Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015-2019

Abstract

Introduction: Internationally comparable estimates of unintended pregnancy and abortion incidence can illuminate disparities in sexual and reproductive health and autonomy. Country-specific estimates are essential to enable international comparison, and to inform country-level policy and programming.

Methods: We developed a Bayesian model which jointly estimated unintended pregnancy and abortion rates using information on contraceptive needs and use, contraceptive method mix, birth rates, the proportions of births from unintended pregnancies and abortion incidence data. Main outcomes were the estimated rates of unintended pregnancy and abortion for 150 countries and territories, reported for the 5-year period 2015-2019, as annual averages per 1000 women aged 15-49 years.

Results: Estimated unintended pregnancy rates ranged from 11 (80% uncertainty interval: 9 to 13) in Montenegro to 145 (131 to 159) in Uganda per 1000 women aged 15-49 years. Between-country heterogeneity was substantial in all Sustainable Development Goal (SDG) regions, but was greatest in sub-Saharan Africa. Estimated abortion rates ranged from 5 (5 to 6) in Singapore to 80 (55 to 113) in Georgia. Variation between country estimates was similar in all SDG regions except for Europe and Northern America, where estimated abortion rates were generally lower.

Conclusion: The estimates reflect variation in the degree to unintended pregnancy and abortion that are experienced in countries throughout the world. This evidence highlights the importance of investing in access to contraception and comprehensive abortion care, including in regions which may have lower rates of unintended pregnancy or abortion, respectively, as countries may differ substantially from regional averages.

Keywords: public health.

Figure 1

Process model (adapted from the study protocol21).

Figure 2

Model-estimated unintended pregnancy rates sorted within Sustainable Development Goal (SDG) regions, annually per 1000 women aged 15–49 years in 2015–2019. Thicker and thinner lines are 80% and 95% uncertainty intervals. Northern America is an SDG region and contrasts with North America, with Mexico in Latin America and the Caribbean. Countries shown in grey were not grouped by the World Bank. *Regional averages were computed from 195 countries and territories; countries in Western Asia and North Africa are shown only if clustered with Eastern Europe.

Figure 3

Model-estimated unintended abortion rates sorted within Sustainable Development Goal (SDG) regions, annually per 1000 women aged 15–49 years in 2015–2019. Thicker and thinner lines are 80% and 95% uncertainty intervals. Northern America is an SDG region and contrasts with North America, with Mexico in Latin America and the Caribbean. Countries shown in grey were not grouped by the World Bank. *Regional averages were computed from 195 countries and territories; countries in Western Asia and North Africa are shown only if clustered with Eastern Europe.