Rates of unplanned pregnancies have fallen around the world, according to new data published by health research organisation the Guttmacher Institute and the UN Human Reproduction Programme (HRP) on Wednesday.
Global rates of unintended pregnancies have fallen from 79 per 1,000 women aged 15 to 49 in 1990 to 64 in 2019, thanks in part to a concerted effort to increase access to contraceptives, but there are concerns that decades of progress in reducing the numbers risk being undone by Covid-19, as lockdown restrictions hamper health services.
Zara Ahmed, a senior policy manager at Guttmacher, warned : “Covid-19 could reverse those declines due to challenges with the supply chain, diversion of providers to the response and lack of access to health facilities during lockdown.”
Ahmed said the pandemic was illuminating existing gaps in – and strains on – healthcare services, adding that some governments had already shifted resources away from basic sexual and reproductive services to Covid-19 responses.
In April, Guttmacher predicted that just a 10% decline in services in poorer countries as a result of coronavirus restrictions could result in 15 million more unplanned pregnancies, 168,000 more newborn deaths, 28,000 more maternal deaths, and 3 million more unsafe abortions.
Guttmacher and HRP’s latest research, published in Lancet Global Health, found that women in the poorest countries were nearly three times as likely to have an unplanned pregnancy as women in the wealthiest countries – 93 per 1,000 women in low-income countries compared with 34 in wealthy states.
Europe and North America had the lowest number of unplanned pregnancies (35 per 1,000 women), while sub-Saharan Africa had the highest (91). Women in sub-Saharan Africa are among the least likely to have access to family planning.
The research also revealed that 61% of unplanned pregnancies globally in 2015–19 resulted in an abortion, up from 51% in 1990. Despite a slight fall in abortion rates in the early 2000s, rates had increased over the past 15 years. Researchers said the trend could reflect increased access to abortion or “a stronger motivation to avoid unintended births”.
The majority of terminations occurred in countries where abortion is banned or restricted, researchers found, which meant they were more likely to be conducted unsafely. At least 22,800 women are estimated to die from an unsafe abortion each year.
Ahmed said even where it was legal some countries had deemed abortion not to be an essential service during the pandemic and had restricted services. “These service gaps could result in some individuals not being able to access abortion care at all, while others are forced to seek unsafe abortions,” she said.
The World Health Organization estimates that 270 million women who want modern contraceptives have no access to them. Universal access to family planning is a target of the sustainable development goals.
A study published in the Lancet last week said increased access to contraception is crucial if new global population forecasts are to be realised. Researchers forecast the global population will be 2 billion below current UN predictions by 2100 if women’s lives are improved.
