Abortion can be defined as a procedure to terminate pregnancy. An “unsafe,” or illegal, abortion is defined by the World Health Organization (WHO) as a “procedure for terminating an unwanted pregnancy either by persons lacking in the necessary skills or in an environment lacking the minimal medical standards or both.” The Centers for Disease Control and Prevention (CDC) says an abortion is unsafe if it is not “performed by a licensed physician or an appropriately licensed advanced practice clinician acting under the supervision of a licensed physician.” The CDC defines an abortion-related death as “a death resulting from a direct complication of an abortion (legal or illegal), an indirect complication caused by a chain of events initiated by an abortion, or aggravation of a preexisting condition by the physiologic effects of abortion.”

The latest data on abortion rates and ratios in the United States come from the CDC’s Morbidity and Mortality Weekly Report, which states that 827,609 abortions were reported to the CDC for 2007. This corresponds to an abortion rate of 1.6 percent for women age 15-44 years old and an abortion ratio of 231 abortions for every 1,000 live births. Sixty-three percent of abortions were obtained before eight weeks gestational age1. The peak abortion ratio occurred in 1984 with 364 abortions for every 1,000 live births, and a rate of 2.3 to 2.4 percent of women, and has been decreasing since, primarily due to better education and contraception2.

The Abortion Surveillance Report for 2007 identified six deaths related to legal abortion, resulting in a risk of death from legal abortion performed with modern methods in the United States of less than 1 in 100,000 procedures. The rate was highest before the 1980s, with very few after 2001-023.

According to the WHO, a woman dies from complications related to pregnancy or childbirth every minute, which comes to about 529,000 per year. More than 70 percent of maternal deaths are caused by five direct complications: hemorrhage (25 percent), infection (15 percent), unsafe abortion (13 percent), eclampsia (12 percent), and obstructed labor (8 percent). For every woman who dies in childbirth, twenty more (about 10 million total) suffer injury, infection or disease4.

It has been estimated that 20 percent of maternal deaths are due to complications of unsafe abortions, mostly in poor and developing countries. The annual global abortion rate is estimated to be between 32 and 46 abortions per 1,000 women. In most developed countries it varies from one to 30. In the Netherlands, which has the most liberal abortion laws, the rate is just five – the lowest overall56789.

There is a relationship between abortion legalization and a decrease in complications and deaths. Five years after Roe v. Wade the death rate from complications in the United States fell by more than 50 percent. The same effect can be seen in other countries. In Romania abortion-related mortality dropped from 142 to 47 for every 100,000 live births, and Guyana saw a 41 percent drop in septic or incomplete abortions10. The WHO has shown that when abortion is illegal it nevertheless continues underground, and deaths result.

In 1966, before Roe v. Wade, there were 29.1 maternal deaths per 100,000 live births, and in 1950 there were 83.3. An estimated 70 percent of 1975’s legal abortions would have occurred illegally11. Abortion was starting to be criminalized in the early 19th century. By the beginning of the 20th century abortion was illegal in every state, although a lot of doctors would perform them under good conditions.

One study found that in 1932, 15,000 women per year12 died from illegal abortion complications (although current, more conservative, estimates put the toll at 5,000 to 10,000). In the 1960s in New York, 42 percent of maternal mortality was caused by illegal abortions13.

When abortions were illegal an unwed mother often was housed in a dormitory sequestered from the public, if her family could afford it. If a woman desired an abortion, she often would try to self-induce labor by one of several methods, most of which were handed down from woman to woman as wives’ tales. Having an abortion was shameful for the woman and her family, so going to the doctor was often out of the question.

One abortion method was taking an ineffective or poisonous abortifacient orally. Another was to put some foreign object, not usually sterile, into the vagina in hope of destroying the fetus and inducing labor. Objects included wire coat hangers, sticks, and pencils.

Complications of such practices included massive bleeding resulting in death if no medical help was available. Perforation of the uterus with resulting peritonitis and a slow agonizing death was the usual result. Sometimes the hook on the wire coat hanger would go through the wall of the uterus and perforate a loop of bowel, which also caused peritonitis. Or, the loop of bowel would be pulled out through the os of the cervix, with the same result. If no perforation or bleeding occurred then usually massive pelvic infections would occur because of dirty conditions. Other techniques included infusing a substance such as turpentine into the uterus to kill the fetus and induce labor. This resulted in death from a massive dose of toxin absorbed directly into the bloodstream. If the operator was not a friend, or the woman herself, it would often be someone, probably an untrained individual, who would take advantage of the situation for money. There was no recourse for complications that might ensue from such dealings.

Before Roe v. Wade the mortality and morbidity rate among women was very high due to unsafe abortion techniques often carried out by amateurs. Society suffered, but the worst effect was on the woman herself, suffering and dying a painful and lonely death.

  1. Pazol, K. et al., “Abortion Surveillance-United States, 2007”; Morbidity and Mortality Weekly Review, CDC, Feb 25, 2011, Vol. 60, #1, pp 1-41. ↩︎

  2. Strauss, L. T., et al. , “Abortion Surveillance-United States, 2003” Morbidity and Mortality Weekly Review, CDC, Nov 23,2007; Vol. 56, #1, pp 1-33. ↩︎

  3. Obstetrics Normal and Problem Pregnancies, 4th Ed. Churchill Livingston. A. Harcourt Health Sciences Co.; New York, Edinburgh, London, Philadelphia, 2002. ↩︎

  4. World Health Organization, “Why Do So Many Women Still Die in Pregnancy or Childbirth?”. Accessed at www.who.int.features/qa/12/en/. ↩︎

  5. Couveytaux, Francine M. “Induced Abortion in Sub-Saharan Africa: What We Do and Do Not Know”. Studies in Family Planning, Vol. 19, #3, May-June 1988, pp 186-198. ↩︎

  6. Gebreselassie, et al. “The Magnitude of Abortion Complications in Kenya” Developing World Issue, Vol. 112, Issue 9, pp 1229-1235. ↩︎

  7. Jewkes, et al. “Prevalence of Morbidity Associated with Abortion Before and After Legalization in South Africa”; BMJ 2002 May 25, 324(7348) pp 1252-1253. ↩︎

  8. Sedgh, et al. “Induced Abortion: Estimated Rates and Trends Worldwide”. Lancet; Vol. 370, Issue 9595, 13-19 October 2007, pp 1338-1345. ↩︎

  9. Singh, Susheela; “Hospital Admissions Resulting from Unsafe Abortions: Estimates from 13 Developing Countries.” Lancet, Vol. 368, Issue 9550, 25 November – 1 December 2006, pp 1887-1898. ↩︎

  10. Gebreselassie, et al. “The Magnitude of Abortion Complications in Kenya” Developing World Issue, Vol. 112, Issue 9, pp 1229-1235. ↩︎

  11. Gynecology and Obstetrics: The Health Care of Women 2nd Edition, Editors Romney et al., McGraw Hill Book Company, New York, St. Louis, etc. 1981, pp 30-33, 840-845. ↩︎

  12. When Abortion Was a Crime; Women, Medicine and Law in the United States 1867-1973, by Leslie J. Reagan; University of California Press. Sept 21, 1998. ↩︎

  13. Reagan, Leslie J.; When Abortion was a Crime: Women, Medicine, and Law in the United States 1867-1973; University of California Press, Sept. 21, 1998. ↩︎