A new report from the Guttmacher Institute has major implications for U.S.
policy, highlighting the urgency for boosting U.S. international family
planning assistance and the need for the United States to be more engaged in
mitigating the impact of unsafe abortion.

The
report, published on October 13, shows positive global trends in increased
contraceptive use, lower unintended pregnancy rates and declining abortion
numbers, but also demonstrates that unsafe abortion remains a critical global
health challenge. According to “Abortion Worldwide: A
Decade of Uneven Progress,” both the developed and the developing world saw
overall improvements on all three indicators. However, developed
regions saw the greatest progress, while improvement varied widely in the
developing world, with Africa lagging behind all other regions.

Increases in global contraceptive use have contributed to a
decrease in the number of unintended pregnancies and abortions, which declined from
45.5 million procedures in 1995 to 41.6 million in 2003. This decline in
worldwide abortion occurred alongside a global trend toward liberalizing
abortion laws, with 19 countries significantly reducing abortion restrictions
since 1997, and only 3 countries substantially increasing legal restrictions.

The report finds that while the incidence of abortion is
closely related to that of unintended pregnancy, it does not correlate with
abortion’s legal status. Indeed, abortion occurs at roughly equal rates in
regions where it is broadly legal and in regions where it is highly restricted.
The key difference is safety—illegal, clandestine abortions cause significant
harm to women, especially in developing countries. Unsafe abortion causes
70,000 deaths each year and 5 million women are treated for severe
complications resulting from unsafe abortion. Another 3 million women with
serious complications go untreated. 
In essence, the report provides new proof that the legality of abortion
has much more to do with the safety than the rate of abortion.

Instead, the rate of abortions in a given country corresponds
mostly to the rate of unintended pregnancy, which in turn corresponds closely to
rates of contraceptive use.  Where
abortion remains severely restricted, it happens about as often as where it
isn’t—but it accounts for high rates of maternal death and disability and huge
costs to already strained health systems in developing countries.

 

The
report’s findings are an urgent call to action, and the United States is
well-positioned to be a leader in helping to prevent unintended pregnancies and
unsafe abortions worldwide. The Obama administration deserves praise for
reprioritizing international family planning assistance by rescinding
the anti-family planning Mexico City Policy (also known as the Global Gag
Rule) and for restoring
U.S. funding to UNFPA. The administration likewise deserves credit for making
unintended pregnancy prevention one of four pillars of its soon-to-be-released
Global Health Initiative. And the new administration and Congress already have
begun making up for lost time and have committed important increases in funding
for international family planning services despite the tough fiscal
environment.

 

But these positive steps are not enough. Deaths from unsafe abortion are utterly preventable
and there is much more the United States can do to avert death and suffering
among millions of women, their children and their families:

• The
  U.S. Congress should increase foreign aid to international family planning programs
  beyond current proposed increases. U.S. advocates have called for U.S. family
  planning assistance to be doubled, to at least $1 billion annually. A recently
  released report by five former directors of the Population and Reproductive
  Health Program of the U.S. Agency for International Development (USAID) goes
  even further, recommending that funding for USAID’s population budget be set at
  $1.2 billion—and raised to $1.5 billion by fiscal year 2014.

• Congress
  should also reexamine restrictive abortion policies. The 1973 Helms
  amendment bars the U.S. government from paying for safe abortion services
  overseas (much like the Hyde amendment does domestically). This
  restriction should be overturned because it is only exacerbating the
  problem of unsafe abortion and having no effect whatsoever on making
  abortion less likely. The United
  Kingdom’s Department for International Development’s position on unsafe
  abortion shows just how far the United States is lagging behind other
  nations when it comes to supporting programs that make safe abortion and
  post-abortion care more accessible globally.

• Until
  such time as Congress is prepared to confront the Helms amendment ban on
  providing funding for safe abortion services in the world’s poorest
  countries, at the very least, the U.S. should work within the existing
  exceptions under Helms (in cases of rape, incest and danger to the
  mother’s life) to make safe abortion care available to women who meet
  these criteria (consistent with local law). The U.S. should also boost
  programs that aim to prevent the worst consequences of unsafe abortions,
  by helping to make post-abortion care more widely available to women
  suffering complications from clandestine procedures.

• Lastly,
  the Obama administration should return the United States to its traditional
  role as a strong advocate for family planning at the international level. As
  part of this overall effort, the United States is recommitting itself to
  achieving reductions in maternal mortality and broader access to family
  planning services under the framework agreed during the 1994 International
  Conference on Population and Development in Cairo as well as under the
  millennium development goals.

 

Women
are critical to the economic and social development of societies and to the realization
of U.S. international development priorities, as well as many, if not most, of
the Millennium Development Goals. It’s time for the U.S. to get serious about
addressing better access to contraception, unwanted pregnancy and unsafe
abortion as the key public health challenges they are.