Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights
imperative. As with other more visible global-health issues, this scourge threatens
women throughout the developing world. Every year, about 19-20 million abortions are
done by individuals without the requisite skills, or in environments below minimum
medical standards, or both. Nearly all unsafe abortions (97%) are in developing countries.
An estimated 68 000 women die as a result, and millions more have complications, many
permanent. Important causes of death include haemorrhage, infection, and poisoning.
Legalisation of abortion on request is a necessary but insufficient step toward improving
women's health; in some countries, such as India, where abortion has been legal for
decades, access to competent care remains restricted because of other barriers. Access
to safe abortion improves women's health, and vice versa, as documented in Romania
during the regime of President Nicolae Ceausescu. The availability of modern contraception
can reduce but never eliminate the need for abortion. Direct costs of treating abortion
complications burden impoverished health care systems, and indirect costs also drain
struggling economies. The development of manual vacuum aspiration to empty the uterus,
and the use of misoprostol, an oxytocic agent, have improved the care of women. Access
to safe, legal abortion is a fundamental right of women, irrespective of where they
live. The underlying causes of morbidity and mortality from unsafe abortion today
are not blood loss and infection but, rather, apathy and disdain toward women.