The health, social, and economic consequences of unsafe abortion: papers presented at an IUSSP Seminar, Mexico, 2010.

Unsafe abortion continues to be an important factor affecting women’s reproductive lives and survival in the developing world, where 98% of all unsafe abortions occur [1]. It has not declined in recent years, continuing at an annual rate of 16 per 1000 women of reproductive age in the developing world according to updated information for 2008 [2,3]. Laws that are highly restrictive help to explain the prevalence of unsafe abortion; however, even in some countries where the law permits abortion under broad indications, difficulties in accessing legal and safe services mean that high proportions of abortions are still unsafe [4]. Unsafe abortion has important consequences for morbidity and mortality, accounting for an estimated 13% of maternal deaths in developing countries, and for 5 million women being treated for complications of induced abortion each year [5], even though not all women who have abortion complications obtain needed medical care [6]. Abortion also has economic consequences in terms of direct cost for health systems and indirect cost for women, their families, and societies. Abortion impacts women’s and families’ budgets, since they must pay for the unsafe abortion, for some or all of the costs of treatment for complications, and for costs incurred by inability to perform normal economic and domestic activities for a period of time [7]. Abortion has social consequences including the risk of being denounced to authorities or imprisoned [8], the impact on the well-being of children and other family members from the death of a mother, and stigma experienced by women and their families [9,10]. Abortion is stigmatized because it violates the “three cherished ‘feminine’ ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing” [9], but stigma is particularly strong where abortion is highly legally restricted. For these reasons stigma tends to be strongest regarding young and unmarried sexually active women. Stigma may appear at the individual, community, or institutional levels. Abortion stigma can increase the risk of morbidity and mortality due to unsafe abortion because it can provoke a delay in seeking treatment; in addition, the negative attitude of health workers leads to poor quality of care, including further delays in attending to women seeking postabortion care. This Supplement presents 16 papers that examine aspects of these 3 major consequences of unsafe abortion. These papers were presented at an international seminar organized by the Scientific Panel on Abortion Research of the International Union for the Scientific Study of Population (IUSSP), held in San Juan del Rio, Mexico, in November 2010, and coordinated by the Population Council, Mexico office [11]. The papers were revised based on comments by discussants, seminar participants, and panel members.