The high rate of the procedure in eastern Europe means that nearly a third of all pregnancies in that continent end in abortion. By contrast, only 12 percent of pregnancies in Africa end in abortion. Worldwide, the rate of abortion is one in every five pregnancies.
China accounts for about a fifth of all abortions worldwide, the survey found. The rate in China dropped 20 percent between 1995 and 2003, as a growing middle class learned more effective use of contraception, Sedgh said.
The survey has both good and bad news, said Beth Fredrick, executive vice president of the International Women's Health Group. "What is good is that the overall number of abortions are going down, primarily because of improved contraceptive use," said Fredrick, who was also the author of an accompanying journal commentary on the findings. "But behind the statistics, we see that the majority of abortions are going to be unsafe, particularly for the impoverished. This is an atrocity in terms of how we recognize human rights."
Legal changes are occurring but differ among countries, Fredrick said. "Portugal, Columbia and Mexico City have liberalized," she said. "Nicaragua has completely outlawed abortion, and there are early indications that this is having a bad impact on the women of Nicaragua, their partners and families."
The abortion survey is included in a special "Women Deliver" issue of The Lancet. It includes articles on the need to improve maternal mortality rates in regions such as southern Africa; the drive for more resources to fight severe childbirth complications; and the uneven progress being made t
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