MEASURE DHS assists countries worldwide in the collection and use of data to 

monitor and evaluate population, health, and nutrition programs. Funded by the 

U.S. Agency for International Development (USAID), MEASURE DHS is 

implemented by ORC Macro in Calverton, Maryland. 

The main objectives of the MEASURE DHS project are: 

1) to provide decisionmakers in survey countries with information useful for informed policy choices, 

2) to expand the international population and health database, 

3) to advance survey methodology, and 

4) to develop in participating countries the skills and resources necessary to conduct high-quality demographic 

and health surveys. 

 

Information about the MEASURE DHS project or the status of MEASURE DHS surveys is available on the 

Internet at http://www.measuredhs.com or by contacting: 

ORC Macro 

11785 Beltsville Drive, 

Suite 300 

Calverton, MD 20705 USA 

Telephone: 301-572-0200 

Fax: 301-572-0999 

E-mail: reports@orcmacro.com

DHS Analytical Studies No. 8 

Recent Trends in 

Abortion and Contraception 

in 12 Countries 

Charles F. Westoff 

Office of Population Research 

Princeton University 

ORC Macro 

Calverton, Maryland, USA 

February 2005 
This publication was made possible through support provided by the U.S. Agency for International Development under the terms of Contract No. HRN-C-00-97-00019-00. The opinions 

expressed herein are those of the authors and do not necessarily reflect the views of the U.S. 

Agency for International Development 

Suggested citation: 

Westoff, Charles F. 2005. Recent Trends in Abortion and Contraception in 12 Countries. DHS 

Analytical Studies No. 8. Calverton, Maryland: ORC Macro. 
Contents iii

Contents 

Tables and Figures v

Preface vii

Acknowledgements ix

Executive Summary xi

1 Background 1

2 Levels and Trends of Contraceptive Prevalence and Abortion Rates 3

3 Trends in Fertility Rates and Number of Children Desired 9

4 Recent Country Trends in Contraceptive Prevalence and Abortion 11

5 A Model of Abortion 23

6 Components of Abortion 27

7 Potential Reduction in Abortion Rates 29

7.1 Unmet Need Shifts to Use of Modern Methods 29

7.2 Use of Traditional Methods Shifts to Use of Modern Methods 30

7.3 Both Unmet Need and Use of Traditional Methods Shift to Use 

of Modern Methods 30

8 Effect of Contraceptive Discontinuation on Abortion 33

9 Receptivity to Abortion 35

10 Covariates of Abortion and Contraception 39

10.1 Abortion Experience 39

10.2 Abortion Attitudes 41

10.3 Modern Contraceptive Practice 42

11 Remaining High Risk of Abortion 43

12 Conclusions 45

References 47

Tables and Figures v

Tables and Figures 

Table 2.1 Trends in abortion rates in 9 countries by age at time of abortion 

and number of years preceding survey that abortion took place 7 

Figure 2.1 Total abortion rate per woman 3

Figure 2.2 Percentage of all women age 15-44 currently using contraception 4

Figure 2.3 Total abortion rate and the prevalence of modern contraceptive 

methods in 18 countries 5

Figure 2.4 Total abortion rate and the prevalence of traditional 

contraceptive methods in 18 countries 5

Figure 2.5 Recent trends in the use of modern contraceptive methods 6

Figure 2.6 Recent trends in abortion rates 8

Figure 3.1 Total fertility rates 1950-2000 9

Figure 3.2 Mean ideal number of children, by current age of women 10

Figure 4.1 Recent trends (relative) in use of modern contraceptive methods 

and prevalence of abortion among all women 11

Figure 4.2 Trends in contraceptive failure rates in five countries, 1992-1999 18 

Table 5.1 Model for parameters for abortion risk among women age 15-44 25 

Figure 5.1 A model of abortion (using Armenia 2000 data) 24

Figure 6.1 Components of abortion as a percentage of all abortions 27

Figure 7.1 Percent reduction in abortion rates if all unmet need shifted to 

modern methods 29

Figure 7.2 Percent reduction in abortion rates if use of traditional methods 

shifted to modern methods 30

Figure 7.3 Percent reduction in abortion rates if all unmet need and all use 

of traditional methods shifted to modern methods 31 

Table 8.1 Percent distribution of all pregnancies that ended in the three 

years preceding the survey by use of contraception before pregnancy, and the percentage of pregnancies in each category that 

ended in abortion 34 
vi Tables and Figures

Figure 9.1 Percentage of women who never heard of specific modern 

methods 36 

Figure 9.2 Percentage of women who think that a woman with an 

unwanted pregnancy should have an abortion, and percentage 

who say they would have an abortion if they become pregnant 

unintentionally 37 

Table 10.1 Odds ratios of ever having had an abortion, women age 15-44 

who ever had sex 40 

Table 10.2 Odds ratios of women preferring an abortion if they become 

pregnant unintentionally 41 

Table 10.3 Odds ratios of ever having used a modern method of contraception, women age 15-44 who have ever had sex 42 

Table 11.3 Estimates of the percentage of currently married women who are 

at high risk for another abortion 43 
Preface vii

Preface 

One of the most significant contributions of the MEASURE DHS program is the 

creation of an internationally comparable body of data on the demographic and 

health characteristics of populations in developing countries. The DHS Analytical 

Studies series and the DHS Comparative Reports series examine these data, focusing 

on specific topics. The principal objectives of both series are: to provide information 

for policy formulation at the international level, and to examine individual country 

results in an international context. Whereas Comparative Reports are primarily descriptive, Analytical Studies take a more analytical approach. 

The Analytical Studies series comprises in-depth, focused studies on a variety of 

substantive topics. The studies are based on a variable number of data sets, depending 

on the topic under study. A range of methodologies is used, including multivariate 

statistical techniques. The topics covered are selected by MEASURE DHS staff in 

conjunction with the MEASURE DHS Scientific Advisory Committee and USAID. 

It is anticipated that the Analytical Studies will enhance the understanding of significant issues in the fields of international population and health for analysts and 

policymakers. 

Martin Vaessen 

Project Director 

Acknowledgements ix

Acknowledgements 

At the Office of Population Research, Princeton University, the author owes special 

thanks to Paul Bern, whose programming skills greatly facilitated the analysis of the 

CDC data. And, as in earlier studies, Judie Miller was responsible for the considerable amount of graphic work in this paper. Thanks also to Elana Broch at the Office 

library, who located many obscure foreign references. 

At the Centers for Disease Control and Prevention in Atlanta, several of the professional staff facilitated the acquisition of country data, in particular, Florina Serbanescu, Leo Morris, and Howard Goldberg. And at DHS, a note of thanks to Jerry 

Sullivan for periodic consultations on some of the intricacies of the analysis of the 

abortion data and for his review of the manuscript, to Sidney Moore for all she does 

in the publication process, and to Justine Faulkenburg for document production. I am 

particularly indebted to Stan Bernstein of UNFPA for his support of this work and 

for his comments on the manuscript. 

Financial support for this work was made possible initially by a grant from the 

Hewlett Foundation and by UNFPA and the World Bank in the later stages of the 

work. The Gates Foundation provided support for the dissemination of the findings. 

The Population Resource Center provided administrative support. Presentations of 

preliminary results benefited from reactions of audiences at Princeton, USAID, 

UNFPA, and the annual meeting of the Population Association of America. 

Executive Summary xi

Executive Summary 

This report is an analysis of recent trends in abortion and contraception in 12 countries of central Asia and eastern Europe—Armenia, Azerbaijan, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, Romania, Russia, Turkey, Turkmenistan, 

Ukraine, and Uzbekistan—where abortion had long been a major if not the principal 

method of birth control.1

 All of these countries have experienced sharp declines in the 

number of children desired and in fertility rates. Despite increasing preferences for 

small families, abortion rates in eight of these countries have recently declined, while 

the use of modern contraceptive methods has steadily increased. Two of the remaining four countries experienced little change in the prevalence of modern contraceptive 

methods and witnessed an increase in abortion, while in the two other countries, the 

number of children desired is very low and unintentional pregnancies have increased. 

Most abortions are associated with pregnancies that occurred as a result of contraceptive failure—particularly the use of traditional methods such as withdrawal—and 

pregnancies of women who were not using contraception despite not wanting any 

(more) children (the “unmet need for family planning” category). In two-thirds of the 

countries, contraceptive failure accounts for most abortions, while in the other third, 

unmet need for family planning contributes most of the abortions. A cross-sectional 

analysis of 18 countries shows a very high negative correlation between abortion and 

the use of modern contraceptive methods but a moderately high positive correlation 

between abortion and the use of traditional contraceptive methods. 

In a series of simulation models, the implications for further reductions in the 

prevalence of abortion are estimated. For example, if the women currently using 

modern methods of contraception were joined by those currently using traditional 

methods, abortion rates on average could be reduced by 23 percent; if women classified as having unmet need for family planning were also added to this group, abortion 

rates could be reduced by as much as 55 percent. 

The report also examines some of the main covariates of the use of modern contraception and abortion, as well as attitudes toward abortion. Multivariate analyses using 

a standard set of variables for all countries highlights the importance of age, urban 

residence, and education. 

The main conclusions are that there is strong evidence that modern contraceptive 

methods are replacing abortion as the primary means of family planning. At the same 

time, there will be continuing if not increasing pressure to avoid unintended pregnancies, which often end in abortion. 

 

1

 Not all 12 countries are included in every analysis because of varying availability of data. 

Background 1

 1

Background 

n the former Soviet Union, which included most of the countries in this study, 

induced abortion was the principal method of birth control. The reasons for this 

include the cost of importing modern contraceptive methods from the West, the poor 

quality of domestically produced contraceptives, the attitudes of the medical profession toward the oral contraceptives, and the availability of abortion through the government health services. Combining these factors with the decline in the average 

number of children desired, and the high failure rates of traditional methods of contraception resulted in high abortion rates. In most of the countries, abortion rates 

declined following independence in 1991, although levels have remained high in a 

few countries. This analysis describes recent trends in conjunction with the increase 

in reliance on modern contraceptive methods. The sources of data are primarily national sample surveys of women of reproductive age conducted by the Demographic 

and Health Surveys (DHS) program (ORC Macro) and the Reproductive Health 

Surveys conducted in collaboration with the Centers for Disease Control and Prevention (CDC). 

 

I 

Levels and Trends of Contraceptive Prevalence and Abortion Rates 3

 2

Levels and Trends of Contraceptive Prevalence 

and Abortion Rates 

he most recent estimates of abortion rates are shown in Figure 2.1. There is a 

wide range of abortion rates in these countries, from rates of less than one abortion per woman in Turkey, Turkmenistan, and Uzbekistan to total abortion rates of 

over three per woman in Azerbaijan, Georgia, and Romania. The estimate for the 

United States (Finer and Henshaw, 2003) is included in some of the figures showing 

abortion rates, simply to provide some perspective; it is very low by comparison. 

Figure 2.1 

Total abortion rate per woman 

0.9

0.7

1.6

0.9

0.7

1.5

3.2

1.3

1.5

1.4

3.7

3.2

2.6

01234

Uzbekistan 2002

United States 2000

Ukraine 2001

Turkmenistan 2000

Turkey 1998

Russia 2001

Romania 1999

Moldova 1997

Kyrgyz Rep. 1997

Kazakhstan 1999

Georgia 1999

Azerbaijan 2001

Armenia 2000

Note: Rates are based on the three years preceding the survey for women age 15-44. In Russia and the United 

States rates are for that year only. 

There is an important difference between the practice of abortion in these countries and in the United States and other Western countries. In the United States, 

most abortions are associated with first pregnancies among unmarried women; in 

eastern Europe and central Asia, abortion is primarily used by married women to 

control fertility after one or two births. 

The measurement of abortion is a particularly difficult task because of its sensitivity and, in many countries, its legal status. Many different approaches to measurement have been developed, each with its strengths and weaknesses (Rossier, 2003; 

Singh, et al., 2003). This comparative analysis relies mostly on self-reported abortions derived from pregnancy histories collected in personal interviews. Since most of 

T 

In the United States, most 

abortions are associated 

with first pregnancies 

among unmarried women; 

in eastern Europe and 

central Asia, abortion is 

primarily used by married 

women to control fertility 

after one or two births. 
4 Levels and Trends of Contraceptive Prevalence and Abortion Rates

these countries have had decades of experience with legal and widely available abortion and, until recently, a lack of acceptable contraceptive alternatives, there is little 

stigma associated with the subject and the reporting appears reasonable. In some 

countries, the level of abortion estimated from the interview data is considerably 

higher than that reported by the Ministry of Health from registered data. The situation is further complicated by the increasing involvement of the private sector and 

mini-abortions that do not get included in official data, a problem that can lead to a 

mistaken view in some countries that abortion rates have declined rapidly. 

The percentage of all women age 15 to 44 in these countries currently using contraception is shown in Figure 2.2 both for all methods combined and for modern 

methods. The lowest proportions using modern methods are in Azerbaijan, Armenia, 

and Georgia, which also show the highest abortion rates. The intrauterine device 

(IUD) is the most frequently used modern method in the study countries, while 

withdrawal is the most frequently used traditional method. 

Figure 2.2 

Percentage of all women age 15-44 currently using contraception 

42

59

31

35

40

45

23

37

36

39

12

7

15

6

3

23

5

27

14

25

17

7

10

13

25

25 40

32

25

49

43

54

48

59

67

40

54

62

48

0 10 20 30 40 50 60 70 80

Uzbekistan 2002

United States 2002

Ukraine 2001

Turkmenistan 2000

Turkey 1998

Russia 1996

Romania 1999

Moldova 1997

Kyrgyz Rep. 1997

Kazakhstan 1999

Georgia 1999

Azerbaijan 2001

Armenia 2000

Modern Methods Traditional Methods

Note: The data for Russia are based on three Russian cities. The data for Turkey are based on currently married 

women. 

The association between the prevalence of modern contraception and abortion is 

displayed in Figure 2.3 for 17 countries in central Asia and eastern Europe, plus the 

United States. There is a very strong negative correlation (-.92) in the expected direction. However, when the prevalence of traditional methods is plotted with abortion 

rates across the 18 countries, the correlation becomes positive (+.55); the greater the 

use of such methods (with their higher failure rates), the higher the abortion rates 

(Figure 2.4). 

The intrauterine device 

(IUD) is the most 

frequently used modern 

method in the study 

countries, while 

withdrawal is the most 

frequently used 

traditional method. 
Levels and Trends of Contraceptive Prevalence and Abortion Rates 5

Figure 2.3 

Total abortion rate and the prevalence of modern contraceptive methods in 18 

countries 

HUN

CSK EST

USA

RUS

TKM

KAZ

UZB

MDA LVA

KGZ

BGR

BLR

UKR

ROM

ARM

AZE

GEO

0

0.5

1

1.5

2

2.5

3

3.5

4

0 10 20 30 40 50 60 70 80

Percent of married women using modern contraception

Abortions per woman

ARM = Armenia AZE = Azerbaijan BLR = Belarus BGR = Bulgaria CSK = Czechoslovakia 

EST = Estonia GEO = Georgia HUN = Hungary KAZ = Kazakhstan KGZ = Kyrgyz Rep. 

LVA = Latvia MDA = Moldova ROM = Romania RUS = Russia TKM = Turkmenistan 

UKR = Ukraine USA = United States UZB = Uzbekistan 

Figure 2.4 

Total abortion rate and the prevalence of traditional contraceptive methods in 

18 countries 

HUN

EST

CSK

USA

RUS

TKM

KAZ

UZB

MDA LVA

KGZ BGR

BE

UKR

ROM

ARM

AZE

GEO

0

0.5

1

1.5

2

2.5

3

3.5

4

0 10 20 30 40 50 60 70 80

Percent of married women using traditional contraception

Abortions per woman

ARM = Armenia AZE = Azerbaijan BLR = Belarus BGR = Bulgaria CSK = Czechoslovakia 

EST = Estonia GEO = Georgia HUN = Hungary KAZ = Kazakhstan KGZ = Kyrgyz Rep. 

LVA = Latvia MDA = Moldova ROM = Romania RUS = Russia TKM = Turkmenistan 

UKR = Ukraine USA = United States UZB = Uzbekistan 
6 Levels and Trends of Contraceptive Prevalence and Abortion Rates

The recent trends in modern contraceptive prevalence (Figure 2.5) show a rise in 

all countries except Russia (Avdeev and Troitskaia, 1999; Avdeev, 2003), where the 

upward movement appears to level off after 1996. Some of these increases are quite 

dramatic, with prevalence rising 1 to 2 percentage points per year. There is some 

speculation that the plateau in Russia resulted from government concerns about low 

fertility, which translated into the Health Ministry abandoning its sex education 

plans and widespread layoffs in the Moscow offices of contraceptive manufacturers. 

Evidently, this reaction has subsided, and contraceptive sales have begun to increase 

again after 2000 (Ismailov, 2003; Bellaby, 2003). Aside from this, the plateau no 

doubt underestimates the increase in prevalence because the measure only includes 

the IUD and hormonal methods. In particular, surgical sterilization, which had been 

increasing, is excluded after 1997. 

Figure 2.5 

Recent trends in the use of modern contraceptive methods 

Armenia Georgia

Kazakhstan

Kyrgyz Rep.

Moldova

Romania

Russia

Turkmenistan

Ukraine

Uzbekistan

Azerbaijan

0

5

10

15

20

25

30

35

40

45

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Percentage of women age 15-44 using a

 modern method

Note: The data for Russia are based on official statistics and are limited to IUD and pill use for women age 

15-49. 

It is possible to reconstruct the earlier trends in abortion for most of these countries over the past 20 years and to observe the patterns at different ages (Table 2.1). 

In Armenia, there has been a decline in abortion rates over the past 10 years for 

women age 20 to 29 and for a longer time among older women. In contrast, in Azerbaijan, abortion rates have increased at every age. The trend in Georgia is clearly upward for women under age 25 but downward for older women, at least in the preceding 10 years. 

The recent trends in 

modern contraceptive 

prevalence show a rise in 

all countries except 

Russia, where the upward 

movement appears to 

level off after 1996. 
Levels and Trends of Contraceptive Prevalence and Abortion Rates 7

Table 2.1 Trends in abortion rates in 9 countries by age at time of abortion and number of years preceding survey that abortion took 

place 

Age at 

Abortion Number of years before the survey 

Armenia 2000 Azerbaijan 2001 Georgia 1999 

 0–4 5–9 10–4 15–19 0–4 5–9 10–14 15–19 0–4 5–9 10–14 15–19 

15–19 6 12 6 7 5 3 1 1 30 22 12 9 

20–24 104 147 133 103 80 63 46 29 151 142 125 106 

25–29 180 194 192 180 163 136 122 87 189 233 232 218 

30–34 128 139 166 187 159 146 140 185 228 241 

35–39 84 83 132 125 113 125 177 

40–44 31 46 63 54 

Kazakhstan 1999 Kyrgyz Republic 1999 Moldova 1997 

 0–4 5–9 10–14 15–19 0–4 5–9 10–14 15–19 0–4 5–9 10–14 15–19 

15–19 12 19 15 9 6 9 4 3 14 12 12 8 

20–24 68 84 100 101 62 42 50 52 73 97 89 85 

25–29 81 88 131 142 68 77 75 96 77 91 100 102 

30–34 60 79 84 110 77 77 77 96 44 63 82 

35–39 40 47 59 55 54 79 30 48 

40–44 19 20 22 28 17 

Romania 1999 Turkmenistan 2000 Uzbekistan 1996 

 0–4 5–9 10–14 15–19 0–4 5–9 10–14 15–19 0–4 5–9 10–14 15–19 

15–19 28 25 11 10 1 4 5 1 2 3 2 2 

20–24 108 134 66 70 21 21 20 25 21 22 16 24 

25–29 126 157 98 117 40 38 41 48 34 48 44 40 

30–34 106 125 81 44 40 45 56 42 44 46 73 

35–39 61 66 32 23 40 25 43 35 

40–44 24 18 9 20 30 

In Kazakhstan, the Kyrgyz Republic, and Moldova, abortion rates are mostly declining with exceptions at a few ages for younger women. In Romania, abortions were 

seriously underreported more than 10 years ago, when they had been illegal, but over 

the 10 years preceding the 1999 survey, there is a clear decline at every age above 19. 

There is little change in the past 15 years in Turkmenistan, but there are some indications of slight declines in Uzbekistan. 

Trends in abortion rates over the past five or six years generally indicate a downward trajectory (Figure 2.6). There are several exceptions to this picture of declining 

abortion rates, which will be discussed below. 

Trends in abortion rates 

over the past five or six 

years generally indicate a 

downward trajectory. 
8 Levels and Trends of Contraceptive Prevalence and Abortion Rates

Figure 2.6 

Recent trends in abortion rates 

Armenia

Georgia

Kazakhstan

Kyrgyz Rep. Moldova

Romania

Russia

Turkmenistan

Ukraine

Uzbekistan

United States

Azerbaijan

0

20

40

60

80

100

120

140

160

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Abortions per 1,000 women age 15-44
Trends in Fertility Rates and Number of Children Desired 9

 3

Trends in Fertility Rates and Number of 

Children Desired 

o understand the prevalence of contraception and abortion, one must consider 

the number of children that couples want (Bongaarts and Westoff, 2000) The 

smaller the “fertility target” (desired number of children), the more likely it is that 

couples will practice some form of birth control. The alternative would be high levels 

of unwanted births and unmet need for family planning. If couples are aiming for 

only one or two children over a period of, say, 20 years, the long exposure to the risk 

of an unwanted pregnancy presents a considerable challenge to fertility regulation. 

The trends in actual fertility (Figure 3.1) dramatically indicate the rapid emergence of the small-family norm in these 12 countries. In 7 of the 12, the total fertility 

rate has declined from a range of 3 to 5 births per woman in 1950-55 to between 1 

and 2 births in 1995-2000; in the other 5 countries, the decline has been from between 4 and 7 births to between 2 and 3. These sharp declines are clear evidence that 

couples in these countries now prefer very few children. There is, of course, the possibility that the number of children preferred is greater than the observed fertility 

rates as a result of the postponement of births. Although it may be that couples prefer 

more children than they are having, it is also true that actual fertility rates may exceed 

the levels that would exist if only wanted births occurred. 

Figure 3.1 

Total fertility rates 1950-2000 

Azerbaijan

Armenia

Kazakhstan

Kyrgyz Rep.

Georgia Moldova

Romania

Turkey

Turkmenistan

Russia

United States

Ukraine

Uzbekistan

0

1

2

3

4

5

6

7

8

1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00

T 

The smaller the “fertility 

target” (desired number 

of children), the more 

likely it is that couples 

will practice some form of 

birth control. 
10 Trends in Fertility Rates and Number of Children Desired

Direct measures of these preferences are only available from estimates derived 

mostly from recent single surveys. An indirect approach to assessing time trends in 

reproductive preferences is shown in Figure 3.2, where the mean ideal number of 

children is tabulated by the current age of women. The assumption is that the ideal 

number reported by women in their 40s, compared with that reported by younger 

women, reveals a time trend in the norm. There are problems with such a measure, 

including the likely rationalization of unwanted births as wanted, but it is the only 

measure available. The progressive declines in the ideal number at each younger age 

category is clearly evident; it is especially pronounced for Turkmenistan, the Kyrgyz 

Republic, and Uzbekistan. In Turkmenistan, the ideal number reported by women 

age 45 to 49 is 4.6 children, in contrast to 2.6 by women age 15 to 19. All of the 

other countries show ideal numbers under 3 children, an average that reaches as low 

as 1.7 in Ukraine. 

Figure 3.2 

Mean ideal number of children, by current age of women 

Uzbekistan

Ukraine

Turkmenistan

Turkey

Romania

Moldova

Kyrgyz Rep.

Kazakhstan

Georgia

Azerbaijan

Armenia

1.5

2

2.5

3

3.5

4

4.5

5

45-49 40-44 35-39 30-34 25-29 20-24 15-19

Note: The data for Turkey are based on currently married women. 

Thus, the evidence both from recorded declines in total fertility rates and imputed 

declines in reproductive norms indicates that fertility goals have become smaller in 

recent years. The implication is that the challenge to fertility control has become 

commensurately greater. As noted above, women in these countries who mostly want 

no more than two children are confronted with some 20 years of exposure to the risk 

of unwanted pregnancy. 

In a similar analysis of the relation between abortion and contraceptive prevalence 

(involving some different countries), Marston and Cleland (2003) show for earlier 

periods that both abortion and contraception increased simultaneously if contraception was not able to satisfy the growing need for fertility control but that the inverse 

relationship described in this report eventually sets in. 

The evidence both from 

recorded declines in 

total fertility rates and 

imputed declines in 

reproductive norms 

indicates that fertility 

goals have become 

smaller in recent years. 
Recent Country Trends in Contraceptive Prevalence and Abortion 11

 4

Recent Country Trends in Contraceptive 

Prevalence and Abortion 

he joint recent trends in abortion and modern contraceptive prevalence are depicted for each country in Figures 4.1. In Armenia, the use of modern contraceptive methods, which is very low, increased only from 10 to 12 percent over a fiveyear period. At the same time, the abortion rate declined moderately. In an earlier 

detailed examination of this relationship (Westoff et al., 2002), recent postponement 

of marriage was found to contribute to the decline in abortion. In Kazakhstan (Agadjanian, 2002; Westoff, 2000), the Kyrgyz Republic, Moldova, and Uzbekistan 

(Westoff et al., 1998), a stronger pattern emerges, with modern contraceptive prevalence rising and abortion declining both by about 50 percent. A similar pattern appears in Russia, where the use of the IUD and the pill increased by 74 percent between 1991 and 2001, while the abortion rate fell by 61 percent (Philipov et al., 

2004). A recent reduction in abortion availability has been reported in Russia and is 

related to the government’s exclusion of social factors as a basis for late abortion 

(Myers, 2003). The motivation is attributed to concerns about loss of population, the 

pressures of conservative lawmakers, and the growing influence of religious groups. 

Figure 4.1 

Recent trends (relative) in use of modern contraceptive methods and prevalence 

of abortion among all women 

Armenia 2000

100 107 114 115 115 118

89

98 100 103 100 101

0

20

40

60

80

100

120

140

160

1995 1996 1997 1998 1999 2000

Use of modern methods Abortion rate

T 

In Kazakhstan, the Kyrgyz 

Republic, Moldova, and 

Uzbekistan, a strong 

pattern emerges, with 

modern contraceptive 

prevalence rising and 

abortion declining both 

by about 50 percent. 
12 Recent Country Trends in Contraceptive Prevalence and Abortion

Figure 4.1 (Continued) 

Recent trends (relative) in use of modern contraceptive methods and prevalence 

of abortion among all women 

Azerbaijan 1996-2001

111 110 105

100 102

130

119

110 112

100

0

20

40

60

80

100

120

140

160

1996 1997 1998 1999 2000-01

Georgia 1994-1999

107 107 111 113 113

100

100

118 118 115

108 100

0

20

40

60

80

100

120

140

160

1994 1995 1996 1997 1998 1999

Use of modern methods Abortion rate
Recent Country Trends in Contraceptive Prevalence and Abortion 13

Figure 4.1 (Continued) 

Recent trends (relative) in use of modern contraceptive methods and prevalence 

of abortion among all women 

Kazakhstan 1991-1998

100 105 110

121

139

130

155 151

46 44

55

64 72

81

99 100

0

20

40

60

80

100

120

140

160

180

1991 1992 1993 1994 1995 1996 1997 1998

Kyrgyz Rep. 1991-1996

150

119

97 100 100 102

42 48

60 58

71

100

0

20

40

60

80

100

120

140

160

1991 1992 1993 1994 1995 1996

Use of modern methods Abortion rate
14 Recent Country Trends in Contraceptive Prevalence and Abortion

Figure 4.1 (Continued) 

Recent trends (relative) in use of modern contraceptive methods and prevalence 

of abortion among all women 

Moldova 1992-1997

135 141

128 121

111

100

52

65

77 80

88

100

0

20

40

60

80

100

120

140

160

1992 1993 1994 1995 1996 1997

Romania 1990-1999

266

243

221

198

175

149

120 125

107 100

65

79 88 93 95 90 95

117 100 108

0

50

100

150

200

250

300

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Use of modern methods Abortion rate
Recent Country Trends in Contraceptive Prevalence and Abortion 15

Figure 4.1 (Continued) 

Recent trends (relative) in use of modern contraceptive methods and prevalence 

of abortion among all women 

Russia 1988-1998

178 181 181

170 174

164 166

150

140

121

100

47 53 50 55 60 64

71 77

88 96 100

0

20

40

60

80

100

120

140

160

180

200

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

Turkey 1988-1998

113 122

100

56

69

100

0

20

40

60

80

100

120

140

160

1988 1993 1998

Use of modern methods Abortion rate
16 Recent Country Trends in Contraceptive Prevalence and Abortion

Figure 4.1 (Continued) 

Recent trends (relative) in use of modern contraceptive methods and prevalence 

of abortion among all women 

Turkmenistan 1995-2000

114 114 115

110

100

146 143 135

120

100

0

20

40

60

80

100

120

140

160

1995 1996 1997 1998 1999

Ukraine 1994-1999

106 109 112 114 104 100

109 112 104 102

91 100

0

20

40

60

80

100

120

140

160

1994 1995 1996 1997 1998 1999

Use of modern methods Abortion rate
Recent Country Trends in Contraceptive Prevalence and Abortion 17

Figure 4.1 (Continued) 

Recent trends (relative) in use of modern contraceptive methods and prevalence 

of abortion among all women 

Uzbekistan 1992-2002

145

130 125

100

72 77 82

100

0

20

40

60

80

100

120

140

160

1992 1995 1998 2002

Use of modern methods Abortion rate

In Turkey, there has been a greater recent decline in the abortion rate than the increase in the use of modern contraceptive methods might imply (Senlet et al., 2001). 

Romania shows the most dramatic increase in the use of modern methods, with 

prevalence rising 2.5 times in ten years while the abortion rate dropped by a third. 

There are three or four countries that do not show this pattern. In Georgia, the 

abortion rate in 1999 was the same as it was in 1994 (although in the interim it had 

increased and then decreased), while use of modern methods increased modestly to 

the current level of 12 percent (Figure 4.1). In effect, not much happened regarding 

levels of abortion or contraception over the five-year period. However, the proportion 

of pregnancies that were unintended increased from 58 percent in 1994 to 65 percent 

in 1999, a trend associated with the increase in contraceptive failure rates that included both modern and traditional methods (Figure 4.2). Part of the explanation for 

the increase in failure rates for modern methods was the increasing use of condoms 

and the decreasing use of the IUD. Also, it is possible that the addition of new users 

may have contributed to higher first-year failure rates. In summary, the increase in 

contraceptive failure offsets the increase in the prevalence of modern methods. 

The increase in 

contraceptive failure 

offsets the increase in 

the prevalence of 

modern methods. 
18 Recent Country Trends in Contraceptive Prevalence and Abortion

Figure 4.2 

Trends in annual contraceptive failure rates in five countries, 1992-1999 

Georgia 1994-1999

0.084

0.2

0.169

0.156 0.142

0.129

0.133

0.116

0.092

0.072 0.066

0.048

0.268

0.222 0.222 0.213

0.195

0.121

0

0.05

0.1

0.15

0.2

0.25

0.3

1994 1995 1996 1997 1998 1999

Moldova 1992-1997

0.12

0.094 0.092 0.101

0.082

0.043

0.045 0.035 0.044 0.052 0.04

0.024

0.284

0.212

0.188 0.197

0.157

0.076

0

0.05

0.1

0.15

0.2

0.25

0.3

1992 1993 1994 1995 1996 1997

All methods Modern methods Traditional methods
Recent Country Trends in Contraceptive Prevalence and Abortion 19

Figure 4.2 (Continued) 

Trends in annual contraceptive failure rates in five countries, 1992-1999 

Russia (3 cities) 1994-1998

0.146

0.11 0.113 0.116

0.071 0.1

0.078 0.073 0.082

0.047

0.273

0.142

0.199

0.223 0.211

0

0.05

0.1

0.15

0.2

0.25

0.3

1994 1995 1995 1997 1998

Romania 1994-1999

0.17

0.132

0.158 0.153 0.139

0.082

0.057 0.061 0.061

0.079

0.063

0.026

0.281

0.197

0.229

0.216

0.114

0.188

0

0.05

0.1

0.15

0.2

0.25

0.3

1994 1995 1996 1997 1998 1999

All methods Modern methods Traditional methods
20 Recent Country Trends in Contraceptive Prevalence and Abortion

Figure 4.2 (Continued) 

Trends in annual contraceptive failure rates in five countries, 1992-1999 

Ukraine 1994-1999

0.054

0.082

0.103 0.104 0.106

0.128

0.026

0.048

0.064 0.062 0.058

0.071

0.087

0.124

0.151 0.155 0.168

0.202

0

0.05

0.1

0.15

0.2

0.25

0.3

1994 1995 1996 1997 1998 1999

All methods Modern methods Traditional methods

Ukraine and Turkmenistan are exceptions to the widening gulf between abortion 

and modern contraceptive practice. In Ukraine, both types of fertility regulation increased slightly between 1994 and 1999. The prevalence of modern contraception in 

Ukraine is higher than in Georgia (31 percent compared with 12 percent), and the 

abortion rate is much lower (1.6 compared with 3.7). These two countries also differ 

substantially in the number of children women consider ideal. The range in Ukraine 

is between 1 and 2 children, while in Georgia the average is between 2.5 and 3.0. 

Ukraine has the lowest ideal family size of all of the countries and therefore the 

smallest fertility target. Like Georgian women, Ukrainian women show increasing 

contraceptive failure rates and increasing rates of unintended pregnancies (Figure 

4.2). 

In Turkmenistan, 34 percent of women are using modern contraceptive methods, 

up slightly from 31 percent five years earlier. The abortion rate is comparatively low 

(0.85 per woman), but it shows an increase in the recent past. The main hypothesis 

to explain the rise in abortion is that Turkmenistan has experienced the sharpest “decline” in the ideal number of children of all of the countries (Figure 3.2), from 4.6 for 

women age 45 to 49 to 2.6 for women age 15 to 19. Again, the fertility target has 

rapidly become smaller. 

Azerbaijan has experienced a substantial increase in abortion in recent years, from 

a total abortion rate of 2.3 in 1994-96 to 3.2 in 1998-2001. This appears to be an 

example of the absence of any effect from the use of modern contraceptive methods. 

Use of modern contraceptive methods in Azerbaijan increased only from 5 to 7 percent and is lower by far than in the other eleven countries. 

In summary, 8 of the 12 countries show declines in abortion accompanied by increases in the prevalence of modern methods; one shows an increase in abortion with 

little change in prevalence (Azerbaijan); two show increases in abortion along with an 

Use of modern 

contraceptive methods 

in Azerbaijan (5 to 7 

percent) is lower by far 

than in the other 

eleven countries. 
Recent Country Trends in Contraceptive Prevalence and Abortion 21

increase in prevalence but with a substantial reduction in the ideal number of children 

(Turkmenistan) or a very low ideal number of children with increasing contraceptive 

failure rates (Ukraine); and one features no net change in abortion rates but with increasing contraceptive prevalence offset by increasing rates of contraceptive failure 

(Georgia). 

A Model of Abortion 23

 5

A Model of Abortion 

bortion is associated primarily with pregnancies resulting from contraceptive 

failure and pregnancies among women who did not use contraception even 

though they did not intend to become pregnant. The latter group constitutes the 

category, unmet need for family planning. In addition to the two main sources of 

abortion, other sources include women who thought they were not exposed to the 

risk of pregnancy (for reasons of low fecundability or limited sexual activity) and 

women who deliberately became pregnant but who experienced a change in circumstances. 

To quantify the relative proportions of these components of the abortion rate, this 

report uses estimates of contraceptive failure rates, the prevalence of unmet need, low 

risk of pregnancy, and intentional pregnancy, along with the associated pregnancy 

and abortion rates for the 12 countries. In each country, the detailed components are 

estimated from monthly calendar data collected in the interviews. Figure 5.1 illustrates the approach with data from the 2000 survey in Armenia. The decomposition 

is evaluated by how closely the resulting abortion rate approximates the overall rate 

based on pregnancy histories. 

A 

The decomposition is 

evaluated by how 

closely the resulting 

abortion rate 

approximates the 

overall rate based on 

pregnancy histories. 
24 A Model of Abortion

Figure 5.1 

A model of abortion (using Armenia 2000 data) 

The total sample of women age 15 to 44 in Armenia is first divided into women 

using contraception (402 per 1,000 women) and those not currently using any 

method (598). The users are then divided into those using a modern method (150 

per 1,000 women) and those using a traditional method (252). The observed annual 

failure rates associated with these categories are .070 and .198, respectively, yielding 

10 and 50 unintentional pregnancies. Armenian women aborted 69 percent of pregnancies that were the result of failure with a modern method (7 abortions) and 83 

percent of pregnancies associated with traditional method failures (41 abortions). 

Together, these resulted in 48 abortions associated with contraceptive failure. Reliance on traditional methods contributes disproportionately to the abortion rate in 

Armenia. 

Armenian women not using any contraception (598 per 1,000 women) are divided 

into those with an unmet need for family planning (88), those at low risk of pregnancy because of low fecundity or little exposure to the risk of pregnancy (142), 

women seeking pregnancy or intentionally pregnant (53), and women who have never 

had sex (315). The latter group, consisting mainly of young unmarried women, obviously contributes no pregnancies or abortions. The main source of abortions among 

women not using any contraception is the relatively small group (88), classified in the 

unmet need category.2

 Their recent pregnancy rate was estimated at .638, with 43 

percent aborting, yielding 61 pregnancies and 24 abortions. 

 

2

 Unmet need was defined differently in the DHS and CDC programs. The estimates for the 

CDC surveys included here are modeled after the DHS algorithm with women who were 

unintentionally pregnant included in the unmet need category. Women who were pregnant 

intentionally are grouped with women seeking pregnancy. 

Reliance on traditional 

methods contributes 

disproportionately to the 

abortion rate in Armenia. 

All Women 15 – 44 1,000 

Using Contraception 

402 

Not Using Contraception 

598 

10 

Abortions per 1,000 Women 15 – 44 81 

7 

50 61 8 35 0 

41 24 6 3 0 

Traditional 

Method 

252 

In Need 

88 

Low Risk 

142 

Seeking 

Pregnancy 

53 

Never Had 

Sex 

315 

Modern 

Method 

150 

Pregnancies: 

Abortions: 
A Model of Abortion 25

The “low-risk” category (with 142 per 1,000 women) had an annual pregnancy 

rate estimated at .020, and contributed 6 abortions. The “seeking pregnancy” category (53 per 1,000 women) had a pregnancy rate of .662 and contributed 3 abortions. 

The sum of these abortions from each category is 81 per 1,000 women, which is the 

same as the rate calculated directly from the pregnancy history. Estimates for the parameters of abortion risk for each country are shown in Table 5.1. 

Table 5.1 Model parameters for abortion risk among women age 15–44 

 Armenia 

Azerbaijan Georgia Kazakhstan Kyrgyz 

Rep. Moldova Romania Russia1 Turkey2 

Turkmenistan Ukraine Uzbekistan 

Parameter 2000 2001 1999 1999 1997 1997 1999 1999 1998 2000 2001 1996 

Abortion 

Total abortion rate3 2.60 3.20 3.70 1.43 1.50 1.30 2.20 2.51 0.70 0.85 1.57 0.63 

General abortion rate3 81 116 130 48 51 43 74 85 24 26 55 21 

Users of contraception 

Percent using any method 40.1 32.4 24.8 49.0 43.1 54.4 48.2 60.1 66.6 39.8 53.5 39.7 

Annual failure rate .150 .283 .186 .063 .073 .088 .147 .118 .055 .030 .098 .023 

Percent of failures 

aborted 80.7 74.2 90.3 83.3 71.3 56.9 69.3 63.7 36.1 43.9 61.7 66.7 

Percent using modern 

method 15.0 7.0 12.2 39.4 35.6 37.4 23.4 44.4 40.2 34.5 31.2 36.8 

Annual failure rate .070 .122 .122 .036 .044 .038 .060 .077 .028 .021 .057 .020 

Percent of failures 

aborted 68.6 75.9 89.4 86.3 69.5 61.6 72.3 68.4 38.1 50.0 62.7 66.7 

Percent using traditional 

method 25.2 25.4 12.6 9.6 7.5 17.0 24.7 15.7 26.5 5.3 22.3 2.9 

Annual failure rate .198 .327 .248 .173 .210 .200 .222 .234 .095 .091 .148 .061 

Percent of failures 

aborted 83.3 81.6 90.7 70.9 73.2 55.0 67.9 72.6 35.2 34.7 61.2 66.7 

Nonusers of contraception 

Percent not using any 

method 59.8 67.6 75.2 51.0 56.9 45.6 51.8 39.9 33.4 60.2 46.5 60.3 

Percent never had sex 31.5 36.2 33.1 21.8 22.5 18.8 18.3 8.5 na 33.2 13.7 26.0 

Annual pregnancy rate4 .369 .476 .421 .339 .478 .359 .330 .348 .381 .415 .312 .487 

Percent aborted 32.7 30.7 49.1 24.6 17.3 16.4 22.9 33.2 8.0 18.4 26.7 9.2 

Unmet need 

Percent unmet need 10.3 7.9 15.9 7.6 7.6 6.4 7.3 9.9 12.3 6.9 11.1 10.1 

Annual pregnancy rate .638 .628 .649 .604 .675 .766 .596 .478 .651 .890 .305 .622 

Percent of pregnancies 

aborted 43.2 60.0 67.6 33.2 45.0 24.2 40.1 63.6 10.0 25.0 52.8 20.0 

Low risk 

Percent low risk 12.5 14.1 16.8 13.5 12.0 13.7 19.1 15.9 7.9 11.4 17.1 8.4 

Annual pregnancy rate .020 .086 .082 .063 .140 .078 .042 .046 .039 .044 .061 .113 

Percent of pregnancies 

aborted 76.7 57.7 76.7 28.8 23.6 27.0 34.0 28.6 28.2 24.5 27.3 20.7 

Seeking pregnancy5 

Percent seeking 

pregnancy 5.5 9.4 9.5 8.2 14.8 6.8 7.1 5.6 13.2 8.8 4.6 15.8 

Annual pregnancy rate .662 .747 .640 .697 .675 .542 .571 .624 .487 .891 .387 .622 

Percent of pregnancies 

aborted 10.4 7.6 11.5 9.8 2.1 3.0 10.8 10.9 3.1 5.2 9.7 1.4 

1

 Based on three Russian cities 3 Based on the three years preceding the survey 5 Includes women intentionally pregnant 2

 Based on currently married women 4 For women who ever had sex 

Components of Abortion 27

 6

Components of Abortion 

s indicated in the Armenia abortion model (Figure 5.1), most abortions are the 

result of contraceptive failure, particularly regarding use of traditional methods. 

Among nonusers of contraception, unmet need is the main precursor to abortion, contributing 30 percent of all abortions in the Armenia example. The remaining 

11 percent originated among other nonusers. The distribution of these categories for 

12 countries is shown in Figure 6.1. 

Figure 6.1 

Components of abortion as a percentage of all abortions 

The study countries form two groups: eight countries where the main source of 

abortion is contraceptive failure and four where the main source is unmet need. This 

difference is important programmatically. In the first group, the obvious need is to 

attract couples to methods with low failure rates; in the second category, the challenge is to provide family planning services. In both cases, there seems to be a potential demand to make available a greater diversity of modern methods to accommodate 

different preferences. 

A 

The study countries form 

two groups: eight countries 

where the main source of 

abortion is contraceptive 

failure and four where the 

main source is unmet need. 

 Unmet Need Modern Method Failure Traditional Method Failure Other Nonuse 

Three Russian cities

Kyrgyz Rep.

22

12

45

21 

Armenia

9 

30 

11 

51 

Azerbaijan

58 

11 

26 

6 

Kazakhstan

24 

17

33

26

Georgia

22

14

54 10

Moldova 

27 

9 

43 

20 

Romania 

51 

10 

24 

14 

Turkmenistan

7

21 60

13

Turkey 

37 33 

18 12 

Ukraine 

37 

8 

33 

21 

31 

7

35

27

Uzbekistan

15

57

22

5

Potential Reductions in Abortion Rates 29

 7

Potential Reductions in Abortion Rates 

he model illustrated in Figure 5.1 permits the simulation of abortion rates under 

different assumptions about potential changes in the components.3

 Several simulations are presented. 

7.1 Unmet Need Shifts to Use of Modern Methods 

In this scenario, the assumption is that unmet need is reduced to zero as all women in 

this category adopt modern contraception. In effect, this is an increase in overall contraceptive prevalence with the further assumption that all of the increase is to modern 

methods. The implications of such a change for the reduction of abortion rates are 

illustrated in Figure 7.1 for each country. For most of the countries, the implied reduction in abortion levels is around 25 percent, with an overall average decline of 32 

Figure 7.1 

Percent reduction in abortion rates if all unmet need shifted to modern 

methods 

50

26

57

28

29

21

24

40

28

41

19

26

0 10 20 30 40 50 60 70

Uzbekistan

Ukraine

Turkmenistan

Turkey

Russia

Romania

Moldova

Kyrgyz Rep.

Kazakhstan

Georgia

Azerbaijan

Armenia

 

3

 The assumption is made in all of these hypothetical changes that the failure rates and 

propensities to abort for the women who move into the status would be the same as the 

prevailing rates in that category. For example, women who shift from the use of a traditional 

method to a modern method are assumed to practice their new method with the same efficacy 

as women already in that category. 

T 

In this scenario, the 

assumption is that unmet 

need is reduced to zero as 

all women in this 

category adopt modern 

contraception. 
30 Potential Reductions in Abortion Rates

percent. In Turkmenistan and Uzbekistan, the effect would be greater (a reduction of 

around half) because in both of these countries the major source of the relatively low 

abortion rates is unmet need, with its high pregnancy rate. 

7.2 Use of Traditional Methods Shifts to Use of Modern Methods 

Since traditional contraceptive methods have considerably higher failure rates than 

modern methods, there is the potential for a substantial reduction in unwanted pregnancies and abortions in a shift to modern methods. The numerical implications are 

shown in Figure 7.2. In this scenario, all of the other categories remain at the same 

level, including unmet need. The effect is equal to associating all current contraceptive use with the failure rate of the current users of modern methods in that country 

(reflecting both the mix of modern methods and their average failure rate) along with 

their propensity to have an abortion. The greatest effects are estimated for Azerbaijan, Romania, and Armenia; the average reduction for all 12 countries is 23 percent. 

Figure 7.2 

Percent reduction in abortion rates if use of traditional methods shifted to 

modern methods 

5

22

5

29

21

38

33

18

20

11

38

37

0 10 20 30 40 50 60 70

Uzbekistan

Ukraine

Turkmenistan

Turkey

Russia

Romania

Moldova

Kyrgyz Rep.

Kazakhstan

Georgia

Azerbaijan

Armenia

7.3 Both Unmet Need and Use of Traditional Methods Shift to 

Use of Modern Methods 

The potential combined effect on the abortion rate if all women shifted from the 

unmet need category and use of traditional methods to the use of modern methods is 

illustrated in Figure 7.3. The estimates are fairly uniform, ranging from reductions of 

47 and 48 percent for Kazakhstan and Ukraine, respectively, to 63 percent for Armenia, with an average of 55 percent for the 12 countries. 

The greatest effects are 

estimated for Azerbaijan, 

Romania, and Armenia; the 

average reduction for all 12 

countries is 23 percent. 
Potential Reductions in Abortion Rates 31

Figure 7.3 

Percent reduction in abortion rates if all unmet need and all use of traditional 

methods shifted to modern methods 

50

26

57

28

29

21

24

40

28

41

19

26

5

22

5

29

21

38

33

18

20

11

38

37 63

57

52

48

58

57

59

50

57

62

48

55

0 10 20 30 40 50 60 70

Uzbekistan

Ukraine

Turkmenistan

Turkey

Russia

Romania

Moldova

Kyrgyz Rep.

Kazakhstan

Georgia

Azerbaijan

Armenia

Unmet need Use of traditional methods

Effect of Contraceptive Discontinuation on Abortion 33

 8

Effect of Contraceptive Discontinuation 

on Abortion 

regnancies can be classified by the pattern of contraceptive use prior to conception. As shown above, the major antecedents are nonuse of any method and contraceptive use that failed. A contraceptive method may also be discontinued either to 

become pregnant or for other reasons (e.g., side effects, health concerns, partner’s 

objections). The focus here is on the last category of method discontinuation—

pregnancy following discontinuation for reasons other than wanting to become pregnant. The frequency of such pregnancies (Table 8.1) ranges from 6 percent in Armenia to 20 percent in Georgia. In all eight countries in Table 8.1, the majority of such 

pregnancies end in abortion, although the magnitude of such abortions is far lower 

than the leading circumstances of either general nonuse of contraception or method 

failure. In Georgia, 18 percent of all (recent) pregnancies were terminated by abortion following this kind of method discontinuation, while twice as many pregnancies 

ended in abortion following simple nonuse. In a population where 64 percent of 

pregnancies end in abortion, this represents 28 percent of all abortions, the highest 

level among the eight countries. 

P 

The majority of 

pregnancies resulting 

from discontinuation of 

contraception for reasons 

other than wanting to get 

pregnant end in abortion. 
34 Effect of Contraceptive Discontinuation on Abortion

Table 8.1 Percent distribution of all pregnancies that ended in the three years preceding the survey by use of contraception before pregnancy, and the percentage of 

pregnancies in each category that ended in abortion 

Armenia Azerbaijan Georgia Kazakhstan Moldova Romania Russian cities Ukraine 

Use of contraception 

before pregnancy 

All 

pregnancies 

Pregnancies 

ending 

in abortion 

All 

pregnancies 

Pregnancies 

ending 

in abortion 

All 

pregnancies 

Pregnancies 

ending 

in abortion 

All 

pregnancies 

Pregnancies 

ending 

in abortion 

All 

pregnancies 

Pregnancies 

ending in 

abortion 

All 

pregnancies 

Pregnancies 

ending in

abortion 

All 

pregnancies 

Pregnancies 

ending 

in abortion 

All 

pregnancies 

Pregnancies 

ending 

in abortion 

No method used 44.5 14.9 41.0 12.5 64.8 35.4 54.7 12.1 36.0 6.0 27.2 11.1 26.0 13.4 36.8 12.5 

Method failed 42.6 34.2 39.8 34.4 10.2 9.5 20.9 14.0 35.6 24.4 46.3 33.7 43.0 33.7 38.1 26.1 

Discontinued method: 

 To get pregnant 6.8 0.2 9.3 1.1 5.5 1.1 12.0 0.6 20.4 1.2 14.7 1.3 14.7 1.8 15.6 1.4 

 Other reason 6.1 5.5 9.9 8.2 19.5 17.6 12.4 7.2 8.1 5.2 11.9 7.8 16.3 11.4 9.6 6.9 

Total 100 54.8 100 56.2 100 63.6 100 33.9 100 36.8 100 53.9 100 60.3 100 46.9 
Receptivity to Abortion 35

 9

Receptivity to Abortion 

n the countries where attitudes toward abortion and contraception were assessed, 

women were generally seen to be opposed to abortion and to prefer contraception. 

However, attitudes toward different methods of contraception were mixed and far 

from enthusiastic. Moreover, knowledge of modern methods is limited in this part of 

the world. Even the pill is not known by a third of the women in half of the countries 

and ignorance of sterilization is widespread (Figure 9.1). The IUD is the most commonly known contraceptive method, followed by the condom.4

 Surgical sterilization 

of women is the least known of the four modern methods of contraception (knowledge of male sterilization is even lower). The high prevalence of traditional methods 

of contraception in some of these countries and the dominance of the IUD seems 

understandable. 

Although declining, reliance on abortion in many of these countries is still high by 

international standards. This phenomenon is related to the limited knowledge of 

contraceptive methods in some countries. Although women say they much prefer 

contraception to abortion, there is a strong inclination to regard abortion as a solution to an unwanted pregnancy. One indicator of the propensity to rely on abortion is 

the high proportion of women who say that women who become pregnant unintentionally should seek an abortion. In Azerbaijan, Georgia, Moldova, and Romania, 

about two-thirds of the respondents said that women with an unwanted pregnancy 

should have an abortion rather than have the child or choose adoption (Figure 9.2). 

In four other countries, the question was more direct and asked the woman whether 

she personally would have an abortion if she became pregnant unintentionally. In 

Armenia, nearly two-thirds said they would have an abortion, and in Kazakhstan, the 

Kyrgyz Republic, and Turkmenistan, an average of 40 percent gave this response. 

It seems clear that unless knowledge and availability of effective and acceptable 

contraceptive methods are increased, abortion rates will remain high in these countries. 

 

4

 These data may be out of date for a few countries where the surveys were conducted in 1996 

and 1997. 

I 

It seems clear that unless 

knowledge and 

availability of effective 

and acceptable 

contraceptive methods 

are increased, abortion 

rates will remain high in 

these countries. 
36 Receptivity to Abortion

Figure 9.1 

Percentage of women who never heard of specific modern methods 

Condom

0 10 20 30 40 50 60 70 80

Uzbekistan 1996

Ukraine 2001

Turkmenistan 2000

Turkey 1998

Romania 1999

Moldova 1997

Kyrgyzstan 1997

Kazakhstan 1999

Georgia 1999

Azerbaijan 2001

Armenia 2001

Female sterilization

0 10 20 30 40 50 60 70 80

Uzbekistan 1996

Ukraine 2001

Turkmenistan 2000

Turkey 1998

Romania 1999

Moldova 1997

Kyrgyz Rep. 1997

Kazakhstan 1999

Georgia 1999

Azerbaijan 2001

Armenia 2001

IUD

0 10 20 30 40 50 60 70 80

Uzbekistan 1996

Ukraine 2001

Turkmenistan 2000

Turkey 1998

Romania 1999

Moldova 1997

Kyrgyzstan 1997

Kazakhstan 1999

Georgia 1999

Azerbaijan 2001

Armenia 2001

Pill

0 10 20 30 40 50 60 70 80

Uzbekistan 1996

Ukraine 2001

Turkmenistan 2000

Turkey 1998

Romania 1999

Moldova 1997

Kyrgyz Rep. 1997

Kazakhstan 1999

Georgia 1999

Azerbaijan 2001

Armenia 2001
Receptivity to Abortion 37

Figure 9.2 

Percentage of women who think that a woman with an unwanted pregnancy 

should have an abortion, and percentage who say they would have an abortion 

if they become pregnant unintentionally 

Think that a woman with an unwanted pregancy 

 should have an abortion

64

63

68

72

0 10 20 30 40 50 60 70 80 90 100

Romania

Moldova

Georgia

Azerbaijan

Say they would have an abortion if they became 

 pregnant unintentionally

35

41

46

64

0 10 20 30 40 50 60 70 80 90 100

Turkmenistan

Kyrgyz Rep.

Kazakhstan

Armenia

Note: The bottom graph includes half of the women who did not know how they felt or would act under the 

circumstances. 

Covariates of Abortion and Contraception 39

 10

Covariates of Abortion and Contraception 

n individual reports and in a summary document covering abortion and other reproductive topics in Eastern Europe and Eurasia (Centers for Disease Control and 

Prevention and ORC Macro, 2003), there are standard tables that examine the association between abortion and contraceptive practice, age, number of children, ruralurban residence, and education. The current analysis adds three dimensions to these 

analyses: 1) Do these variables relate to abortion and contraceptive behavior in the 

same way in all of the countries? 2) Are particular relationships independent of other 

covariates? For example, do residents of cities use abortion more than their rural 

counterparts, even when education and number of children are taken into account 

simultaneously? 3) What is the interaction between having an abortion and using 

contraception, again holding constant the other covariates? The current analysis also 

includes similar multivariate analyses of the covariates of attitudes toward abortion in 

the countries that included such questions in their surveys. 

10.1 Abortion Experience 

The odds ratios (logistic regression) of ever having had an abortion are shown for 12 

countries in Table 10.1. The pattern for age is similar across countries and uniformly 

indicates a predictable increase with age: the older the woman, the more likely she is 

to have had an unintended pregnancy with an associated abortion. 

I 
40 Covariates of Abortion and Contraception

Table 10.1 Odds ratios of ever having had an abortion, women age 15-44 who ever had sex 

Variable Armenia 

Azerbaijan Georgia KazakhstanKyrgyz 

Rep. Moldova Romania Russia1 Turkey2

Turkmenistan Ukraine Uzbekistan 

Age (single years) 1.08 1.04 1.07 1.09 1.13 1.08 1.04 1.08 1.07 1.09 1.08 1.10 

Number of children 2.53 2.34 2.45 ns 0.86 1.41 1.51 1.97 1.08 ns 1.26 ns 

Residence 

Rural 1.00 1.00 1.00 1.00 1.00 1.00 1.00 na 1.00 1.00 1.00 1.00 

Urban ns 1.55 1.43 2.06 2.00 1.64 1.36 na 1.22 2.25 1.36 2.28 

Education 

Less than primary 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Primary 1.38 1.27 ns ns 0.72 ns 1.23 ns ns ns ns ns 

Secondary 1.36 1.43 1.44 0.78 ns ns 1.25 ns ns 3.00 ns 2.20 

More than secondary 1.39 ns ns 0.69 ns ns ns 0.68 ns 2.68 0.65 1.80 

Ever used modern 

method 

 

No 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Yes 1.83 2.44 2.52 3.70 6.30 3.27 2.74 3.89 2.12 2.78 3.50 2.68 

Number of women 3,882 5,540 5,765 3,832 2,716 4,694 5,890 6,004 6,151 4,613 5,046 2,997 

Chi squared 1,156 1,565 1,580 702 641 1,009 689 1,933 809 596 732 440 

R squared .225 .206 .208 .132 .180 .155 .085 .234 .095 .115 .107 .149 

1

 Based on three Russian cities 

2

 Based on ever-married women 

na = Not applicable 

ns = Not statistically significant 

The association of abortion with the number of living children a woman has is a 

particularly interesting variable. With age constant, and in the presence of the other 

covariates, the likelihood of having had an abortion is strongly associated with the 

number of children in most of the countries. The small number of children desired, 

and the motivation to prevent the birth of unwanted children, is undoubtedly the 

explanation. 

Women who live in cities are more likely to have experienced an abortion than 

those in rural areas. The exception here is Armenia,5

 an anomaly previously discussed 

(Westoff et al., 2002), that can be traced to the greater reliance on traditional methods in rural areas of that country, which results in more unintended pregnancies and 

therefore more abortions. The reasons abortion rates are higher in cities include the 

proximity of medical facilities, greater desire for smaller families, and perhaps more 

secular attitudes toward the abortion procedure. 

The association of abortion with education is more varied across countries. In five 

of the countries, there is evidence of a positive correlation, while in other countries, 

less educated women seem more likely to seek abortions. Given the mix of results, it 

is impossible to generalize about any universal relation between abortion and education. This is in sharp contrast to the pattern observed between education and the use 

of modern contraception (see below). 

Abortion is strongly associated with whether a woman has ever used a modern 

method of contraception. In this measure, there is no information about whether that 

use preceded or followed the abortion, or both, but only whether the woman’s history 

includes such use. Thus, the basis for the observed strong association can include past 

experience with contraceptive failure, the adoption of a contraceptive method after an 

 

5

 The data for Russia are based on three cities, so the comparison could not be made. 

Abortion is strongly 

associated with whether 

a woman has ever used a 

modern method of 

contraception. 
Covariates of Abortion and Contraception 41

abortion that did not include past use, or some combination of such circumstances. 

Overall, the association between abortion and contraceptive use reflects a motivation 

to control fertility. 

10.2 Abortion Attitudes 

In eight of the countries, a variety of attitudinal questions about abortion were included, although the wording of the questions was different in the CDC and DHS 

interviews. The responses to one question seem to be the most revealing. In the 

CDC interview, the phrasing of the question was: “If a woman had an unwanted 

pregnancy what should she do?” Three possible responses were read to the respondent: 1) Have the baby and keep it; 2) Have the baby and give it up for adoption; and 

3) Have an abortion. In the DHS interview, the question was more direct and read, 

“Would you have an abortion if you unintentionally became pregnant sometime in 

the future?” with Yes, No, and Don’t Know responses coded. 

The same covariates in the multivariate analysis of whether a woman ever had an 

abortion are included in a similar analysis of these attitudinal data—the propensity to 

have an abortion as indicated by whether a woman would have an abortion if confronted with an unwanted pregnancy. The main predictor of such a propensity is 

whether the woman has ever had an abortion (Table 10.2). In all eight countries, past 

experience with abortion relates strongly to the option of abortion in the future. 

Women with abortion experience are two to six times more likely to choose an abortion under this circumstance than are women who have never had an abortion. In 

most countries, experience with the use of modern contraceptive methods also relates 

positively to the likelihood of having an abortion. 

Table 10.2 Odds ratios of women preferring an abortion if they become pregnant unintentionally 

Variable Armenia Azerbaijan Georgia Kazakhstan Kyrgyz Rep. Moldova Romania Turkmenistan 

Age (single years) ns 0.99 ns 1.03 ns 0.99 0.99 1.01 

Number of children 1.51 1.16 1.11 ns 1.31 ns 1.16 1.07 

Residence 

Rural 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Urban 0.73 ns ns 1.60 1.44 1.61 1.39 1.49 

Education 

Less than primary 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Primary 1.26 ns 1.41 ns 0.73 ns ns ns 

Secondary 1.75 1.25 1.32 ns ns 1.30 1.19 1.95 

More than secondary 1.42 1.47 ns ns ns 1.32 1.38 2.34 

Ever used modern 

method 

No 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Yes 1.24 ns ns 1.48 1.32 1.99 1.85 1.37 

Ever had abortion 

No 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Yes 3.93 2.38 2.98 3.08 3.09 2.39 3.25 6.46 

Number of women 4,017 7,297 7,598 3,206 2,877 5,327 6,275 4,664 

Chi squared 981 340 567 505 543 544 683 948 

R squared .195 .042 .061 .114 .144 .077 .081 .160 

ns = Not statistically significant 

Past experience with 

abortion relates strongly 

to the option of abortion 

in the future. 
42 Covariates of Abortion and Contraception

Age does not appear important in determining this attitude, but in most of the 

countries the number of children does correlate directly with propensity to have an 

abortion. Urban residence also shows a relationship in five of the countries, and education likewise correlates directly with this attitude in five countries. 

10.3 Modern Contraceptive Practice 

Women’s age operates in the opposite direction for use of modern contraceptive 

methods as it does for use of abortion (Table 10.3). Despite definition of the contraception variable as “ever having used a modern method,” the age pattern for contraception indicates that the younger generation is more apt to be drawn to such practice. On the other hand, the number of children is directly correlated with modern 

method use as it is with abortion, no doubt for similar reasons. Women who have 

had an abortion are much more likely to use modern contraceptive methods, an association seen above in the reverse association of contraception with abortion. 

Both urban residence and education are directly associated with experience with 

modern contraceptive methods. In both cases, the associations are strong and consistent across countries. 

Table 10.3 Odds ratios of ever having used a modern method of contraception, women age 15-44 who have ever had sex 

Variable Armenia Azerbaijan Georgia 

Kazakhstan Kyrgyz 

Rep. Moldova Romania Russia1 Turkey2 Ukraine Uzbekistan 

Age (single years) 0.97 0.98 0.97 0.97 0.98 0.97 0.94 0.97 1.02 0.97 ns 

Number of children 1.43 1.43 1.30 1.52 1.92 1.73 1.53 2.37 1.26 ns 1.66 

Residence 

Rural 1.00 1.00 1.00 1.00 1.00 1.00 1.00 na 1.00 1.00 1.00 

Urban 1.33 1.99 1.60 1.59 2.08 2.50 1.35 na 1.40 2.17 1.40 

Education 

Less than primary 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Primary 1.60 1.26 2.17 1.29 ns 1.33 2.48 2.91 2.73 ns 1.33 

Secondary 2.10 2.01 3.04 1.44 1.69 2.18 4.16 5.24 5.02 1.54 1.72 

More than secondary 2.95 3.25 5.44 2.31 2.23 3.17 12.63 9.34 9.83 2.53 1.93 

Ever had abortion 

No 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Yes 1.93 2.51 2.69 3.48 5.27 3.13 2.62 3.57 2.07 3.46 2.50 

Number of women 3,882 5,540 5,765 3,832 2,716 4,694 5,890 6,004 6,151 5,046 2,997 

Chi squared 310 726 704 365 664 784 429 1180 717 571 526 

R squared .058 .105 .093 .095 .211 .137 .110 .201 .091 .095 .134 1

 Based on three Russian cities 

2

 Based on ever-married women 

na = Not applicable 

ns = Not statistically significant 

Both urban residence and 

education are directly 

associated with 

experience with modern 

contraceptive methods. 
Remaining High Risk of Abortion 43

 11

Remaining High Risk of Abortion 

igh levels of risk for abortion remain in the four countries with the highest 

overall rates of abortion: Armenia, Azerbaijan, Georgia, and Romania. High 

risk is defined here as women who are married, who want no more children, who are 

not using a modern method of contraception, who are at risk of an unwanted pregnancy (sexually active and fecund), and whose last pregnancy ended in abortion. The 

magnitude of this high risk in the four countries ranges from 12 percent in Romania 

to 27 percent in Armenia (Table 11.1). By definition, all of these women have already had at least one abortion (associated with their last pregnancy). Without the 

criterion that the women terminated their last pregnancy with abortion, the levels of 

risk range from 27 to 47 percent. 

Table 11.1 Estimates of the percentage of currently married women who are at high risk for 

another abortion 

Criterion Armenia Azerbaijan Georgia Romania 

Currently married women who: 

Want no more children 72 70 58 59 

And are not using a modern 

method 58 61 34 48 

And are at risk of an unwanted 

pregnancy 43 47 29 27 

And whose last pregnancy ended in 

abortion 27 19 20 12 

H 

The magnitude of the 

remaining high risk for 

abortion in the four 

countries ranges from 12 

percent in Romania to 27 

percent in Armenia. 

Conclusions 45

 12

Conclusions 

he main conclusion of this report is that there is increasing international data 

indicating that use of modern contraceptive methods reduces the occurrence of 

abortion. With few exceptions, the countries reviewed here that experienced recent 

increases in the use of modern methods also experienced significant declines in abortion. Despite declining abortion rates, all 12 countries showed substantial reductions 

during the 1990s in both fertility and the number of children desired, which demonstrates the increasing role of modern methods of contraception. In contrast, use of 

traditional methods is associated with higher rates of abortion. 

Abortion is associated primarily with contraceptive failure and unmet need for 

family planning. Contraceptive failure accounts for most of the abortions in twothirds of the countries, and unmet need accounts for the other one-third. Most of the 

contraceptive failures result from use of traditional methods. Discontinuation of contraceptive use for reasons other than failure or intention to become pregnant also 

contributes to abortion but in a more minor way. 

On the basis of observed failure rates for the two types of methods and pregnancy 

rates for the different types of nonuse, as well as the associated abortion rates for each 

of these categories, a series of simulation models were developed to illustrate the potential further declines in abortion rates that could be expected if conditions changed. 

One simulation indicates that if all of the women currently classified with unmet 

need or using traditional methods were to join the women using modern methods, 

the abortion rate could be reduced by an average of 55 percent. Other simulations 

isolated the effects of traditional method use and unmet need separately. 

Despite an overwhelming preference for contraception over abortion, about half to 

two-thirds of the women say that they would opt for an abortion if they became 

pregnant unintentionally. There remains, however, a considerable amount of ignorance about modern methods other than the IUD, the most commonly used method. 

Given the widespread continuing decline in the number of children desired, there 

will be upward pressure on abortion if the use of modern contraceptive methods does 

not increase. There are four countries in the group where women remain at high risk 

for abortion: Armenia, Azerbaijan, Georgia, and Romania. 

T With few exceptions, the 

countries reviewed here 

that experienced recent 

increases in the use of 

modern methods also 

experienced significant 

declines in abortion. 

Contraceptive failure 

accounts for most of the 

abortions in two-thirds of 

the countries, and unmet 

need accounts for the 

other one-third. 

Given the widespread 

continuing decline in the 

number of children desired, 

there will be upward 

pressure on abortion if the 

use of modern 

contraceptive methods 

does not increase. 

References 47

References 

Agadjanian, V. 2002. Is “abortion culture” fading in the former Soviet Union? Views 

about abortion and contraception in Kazakhstan. Studies in Family Planning 33(3): 

237-248. 

Avdeev, A. 2003. Personal communication. 

Avdeev, A. and I. Troitskaia. 1999. New features in abortion dynamics in Russia in 

the 1990s. Paper presented at the European Population Conference 1999, The 

Hague. 

Bellaby, M.D. 2003. Russian abortion rate declines while government considers scaling back liberal law. Associated Press, July 28. 

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Myers, S.L. 2003. After decades, Russia narrows grounds for abortion. New York 

Times August 24. 

Philipov, D., E. Andrew, T. Karkova and V. Shkolnikov. 2004. Induced abortion in 

Russia: Recent trends and underreporting in surveys. European Journal of Population 

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Rossier, Clemintine. 2003. Estimating induced abortion rates: A review. Studies in 

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Senlet, P., S.L. Curtis, J. Mathis, and H. Raggers. 2001. The role of changes in contraceptive use in the decline of induced abortion in Turkey. Studies in Family Planning 32(1): 41-52. 

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48 References

Westoff, C.F., A.T. Sharmanov, J.M. Sullivan and T. Croft. 1998. Replacement of 

abortion by contraception in three Central Asian Republics. Calverton, Maryland: The 

Policy Project and Macro International Inc. 

Westoff, Charles F. 2000. The substitution of contraception for abortion in Kazakhstan 

in the 1990’s. Calverton, Maryland: ORC Macro. 

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Maryland: ORC Macro. 

Zhurnal, E. 2003. Contraception catches on in Russia. Transitions on Line. July 11, 

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