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Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model

Global estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widesp... Full description

Journal Title: The Lancet (British edition) 2017, Vol.390 (10110), p.2372-2381
Main Author: Ganatra, Bela
Other Authors: Gerdts, Caitlin , Rossier, Clémentine , Johnson, Brooke Ronald , Tunçalp, Özge , Assifi, Anisa , Sedgh, Gilda , Singh, Susheela , Bankole, Akinrinola , Popinchalk, Anna , Bearak, Jonathan , Kang, Zhenning , Alkema, Leontine
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
Link: https://www.ncbi.nlm.nih.gov/pubmed/28964589
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5711001
title: Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model
format: Article
creator:
  • Ganatra, Bela
  • Gerdts, Caitlin
  • Rossier, Clémentine
  • Johnson, Brooke Ronald
  • Tunçalp, Özge
  • Assifi, Anisa
  • Sedgh, Gilda
  • Singh, Susheela
  • Bankole, Akinrinola
  • Popinchalk, Anna
  • Bearak, Jonathan
  • Kang, Zhenning
  • Alkema, Leontine
subjects:
  • Abortion
  • Abortion safety
  • Abortion, Induced - statistics & numerical data
  • Abortion, Legal - statistics & numerical data
  • Abortion, Therapeutic - statistics & numerical data
  • Analysis
  • Article
  • Bayes Theorem
  • Bayesian analysis
  • Classification
  • Cohort Studies
  • Databases, Factual
  • Developed countries
  • Developed Countries - statistics & numerical data
  • Developing countries
  • Developing Countries - statistics & numerical data
  • embryonic structures
  • Estimates
  • Female
  • Global Health
  • Health care reform
  • Humans
  • Internationality
  • Language
  • Laws
  • LDCs
  • Low income groups
  • Misoprostol
  • Models
  • Mortality
  • Patient Safety
  • Political aspects
  • Pregnancy
  • Prevalence
  • Primary care
  • reproductive
  • Risk Assessment
  • Safety
  • Safety and security measures
  • Socioeconomic factors
  • Standards
  • United Nations
  • urinary physiology
  • Womens health
  • World
ispartof: The Lancet (British edition), 2017, Vol.390 (10110), p.2372-2381
description: Global estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where abortion is legally restricted, and the need to account for the multiple factors that affect abortion safety. We used all available empirical data on abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe abortion and WHO guidelines on safe abortion to categorise abortions as safe or unsafe and to further divide unsafe abortions into two categories of less safe and least safe. Of the 55· 7 million abortions that occurred worldwide each year between 2010–14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9–59·4) were safe, 17·1 million (30·7%, 25·5–35·6) were less safe, and 8·0 million (14·4%, 11·5–18·1) were least safe. Thus, 25·1 million (45·1%, 40·6–50·1) abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws. Increased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleGlobal, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model
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creatorGanatra, Bela ; Gerdts, Caitlin ; Rossier, Clémentine ; Johnson, Brooke Ronald ; Tunçalp, Özge ; Assifi, Anisa ; Sedgh, Gilda ; Singh, Susheela ; Bankole, Akinrinola ; Popinchalk, Anna ; Bearak, Jonathan ; Kang, Zhenning ; Alkema, Leontine
creatorcontribGanatra, Bela ; Gerdts, Caitlin ; Rossier, Clémentine ; Johnson, Brooke Ronald ; Tunçalp, Özge ; Assifi, Anisa ; Sedgh, Gilda ; Singh, Susheela ; Bankole, Akinrinola ; Popinchalk, Anna ; Bearak, Jonathan ; Kang, Zhenning ; Alkema, Leontine
descriptionGlobal estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where abortion is legally restricted, and the need to account for the multiple factors that affect abortion safety. We used all available empirical data on abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe abortion and WHO guidelines on safe abortion to categorise abortions as safe or unsafe and to further divide unsafe abortions into two categories of less safe and least safe. Of the 55· 7 million abortions that occurred worldwide each year between 2010–14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9–59·4) were safe, 17·1 million (30·7%, 25·5–35·6) were less safe, and 8·0 million (14·4%, 11·5–18·1) were least safe. Thus, 25·1 million (45·1%, 40·6–50·1) abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws. Increased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.
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1EISSN: 1474-547X
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languageeng
publisherEngland: Elsevier Ltd
subjectAbortion ; Abortion safety ; Abortion, Induced - statistics & numerical data ; Abortion, Legal - statistics & numerical data ; Abortion, Therapeutic - statistics & numerical data ; Analysis ; Article ; Bayes Theorem ; Bayesian analysis ; Classification ; Cohort Studies ; Databases, Factual ; Developed countries ; Developed Countries - statistics & numerical data ; Developing countries ; Developing Countries - statistics & numerical data ; embryonic structures ; Estimates ; Female ; Global Health ; Health care reform ; Humans ; Internationality ; Language ; Laws ; LDCs ; Low income groups ; Misoprostol ; Models ; Mortality ; Patient Safety ; Political aspects ; Pregnancy ; Prevalence ; Primary care ; reproductive ; Risk Assessment ; Safety ; Safety and security measures ; Socioeconomic factors ; Standards ; United Nations ; urinary physiology ; Womens health ; World
ispartofThe Lancet (British edition), 2017, Vol.390 (10110), p.2372-2381
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02017 World Health Organization
1Copyright © 2017 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY-NC-ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
2COPYRIGHT 2017 Elsevier B.V.
3Copyright Elsevier Limited Nov 25, 2017
42017. World Health Organization. Copyright © 2017 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY-NC-ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
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7Singh, Susheela
8Bankole, Akinrinola
9Popinchalk, Anna
10Bearak, Jonathan
11Kang, Zhenning
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0Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model
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descriptionGlobal estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where abortion is legally restricted, and the need to account for the multiple factors that affect abortion safety. We used all available empirical data on abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe abortion and WHO guidelines on safe abortion to categorise abortions as safe or unsafe and to further divide unsafe abortions into two categories of less safe and least safe. Of the 55· 7 million abortions that occurred worldwide each year between 2010–14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9–59·4) were safe, 17·1 million (30·7%, 25·5–35·6) were less safe, and 8·0 million (14·4%, 11·5–18·1) were least safe. Thus, 25·1 million (45·1%, 40·6–50·1) abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws. Increased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.
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2Abortion, Induced - statistics & numerical data
3Abortion, Legal - statistics & numerical data
4Abortion, Therapeutic - statistics & numerical data
5Analysis
6Article
7Bayes Theorem
8Bayesian analysis
9Classification
10Cohort Studies
11Databases, Factual
12Developed countries
13Developed Countries - statistics & numerical data
14Developing countries
15Developing Countries - statistics & numerical data
16embryonic structures
17Estimates
18Female
19Global Health
20Health care reform
21Humans
22Internationality
23Language
24Laws
25LDCs
26Low income groups
27Misoprostol
28Models
29Mortality
30Patient Safety
31Political aspects
32Pregnancy
33Prevalence
34Primary care
35reproductive
36Risk Assessment
37Safety
38Safety and security measures
39Socioeconomic factors
40Standards
41United Nations
42urinary physiology
43Womens health
44World
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titleGlobal, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model
authorGanatra, Bela ; Gerdts, Caitlin ; Rossier, Clémentine ; Johnson, Brooke Ronald ; Tunçalp, Özge ; Assifi, Anisa ; Sedgh, Gilda ; Singh, Susheela ; Bankole, Akinrinola ; Popinchalk, Anna ; Bearak, Jonathan ; Kang, Zhenning ; Alkema, Leontine
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30Patient Safety
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37Safety
38Safety and security measures
39Socioeconomic factors
40Standards
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42urinary physiology
43Womens health
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abstractGlobal estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where abortion is legally restricted, and the need to account for the multiple factors that affect abortion safety. We used all available empirical data on abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe abortion and WHO guidelines on safe abortion to categorise abortions as safe or unsafe and to further divide unsafe abortions into two categories of less safe and least safe. Of the 55· 7 million abortions that occurred worldwide each year between 2010–14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9–59·4) were safe, 17·1 million (30·7%, 25·5–35·6) were less safe, and 8·0 million (14·4%, 11·5–18·1) were least safe. Thus, 25·1 million (45·1%, 40·6–50·1) abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws. Increased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.
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