Following the overwhelming success of my earlier blogs (zero comments, three hits and one lukewarm response from someone in the office), I am starting a more regular blog about evidence and research in Sexual and Reproductive Health. Yes, I am going to try and make numbers and science sexy.
First post has to be around the new
global abortion estimates released by the Guttmacher Institute . The bible for anyone working on safe abortion, the new estimates have received some impressive news coverage and are generally being heralded as a success for family planning and public health efforts.
The Economist magazine concludes that the numbers show us a “glimmer of hope” and that we now know how to reduce the rate of abortion.
Unfortunately, a closer inspection of the statistics reveals a rather more bleak picture: overall, the rate of abortions globally has decreased but it is mostly due to changes that happened in the late 1990s in Eastern Europe. Fifteen years ago, access to contraception in Eastern Europe was very low and therefore abortion was the primary way to limit the size of families. Thankfully, this has changed with more family planning methods available and consequently, we have seen some large decreases in abortion numbers. However, this sub-region continues to have the highest abortion rates in the world, so we have some ways to go. More disappointingly, there have been no real decreases in the number of unsafe abortions globally, which mostly means Africa, Asia and Latin America.
The numbers are sobering. But what worries me when I look at the stats is that we don’t really know what is going on at all. We all know it is difficult to come up with estimates for abortion in legally restricted environments and The Guttmacher Institute is doing the best it can with little data. Yet these latest state-of-the-art estimates are based on 2003 data and are often sub-regional or regional. This is an outrage. The latest data are seven years old and we don’t even have many national estimates. And all this is in the context of five million women a year being hospitalised because of abortion-related complications
1 and over one in eight maternal deaths caused by unsafe abortion.
2 Is there a good reason why we can’t have better estimates? Methodologically, it is difficult to get estimates in legally restricted environments in which people are often hesitant to talk about such a taboo issue. Guttmacher (like WHO) use a combination of approaches such as analysing hospitalisation data or talking with abortion providers and other key stakeholders. This type of incomplete information can only provide an indirect estimation at best.
So it is difficult to do but that doesn’t mean it can’t be done. Ten years ago, we had equally shoddy statistics on HIV – another highly taboo subject. Yet, with enough political mobilisation and investment in surveillance systems, this has turned around with HIV now being one of the best monitored diseases in public health.
We need better data on trends in safe and unsafe abortion. This isn’t just the geeky research side of me talking : it is simply unacceptable that we don’t have a good grasp on such an important public health issue.
Next time, something more light-hearted, I promise!
1Singh S, Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries, Lancet, 2006, 368(955):1887–1892.
2