition from the church, while others, such as Nicaragua, increased restrictions on it.
A broad social movement for the relaxation or elimination of restrictions on the performance of abortions resulted in the passing of liberalized legislation in several states in the United States during the s. The U. Supreme Court ruled in Roe v. Wade that unduly restrictive state regulation of abortion was unconstitutional, in effect legalizing abortion for any reason for women in the first three months of pregnancy.
A countermovement for the restoration of strict control over the circumstances under which abortions might be permitted soon sprang up, and the issue became entangled in social and political conflict. In rulings in and a more conservative Supreme Court upheld the legality of new state restrictions on abortion, though it proved unwilling to overturn Roe v.
Wade itself. In the court also upheld a federal ban on a rarely used abortion method known as intact dilation and evacuation. The public debate of the issue has demonstrated the enormous difficulties experienced by political institutions in grappling with the complex and ambiguous ethical problems raised by the question of abortion.
Opponents of abortion, or of abortion for any reason other than to save the life of the mother, argue that there is no rational basis for distinguishing the fetus from a newborn infant; each is totally dependent and potentially a member of society, and each possesses a degree of humanity.In addition, attention is focused on gathering data to better understand the extent of maternal and infant morbidity, adverse behaviors during pregnancy, and long-term consequences of pregnancy. Public health surveillance is the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in public health practice.
The public health approach to problem solving includes using surveillance data to identify problems and assess the effectiveness of interventions. Without accurate and timely data, public health programs suffer. Reports are generated from these systems on a routine ongoing basis. DRH researchers sometimes analyze secondary data on such topics as ectopic pregnancy and hysterectomy.
In, legal induced abortions were reported to CDC from 48 reporting areas. The abortion rate for was Inall three measures reached their lowest level for the entire period of analysis Women in their twenties accounted for the majority of abortions in and throughout the period of analysis. The majority of abortions in took place early in gestation: In Fertility clinics in the U. ART includes all fertility treatments in which either eggs or embryos are handled. View the most recent ART success rates.
Locate fertility clinics near you, learn about the services they provide, the types of patients they see, and their success rates. This provides instant view and download of datasets generated by the Executive Branch of the federal government.
These findings underscore the importance of state-based public health programs to prevent unnecessary opioid use and to treat substance use disorders during pregnancy. Source: National Vital Statistics Reports.
Source: MMWR. Preterm Births—United States, and Infant Deaths—United States, — Infant Deaths— United States, — Preterm Births—United States, Virgin Islands. The chartbook was developed to provide readers with an easy-to-use collection of current jurisdiction data on critical issues of relevance to women.