First ever country level estimates of unintended pregnancy and abortion

The Guttmacher Institute, the World Heath Organization and the UN’s Human Reproduction Programme (HRP) today released the first-ever model-based estimates of unintended pregnancy and abortion rates for 150 countries, highlighting major disparities in access to sexual and reproductive health care.

The study, published in BMJ Global Health, analyzes rates from 2015 to 2019, with the aim of providing deeper insights into access to sexual and reproductive health services in countries of all income levels across the globe.

“To build sexual and reproductive health policies that are truly inclusive and equitable, we need to understand what is happening at a country level,” said Dr Herminia Palacio, President and CEO of the Guttmacher Institute. “Having current and reliable data at hand will not only help identify and find solutions to disparities, but also make a case for smarter investments that deliver impact.”

Alongside the estimates, Guttmacher has published more detailed country profiles to allow decision makers and health advocates to better understand and act on sexual and reproductive health needs in their countries, particularly for family planning, including contraception and comprehensive abortion care.

Regional averages mask large disparities in unintended pregnancy and abortion rates

The new estimates indicate that unintended pregnancy and abortion rates vary widely between countries—even within the same region or geographic area. The greatest variations were found in Latin America and sub-Saharan Africa, where for instance, unintended pregnancy rates in countries ranged from 41 to 107 per 1000 women, and 49 to 145 per 1000 women respectively.

These disparities are not shaped purely by income-level: in Europe, for example, most countries with higher unintended pregnancy rates than the regional average are classified as high-income, while the two countries with the lowest estimates are middle-income. This finding reflects how barriers to accessing and using effective sexual and reproductive healthcare exist in settings with greater as well as fewer resources.

“These variations speak to the need for investment, even in regions with low unintended pregnancy rates, that empowers women and girls across countries to choose under what circumstances they want to have children,” says Jonathan Bearak, a senior research scientist at Guttmacher Institute and lead author of the article. “The proportion of unintended pregnancies ending in abortion—as great as 68%, even among countries that completely prohibited abortion—illustrates the strength of the desire of millions of women and adolescents to avoid unplanned childbearing.”

While the estimates go a long way in increasing the quality of evidence available, there remains a pressing need for more and better data. The availability of reliable abortion data varied substantially by region, ranging from 12 percent of countries in Western Asia and Northern Africa to 73 percent of countries in Europe and Northern America. With additional investments in country data collection, it would be possible to make estimates with greater certainty, monitor trends and possibly assess the impact of large-scale programmes in the future.

Sexual and reproductive health and rights are an essential part of universal health coverage and are required to end discrimination against women and girls. These country-level estimates highlight the importance of equitable investment in comprehensive sexual and reproductive health care, and will further inform countries working to implement WHO’s new guidelines for quality abortion services.

“For good health, people in countries around the world need access to a comprehensive package of sexuality education, accurate family planning information and services, as well as quality abortion care,” said Dr Bela Ganatra, who leads WHO’s Prevention of Unsafe Abortion unit. “This research aims to support countries as they work to strengthen the lifesaving services they provide for sexual and reproductive health and improve health outcomes – especially for women and girls.”

The country-specific numbers and rates of unintended pregnancies and of abortions, and the proportion of those pregnancies ending in abortion, are produced using a statistical model.

This model integrates and is informed by all available data on pregnancy intentions and abortion among women of reproductive age collected across the respective countries and territories.