Q&A on the consequences of unsafe abortion and the provision of safe abortion care

A pregnant 16-year-old girl seeks family planning advice at a health care facility at a non-MSF hospital funded by UNFPA and the Haitian government in Port-au-Prince called Petite Place Cazeau.
HAITI 2013 © Patrick Farrell
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This page was updated on March 6, 2019.

Unsafe abortion is one of the top five causes of maternal death worldwide, along with post-partum hemorrhage, sepsis, complications from delivery, and hypertensive disorder. Of these causes, unsafe abortion is the only one that is almost wholly preventable.

According to the World Health Organization (WHO), about 25 million unsafe abortions are performed every year—97 percent of those take place in developing countries, where most Doctors Without Borders/Médecins Sans Frontières (MSF) projects are located. “Unsafe” means that the abortions are performed by someone who lacks the necessary skills or take place in an environment lacking the minimal medical standards, or both. 

The Guttmacher Institute estimates that, in recent years, at least 22,800 women and girls have died annually due to abortion-related causes. Many more are injured or maimed—around 7 million women are admitted to hospitals as a result of unsafe abortion every year in developing countries. However, the full picture of the consequences of unsafe abortion is unknown since many women and girls are unable to seek medical care after an unsafe abortion and no one knows how many of them die.

Does MSF provide birth control and abortions as part of your programs? 

It is MSF’s policy to provide contraceptives and safe abortion care as part of our response to women’s and girls' health needs. 

MSF works to increase the availability of contraceptive services as part of its reproductive health activities. Acceptance and up-take of these services vary from country to country, community to community, and engaging with women and men on the community level to provide health information and promotion is an integral part of offering this care. In some projects, where women had access to contraception before the outbreak of a crisis, making this service available becomes a top priority.

MSF provides medical care for the termination of pregnancy. The laws and regulations of the vast majority of countries provide some allowance for the termination of pregnancy. However, women also face economic and social barriers, as well as administrative obstacles. Medical providers and institutions might also lack knowledge, fear repercussions, or object on conscientious grounds.

In MSF projects, we see the devastating consequences of unsafe abortion daily. MSF recognizes that unplanned pregnancy can be a source of extreme suffering due to the social, economic, health, and legal consequences women and girls can face because they are pregnant at a given time and in a given context. We recognize the medical need for safe abortion care as a means to alleviate suffering and to avert unsafe abortion procedures that often result in injury or maternal death.  

MSF staff members have to understand and agree with the MSF policy for reproductive health, including the policy on abortion. For certain medical professions the agreement to personally provide medical care for the termination of pregnancy is required. 

Why is abortion part of the care that MSF provides?

The consequences of unsafe abortion are a medical issue. As stated above, unsafe abortion is one of the main causes of maternal mortality worldwide. 

We have seen time and time again that many women and girls resort to unsafe abortion methods when safe abortion care is not accessible, in spite of the considerable risks. 

Do my donations fund abortions?

Donations made to MSF go toward a general fund for our medical programs all over the world. We use your donation to run hundreds of medical programs, some of which include the provision of safe abortion care.

Can I designate my donation so that it does not fund abortions?

No, it’s not possible to make this kind of designation because the ability to provide safe abortion care is a critical part of ensuring the health and safety of women everywhere.

While we do not run specific abortion programs, the need to provide abortion or to treat the medical complications of unsafe abortion is a reality in all types of medical programs and in a variety of contexts where we work. MSF staff must be able to provide care that meets the needs of patients and cannot rule out the provision of particular procedures, including safe termination of pregnancy, which helps to reduce suffering and the incidence of maternal deaths. 

What is your position on abortion?

MSF does not have a political position on abortion. We see the consequences of unsafe abortion as a medical issue: unwanted pregnancy and unsafe abortions cause suffering and death and contribute to the overall burden of ill health.

Do you provide abortions in all of your programs? What about in countries where abortion is illegal?

MSF’s aim is to reduce suffering and maternal death in places that are affected by conflict and crisis. 

Certain health conditions require termination of pregnancy to save the woman’s life. MSF medical staff will inform and counsel the patient and proceed following the patient’s decision. With very few exceptions, all countries have legal allowances for this scenario. Most countries make further allowances for other situations—typically, pregnancy resulting from rape or incest, or when the pregnancy is considered a threat to the woman’s health, including her mental health. But the requirements around these allowances can be complex, involving different laws, and some administrative requirements can be difficult or impossible to meet in humanitarian contexts. In those cases, MSF will act in the best interest of the patient and with her informed consent.

MSF staff have witnessed many times over that if a woman or girl cannot access an abortion in a safe medical facility with trained staff, she will seek an unsafe abortion, which very often leads to more suffering, and even death. However, providing safe abortion care in some places can present a risk to patients and staff. That risk and the relevant local laws, customs, and perceptions have to be taken into account. 

Does MSF give formal guidance on how far into pregnancy medical staff may provide an abortion? 

The vast majority of abortions that MSF provides are in the first trimester, or up until 13 weeks. MSF also provides abortions beyond 13 weeks and up until 22 weeks in projects that have the necessary resources and set-up. Studies show that while abortions at or after 13 weeks comprise a minority (10-15 percent) of the total abortions worldwide, they are responsible for the majority of serious abortion-related complications. Women who present for abortions after 13 weeks are more likely to be young girls, victims of sexual violence, have detected their pregnancy later, and/or have financial or logistical barriers to care. These women and girls are disproportionately underserved and especially vulnerable.

Does MSF provide the morning after pill?

Yes. When a girl or woman approaches MSF with the fear of being pregnant as a result of forced sex, sexual violence, failure of a contraceptive, or any other reason, MSF will assess if emergency contraception is an option and provide it if it is the choice of the patient.

 

See more FAQs on other topics.