When Laws Put Lives at Risk

Around 73 million abortions are performed worldwide each year, and nearly half of them take place under unsafe medical conditions. In many cases, these procedures are carried out by unqualified individuals using invasive and dangerous methods. This can lead to serious physical and psychological harm for the women affected and, in the worst cases, even result in death. According to the World Health Organization, unsafe abortions accounted for eight percent of all maternal deaths between 2009 and 2020.

In Sub-Saharan Africa, the rate of unsafe abortions is particularly high, driven by restrictive laws, social stigma, and limited access to adequate healthcare – especially in rural areas. In response, the African Union adopted the so-called Maputo Protocol in 2003. Among other provisions, it states that abortion must be legal when it is necessary to save a woman’s life or to protect her physical or mental health. It also calls for access to safe, high-quality, and respectful medical care – including abortion services – in cases of rape, incest, or severe fetal abnormalities. Since then, 21 out of 48 countries in Sub-Saharan Africa have reformed their laws to align with the Maputo Protocol. Nevertheless, more than two-thirds of all abortions in the region are still unsafe. Since 2019, this has amounted to approximately 6.2 million cases each year.

The combination of more liberal legislation and improved access to contraception is therefore crucial: it leads to fewer unintended pregnancies and, consequently, to fewer abortions. In countries where abortion is legal, the number of abortions declined by nearly half between the periods 1990–1994 and 2015–2019. In contrast, in countries with restrictive laws, the abortion rate increased by around 12 percent over the same period.

Evidence also suggests that decriminalising abortion does not necessarily reduce birth rates. Instead, in countries with more liberal laws, women tend to have children later in life. This trend was already observed in the 1960s in Oslo: despite the legalisation of abortion, average family size remained stable, while educational attainment among women and their children increased at the same time.

When women have access to contraception and safe abortion services, it not only improves their health but also expands their educational opportunities and participation in society. It allows them to make autonomous decisions about their bodies, family planning, careers, and overall life paths. Contraception and safe abortion are therefore not only essential for women’s health but also play a crucial role in enhancing their quality of life. Restrictive laws, by contrast, do not lead to fewer abortions – quite the opposite. They increase the number of unsafe procedures, limit women’s rights, and expose women to preventable health risks that, in the worst cases, can be fatal.