Various Aspects of Abortion and Related Policies in the World

One of the challenges for women's reproductive health is unsafe abortions resulting from unwanted pregnancies. The losses due to abortion complications are sometimes irreparable and their imposed costs to the health system is high. The aim of this study was to explore various aspects of abortion and related health policies in the world.
In this review, observational studies published in Persian and English were searched in Google Scholar, PubMed, Iranmedex, SID databases and WHO website using the keywords Abortion" and "policy" or "politic", in the time limit of 2010-2015. After the initial assessment, abstracts of articles were studied, and duplicates and irrelevant articles were removed. Finally, the full text of 21 articles in Persian and 38 articles in English were enrolled and analyzed.
Ethical Considerations: Honesty in the literature and citation analysis and reporting were considered.
Findings: Abortion pattern has long been the same around the world and women accept the risks of abortion when they face with unwanted pregnancy, despite the legal bans. According to reports, 22 million unsafe abortions occur around the world annually among which 98% occur in developing countries. Abortion has been prohibited in various religions except in special cases. But social changes and socio-economic participation of women lead to their incompatibility in the theoretical and practical aspects and women apply to induced abortion without regard to the rules. Legal aspects of abortion has been included threatening the mother’s life, rape, and fetal abnormalities, but obstacles such as lack of information, third party permissions, elimination of insurance coverage, lack of access to providers or their beliefs has limited access to the safe abortion. Despite restrictive policies, developments occurring around the world have been caused increasing requests for unsafe abortion and therefore associated maternal mortality and morbidity rates in the different continents and countries.
Developments of abortion laws from 1996 to 2013 represents an increase in licensing of therapeutic abortion in almost all legal areas that approximately two third of the countries in the cases of physical and mental endangerment of the mother health, half of the cases of pregnancy resulting from rape and anomalies, and only one third of the countries for socio-economic causes or due to the requests of the women are allowed to implement abortion. During this period, 56 countries have increased legal bases of abortion. While 8 countries have reduced the legal fields in a way that policy constraints in developing countries than in developed countries, has been 4 times higher. Studying the abortion laws and the situation in different continent and countries show that most European countries except Malta permits abortion in all fields of law. Abortion rate is between 1.4 and 25.5 per thousand women of childbearing age in Europe and lowest in Austria and highest were observed in Estonia. However, in European countries achieving legal permission for abortion needs certain circumstances, for example, in France less than 12 weeks of pregnancy, 10 weeks in Portugal, 90 days in Italy, 18 weeks in Sweden, 22 weeks in the Netherlands, and less than 24 weeks in Finland after fertilization is deadline for abortion licensing. Among different countries in the America region, the Dominican Republic, El Salvador, Nicaragua and Chile, abortion is not permitted in any area. On the contrary, in Cuba, Mexico, Canada and America in all fields abortion is licensed. The lowest abortion rate has been reported in Mexico as 0.05 and the highest rate as 28.9 per thousand women in Cuba have been recorded. In Africa, the annual rate of induced abortions has been between 2003 and 2008, from 5.6 to 6.4 million, much of it in East Africa and lowest in southern Africa have been happened. The situation in Asia indicate that although most residents are Muslims, and in Islam viewpoint abortion without indications for treatment is religiously forbidden, but since in the two countries of India and China, abortion in all areas of law is legal and most of the women live with free abortion laws, most abortions are observed in south Central and east Asia, and the annual number of abortions in Asia has increased between 2003 and 2008, from 25.9 million to 27.3 million. In Iran there are no accurate statistics of the unsafe abortion.
There is a wide range of behavior among the people because of its functions, and dysfunctions of the related structures. The findings suggest that severe restrictions on access to services related to the abortion has not only failed to prevent it, but also increased unsafe abortions by unskilled people and even cause women to migrate to other countries for this action. There is no accurate statistics regarding the rate of abortion, even in countries with free policies. Hence, more research is needed to learn about various aspects of the abortion completely. Also, preventive policies in this area are helpful. So that using primary measures such as increasing health literacy in communities, the establishment of programs to protect the poor and vulnerable groups, increased counseling facilities appropriate to increase women's awareness about spacing between births, sexual education of young people and couples, facilitates the process of marriage, educational programs about the complications of abortion, increased monitoring of offices and private training health care providers about the areas of abortion law and the conditions of safe abortion and access to services, and postoperative care miscarriage, abortion and its adverse consequences can be prevented. Regarding social changes, policies must be based on understanding the social determinants of health. Facilitating consultation and lawful grounds for abortion, and access vulnerable groups to reproductive health services is recommended.