Key Estimates for 2018
Globally, an estimated 73.3 million abortions occurred in 2018, according to the most comprehensive peer-reviewed analysis published in The Lancet in 2020. Regionally, the highest numbers were in Asia (34.2 million), Africa (19.9 million), and Europe (11.9 million), though rates per 1,000 women of reproductive age vary substantially due to differences in population age structure, fertility, and access to contraception. In the United States, the most recent reliable national estimate for 2018 reports approximately 930,000 abortions, down from a peak in the early 1980s and consistent with a long-term decline since the 1990s. These figures are estimates derived from survey data, facility records, and statistical modeling, with uncertainty intervals reflecting gaps in reporting and variability across sources.
How Incidence Is Defined and Measured
Abortion incidence is typically measured as the number of procedures performed in a given year, often expressed as a rate per 1,000 women aged 15–44 or 15–49. Incidence should be distinguished from abortion ratio (abortions per 100 live births plus abortions) and mortality (deaths related to abortion divided by total abortions). Reliable estimation usually depends on three main data sources: facility records, surveys of providers and patients, and statistical models used where direct reporting is incomplete or inconsistent. Organizations such as the World Health Organization (WHO), the Guttmacher Institute, and the United Nations apply different methods, which affects cross-country and cross-year comparability.
Global Estimates and Regional Patterns in 2018
On a global scale, the 2018 estimate of about 73 million abortions reflects a continuation of the overall decline observed since the early 1990s in age-standardized rates, even as the absolute number remains substantial due to population growth. Regionally, the distribution in 2018 was as follows:
- Asia: approximately 34.2 million abortions
- Africa: approximately 19.9 million abortions
- Europe: approximately 11.9 million abortions
- Latin America and the Caribbean: approximately 4.4 million abortions
- Oceania: a smaller share of the global total
At the rate level, the global annual incidence rate (abortions per 1,000 women aged 15–44) has generally declined, but significant variation persists by region, often linked to the availability and use of modern contraception, legal frameworks, and socioeconomic context.
United States 2018 Estimate and Historical Context
National Figures and Trends
In the United States, the 2018 estimate of roughly 930,000 abortions represents a continued downward trend from earlier peaks. The U.S. rate in 2018 was approximately 14.6 abortions per 1,000 women aged 15–44, a marked decline from the late 20th century. This long-term decline has been attributed to multiple factors, including increased contraceptive use, changes in service delivery, and sociodemographic shifts. It is important to note that year-to-year changes can be influenced by fluctuations in reporting completeness, legislative environments, and provider availability, so multi-year trends are more informative than single-year movements.
Data Sources and Limitations
U.S. estimates are primarily derived from the Guttmacher Institute’s periodic surveys of abortion providers, which compile counts from a representative sample of facilities. These surveys achieve high response rates but inherently rely on self-reporting, which can lead to underreporting where participation is incomplete or where certain providers are missed. The Guttmacher Institute supplements survey data with statistical adjustments and, when necessary, modeling to account for missing data. Users should treat point estimates as central tendencies within uncertainty ranges rather than exact counts.
| Region / Country | Estimated Abortions (2018) | Rate (per 1,000 women aged 15–44) | Source Type |
|---|---|---|---|
| Global | 73.3 million | — | The Lancet modeling (2020) |
| Asia | 34.2 million | — | The Lancet modeling (2020) |
| Africa | 19.9 million | — | The Lancet modeling (2020) |
| Europe | 11.9 million | — | The Lancet modeling (2020) |
| Latin America and Caribbean | 4.4 million | — | The Lancet modeling (2020) |
| United States | 930,000 | 14.6 | Guttmacher Institute (2020 analysis) |
Interpreting the Numbers: Rates Versus Counts
When comparing countries or years, the distinction between counts and rates is essential. A higher count does not necessarily imply a higher incidence rate, because population size and age structure differ widely. For example, a country with a large reproductive-age population may report more total abortions even if its rate is moderate, whereas a small population with a high rate may have fewer total procedures. In 2018, regions with high total numbers such as Asia and Africa often had varying rates when standardized, reflecting differences in fertility levels, contraceptive prevalence, and access to sexual and reproductive health services.
Limitations, Definitions, and Data Challenges
Estimates of abortion incidence face several challenges. Not all abortions are clinically recognized or reported, especially where services are restricted or stigmatized. Definitions vary: some sources include only induced abortions, while spontaneous abortions (miscarriages) are generally excluded from these counts. Measurement errors, sampling variability, and differences in classification across studies can produce ranges rather than precise numbers. Methodological choices—such as whether to model missing data or adjust for underreporting—can meaningfully affect estimates. Users should therefore consider uncertainty intervals and avoid treating single-year figures as definitive point values.
How These Estimates Are Used and Why They Matter
Abortion incidence data support public health planning, service provision, and policy evaluation. Accurate counts and rates help assess unmet need for contraception, track progress toward health goals, and inform discussions about sexual and reproductive rights and access. While the numbers themselves do not capture individual experiences or policy impacts, they provide a baseline for understanding trends and disparities. Reliable, transparent methods and clear communication about limitations are essential for responsible interpretation and use.
Conclusion
In 2018, an estimated 73.3 million abortions occurred globally, with regional distributions reflecting diverse demographic and policy contexts. In the United States, approximately 930,000 abortions were reported, consistent with a long-term downward trend in incidence rates. These figures are model-based estimates subject to uncertainty and should be interpreted alongside measures of rate and broader contextual factors such as contraceptive access and legal frameworks. Understanding definitions, sources, and limitations enhances the ability to use abortion incidence data thoughtfully and effectively.