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

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.