changes in fertility rates, which may otherwise be incorrectly attributed to contraceptive use or other determinants of fertility. Singh’s article presents key reasons for developing estimates of unsafe abortion and provides an overview of current estimates of the numbers and rates of induced abortion worldwide, for developed and developing countries, and for all major world regions. Countries are divided into two broad categories: those in which abortion is legal under a broad array of conditions and those where the procedure is highly legally restricted. Singh demonstrates that although the practice of abortion is universal, there are substantial global variations in the levels and incidence of abortion, based on the limited data available. There are also wide variations across countries in the legal status of abortion, access to safe abortion services, acceptance of abortion, and moral and ethical views about its practice. The bulk of unsafe abortions, however, occur in the developing world. Singh concludes by noting the challenges to the collection of data on unsafe abortion, including the predicted rise in the clandestine use of medical abortion, which will require changes in estimation procedures. To better understand the factors and conditions that lead women to choose abortion even when the conditions are unsafe, Mundigo’s article explores the main determinants of unsafe induced abortion in the developing world using a framework of two categories of determinants. Proximate determinants are individual-level factors directly affecting contraceptive behaviour and the decision to terminate an unwanted pregnancy. Systemic determinants of unsafe abortion encompass the legal, social, economic, and religious factors affecting the abortion decision-making process and access to safe abortion care. Mundigo considers the impact of policies and legislation on women’s choices when confronted with an unwanted pregnancy by analysing data from case studies conducted as part of a WHO research initiative on the determinants of abortion in areas where access B-Chap 1.indd 8 07/02/2006 13:31:35 9 UNSAFE ABORTION : AN OVERVIEW OF PRIORITIES AND NEEDS to safe services is restricted by law. In much of the developing world, systemic determinants prohibit women who desire an abortion from accessing safe abortion services, leading to unsafe abortion and its consequences. The article recommends more research on the causes and consequences of unsafe abortion in the developing world and bringing these findings to the attention of policy-makers. Legal obstacles to the provision of safe abortion services give women little choice but to resort to unsafe abortion when faced with an unintended pregnancy. Cook’s article addresses the problem of unsafe abortion using a human rights framework that would reduce unsafe abortion and its harmful consequences for women and their families. The application of human rights to reduce unsafe abortion includes the right to be free from inhuman and degrading treatment, and the rights to equal protection of the law, to liberty and security of the person, to health, and to non-discrimination on grounds of sex and race. Cook argues that countries interested in reducing unsafe abortion should conduct a human rights needs assessment to identify the ways laws, policies or practices facilitate or inhibit the availability of and access to services at the clinical and health system levels. Such an assessment should also address the underlying social or economic conditions that inhibit access to safe abortion care. Where laws, policies or practices directly or indirectly obstruct the availability of or access to preventive family planning services or to abortion services, they need to be reformed to comply with human rights principles. From a medical standpoint, women undergoing abortions performed under unsafe conditions are at greater risk of serious and life-threatening complications. Two articles address medical and clinical practices that reduce complications from unsafe abortion and their burden on health systems. Grimes addresses complications from unsafe abortion that remain endemic in developing countries and may be worsening in both Africa and Latin America. From a preventive medicine viewpoint, strategies at three different levels can reduce the frequency and severity of complications from unsafe abortion. Primary prevention includes improving the skills of providers in countries where induced abortion is legal. Secondary prevention includes prompt evacuation of incomplete abortions by either misoprostol or manual vacuum aspiration. Prompt empiric antibiotic therapy and rapid emptying of the uterus can reduce the morbidity related to infection. Tertiary prevention includes management of life-threatening complications. Grimes also discusses the emerging role of medical abortion. Women who, after a medical abortion, have excessive bleeding or retained products of conception and do not seek necessary treatment should be of particular concern to the medical community. B-Chap 1.indd 9 07/02/2006 13:31:35 10 INA K.WARRINER The article by Huntington examines the role of postabortion care as part of women’s reproductive health care. Postabortion care (PAC) encompasses emergency treatment for complications from an incomplete abortion, the