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Caitlin Gerdts, PhD, MHS

Caitlin Gerdts, PhD, MHS. UCLA Fielding School of Public Health, Bixby Lecture November 26, 2012. Safe, Legal, and Rare? A n update on abortion a round the world. Women all over the World have Abortions for Similar R easons. The Decline in Global Abortion Rates has Stalled.

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Caitlin Gerdts, PhD, MHS

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  1. Caitlin Gerdts, PhD, MHS UCLA Fielding School of Public Health, Bixby Lecture November 26, 2012 Safe, Legal, and Rare? An update on abortion around the world

  2. Women all over the World have Abortions for Similar Reasons

  3. The Decline in Global Abortion Rates has Stalled Abortions per 1,000 women aged 15–44

  4. Stall in global abortion decline coincides with plateau in contraceptive use Contraceptive prevalence (%) Abortion rate

  5. The abortion rate is lower in developed countries than in developing countries Abortions per 1,000 women aged 15–44 *Excluding Eastern Europe www.guttmacher.org

  6. Is Abortion Safe?

  7. When performed in safe, sterile conditions… …abortion is safer than taking a dose of penicillin.

  8. When performed in unsafe or unsterile conditions… • Maternal Morbidity • Maternal Mortality • Strains on Health Systems • Strains on Families

  9. Disproportionate Impact of Unsafe Abortion “Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.” -Iqbal Shah, WHO

  10. An increasing proportion of abortion are unsafe % of abortions that are unsafe

  11. By the WHO definition, virtually all Abortions in Latin America and Africa are Unsafe % of abortions

  12. Deaths from Unsafe Abortion are Highest in Africa Deaths per 100,000 unsafe abortions, 2003

  13. Is Abortion Legal?

  14. Most women live in countries where abortion is restricted This is a slide to use for large images where you want to eliminate everything else but a two-line title and caption. It’s based on the last slide master.

  15. Global Abortion Legality

  16. Consequences of restricting contraception and legal abortion in Romania

  17. Disproportionate Impact of Unsafe Abortion “Deaths and disability related to unsafe abortion are entirely preventable…Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post-abortion care, when they need treatment for complications.” -Iqbal Shah, WHO

  18. Abortion law reforms in developing countries have been followed by declines in morbidity and mortality South Africa (1997): Annual number of abortion-related deaths decreased by 91% after the law was liberalized. Nepal (2002): Abortion-related complications as a proportion of all of maternal illnesses decreased by 48% in a study of facilities in eight districts. Ethiopia (2005): Abortion complications per 100,000 live births (at one large hospital) decreased by about 70%.

  19. Should Abortion be Rare?

  20. Impact of contraception on reducing the number of abortions Estimated number of induced abortions 141 million Without modern methods 45 million Current use 14 million If unmet need were met

  21. Focus on Rare Abortion Increases Stigma

  22. Global Turnaway Study www.indiegogo.com/theglobalturnawaystudy

  23. Global TurnawayStudy aim To describe the mental health, physical health and socioeconomic consequences of receiving a legal abortion compared to being denied a legal abortion in multiple geographic, cultural, and legal settings.

  24. Global Turnaway Study groups Abortion comparison Turnaway Site A Gestational age limit = 12 4 6 8 10 12 14 16 18 20 22 24 26 28 … Site B Gestational age limit = 20 4 6 8 10 12 14 16 18 20 22 24 26 28 …

  25. References • Weitz, T. Rethinking the Mantra that Abortion Should be “Safe, Legal, and Rare • Singh S, Sedgh G, Hussain R. Unintended Pregnancy: Worldwide Levels, Trends and Outcomes. Studies in Family Planning. Dec 2010;41(4). • WHO. The prevention and management of unsafe abortion. Report of a technical working group. Geneva: World Health Organization, 1992 (WHO/MSM/92.5). • Fawcus SR. Maternal mortality and unsafe abortion. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008; 22(3). • The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society & Abortion Worldwide, New York: AGI, 1999 • Sedgh G, Henshaw S, Singh S, Ahman E, Shah I. Induced Abortion: estimated rates and trends worldwide. Lancet. 2007; 370. • Sedgh G, Singh S, Shah I, Ahman E, Henshaw S, Bankole A. Induced Abortion: incidence and trends worldwide from 1995-2008. Lancet. 2012; 379. • Adler AJ, Filippi V, Thomas S, Ronsmans C. Quantifying the global burden of morbidity due to unsafe abortion: Magnitude in hospital-based studies and methodological issues. International Journal of Gynecology and Obstetrics. 2012. • Adler AJ, Filippi V, Thomas S, Ronsmans C. Incidence of severe acute maternal morbidity associated with abortion: a systematic review. Tropical Medicine and International Health. 2011. • WHO. Unsafe Abortion: Global and Regional Estimates of Incidence of Unsafe Abortion and Associated Mortality. Geneva: World Health Organization, 2007. • Gipson J, Koenig M, Hindin M. The effects of unintended pregnancy on infant, child and parental health: a review of the literature. Studies in Family Planning. 2008; 39(1): 18-38. • Brown S, Eisenberg L (eds). The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academic Press. • Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Population Studies. 2003; 51(1): 77-93.

  26. Caitlin Gerdts, PhD, MHS gerdtsc@obgyn.ucsf.edu UCLA Fielding School of Public Health November 26, 2012 Thank you

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