The human cost of unsafe abortions
Romania’s history offers a rare natural experiment on what happens when abortion laws change rapidly. What can the rest of the world learn from this?
In the two decades from 1965 to 1985, maternal mortality fell sharply across Europe. Rates in my own country, the United Kingdom, fell by more than two-thirds.
Romania was the exception. Its rates increased by almost 150%.
By the late 1980s, Romanian women were dying at rates several times higher than in other Eastern European countries, and ten times higher than those in Western Europe, as the chart below shows.
Why were Romanian women dying at much higher rates than in neighboring countries? To understand this, we need to go back three decades.
In 1957, Romania legalized abortion. Surgical procedures became readily available, affordable, and relatively safe.1 At the same time, there was very little access to contraception, which made unintended pregnancies extremely common. As a result, many women relied on abortion to control their fertility. By the mid-1960s, more than a million abortions were performed each year, four times the number of babies born.2
You can see the impact of this in the next chart. In the decade from 1957 to the late 1960s, births fell by around 40%.3
But things changed when Nicolae Ceaușescu became president in 1965. Worried about declining births in Romania, Ceaușescu implemented “Decree 770”, which put tight restrictions on abortions and contraception. Abortion was banned except for women who were over 45 years old, had at least four children (later raised to five), faced life-threatening complications, or had been victims of rape.4
The impact of these restrictions was dramatic. Births nearly doubled from 1966 to 1967. Fertility rates increased from less than 2 births per woman to more than 3.5, as you can see in the chart below.
Eventually, they fell again as couples found other ways to manage births, but it took many decades for them to drop back to pre-ban levels.
So Ceaușescu’s plan to boost population growth worked. But making abortion illegal for most women meant that many turned to more dangerous alternatives.
We know abortions continued because women and those who performed them were imprisoned or heavily fined when caught. Records suggest that many of these people were not medically trained.5
These procedures often relied on non-sterile metal instruments, improvised tools, or toxic substances to induce a miscarriage. As a result, many women suffered from severe internal bleeding, perforation of the uterus, or life-threatening conditions caused by infections. Because these procedures were illegal, women often delayed seeking medical help when complications arose, turning treatable problems into fatal ones.
As you can see in the chart below, maternal mortality rates in Romania increased substantially in the decades following the abortion ban. This reflects the expansion of illegal abortion methods and practitioners, and partly explains why births gradually fell over the same period. A growing fraction of maternal deaths were caused by unsafe abortion; by the 1980s, these deaths accounted for more than 80% of the total.6
In 1989, Ceaușescu was overthrown, and just as quickly as abortion was criminalized, restrictions were lifted again. Maternal deaths declined as abortions moved from illegal methods to regulated ones.7
Over the course of the two-and-a-half decades when abortion was restricted, it’s estimated that around 10,000 Romanian women died from unsafe terminations.8
What can we learn from Romania’s experience?
Romania’s sudden policy changes created a rare natural experiment: when abortion was legal, maternal deaths were low; when it was banned, they rose; and when it was legalized again, they fell.
If we want to draw lessons from Romania’s history, we need to keep in mind that its situation was unusual.
Over the two-and-a-half decades when abortion was restricted, it’s estimated that around 10,000 Romanian women died from unsafe terminations.
No country today has anywhere close to the abortion rates that Romania had in the early 1960s. I estimate that around 20% of women of reproductive age in Romania were having an abortion each year at that time.9 Globally, the country with the highest rate today is less than half that of Romania in the 1960s.10 Most countries in Europe and North America have rates closer to 1%.11 Romania was an extreme case, and we shouldn’t expect changes today to have such dramatic consequences. But the mechanism still applies.
It is estimated that around 40% of women in the world live in countries where abortion is either completely illegal or severely restricted. Yet abortion rates are still higher in these places than they are in Western Europe and many other places where abortion is legal.
Where abortions are illegal, most take place in unsafe and unsanitary conditions. In countries with tight restrictions, three-quarters of abortions are estimated to be unsafe, compared to far less than 10% in North America and North and Western Europe.12
How does this affect the health risks for women? Safe abortions have very low mortality rates, typically below 1 death per 100,000 abortions.13 In regions where the majority of abortions are unsafe, mortality rates can be several hundred times higher; in Western and Middle Africa, around 1-in-200 abortions result in the woman dying.14
Estimates suggest that unsafe abortions account for 8% of maternal deaths globally.15 This means that an estimated 23,000 women die every year.16 Romania learned about the consequences of unsafe abortion at an enormous cost. In many parts of the world, that lesson continues.
Acknowledgments
Many thanks to Max Roser and Edouard Mathieu for editorial feedback and comments on this article.
If we can make maternal deaths as rare as in the healthiest countries, we can save 275,000 mothers each year
Maternal mortality was much more common in the past. It is much lower today, but global inequalities are still large.
Maternal Mortality
What could be more tragic than a mother losing her life in the moment that she is giving birth to her newborn? Why are mothers dying and what can be done to prevent these deaths?
The rise in reported maternal mortality rates in the US is largely due to a change in measurement
Maternal mortality rates appear to have risen in the last 20 years in the US. But this reflects a change in measurement rather than an actual rise in mortality.
Endnotes
Teitelbaum, M. S. (1972). Fertility effects of the abolition of legal abortion in Romania. Population Studies.
Horga, M., Gerdts, C., & Potts, M. (2013). The remarkable story of Romanian women's struggle to manage their fertility. Journal of Family Planning and Reproductive Health Care.
By the mid-1960s, births had fallen to around 260,000 per year.
Birth rates fell by slightly more than 40%.
The policy initially had an age threshold of 45 years, which was later lowered to 40 years, then raised again to 45.
The government became deeply involved in women's and families' reproductive decisions in other ways, too. Working women had to get a monthly gynaecological exam; if they failed to attend, they lost their rights to medical care, pensions, and social support. If a married couple did not have a child within two years — and there were no medical reasons preventing them from doing so — they had to pay extra taxes.
Hord, C., David, H. P., Donnay, F., & Wolf, M. (1991). Reproductive health in Romania: reversing the Ceausescu legacy. Studies in family planning.
Hord, C., David, H. P., Donnay, F., & Wolf, M. (1991). Reproductive health in Romania: reversing the Ceausescu legacy. Studies in Family Planning.
The drop in deaths might have been even larger if it weren’t for the fact that abortion clinics were overwhelmed in the year after legalization. The demand from women was high, and medical support was limited; abortion clinics had either been severely restricted or closed completely.
I’ve seen this figure cited in several places, but failed to find a solid original reference.
However, based on my own calculations, this seems reasonable as an estimate.
Based on the previous chart in this article, mortality from abortions over the period when abortion was restricted averaged around 80 to 120 deaths per 100,000 live births. Earlier in the period, it was around 30, and by the end, it had reached over 140. An average of 100 deaths per 100,000 live births seems like a reasonable estimate.
Using the number of births from 1966 to 1989 (the period of restriction), dividing by 100,000 and multiplying by 100 (the number of abortion deaths per 100,000 births), I calculated a figure of around 9,500 deaths in that 24-year period. Approximately 10,000 deaths, therefore, seems like a reasonable estimate.
I’ve based this on the number of girls and women aged 15 to 49 years (often described as the “reproductive age”). In 1965, there were around 4.9 million Romanian women in this age bracket.
Some women could have multiple abortions in a given year, so this 20% figure is a simplification assuming that women only had one.
At those rates, the average woman would have had four abortions in her lifetime.
Horga, M., Gerdts, C., & Potts, M. (2013). The remarkable story of Romanian women's struggle to manage their fertility. Journal of Family Planning and Reproductive Health Care.
The study by Bearak et al. (2022) estimated that Georgia had the highest rate in the world, at 80 abortions per 1,000 women aged 15 to 49 years per year.
Bearak, J. M., Popinchalk, A., Beavin, C., Ganatra, B., Moller, A. B., Tunçalp, Ö., & Alkema, L. (2022). Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019. BMJ Global Health.
This study is based on data from the period 2010 to 2014, so it’s a bit outdated. However, I could not find a more recent global study of this question.
Ganatra, B., Gerdts, C., Rossier, C., Johnson, B. R., Tunçalp, Ö., Assifi, A., ... & Alkema, L. (2017). Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet.
In countries like the United States, there are around 0.5 deaths per 100,000.
Steenland, M. W., Mercon, K., Brown, B. P., & Thoma, M. E. (2026). Pregnancy-and Abortion-Related Mortality in the US, 2018-2021. JAMA Network Open.
Estimates are that case fatality rates are between 450 and 500 per 100,000 abortions.
Ganatra, B., Gerdts, C., Rossier, C., Johnson, B. R., Tunçalp, Ö., Assifi, A., ... & Alkema, L. (2017). Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet.
Cresswell, J. A., Alexander, M., Chong, M. Y., Link, H. M., Pejchinovska, M., Gazeley, U., ... & Say, L. (2025). Global and regional causes of maternal deaths 2009–20: a WHO systematic analysis. The Lancet Global Health.
Some earlier figures from the 2010s suggested that abortions were responsible for as much as 13% of maternal deaths globally.
World Health Organization (2011). Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008.
In 2023, there were 286,000 maternal deaths globally. 8% of this figure is 23,000.
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Hannah Ritchie (2026) - “The human cost of unsafe abortions” Published online at OurWorldinData.org. Retrieved from: 'https://archive.ourworldindata.org/20260323-091329/the-human-cost-of-unsafe-abortions.html' [Online Resource] (archived on March 23, 2026).BibTeX citation
@article{owid-the-human-cost-of-unsafe-abortions,
author = {Hannah Ritchie},
title = {The human cost of unsafe abortions},
journal = {Our World in Data},
year = {2026},
note = {https://archive.ourworldindata.org/20260323-091329/the-human-cost-of-unsafe-abortions.html}
}
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