Induced Abortion in the Developing World: Indirect Estimates

Indirect abortion estimates for 21 developing countries were derived through use of an alternative method of calculating the influence of abortion on fertility. The method is based on the assumption that the socioeconomic cultural and biologic variables that influence fertility operate through a limited number of proximate determinants. The total fertility rate for the countries for which Demographic and Health Survey data were analyzed averaged 5.2 lifetime births per woman but ranged from 2.7 (Turkey) to 7.7 (Yemen). The average value for the abortion index was 0.78: similar to the influence of contraceptive use (0.79) and marriage (0.78) but less important than postpartum insusceptibility (0.72). Abortion had its strongest effect on fertility in South America (range 0.45 in Colombia to 0.62 in Peru); in high-fertility areas of Africa abortions impact was minimal (range 0.95 in Burkina Faso to 1.06 in Rwanda). The values for three minor proximate determinants (fecundability intrauterine mortality and sterility) did not confound abortion estimates. Overall the analysis suggests that abortion is widely used to control fertility even under conditions of illegality increases in importance as fertility declines and contributes to fertility control at a level similar to that of contraception.