Thank you for inviting me to give evidence to the joint committee. It is a privilege to be here. By way of introduction, and to add to the introduction the Chairman provided, I am a principal research scientist at the Guttmacher Institute in New York. We are a research and policy organisation and we conduct population-level research on reproductive health in the United States and globally. The Guttmacher Institute advocates for evidence-based policies that promote reproductive and sexual health. Our evidence is used by stakeholders on various sides of the discourse. I have been asked to present evidence on abortion trends worldwide and on the characteristics of women who have abortions.
I will start by giving a global overview of abortion trends, which can provide some context for abortion incidents and trends in Europe. This evidence was published in The Lancet last year, and it is based on work that we did in collaboration with our colleagues at the World Health Organization.
We estimate that worldwide approximately 56 million abortions took place each year between 2010 to 2014. The annual number of abortions has increased slightly since the early 1990s. It can be more useful to talk about how many abortions take place for every 1,000 women of child-bearing age. This is because the absolute number of abortions can increase as the number of women in a population increases, but the number of abortions for every 1,000 women, also known as the abortion rate, is not influenced by the size of the population. The 56 million abortions that take place each year translate to about 35 abortions for every 1,000 women of reproductive age. Another way of saying this is that, roughly speaking, about 3.5% of women of child-bearing age have an abortion each year globally. The global abortion rate has declined slightly over the past 25 years.
We have also estimated abortion incidence across the 17 major subregions of the world. We were not able to estimate incidence for every individual country because we did not have enough data on which to base country estimates. I refer the trends in the abortion rate in major parts of the developed world, that is, Europe and North America. We can look at northern, western and southern Europe together because the abortion levels and trends in these three sub-regions are similar. The abortion rate is much lower in North America and in Europe, outside of eastern Europe, than the global average of 35 per 1,000 women. It is about 17 in North America and 21 in non-eastern Europe, and the rate has declined modestly in both of these regions in the past 25 years or so.
Eastern Europe is a different story. As members are probably aware, the abortion rate was very high in eastern Europe during the Soviet era. It declined dramatically in the past 25 years to less than half of what is was in the early 1990s. The abortion rates in northern, western and southern Europe are the lowest sub-regional abortion rates in the world, and the decline in eastern Europe is by far the sharpest decline that we have seen in the world.
While we were not able to estimate abortion incidence for all countries, we compiled statistics from countries with good reporting systems for the most recent year for which such evidence was available at the time of our compilation. I refer to the countries where it is recognised that at least 90% of all abortions are included in the official reports. Across these 18 countries, almost all of which are all in Europe, the abortion rate varies from five per 1,000 in Switzerland to 18 per 1,000 in Sweden. In eight of these 18 countries, the abortion rate is fewer than ten per 1,000. Globally, when we grouped countries according to their abortion laws, we found that, on average, the abortion rate in countries where the procedure is prohibited altogether or allowed only to save a woman’s life is not significantly different from the rate in countries where abortion is allowed without restriction as to reason. The vertical lines around the points indicate the margins of error around these estimates and members can see they all overlap. This is a bird’s eye view of abortion rates in these groups of countries and it does not examine the various factors that could influence abortion rates in these countries.
We were also able to estimate the percent of all abortions that were obtained by married women and the percent obtained by unmarried women. We used data from the United Nations, which defines married women to include women in cohabiting unions. We estimate that about 73% of all abortions worldwide are obtained by married women, and 27% are obtained by unmarried women. In the developed world, about 69% of all abortions are obtained by married women. These are estimates across broad geographic areas, and there are variations across countries within each of these groups of countries.
I showed abortion rates in countries grouped by the legal status of abortion. Last month we published estimates of the safety of abortions performed worldwide, and in groups of countries classified according to their abortion laws. These estimates were also made with colleagues from the World Health Organization, and are also published in The Lancet.
As defined by the World Health Organization, safe abortions are those done by a trained provider or a trained person and using methods appropriate to the gestational age of the pregnancy. Less safe abortions are those for which only one of these criteria is met, and least safe abortions are those for which neither of these two criteria are met. About 31% of abortions are in the least safe category in countries where abortion is illegal on all grounds or only allowed to save a woman’s life or preserve her physical health. Less than 1% of abortions are in the least safe category in countries where abortion is permitted without restriction as to reason. We also found that abortions are also more likely to be unsafe in low income countries than in high income countries, based on the World Bank classification of countries. Countries with restrictive abortion laws tend to be low-income countries, and Ireland is anomalous as a high-income country with a restrictive abortion law, so it is not easy to assess the relationships of economic development and legal status with the safety of abortion.
We did not have enough information with which to estimate the ages of women obtaining abortions across the world’s sub-regions. Instead we compiled statistics from the countries with good quality reporting. These are countries with liberal abortion laws where at least 90% of abortions are included in the reporting systems. Across the countries with this information, about half of abortions are obtained by women in their 20s, and another third are obtained by women in their 30s. Across all these countries, adolescents of 19 years old or younger, predominantly adolescents of 15 to 19 years old, account for a smaller share of abortions than their share of the population - that is, the abortion rate is lower among adolescents than among women in their 20s and 30s. In almost all these countries, adolescents’ share of all abortions has decreased since the early 1990s. In the countries that further break down the ages of women having abortions into smaller windows, the majority of adolescents’ abortions are obtained by 18 and 19 year olds.
According to the statistics we compiled from 15 countries, 48% to 74% of women who obtained an abortion already had at least one child. In all but two of these countries, more than half of women obtaining an abortion already had at least one child.
We are currently preparing a report on the gestational ages of pregnancies when they are terminated across countries that have reliable statistics. I refer to abortions done in the first trimester of pregnancy. According to these preliminary findings, in all but three of these countries, 90% or more of abortions are obtained in the first trimester.
For four countries we have information from nationally representative surveys of women on the reasons for wanting an abortion, among those who have had an abortion. Women obtain abortions for a wide variety of reasons. In these surveys women were asked to give just their primary reason for having an abortion. For example, in Belgium, about one fourth of women said they sought an abortion for socioeconomic reasons, and another one fourth had an abortion for partner-related reasons - for example, their partner did not want to have a child or their relationship was dissolving. Approximately 18% wanted to space their children or postpone having a child, and another 13% already had as many children as they wanted or could manage. Approximately 1% of women in Belgium said that they were having an abortion because of issues related to the health of the foetus. In the other three countries, less than 1% of all abortions were for reasons related to foetal health.
In a survey in the United States, women who had an abortion were asked to indicate all their reasons for having the abortion. An interesting take-away message from this survey is that many women gave more than one reason. Financial issues, wanting to space or delay child-bearing and partner-related issues remained common. Approximately 30% of women said they sought an abortion because they needed to focus on the children that they already had at home.
I will shift gears and wrap up by giving a broad overview of abortion laws of countries across the world. Ms Leah Hoctor will go into more detail on this topic. Of the 199 countries and major territories in the world, 75 allow abortion without restriction as to reason or for socioeconomic reasons; 58 countries and territories allow abortion to preserve a woman’s physical or mental health; and 40 allow abortion to save a woman’s life.
Ireland is one of these 40 countries. In 26 countries, abortion is not allowed for any reason, although some of these make exceptions in cases of rape, incest or foetal anomaly.
Using the UN's classification of countries according to whether they are developed or developing, 41 of the 50 developed countries allow abortion without restriction as to reason or for socioeconomic reasons, five allow abortion to preserve a woman's physical or mental health, one – Ireland – allows abortion to save a woman's life, and three do not allow abortion on any ground.
I will end by summarising some of the key points from the review. The sub-regions with the lowest abortion rates are those in which most countries are developed, where abortion is legal on broad grounds and there are strong reproductive health programmes. Women obtaining abortions represent a broad spectrum of all women - young and old, single and married, childless and with children - and many who seek an abortion have multiple reasons for doing so.
