Guttmacher Institute, New York, NY, USA.
Lancet. 2012 Feb 18;379(9816):625-32. doi: 10.1016/S0140-6736(11)61786-8. Epub 2012 Jan 19.
Data of abortion incidence and trends are needed to monitor progress toward improvement of maternal health and access to family planning. To date, estimates of safe and unsafe abortion worldwide have only been made for 1995 and 2003.
We used the standard WHO definition of unsafe abortions. Safe abortion estimates were based largely on official statistics and nationally representative surveys. Unsafe abortion estimates were based primarily on information from published studies, hospital records, and surveys of women. We used additional sources and systematic approaches to make corrections and projections as needed where data were misreported, incomplete, or from earlier years. We assessed trends in abortion incidence using rates developed for 1995, 2003, and 2008 with the same methodology. We used linear regression models to explore the association of the legal status of abortion with the abortion rate across subregions of the world in 2008.
The global abortion rate was stable between 2003 and 2008, with rates of 29 and 28 abortions per 1000 women aged 15-44 years, respectively, following a period of decline from 35 abortions per 1000 women in 1995. The average annual percent change in the rate was nearly 2·4% between 1995 and 2003 and 0·3% between 2003 and 2008. Worldwide, 49% of abortions were unsafe in 2008, compared to 44% in 1995. About one in five pregnancies ended in abortion in 2008. The abortion rate was lower in subregions where more women live under liberal abortion laws (p<0·05).
The substantial decline in the abortion rate observed earlier has stalled, and the proportion of all abortions that are unsafe has increased. Restrictive abortion laws are not associated with lower abortion rates. Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps toward achieving the Millennium Development Goals.
UK Department for International Development, Dutch Ministry of Foreign Affairs, and John D and Catherine T MacArthur Foundation.
为了监测改善孕产妇健康和计划生育服务获取方面的进展，需要有堕胎发生率和趋势的数据。迄今为止，全球范围内对安全和不安全堕胎的估计仅针对 1995 年和 2003 年做出过估计。
我们使用世卫组织关于不安全堕胎的标准定义。安全堕胎的估计主要基于官方统计数据和具有代表性的全国性调查。不安全堕胎的估计主要基于已发表研究、医院记录和对妇女的调查资料。我们使用了其他资料来源和系统方法，在数据报告有误、不完整或属于早年数据的情况下进行了必要的修正和预测。我们使用 1995 年、2003 年和 2008 年制定的方法，使用发展率评估堕胎发生率的趋势。我们使用线性回归模型探讨了 2008 年世界各次区域的堕胎合法状况与堕胎率之间的关联。
2003 年至 2008 年期间全球堕胎率保持稳定，15-44 岁年龄组妇女的堕胎率分别为每 1000 名妇女 29 次和 28 次，此前该比率呈下降趋势，从 1995 年的每 1000 名妇女 35 次下降。1995 年至 2003 年期间，该比率每年平均变化近 2.4%，而 2003 年至 2008 年期间则为 0.3%。2008 年全球 49%的堕胎为不安全堕胎，而 1995 年这一比例为 44%。2008 年约有五分之一的妊娠以堕胎而告终。在更多妇女生活在堕胎法律较宽松的次区域，堕胎率较低（p<0.05）。
此前观察到的堕胎率大幅下降已趋于停滞，不安全堕胎所占比例有所增加。限制堕胎的法律与较低的堕胎率并无关联。减少意外怀孕和不安全堕胎发生率的措施，包括对计划生育服务和安全堕胎护理的投资，是实现千年发展目标的关键步骤。
英国国际发展部、荷兰外交部和约翰·D 和凯瑟琳·T·麦克阿瑟基金会。
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