Passions undoubtedly run high on whether abortion should be legal. But whether you accept the need for abortion or oppose it outright, the most comprehensive survey of global abortion trends since 1995 seems to confirm what many might have suspected - that women will continue to seek out abortions regardless of whether they are legal or not. It also showed the fastest way to reduce the number of abortions is to provide access to reliable contraception.

The study, which shows that the total number of abortion - both legal and illegal - fell worldwide between 1995 and 2003, was published in The Lancet last week ([link|http://www.thelancet.com/journals/lancet/article/PIIS014067360761575X/abstract|vol 370, p 1338]). It compares abortion data from 2003 and 1995 assembled by the World Health Organization and the New York-based Guttmacher Institute, which studies sexual and reproductive health. "The total number of induced abortions declined from 46 to 42 million [per year], and for every 1000 women of childbearing age, 29 had abortions, down from 35 in 1995," says lead author Iqbal Shah of the WHO.

Tellingly, the number of abortions fell almost exclusively in rich countries where terminating a pregnancy is both legal and safe. In poorer countries, where access to abortion is often restricted or illegal, there has been very little progress in reducing the number of abortions, says Shah.

In such countries, women are prepared to endanger their lives to terminate a pregnancy (see [link|http://www.newscientist.com/article/mg19626263.900-family-planning-lowers-abortion-rates.html#bx262639B1|"By any means available"]). In Africa, for example, where access to safe, legal abortions is almost non-existent, there were 29 abortions per 1000 women of childbearing age in 2003. In Europe, where abortion is widely available and legal (with the exception of Poland and Ireland), the rate was almost identical, at 28.

There is a crucial difference, notes the report. While 98 per cent of abortions in Africa are unsafe, leading to widespread maternal death and disability, less than 1 per cent of European women suffer complications such as haemorrhaging and post-abortion infection. "Making abortion illegal doesn't stop it happening, and if it happens in a context that's not safe, women will die," says Ann Starrs of Family Care International, a charity in New York lobbying to improve women's global health and status.

The European data is skewed slightly by extremely high rates of abortion in eastern Europe and former members of the Soviet Union, where until recently abortions were the cheapest and most reliable method of contraception. But it is balanced by some of the lowest rates of abortion in the world. In Austria, Switzerland, France, Germany, the Netherlands, Belgium and Luxembourg, there were just 12 abortions per 1000 women in 2003. These countries generally have the most abortion clinics and the most liberal abortion laws. "It shows that making abortion legal and available doesn't increase it," says Sharon Camp, president of the Guttmacher Institute.

Even in eastern Europe, abortion rates have halved from 90 abortions per 1000 women in 2005, to 44 per 1000 in 2003 - thanks almost entirely to the wider availability of effective contraceptives. "We now have a very powerful body of data from multiple countries showing a connection between the rise in contraception availability and a decline in abortions," says Camp.

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