Unsafe abortions continue to hurt women around the world, especially in Pakistan, which faces the highest rate of hospitalization following pregnancy termination, according to a new study published on behalf of the Royal College of Obstetricians and Gynaecologists.

Often, women don’t have the information they need to understand terminating their pregnancy with misoprostol, a drug that effectively breaks down and empties the lining of a woman’s uterus so she’ll no longer be pregnant (a process not to be confused with the morning-after pill). If women do have the right information, they may still order a low-quality version of the drug or fail to follow-up as the medication takes effect. A result of this is an increased rate of post-abortion care — even maternal death.

To see where treatment rates were highest in the world, study authors Susheela Singh and Isaac Maddow-Zimet of the Guttmacher Institute (GI) analyzed data from a series of existing studies that provided national estimates of the number of women treated for complications of pregnancy. The majority of studies took place between 2008 and 2013. Although the means of data collection varied with each study, Singh and Zimet found that they were able to obtain comparable data on the number of women who received post-abortion care.

Across 26 countries, post-termination treatment rates were highest among Pakistani and African women, namely women in Kenya, Malawi, and Uganda. By termination, researchers meant women “terminating an unwanted pregnancy before independent viability, typically defined as before 22 weeks.” Any termination deemed unsafe, thus requiring further treatment, means “it was carried out by person lacking the necessary skills or in an environment lacking minimal medical standards, or both.”

Researchers also found that, in Latin America, the Dominican Republic had the highest treatment rates, while the highest regional rate was in South-Central Asia — Africa was a close second. These rates excluded women who had miscarried. And oftentimes this care was not offered at an affordable price, putting out not only women but their families, too. That said, Singh and Zimet conceded their estimates have “several significant limitations.” For one, they’re based on a small number of countries, and in all but a few countries, information on the coverage of these data was sparse or unavailable.

“The incidence of treatment for complications from unsafe termination of pregnancy continues to be high,” researchers wrote. “An estimated 6.9 million women were treated for such complications in 2012, an annual treatment rate of 6.9 per 1,000 women aged 15 to 44 years. These results indicate that unsafe termination of pregnancy remains a significant source of morbidity for women in the developing world in 2012.”

Currently, an approximate 800 women die from preventable causes related to pregnancy and childbirth, with unsafe abortion specifically accounting for eight to 15 percent of maternal deaths. In terms of post-abortion treatment, the study authors estimated the total number of women treated for complications was seven million in 2012.

According to GI, abortion is “an extremely safe procedure” when performed under the right conditions; fewer than one percent of all U.S. abortion patients experience major complications. But the U.S. is much more developed than Pakistan and Kenya. In fact, the rate of unsafe abortions in developing regions is 16 times higher than the rate in developed regions. That largely has to do with the fact that abortion remains illegal in several developing regions.

“Broader access to safe termination of pregnancy is an additional effective preventive measure,” Singh and Zimet concluded. “Reducing unsafe termination of pregnancy would benefit women’s health and the well-being of their families. It would also yield economic gains by improving women’s productivity and by reducing the costs of… care.”

Source: Singh S and Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG. 2015.