Abortion is an essential part of health care around the world. More than half of all unintended pregnancies in the world end in abortion, whether spontaneously (referred to as miscarriage) or as the result of a deliberate intervention. People all over the world seek abortions when they do not wish to be pregnant. Chances are, someone close to you has had an abortion. 

Safe abortion care

An abortion is considered safe if the person providing or supporting the abortion is trained and an evidence-based method that is appropriate to the pregnancy duration is used. MSF’s medical projects provide abortion in alignment with these criteria. In general, MSF personnel use medication abortion or manual vacuum aspiration (MVA) to provide care. These abortion methods are extremely safe and effective in ending a pregnancy. In fact, abortion is safer than many common health services, including a shot of penicillin and tooth extraction.

MSF also supports self-managed abortion. This refers to a method in which an individual takes abortion medications outside of a medical setting. Self-managed abortion is just as safe and effective as a facility-based approach if the person has access to accurate information, quality medications, and respectful support throughout the process, if desired. It also increases access to safe abortion care for marginalized and underrepresented people, and those who live far away from health care facilities. Self-care interventions like self-managed abortion uphold patient’s bodily autonomy and support them to make decisions about and take the lead in their own care.

For more information on the methods utilized by MSF to provide safe abortion care, you can visit our medical guidelines: medicalguidelines.msf.org.

Pregnant people in crisis-affected settings are at greater risk of experiencing adverse health outcomes. In some cases, abortion is necessary to save the person’s life or preserve their health. 

When people are denied access to safe abortion care, they are at higher risk of resorting to unsafe methods that can lead to severe or life-threatening complications. Unsafe abortion is a leading cause of maternal mortality, causing an estimated 22,800—31,000 maternal deaths per year, worldwide. 

What makes an abortion unsafe

According to the World Health Organization, an abortion is unsafe if the person providing the abortion does not have the necessary skills or if the abortion takes place in an environment that does not meet minimal medical standards. 

What are the health consequences of unsafe abortions?

Safe abortion care is not resource-intensive to provide. When safe abortion is legal and accessible, complications are rare and generally do not require complex treatment. 

However, health complications due to unsafely induced abortion require emergency care to prevent long-term health consequences and death. At MSF, we regularly see patients experiencing severe and life-threatening health conditions and injuries due to unsafe abortion, including severe hemorrhage, sepsis (severe general infection), poisoning, uterine perforation, or damage to other internal organs. Some patients die before arriving at a hospital; others need major surgery to survive, and some are left permanently disabled. 

Laws and policies restricting or banning access to safe abortion do not reduce abortion-seeking behavior, nor do they affect the need for this important form of health care, or protect people from complications related to unsafe abortion.

The impact of abortion-related legal and policy restrictions on patients’ health

In contexts when abortion is illegal or otherwise restricted through laws or policies, individuals carrying an unintended pregnancy may have no choice but to resort to unsafe abortion methods that pose severe risks to their health and wellbeing. When abortion is criminalized, individuals are less likely to seek timely medical attention if complications occur due to fears of prosecution. In one year, MSF treated more than 2,800 cases of unsafely induced abortion in Democratic Republic of Congo (DRC). A study of MSF health care facilities in DRC found that women and girls experiencing abortion-related complications delayed accessing care due to fears of legal and societal repercussions.

The criminalization of abortion has broader harmful implications for health providers and personnel as it may also impede sexual and reproductive health service delivery more generally. A study by MSF and partners on unsafe abortion morbidity and mortality in Nigeria found that providers working in contexts restrictive toward safe abortion care could be cautious to support access to other sexual and reproductive health services. Among providers surveyed in Nigeria, 79 percent reported that they would seek spousal consent before providing patients with contraception, and 60 of providers would seek parental consent for contraception if the patient was a minor. When asked the same question about post-abortion care—92 percent of providers said they would seek spousal consent, and 88 percent said they would seek parental consent if the patient was a minor. 

If a health provider has to evaluate legal and criminal risks before providing a patient with care, the resulting delay could be dangerous for the patient’s health and well-being, especially in emergencies. Restrictive laws and policies on abortion worsen health equities by creating barriers to safe abortion care that disproportionately impact marginalized and underrepresented people.

In 2022, the United States Supreme Court overturned decades of legal precedent recognizing abortion access as a constitutional right set by Roe v. Wade in 1973. MSF is concerned that the loss of the constitutional right to abortion in the US will lead to terrible health outcomes for all people who can become pregnant, particularly people of color and those with limited resources to access care in states where abortion is not restricted.

Although decriminalization and the elimination of legal and policy restrictions to abortion are important steps, they do not alone guarantee the availability of safe abortion care, particularly in places in which abortion was previously legally prohibited or heavily restricted. Health systems respond slowly and inconsistently to change and persisting knowledge gaps and resistance from health workers may hinder access to safe abortion care. In some cases, people may not be aware of their options for safe abortion care or how to access it. In Colombia, for example, despite significant decriminalization of abortion over a decade ago, MSF teams working in the port cities of Buenaventura and Tumaco have found general ignorance about the current scope of safe abortion care, including among health care workers.

Safe abortion should be legal and regulated like any other medical procedure to ensure that all people have access to essential care. 

Access to safe abortion care is a critical, lifesaving part of sexual and reproductive health care, one that safely supports patients who do not wish to be pregnant. In the settings where MSF works, safe abortion care is an effective intervention to prevent maternal mortality and suffering.

Sexual and reproductive health care services at MSF

Providing sexual and reproductive health care services, including safe abortion care and post-abortion care, has long been part of our health programming. In 2023, MSF teams around the world provided 54,500 consultations for safe abortion care, the majority in African countries, along with 31,000 consultations for post-abortion care, most taking place in Afghanistan, Yemen, South Sudan, and Bangladesh.

In addition to providing safe abortion and post-abortion care, MSF provides contraceptive counseling and access to a range of contraceptive methods. Our projects provide a variety of contraceptive methods to help patients prevent unintended pregnancy and/or STI transmission. MSF aims to provide the full range of contraceptives, including implants, intrauterine devices, injectables, oral contraceptive pills, condoms, and emergency contraception. 

Access to quality contraceptive care, including accurate information and a mix of methods, can be an important and positive force in the lives of patients, their families, and communities. At the same time, increasing access to contraceptives must always be accompanied by respect for contraceptive autonomy, wherein patients are supported in their decision regarding whether to use contraception, which methods to use or not use, when to use them, and when to not use them. This means that we support patients to decide for themselves what they want regarding contraceptive use and help them achieve that.

Contraception is not, however, a replacement for safe abortion care. Even when individuals have access to contraception, they can still experience an unintended pregnancy and require access to safe abortion care. As part of our commitment to medical ethics and patient-centered care, MSF provides a range of sexual and reproductive health services to meet the needs of our patients. 

MSF recognizes that it is not the role of health providers to scrutinize the reasons why someone might seek an abortion. 

We respect our patients’ decisions and provide them with accurate and comprehensive information, so they can make informed decisions about their own bodies. Regardless of what these decisions are, it is our responsibility to provide them with safe and high-quality care.

We know that there are often serious and detrimental consequences on people’s lives when they are denied access to abortion. Supporting abortion as health care is a powerful way to prevent poor outcomes and improve people’s well-being.  Anyone who seeks an abortion—no matter their reason—is deserving of high-quality and dignified care.