Advancing knowledge and public health: a scientific exploration of abortion safety

Abstract

Abortion is a fundamental component of reproductive healthcare, essential for managing unintended pregnancies and preserving the health and autonomy of individuals. Despite its medical necessity and established safety, abortion remains a topic of global controversy, shaped by sociopolitical, ethical, and legal factors rather than evidence-based practice. This editorial consolidates current scientific insights into abortion safety, mainly exploring its medical, but also legal, ethical, social, and public health dimensions. Globally, nearly 73 million abortions occur annually, highlighting the procedure’s significance in healthcare systems. Abortion safety is highly dependent on the medical and systemic context. Medical abortion, involving mifepristone and misoprostol, boasts a success rate exceeding 95% for early gestation, with serious complications in less than 1% of cases. Surgical abortion, particularly vacuum aspiration, offers comparable safety with a major complication rate below 0.2%. When provided by trained professionals in supportive healthcare environments, abortion procedures are among the safest medical interventions. However, disparities persist globally. High-income countries with liberal abortion laws and robust healthcare infrastructures report near-universal access to safe abortions, with mortality rates approaching zero. In contrast, restrictive laws in low- and middle-income countries (LMICs) force individuals to seek unsafe procedures, contributing significantly to maternal morbidity and mortality. Unsafe abortion accounts for 13% of global maternal deaths, disproportionately affecting marginalized populations. Addressing these inequities requires comprehensive strategies, including legal reform, improved access to contraception, enhanced provider training, and destigmatization efforts. Integrating abortion care into broader reproductive health services can ensure safety and equity, advancing public health outcomes worldwide.

Introduction

Abortion is an integral component of reproductive healthcare, serving as a critical mechanism for managing unintended pregnancies and preserving the health and autonomy of individuals. Despite its medical necessity and widespread occurrence, abortion remains a subject of intense debate, often influenced by legal, political, ethical, religious, and sociocultural factors. Globally, an estimated 73 million abortions occur annually, a number that highlights its prevalence and indispensability as a healthcare service. This editorial seeks to summarize the vast body of scientific research on abortion safety, encompassing its medical, legal, psychological, and public health dimensions. By consolidating the evidence and identifying areas for future research, this analysis aims to contribute to contribute to our understanding of abortion safety and its implications for health policy and practice.

Abortion in global health context

Abortion is one of the most common medical procedures worldwide, with rates varying across regions due to differences in contraceptive access, sociocultural norms, and legal frameworks. According to the World Health Organization (WHO), nearly half of all abortions globally are unsafe, performed by individuals lacking adequate skills or in unhygienic environments that do not meet medical standards [1]. The consequences of unsafe abortion are profound, accounting for approximately 13% of maternal deaths and contributing significantly to maternal morbidity [2]. The disparity in abortion safety between high-income and low- and middle-income countries (LMICs) underscores the role of systemic inequities in shaping health outcomes. While individuals in high-income settings often benefit from safe and regulated abortion services, those in LMICs face significant barriers, including restrictive laws, limited healthcare infrastructure, and pervasive stigma [1].

Understanding the safety of abortion today requires an appreciation of its historical evolution. Abortion practices date back centuries, but the safety of the procedure has drastically improved with advancements in medical science and training, especially knowledge of hygiene, female anatomy, development of medical instruments, such as suction curettage, and pharmaceutical products, such as prostaglandins. Prior to the development of modern techniques, abortion was often associated with high morbidity and mortality rates. In the early twentieth century, complications from unsafe abortion were a leading cause of maternal death globally, particularly in regions, where legal access to safe services was restricted.

The advent of antibiotics, sterile techniques, and later the introduction of medication-induced abortion transformed abortion safety. These developments coincided with movements to decriminalize abortion in many countries, which further facilitated access to safe, regulated procedures. By the late twentieth century, abortion was recognized as one of the safest medical interventions in settings, where it was legal and provided by trained healthcare professionals. Today, the safety of abortion continues to improve, but disparities persist, particularly in regions with restrictive laws regarding abortion.

In regions with liberal abortion policies, the procedure is highly regulated, accessible, and integrated into standard healthcare systems, resulting in minimal health risks [3]. Conversely, in environments with wide regulatory restrictions, individuals frequently resort to unsafe methods, such as ingesting toxic substances or using unsterile instruments, to terminate pregnancies. These dangerous practices contribute to complications including severe hemorrhage, infections, and uterine perforation, which, in the absence of timely medical intervention, can lead to death.

It is important to note that global data on maternal morbidity associated with abortions is likely to be significantly under-reported. This is due to a number of factors, including structural difficulties, such as the lack of reliable birth and death records, as well as social stigmatisation of abortions and fear of legal consequences for mothers and physicians [4].

Pharmacological and procedural safety of abortion

Scientific research over several decades has established abortion as one of the safest medical procedures when performed under appropriate conditions. When conducted in an appropriate medical environment with well-trained providers, both drug-induced and surgical abortion are associated with a low risk of complications and a safety profile that rivals or surpasses many routine medical interventions [5]. This safety is consistent across various gestational stages, provided that evidence-based practices and protocols are followed [6].

For medical abortion, studies show that the major complication rate—defined as cases requiring hospital admission, surgery, or blood transfusion—is approximately 0.31%. When considering all complications, including those managed in emergency departments or at the original abortion facility, the rate rises to around 5.2%. These complications are typically minor and manageable with prompt medical care [7].

In contrast, first-trimester surgical abortion has an even lower complication profile. The major complication rate for this method is reported to be 0.16%, with a total complication rate of 1.3%. These findings indicate that while both methods are highly safe, surgical abortion in the first trimester carries a marginally lower risk of complications than medical abortion [3, 7].

Medical abortion, involving the use of mifepristone and misoprostol, has revolutionized early pregnancy termination. Mifepristone, a progesterone receptor antagonist, disrupts the hormonal environment necessary for maintaining pregnancy, while misoprostol induces uterine contractions to expel the pregnancy tissue. Approved by the United States Food and Drug Administration (FDA) in 2000, this method is now widely recognized as a safe and effective option for terminating pregnancies up to 10 week gestation. It is also used later on in pregnancy to accelerate the termination process [8, 9].

The efficacy of medical abortion exceeds 95% in early gestation, with serious complications occurring in less than 1% of cases [10]. The safety of this method has been reinforced by large-scale studies across diverse populations and healthcare settings. Furthermore, its non-invasive nature makes it particularly appealing for individuals who value privacy and autonomy. The advent of self-managed medical abortion, supported by telemedicine and accurate information, has further expanded access, particularly in settings, where in-person clinical services are limited.

Surgical abortion, encompassing methods, such as vacuum aspiration as well as dilation and evacuation (D&E), remains a cornerstone of first-trimester pregnancy termination. Vacuum aspiration employs gentle suction to remove pregnancy tissue, while D&E combines suction with specialized instruments to ensure complete uterine evacuation in later gestation. Both methods have been rigorously studied and refined, achieving success rates exceeding 98% [11].

The safety of surgical abortion has been enhanced by advancements in medical technology, including the use of ultrasound guidance and improved pain management techniques. When performed by trained providers in clinical settings, the risk of serious complications—such as infection, uterine perforation, or excessive bleeding—is exceedingly low. Data from high-income countries consistently demonstrate that the risk of death associated with childbirth at term is significantly higher than that of abortion [12]. A comprehensive study conducted in the United States looking on the intervention itself from the pregnant woman’s perspective found that the mortality rate for childbirth was approximately 14 times higher than for legal abortion [13]. This finding underscores the importance of framing abortion as a medically necessary and safe healthcare service rather than a hazardous procedure. In certain maternal conditions when continuing a pregnancy or undergoing childbirth poses significant risks to the well-being of the pregnant woman, an abortion may become medically necessary. These risks can arise from acute pregnancy complications, such as severe bleeding due to placental abruption or uterine rupture, or life-threatening infections (Table 1). In addition, chronic conditions such as malignancies requiring urgent radiation or chemotherapy, as well as advanced chronic diseases, may necessitate terminating the pregnancy. Psychiatric indications, including severe mental health disorders that may deteriorate during pregnancy or instances of acute suicidality as well as pregnancies resulting from criminal incidents may also justify this decision to safeguard the mother’s health.

Table 1.

Comparison of complications Between Medication and Surgical Abortion Methods According to the German Guideline on First-Trimester Abortion [14]

Complications	Medical abortion	Surgical abortion
Heavy bleeding	10/1000	2/1000
Ongoing pregnancy	10/1000	2/1000
(Repeat) Vacuum aspiration	30–50/1000	30/1000
Infections	1–2/1000	0–110/1000*
Uterine perforation	Not applicable	1/1000
Cervical injury	Not applicable	1–6/1000

*Note: with antibiotic prophylaxis, the risk of infections in surgical abortion is less than 20/1000

Impact of social and legal variables on abortion safety

While under ideal conditions, the medical procedures themselves are safe and scientifically well-established, the practical safety of a medical abortion depends on the local healthcare system’s capacity to provide accessible and high-quality care. Under the corresponding legal situation, several factors in the health care system directly determinate the implementation of safe abortion services [15]:

• Training and accreditation of providers: Ensuring that healthcare professionals are adequately trained in abortion care is critical. Studies show that provider training significantly reduces the risk of complications and improves patient outcomes. WHO and other global health organizations have developed training curricula to equip providers with the necessary skills. However, they have to be accepted by the medical staff and terminations have to be carried out on a regular basis to be able to handle complications appropriately.

• Availability of equipment and medications: Access to essential medications (e.g., mifepristone, misoprostol) and equipment (e.g., manual vacuum aspiration kits) is crucial for safe abortion care. Stockouts or supply chain disruptions can force individuals to resort to unsafe methods.

• Integration with other reproductive health services: Comprehensive reproductive health services, including contraception and post-abortion care, enhance the safety and accessibility of abortion. Studies show that integrating abortion services with family planning programs reduces unintended pregnancies and repeat abortions [16].

• Health system responsiveness: Timely care is a key determinant of abortion safety. Delays in accessing abortion services—whether due to logistical, legal, or financial barriers—can increase the risk of complications. Health systems must prioritize reducing these delays to improve outcomes [3].

Legal and policy determinants of abortion safety and maternal mortality

Legal and policy frameworks play a decisive role in determining abortion safety and accessibility. Liberal abortion laws, which permit the procedure on broad grounds, are associated with lower rates of unsafe abortion and improved maternal health outcomes [17]. The global distribution of abortion safety reflects broader inequities in healthcare access and outcomes. High-income countries with well-developed healthcare systems report near-universal access to safe abortion, with mortality rates approaching zero [1]. In these settings, abortion is integrated into routine reproductive healthcare, and individuals benefit from comprehensive services, including counseling, contraception, and follow-up care.

In contrast, LMICs bear a disproportionate burden of unsafe abortion. These regions account for the vast majority of abortion-related deaths and complications, driven by a combination of restrictive legislature, inadequate healthcare infrastructure, and pervasive stigma. For example, in sub-Saharan Africa, where restrictive abortion policies are common, unsafe abortion remains a leading cause of maternal mortality [18]. Women in these settings are often forced to choose between continuing unwanted pregnancies and risking unsafe procedures, with devastating consequences for their health and well-being. This stark reality underscores the critical influence of legal frameworks on abortion safety and maternal health, as evidenced by global studies that highlight the correlation between restrictive abortion laws and adverse outcomes. An analysis of Ganatra et al. published in the Lancet in 2017 demonstrated that during the period between 2010 and 2014, the proportion of unsafe abortions was significantly higher in countries with highly restrictive legislation [1]. Furthermore, a study by Latt et al. examining the legal rigidity in 182 countries worldwide between 1985 and 2013 demonstrates that more flexible abortion laws are associated with significantly lower maternal mortality. Specifically, countries allowing abortions for at least three reasons experienced a reduction of 45 maternal deaths per 100,000 live births [17].

Moreover, this correlation can be identified not only in a global comparison between regions with markedly disparate levels of development, but also in areas with similar levels of economic advancement. A comparative analysis of the maternal mortality rate between states in the United States with reveals a markedly elevation in those with restrictive legislation. The states with neutral legislation occupy an intermediate position in the aforementioned comparison [19]. These findings highlight the potential for abortion law reforms in restrictive settings to enhance maternal health outcomes.

Barriers to abortion safety: economic, social and ethnocultural dimensions

Despite robust evidence supporting the safety of abortion, numerous barriers continue to undermine access to safe care. These obstacles are deeply rooted in legal, cultural, social, and economic factors, which intersect to create widespread inequities in abortion safety. Each of these barriers plays a critical role in shaping access to abortion services, influencing both the safety and quality of care.

Economic disparities present a significant barrier to abortion safety [20]. Individuals from low-income backgrounds are less likely to afford the costs associated with safe abortion services, including clinic fees, transportation, and post-abortion care. These financial constraints often force economically disadvantaged individuals to delay care or resort to unsafe methods, increasing their risk of complications. Economic barriers are particularly pronounced in countries, where abortion is heavily regulated, as individuals may need to travel long distances to access safe services or pay inflated prices for clandestine care. Thereby, constrained legal contexts not only jeopardize individual health but also exacerbate broader societal inequities. In 2023, the Guttmacher Institute conducted a comparative analysis of patients who underwent abortion procedures prior to the elimination of the federal constitutional right to abortion in both restricted and liberal states in the US. The findings revealed that in restrictive states more than twice as many patients were required to pay for the procedure out of pocket or relied on financial assistance from relief funds or hospital discounts, compared to their counterparts in liberal states. However, in states with more stringent abortion laws, the patients who obtained abortion tended to have higher income and level of education. This indicates that under these circumstances, this medical service is more accessible to a socio-economically advantaged population [21].

Addressing economic barriers requires a comprehensive approach, including expanding public funding for abortion services and removing cost-related obstacles. In addition, targeted interventions to subsidize care for marginalized populations, including adolescents and those in rural areas, are critical for promoting equitable access to abortion. Ireland’s 2018 referendum to legalize abortion following decades of restrictive policies serves as a powerful example of how cultural attitudes can evolve. Previously, many Irish women were required to travel to the UK for an abortion. As documented in the annual reports on the abortion rate in Ireland, the number of abortions performed increased markedly from 17 in 2017 to 10,033 in 2023 [23, 24], showing the recent implementation of new legislation has enabled them to obtain this medical service in their home country.

In addition to economic factors, social, cultural and religious considerations also exert a significant influence on the decision to terminate a pregnancy. A systematic review of studies published between 2001 and 2016 on the factors influencing public opinions on abortion identified religion as the most powerful predictor of attitudes towards abortion. Education and income were identified as the second and third most influential factors, respectively, followed by political affiliations [25].

The investigation of the impact of individual and national religiosity on attitudes towards abortion in 76 countries revealed that individuals for whom religion holds a high personal significance tend to exhibit greater opposition to abortion [26]. The average importance of religion within a country also exerts a significant influence on attitudes towards abortion. Individuals residing in countries with a higher degree of religiosity tend to exhibit more conservative attitudes towards abortion, even if they themselves adhere to a less religious belief system. The economic development of a country also exerts an influence on the importance of religion in relation to attitudes towards abortion. While people in economically prosperous countries are, on average, more liberal, personal religious beliefs serve to reinforce their opposition to abortion to a greater extent than in poorer countries. In wealthy societies, there is a greater degree of normative ambiguity, which leads religious people to emphasize their beliefs with greater conviction. In countries with a low gross domestic product, there is a more uniform rejection of abortion, regardless of the individual level of religiosity [26].

Stigmata arising from strong opposition to abortion may deter individuals from seeking care, delaying access to services and thereby increasing costs and the likelihood of complications. It also extends to healthcare providers, many of whom face social ostracism, professional isolation, or institutional pressures when offering abortion services [27]. However, societal attitudes are not static; public opinion can shift in response to advocacy, education, and changes in cultural discourse.

In addition to religious considerations, cultural and ethnic factors can also influence perspectives on, access to, and the safety of abortion. A study examining abortion rates between 2008 and 2014 in the United States confirmed significant differences in abortion rates per 1,000 women of different ethnicities [28]. The incidence of abortion was markedly higher among non-white women (with a rate of 10 per 1000 for white women and 27 per 1000 for women of color). In general, a decline in abortion rates was observed over the course of the study for all cohorts, with the greatest reduction occurring among the non-white population [28]. However, it remains uncertain whether this decline can be attributed to a reduction in the number of unplanned pregnancies due to enhanced contraceptive availability or whether access to abortion has become more challenging for this demographic, resulting in a decline that may indicate greater inequity in healthcare [28].

An analysis of ethnic and racial differences in contraceptive method preferences revealed that the desire for self-control over starting and stopping the chosen method, preferences regarding the return to fertility and freedom from menstrual cycle disorders are significant factors influencing contraceptive choice. However, these characteristics are frequently observed in less secure contraceptive strategies [29]. In light of the historical traumas experienced by non-white populations, including forced reproduction and sterilization measures during times of slavery, as well as ongoing discriminating experiences within the healthcare system, there is a risk that these population groups will be significantly disadvantaged in terms of the provision of contraceptive and abortion-related services [22].

In a socio-medical framework, it is imperative to account for social, cultural, ethnic, and historical factors when examining both income-dependent and income-independent determinants influencing the utilization of contraception and abortion services among diverse population groups. To promote equitable access to care, it is crucial to comprehend these factors and actively address the disparities that shape service provision [22].

Psychosocial aspects of abortion safety

While the physical safety of abortion is well-established, its psychosocial dimensions are equally critical to consider. The emotional and psychological experiences of individuals seeking abortion are deeply influenced by the context in which care is provided. Safe and supportive environments enhance mental well-being, whereas stigma, discrimination, and delays in care can have detrimental effects.

Patient-centered care is a cornerstone of abortion safety, emphasizing the importance of tailoring care to the individual’s needs, preferences, and circumstances. This approach fosters a sense of empowerment and respect, contributing to better psychological and emotional outcomes. Research shows that individuals who receive patient-centered abortion care report higher levels of satisfaction and lower levels of distress.

Key elements of patient-centered abortion care include:

• Nonjudgmental communication: Healthcare providers should deliver unbiased information and support, enabling individuals to make informed decisions. Judgmental attitudes and coercion can exacerbate feelings of shame and anxiety, undermining the care experience.

• Privacy and confidentiality: Ensuring privacy is critical for reducing the stigma and fear associated with seeking abortion. Individuals are more likely to seek care when they are confident that their decision will be respected and their information kept confidential.

• Emotional support: Counseling services can help individuals navigate complex emotions and reduce anxiety related to the procedure. Access to trained counselors or peer support networks can provide a vital source of reassurance and guidance.

The psychological outcomes of abortion are heavily influenced by the context in which the procedure occurs. Factors such as supportive healthcare environments, patient autonomy, and access to accurate information play critical roles in shaping emotional well-being. Policies and practices that reduce barriers to care and respect individual decision-making are essential for promoting positive mental health outcomes.

Consideration of the unborn child

It is imperative to consider both maternal well-being and fetal development when addressing abortion safety and access. However, the perspective of the unborn child is often under-represented in discussions surrounding abortion. Current discourse frequently focuses on the rights and health of the woman, sometimes overlooking that denying an abortion results in the birth of a child who will have a future and potential societal contribution. Ethical considerations surrounding the unborn child involve complex questions about the beginning of personhood and human rights, which merit inclusion in any comprehensive discussion on abortion. The conflict between the rights to self-determination and physical integrity of the unborn child and those of the mother constitutes a central aspect of the discussion. This ethical dilemma becomes particularly complex when considering cases, where medical or developmental circumstances significantly impact the quality of life for both the mother and the unborn child. Pre-existing health conditions of the mother as well as fetal anomalies which are associated with severe restrictions should also be taken into account with the objective to protect mother and child from experiencing extreme pain, discomfort or dangerous complications.

Acknowledging the existence and potential of the unborn child provides a more holistic perspective that can inform both clinical practice and policy-making. However, in this analysis, it is also necessary to consider potential adverse outcomes for the child. Studies examining the outcomes of women who were denied an abortion often highlight the psychosocial and economic impacts on the women themselves [31, 33]. However, these studies may not fully address the long-term implications for the children. Research indicates that children born under such circumstances may face challenges, including economic hardship, unstable family environments, violence and criminality as well as further adverse health outcomes [34].

Considering the well-being of both the mother and the child is essential in making informed decisions regarding abortion services.

The role of contraceptive access and education in abortion safety

Ensuring access to effective contraception and comprehensive sexual education is a cornerstone in promoting reproductive health and reducing the incidence of unintended pregnancies, which directly influences abortion safety. By addressing the root causes of unintended pregnancies, health systems can minimize the need for abortions, particularly those performed under unsafe conditions.

Access to modern contraceptive methods is a critical determinant in preventing unintended pregnancies. Studies have shown that regions with widespread availability of contraception experience significantly lower rates of unintended pregnancies and, consequently, abortions [32, 35]. For instance, in developing countries, providing adequate access to modern contraceptive methods could enable women to prevent an estimated 67 million unintended pregnancies, 23 million unplanned births, 36 million abortions, and 76,000 maternal deaths annually [36]. In addition, when contraceptives are both affordable and accessible, they empower individuals to make informed choices about family planning and reduce reliance on abortion as a last resort of unintended parenthood.

Barriers to contraception, including financial constraints, lack of healthcare infrastructure, and sociocultural stigma, disproportionately affect marginalized populations. Addressing these barriers through subsidized contraceptives, integration of family planning services into primary care, and culturally sensitive outreach programs is essential in ensuring equitable access.

Comprehensive sexual education is equally vital in equipping individuals with the knowledge and skills to make informed decisions about their sexual and reproductive health. Programs that include information about contraception, reproductive anatomy, and the risks of unintended pregnancies have been shown to delay the onset of sexual activity, reduce the number of sexual partners, and increase the use of contraceptives [37].

Contrary to abstinence-only approaches, comprehensive sexual education fosters an environment of informed choice and personal responsibility. It also addresses misconceptions about contraceptives, such as their efficacy and potential side effects, thereby increasing their acceptance and consistent use.

A reduction in unintended pregnancies through improved access to contraception and education has a direct impact on abortion safety. Fewer unintended pregnancies mean fewer abortions overall, reducing the number of women who might otherwise seek unsafe abortion services. Moreover, individuals who are empowered with reproductive knowledge are more likely to access healthcare early, should abortion become necessary, improving the safety and health outcomes of the procedure [5].

In settings where abortion laws are restrictive, increased contraceptive use and education are particularly critical. They serve as preventive measures that reduce the risks associated with unsafe abortions, which remain a significant cause of maternal morbidity and mortality in low-resource settings.

Enhancing access to effective contraception and comprehensive sexual education is crucial in reducing unintended pregnancies and, consequently, the demand for abortions [38]. By providing individuals with the necessary resources and knowledge to make informed reproductive choices, the incidence of unintended pregnancies—and the complex ethical and practical issues that accompany abortion denial—can be significantly decreased. This proactive approach addresses the root causes of abortion requests and supports both maternal and child health.

Innovations in abortion care

Technological advancements have significantly enhanced the safety, accessibility, and autonomy of abortion care. Innovations such as telemedicine and self-managed abortion have emerged as critical tools for expanding access, particularly in underserved regions.

Telemedical abortion, which involves remote consultation and the prescription of medical abortion regimens, has gained prominence as a safe and effective option for early pregnancy termination [39]. Studies conducted during the COVID-19 pandemic demonstrated the feasibility of telemedical abortion, with outcomes comparable to in-person care. This approach has been particularly impactful in regions, where physical access to clinics is limited, enabling individuals to receive care in the privacy of their homes [40]. An example of this is the United States, where restricted abortion rights have increasingly led individuals to turn to home abortion methods [41].

Self-managed abortion, supported by accurate information and access to follow-up care, represents a paradigm shift in abortion provision. The WHO recognizes self-management as a safe option for early abortion when individuals have access to high-quality medications and reliable information. However, barriers such as legal restrictions, stigma, and limited access to resources continue to constrain its potential.

Stigma remains a pervasive barrier to abortion access, affecting both individuals seeking care and providers. Stigma manifests in various forms, including societal judgment, discriminatory policies, and bias within healthcare systems. It deters individuals from seeking care, isolates providers, and perpetuates misinformation.

Reducing abortion stigma requires a multifaceted approach. Public education campaigns, provider training, and policy reforms that normalize abortion as a routine healthcare service are essential. In addition, fostering inclusive and supportive healthcare environments can help mitigate the psychological impact of stigma on patients and providers alike.

Future directions and research gaps

Abortion is a safe and essential component of reproductive healthcare, with profound implications for public health and individual well-being. The evidence overwhelmingly supports its safety, yet access remains inequitable, constrained by legal, political, ethical, and sociocultural barriers. Ensuring safe and accessible abortion services requires a comprehensive approach that integrates scientific evidence, changes in policy, and public education.

Addressing global and local inequities requires coordinated international efforts. The WHO and other global health organizations emphasize the importance of strengthening health systems [30], liberalizing restrictive laws, and addressing the social determinants of health to improve abortion safety. Donor funding and technical support for reproductive health programs in LMICs have also played a crucial role in expanding access to safe abortion. However, sustained investment and advocacy are needed to address the structural inequities that perpetuate unsafe abortion.

Despite significant progress in understanding abortion safety, important gaps remain in the literature. Future research should prioritize the experiences of marginalized populations, the short and long-term effects of restrictive or liberal abortion policies, and the effectiveness of interventions to reduce stigma. In addition, studies examining the structural determinants of abortion access, including economic inequality, racism, and gender-based violence, are critical for safe abortion. On the other hand, as a result of demographic change and the associated socio-structural effects on society, modern societies are obliged to address the question of how family planning can be better supported and promoted. The aim is for young women and families to feel financially and socially able to decide to carry a pregnancy to term.

In the end, despite the medical efficacy and high safety of medical abortion, the most effective means of protecting women from the psychological and physical risks associated with an unplanned pregnancy and, if indicated or desired, its termination, is through its prevention through comprehensive education and access to suitable contraceptives.

By addressing these challenges and closing knowledge gaps, the global community can advance reproductive rights and achieve health equity for all.

Author contribution

FR conceptualized the editorial and led the development of the manuscript. He was responsible for synthesizing the medical and public health aspects of abortion safety and contributed significantly to drafting and revising the manuscript. KOK contributed expertise in legal and ethical considerations, as well as provided critical input on the historical and global context of abortion safety. He also reviewed and edited the manuscript to ensure accuracy and comprehensiveness. HM performed a detailed review of the literature on access to reproductive healthcare and provided editorial support in refining the final draft. All authors have reviewed and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Funding

The authors have not disclosed any funding.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Conflict of interest

The authors declare no competing interests.