Women around the world, of all ages, races, nationalities, and religions, have abortions. It’s estimated that one in three women will experience an abortion at some point during her lifetime. Yet a heavy stigma remains that keeps women suffering in silence.
When safe abortion care is inaccessible, many women and girls turn to dangerous methods for abortion, regardless of safety and legal restrictions.
Since MSF projects often see patients suffering from the severe, potentially life-threatening effects of unsafe abortion, we have expanded our efforts to help women access safe abortion care and to find ways of providing it at our projects.
In 2021, we provided over 35,200 safe abortions, in 33 countries around the world, to women and girls who requested it. We also provided treatment to 18,300 women and girls for abortion related concerns and complications.
Facts about abortion
Abortion occurs when a pregnancy is ended. It can happen spontaneously, also referred to as miscarriage, or as the result of a deliberate intervention.
Abortion is very common: three out of every 10 pregnancies worldwide end in abortion. Chances are, someone close to you has had an abortion.
According to the World Health Organization, an abortion is unsafe if the person providing it does not have the necessary skills or if the abortion takes place in an environment that does not meet minimal medical standards.
Examples we see in our projects include: ingesting traditional remedies or toxic substances such as bleach, battery acid, or chlorine; incorrect administration of medications without the appropriate support; inflicting repeated blunt trauma to the abdomen; and inserting sharp sticks or needles into the body.
Complications from unsafe abortion include severe bleeding, infection, and injury to the genital tract or internal organs. Unsafe abortion can also lead to long-term health consequences such as infertility and chronic pain. At least 22,000 people die from the complications of unsafe abortion each year.
Anyone with an unwanted pregnancy who cannot access safe abortion services is at risk of injury or death from unsafe abortion. Barriers to safe abortion include high cost, legal restrictions, stigma, lack of trained or willing providers, and unnecessary requirements.
Poor women, women of colour, and women living in remote areas are disproportionately cut off from safe abortion services. The vast majority – 97 per cent – of unsafe abortions take place in low- and middle-income countries in Latin America, Africa and Asia. Women and girls trapped in war, crisis, and conflicts often face additional barriers to accessing safe abortion care.
By providing comprehensive reproductive health care programming, including sexuality education, contraceptive services, safe abortion care and post-abortion care.
An abortion is considered safe if:
1) The person providing or supporting the abortion is trained, and
2) An evidence-based method that is appropriate to the pregnancy duration is used.
Examples of safe, evidence-based methods of abortion include:
1) Medication abortion (an abortion with pills).
2) An outpatient procedure performed in a hygienic environment by a qualified provider.
In an abortion with pills, a woman takes medicines that cause the uterus to contract and push out the pregnancy ─ similar to a miscarriage. An abortion with pills is more than 95 per cent effective and is extremely safe, with less than a one per cent chance of severe, life-threatening complications. The risk of death from a safe abortion is lower than from a shot of penicillin or from a tooth extraction.
An abortion with pills can safely be provided in low-resource settings – including those without ultrasound or laboratory testing available. A safe abortion with pills needs only three things: accurate information, quality medications, and mutual respect and trust. Because of this, medication abortion has expanded access to safe abortion care for millions of women and girls around the world – especially in conflict and crisis settings.
How we respond
In order to reduce the maternal death and suffering from unwanted pregnancy and unsafe abortion, MSF provides a comprehensive package of reproductive healthcare services - including contraception, safe abortion care, and post-abortion care.
We also publicly speak out against harmful governmental policies like the Global Gag Rule and other efforts to limit access to care, and share evidence-based, factual information about safe abortion care. Lastly, we conduct research investigating the severity and treatment of complications from unsafe abortion in conflict-affected settings.
Comprehensive package of reproductive healthcare services
Contraception: Our projects aim to provide a wide variety of contraceptive methods to meet the different needs of our patients, including implants, intrauterine devices, injectables, oral contraceptive pills, and condoms. As we work in settings where ongoing crisis or conflict may restrict access to services, we strive to adapt our contraceptive programmes to reach women where they are - for example, we have created tools to support more self-managed and community-based models of contraceptive care.
In 2021, MSF provided 524,100 consultations for contraception.
Safe abortion care: In 2004, MSF passed a resolution stating that safe abortion care should be integrated as a part of routine reproductive healthcare services. Despite this policy, in the years that followed very few MSF projects started to provide safe abortion care. Internal barriers, such as abortion-related stigma, myths and misperception, and security concerns were identified as the main reasons for this inaction. In order to increase the availability of safe abortion care in MSF projects, in 2016 MSF launched the Task Force for Safe Abortion Care. With the support of the Task Force, MSF has developed a systematic approach to supporting field teams in the implementation of safe abortion care, along with multiple tools and resources. This initiative has served as a catalyst for change throughout the organisation.
In 2021, we provided over 35,200 safe abortions, in 33 countries around the world, to women and girls who requested it.
Post-abortion care: Despite this progress, MSF teams continue to treat the complications from unsafe abortion – also known as post-abortion care – on a daily basis. In 2021, MSF teams treated over 18,300 abortion-related complications, the majority likely due to unsafe abortion. This figure highlights the sad reality that in much of the world, women still cannot access the safe abortion services need.
Education, advocacy and research
MSF shares factual, evidence-based information about abortion in order break abortion stigma and dispel myths and misperceptions. In January 2020, MSF launched a free, open-source, evidence-based online course on medication abortion. Developed in partnership with HowToUseAbortionPill.org, its five animated videos provide information on how to safely administer an abortion with pills in both the first and second trimester.
MSF also speaks out on the medical need for life-saving safe abortion care. We share the stories of patients who lack access to care, and of doctors and nurses who see the devastating effects of unsafe abortion every day. We also speak out against harmful governmental policies, like the Global Gag Rule, which has recently been rescinded. While this is an important first step, there are still many other barriers to overcome to ensure that all people have access to this care.
MSF has partnered with the Guttmacher Institute, Ipas, and the ministries of health of three countries (Democratic Republic of Congo, Central African Republic and Nigeria) on a three-year study to assess the frequency and severity of abortion-related complication and the quality of abortion-related care.