
 
 
 
 There are nearly 56 million abortions every year in the world and almost half of them are unsafe, according to a major piece of research from the World Health Organisation. 
 
 The study found that there were 55.7 million abortions every year between 2010 and 2014 worldwide, and of them 17.1 million were unsafe because the woman was taking pills alone or was with a trained helper but using a method of abortion that is no longer considered best practice. 
 
 But a further eight million abortions, categorised as “least safe” in the study, involved desperate and dangerous backstreet measures, from swallowing toxic substances to inserting wires to try to bring about a miscarriage. 
 
 The highest levels of unsafe abortions were in Africa, where only about one in four are safe and as a result abortion deaths are high. 
 
 The new figures, from the WHO with the Guttmacher Institute, are published in the Lancet medical journal at a time when international family planning organisations are deeply concerned over cuts to their budgets announced by the Trump administration in the United States. 
 
 Experts say the proposed cuts, together with the reimposition of the restrictive Mexico City policy (also known as the Global Gag rule) which forbids US federal funds to any organisation that counsels women on abortion, can only make things worse. 
 
 The study finds that there are fewer abortions in places where abortion is safest, such as in northern Europe and northern America where women can get contraception easily. The authors explain that most countries in those two regions “have less restrictive laws on abortion, high contraceptive use, high economic development, high levels of gender equality, and well developed health infrastructures”. 
 
 Lead author Dr Bela Ganatra, from the WHO, told the Guardian their work showed “the persistence of inequalities by geography, by income, by levels of development ... that’s the real tragedy that these findings point to. 
 
 
 
 “Safe abortion is a very safe procedure. It can be provided at primary healthcare level. It isn’t even necessary that it has to be a procedure. Now you can use tablets. There is nothing that requires this to be highly resourced. 
 
 “It is not science that is holding back the progress but barriers in terms of stigma and law.” 
 
 In Latin America, where many countries have a ban on abortion in nearly all circumstances, women have resorted to misoprostol, a tablet which they can access online, ideally taken with mifepristone as well. “It is a very safe method that women are taking into their own hands,” said Ganatra. 
 
 If they access the pills through a telemedicine service such as Women on Web which gives them information and support, the study classifies this as safe abortion, she said. But there are large numbers of women obtaining the pills online who do not have help, and those would be less safe. 
 
 The availability of the tablets is an improvement, said Ganatra. “At least it is moving away from the means that led to death. But at the same time, not dying is not enough.” 
 
 Deaths are highest in west and central Africa, at around 450 per 100,000 abortions, although the study authors warn that the mortality estimates are based on data from different time periods. They say women may die as a result of more serious complications because of the dangerous methods used to bring about an abortion – and their health services may then not have the skills or resources to treat them. 
 
 Gilda Sedgh, the Guttmacher Institute’s lead on the study, said it had not been long enough since the re-imposition of the Global Gag rule by President Trump on his first day in office to assess the impact. But there had been some research on the effects of its imposition during other Republican administrations, which had stripped funds from organisations such as the International Planned Parenthood Federation. 
 
 “There was no evidence that the Gag rule resulted in a decrease in the incidence of abortion,” she said. A couple of studies in sub-Saharan Africa had suggested it led to an increase as a result of the shrinking of contraception provision by NGOs. 
 
 “Looking forward we can only predict, based on the past, that that’s how it might play out,” she said. 
 
 Ganatra said their findings “call for the need to ensure access to safe abortions to the full extent of the law, particularly in low income regions of the world, and efforts are needed to replace the use of unsafe methods with safe methods. Increasing the availability, accessibility and affordability of contraception can reduce the incidence of unintended pregnancies, and therefore abortions, but it is essential to combine this strategy with interventions to ensure access to safe abortions.” ||||| Since 2008, the obstetrician-gynecologist has been traveling to sub-Saharan Africa. While working in Zambia, she saw gynecologic units in the hospital filled with women admitted with heavy bleeding or life-threatening infections, she said. 
 
 The women often would remain tight-lipped about why they were hemorrhaging, but Haddad said that it was clear to her and the Zambian clinicians what was happening. Some of the women had unsafe abortions and were facing serious complications, she said. 
 
 "This is a public health priority and I don't think it's been placed on that level and given the attention that it needs," said Haddad, associate professor in the department of gynecology and obstetrics at Emory University School of Medicine. 
 
 A new study finds nearly half of all 55.7 million estimated abortions around the world each year between 2010 and 2014 were performed in an unsafe manner, putting women at risk for serious complications. 
 
 , The study published Wednesday in the journal The Lancet , suggests that unsafe abortions are still a major health problem globally, especially in developing countries. 
 
 "These are the first global estimates to show the distribution of the abortions across three safety categories," said Dr. Bela Ganatra, a scientist at the department of reproductive health and research at the World Health Organization and lead author of the study. 
 
 "For the first time, we actually tried to determine the conditions under which abortions take place, how, who, where. This allows us to develop a better understanding of actions needed," she said. 
 
 a pregnancy that is terminated either by someone who lacks the necessary medical skills or in an environment that does not conform to minimal medical standards, or both. Based on the WHO definition, an unsafe abortion results froma pregnancy that is terminated either by someone who lacks the necessary medical skills or in an environment that does not conform to minimal medical standards, or both. 
 
 Unsafe abortions can lead to complications , such as heavy bleeding, infection, damage to genitals or internal organs, or an incomplete abortion, such as when all of the pregnancy tissue is not removed from the uterus, according to WHO. 
 
 Complications related to unsafe abortions sometimes can be fatal 
 
 "I think that there's no question that unsafe abortion continues to be one of the leading causes of maternal mortality and morbidity, and importantly this is preventable," said Haddad, who was not involved in the new study. Abortions performed by trained providers through evidence-based approaches are safe, she said. 
 
 Counting unsafe abortions 
 
 The study, conducted by an international team of researchers at WHO and Guttmacher Institute, involved 150 pieces of data from 61 countries on both safe and unsafe abortions performed around the world between 2010 and 2014. 
 
 The information was collected from previous surveys and studies, bibliographic databases, and ministries of health or national statistical organizations. 
 
 The researchers analyzed the data to determine how many abortions fit within the WHO's definition of "unsafe." 
 
 They found that, in total, about 55.7 million abortions occurred annually worldwide between 2010 and 2014. Among those abortions, about 25.1 million were performed in unsafe circumstances each year -- with about 17.1 million being "less safe" and 8 million being "least safe," the researchers found. 
 
 Overall, almost all abortions in developed countries were deemed safe, whereas roughly half of those in developing countries were safe, according to the findings. 
 
 "Among the developed regions, the distributions of abortions across the safety categories were similar with the majority of abortions being performed under safe conditions, except for Eastern Europe, where 14% were less safe," Ganatra said. 
 
 "While both Africa and Latin America had low proportions of abortions that were carried out in safe conditions, it was striking to note that among the unsafe abortions, the vast majority in the Latin America region were performed under less safe conditions (59.7%) while in Africa the majority of unsafe abortions were performed under the least safe conditions (48%)," she said. "It is also important to note that women undergoing abortions in Africa had the highest risk of dying from a least safe abortion." 
 
 Eastern Asia, including China, had a distribution similar to developed regions, Ganatra said. Yet in South-Central Asia, less than one in two abortions were safe. 
 
 "The paper did not examine country specific data, but other evidence shows that the same disparities exist within countries as well -- between rural and urban, rich and poor," Ganatra said. 
 
 Such a disparity often emerges when any health outcome is measured in developed versus developing regions, but safe abortion care is possible in developing countries, Ganatra said. 
 
 She pointed to Nepal Ethiopia , and Uruguay as examples of countries that have made progress in expanding access to safe abortion procedures, she said. 
 
 A separate study found that in 2012 almost 7 million women were treated for complications of unsafe abortions in the developing world. The study published in BJOG: An International Journal of Obstetrics and Gynaecology in 2015. 
 
 'She really saw no other option for herself' 
 
 The researchers wrote in the new study, "this analysis suggested that unsafe abortion is still a major problem in developing countries and that progress towards safer abortion is needed, even in some developed countries." 
 
 Yet the study came with several limitations due to the dearth of data. 
 
 "They're basing their data on other studies and numbers that are available and those numbers that are out there are limited based on their ability to estimate the true incidence," Haddad said. "So, they're likely underestimates." 
 
 The researchers themselves noted in the study that, in general, empirical data on abortions were scarce, especially in countries where abortions were legally restricted, stigmatized or less likely to be reported. 
 
 "This study gives us the first global estimates of how often women are able to find safe abortions, even if they are not getting legal abortions. It is very difficult to accurately measure abortion and abortion-related mortality, especially in countries where it is illegal. These may be the best estimates possible and yet still be an undercount," said Diana Greene Foster, professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, who was not involved in the new study. 
 
 "I have studied women who are unable to get a legal abortion in six countries: the United States, Colombia, Tunisia, South Africa, Bangladesh and Nepal. Even where abortion is supposed to be legal and available, many women are unable to access services within the medical system," she said. "Some women facing an unwanted pregnancy go on to get illegal, but safe, abortions, some get illegal unsafe abortions and some carry the unwanted pregnancy to term." 
 
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 Emory University's Haddad said that she remembers traveling to Nepal as a medical student around 2005, after the South Asian country liberalized some of its abortion restrictions. Knowledge of those reduced restrictions was not widespread, she said. 
 
 "We had a woman who came in the clinic who was right above the gestational age limit to which abortion was legal. ... It was very clear that she was seeking any way to end the pregnancy," Haddad said. "She spoke openly about suicide as an option rather than continuing with the pregnancy." 
 
 The woman was desperate because she was raped while her husband was away and she feared what would happen when her husband would return to find her pregnant, Haddad said. 
 
 "She really saw no other option for herself. ... I don't know whatever happened with her, but I can't imagine that it was good," Haddad said. 
 
 "It spoke to me because she did nothing on her own to get herself in that situation and saw no way out of it, and there was nothing I could do," she said. "And unfortunately, irrelevant of what people think of abortion, you can't ignore the fact that this is a crisis that is avoidable." ||||| TIME Health For more, visit TIME Health 
 
 About half of all abortions that take place around the world are considered unsafe, a new report reveals. 
 
 Every year, an estimated 55.7 million abortions are performed worldwide. Among those, 25.5 million are not considered safe, according to a new report published in the journal The Lancet. Researchers from the World Health Organization (WHO) and Guttmacher Institute looked at abortions performed worldwide and classified the procedures as as safe, less safe and least safe, based on what methods were used and whether a trained provider was involved. 
 
 They found that 55% of abortions performed worldwide were considered safe, which meant that the abortions used a method that was recommended by the WHO, including medical abortion, vacuum aspiration or dilatation and evacuation, and that the abortion was provided and supported by someone who is trained in the procedure. 
 
 Among the unsafe abortions, nearly 31% were classified by the study authors as less safe. This meant that while the abortion was done by a trained provider, they may have used an outdated method. It also meant that the abortion may have been done with a currently advised method, but without the oversight of a professional. 
 
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 Slightly more than 14% of abortions performed worldwide were classified as the least safe, which meant they were provided by someone who was untrained and used unsafe methods like sharp curettage. 
 
 “It’s sad that there are so many unsafe abortions, when actually the science and technology for making safe abortion assessable is very simple,” said study author Dr. Bela Ganatra, a scientist at the Department of Reproductive Health and Research at the WHO. “It’s something that can be provided at primary care level.” 
 
 The countries with the highest rates of unsafe abortions were also the countries that had the most restrictive laws regarding abortion. In the countries where abortion is legal and available, 87% of abortions were deemed safe. In countries where abortion is banned or only allowed to protect a woman’s health, only 25% of abortions were deemed safe. 
 
 MORE: Abortion Does Not Negatively Affect Women’s Mental Health: Study 
 
 Regions with the most unsafe abortions were Africa and Latin America. However, the study authors note that abortions in Latin America were more likely to be classified as “less safe” rather than “least safe,” possibly because of the increased use there of misoprostol, a medication for abortion, rather than traditional unsafe procedures. 
 
 Ganatra says that having access to abortion is just one part of meeting women’s reproductive health needs. Contraception and sex education are also important, she says, but arguments to ban abortions or increase restrictions to the procedure are not helpful. 
 
 MORE: Getting an Abortion With Telemedicine Is Safe, Study Says 
 
 “We found that [abortion] was no more common or less common based on the laws in each country, but we did see an association between the types of abortion laws and safety of abortions,” says Ganatra. 
 
 The report authors say that in order to address the high numbers of unsafe abortions around the world, more efforts are needed to ensure that unsafe methods are replaced with up-to-date methods, and more monitoring is needed to address gaps in care.
– Between 2010 and 2014, nearly 56 million women around the world got abortions each year—and the World Health Organization has found that almost half of them weren't safe. Per a WHO/Guttmacher Institute study published in the Lancet journal, of those 55.7 million annual abortions, just over 17 million fell into the "less safe" category, either because women used a mostly safe method (such as taking misoprostol pills) but without the guidance of a trained professional, or had a trained provider but used outdated methods. An additional 8 million abortions veered into the "least safe" category, using what the Guardian calls "desperate and dangerous backstreet measures," including everything from "ingestion of caustic substances" to "insertion of foreign bodies." The WHO looked at data from 182 countries and regions and found almost all of the abortions performed in developed countries were safe. In both Africa and Latin America, fewer than one in four abortions were considered safe, with the highest percentage of "least safe" abortions taking place in Africa (especially in the middle of the continent), where almost half of the pregnancy terminations fell into this most-perilous category. Per CNN, unsafe abortions can lead to everything from hemorrhaging and infection to incomplete abortions and even death. "It's sad that there are so many unsafe abortions, when actually the science and technology for ... safe [abortions] ... is very simple," study lead author Dr. Bela Ganatra says, per Time. (A story about Down syndrome in Iceland set off a fierce debate on abortion.)