Legal abortion worldwide: incidence and recent trends.

CONTEXT: Information on abortion levels and trends can inform research and policies affecting maternal and reproductive health, but the incidence of legal abortion has not been assessed in nearly a decade. METHODS: Statistics on legal abortions in 2003 were compiled for 60 countries in which the procedure is broadly legal, and trends were assessed where possible. Data sources included published and unpublished reports from official national reporting systems, questionnaires sent to government agencies and nationally representative population surveys. The completeness of country estimates was assessed by officials involved in data collection and by in-country and regional experts. RESULTS: In recent years, more countries experienced a decline in legal abortion rates than an increase, among those for which statistics are complete and trend data are available. The most dramatic declines were in Eastern Europe and Central Asia, where rates remained among the highest in the world. The highest estimated levels were in Armenia, Azerbaijan and Georgia, where surveys indicate that women will have close to three abortions each, on average, in their lifetimes. The U.S. abortion rate dropped by 8% between 1996 and 2003, but remained higher than rates in many Northern and Western European countries. Rates increased in the Netherlands and New Zealand. The official abortion rate declined by 21% over seven years in China, which accounted for a third of the world's legal abortions in 1996. Trends in the abortion rate differed across age-groups in some countries. CONCLUSIONS: The abortion rate varies widely across the countries in which legal abortion is generally available and has declined in many countries since the mid-1990s.

Legal abortion worldwide: incidence and recent trends.

CONTEXT: Information on abortion levels and trends can inform research and policies affecting maternal and reproductive health, but the incidence of legal abortion has not been assessed in nearly a decade. METHODS: Statistics on legal abortions in 2003 were compiled for 60 countries in which the procedure is broadly legal, and trends were assessed where possible. Data sources included published and unpublished reports from official national reporting systems, questionnaires sent to government agencies and nationally representative population surveys. The completeness of country estimates was assessed by officials involved in data collection and by in-country and regional experts. RESULTS: In recent years, more countries experienced a decline in legal abortion rates than an increase, among those for which statistics are complete and trend data are available. The most dramatic declines were in Eastern Europe and Central Asia, where rates remained among the highest in the world. The highest estimated levels were in Armenia, Azerbaijan and Georgia, where surveys indicate that women will have close to three abortions each on average in their lifetimes. The U.S. abortion rate dropped by 8% between 1996 and 2003, but remained higher than rates in many Northern and Western European countries. Rates increased in the Netherlands and New Zealand. The official abortion rate declined by 21% over seven years in China, which accounted for a third of the world's legal abortions in 1996. Trends in the abortion rate differed across age-groups in some countries. CONCLUSIONS: The abortion rate varies widely across the countries in which legal abortion is generally available and has declined in many countries since the mid-1990s.

Early childbearing in Honduras: a continuing challenge.

(1) Honduras has the highest adolescent birthrate in Central America, at 137 births for every 1,000 15-19-year-olds. This rate has remained unchanged over the past two decades, despite declines in the birthrate among women in all other age-groups. In absolute numbers, births to adolescents increased by 50% between 1987 and 2001. (2) As of 2001, only one-third of all women aged 20-24 (and only one-seventh of those in rural areas) had completed primary school; less education is associated with a higher likelihood of early childbearing. (3) One-half of 20-24-year-olds give birth by age 20; this proportion is higher among the least-educated women (70%), the poorest women (64%) and those in rural areas (60%). (4) In 2001, 40% of all recent adolescent births were unplanned, and the highest proportion was among those with the most education (48%). Most sexually active 15-19-year-olds (70%) do not want to have a child in the next two years. (5) Despite these reproductive preferences, just one in three sexually active adolescents uses a modern contraceptive method. Overall, 48% of adolescents have an unmet need for effective contraception. (6) High levels of early childbearing coexist with low rates of professional prenatal and delivery care. In 2001, one-third of recent 15-24-year-old mothers did not make a single prenatal care visit. The same proportion gave birth without a medical professional in attendance. (7) Policies and programs that aim to promote adolescents' reproductive health and support their childbearing preferences exist, but they are often not fully implemented and need more official commitment and resources.

Early childbearing in Guatemala: a continuing challenge.

(1) Guatemala has the third highest adolescent birthrate in Central America-114 births for every 1,000 women aged 15-19 each year. (2) Only two-fifths of 20-24-year-old women have completed primary school. The proportion is one in four in rural areas and one in 10 among indigenous women. (3) One-half of young women enter into a union (formal or consensual) before their 20th birthday. Three-quarters of those with no schooling do so, compared with one-quarter of those with a primary education or more. (4) Forty-four percent of 20-24-year-olds were mothers by age 20; the proportion is highest among young women with no education (68%) and among indigenous women (54%). (5) The great majority of 15-19-year-old women in union-83%, with little variation by residence or ethnicity-do not want to have a child in the next two years. However, only 18% are using an effective contraceptive. (6) Although 70% of 15-24-year-olds who recently gave birth made at least one prenatal care visit, roughly half of the least educated and of indigenous women made none. Moreover, only half of 15-24-year-old mothers had professional medical care at their most recent delivery; the proportion is even lower among the least educated and indigenous women (one-quarter).

Early childbearing in Nicaragua: a continuing challenge.

(1) Among Nicaraguan women 20-24 years old, six in 10 had entered a union and almost half had had a child before their 20th birthday. (2) A quarter of all births in Nicaragua--35,000 per year--are to 15-19-year-olds. (3) Rural women, who have less education, on average, than their urban counterparts, are more likely than city dwellers to enter a union and become mothers during adolescence. (4) The proportion of 20-24-year-olds who had a child during adolescence is more than twice as high among the poorest as among those in the highest socioeconomic category. (5) Nearly half--45%--of births to adolescent women are unplanned, a level that varies little by women's urban-rural residence and their educational achievement. (6) Among all sexually active women aged 15-19 (in union and not in union), 86% do not want a child in the next two years, and 36% have an unmet need for effective contraception. Unmet need for family planning is equally high in urban and rural areas. (7) The strong link between low educational attainment and early motherhood suggests that improving educational opportunities for girls is a promising way of reducing high levels of adolescent childbearing in Nicaragua.