Despite global commitments to achieving gender equality and improving health and well-being for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and sub-national data provide key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies demonstrated that: 1) gender norms are complex and may intersect with other social factors to impact health over the life course; 2) early gender-normative influences by parents and peers may have multiple and differing health consequences for girls and boys; 3) non-conformity with, and transgression of, gender norms may be harmful to health, in particular when they trigger negative sanctions; and 4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programs. Limitations of survey-based data are described that resulted in missed opportunities for exploring certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.

Objective Many reasons inform women’s reproductive decision-making. This paper aims to present the reasons women give for obtaining induced abortions in 14 countries. Study design We examined nationally representative data from 14 countries collected in official statistics, population-based surveys, and facility-based surveys of abortion patients. In each country, we calculated the percentage distribution of women who have abortions by main reason given for the abortion. We examined these reasons across countries and within countries by women’s sociodemographic characteristics (age, marital status, educational attainment, and residence). Where data are available, we also studied the multiple reasons women give for having an abortion. Results In most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women’s sociodemographic characteristics. Data from three countries where multiple reasons could be reported in the survey showed that women often have more than one reason for having an abortion. Conclusion This study shows that women have abortions for a variety of reasons, and provides a broad picture of the circumstances that inform women’s decisions to have abortions. Implications Future research should examine in greater depth the personal, social, economic, and health factors that inform a woman’s decision to have an abortion as these reasons may shed light on the potential consequences that unintended births can have on women’s lives.

BackgroundIn 2010–2014, approximately 86% of abortions took place in low- and middle-income countries (LMICs). Although abortion incidence varies minimally across geographical regions, it varies widely by subregion and within countries by subgroups of women. Differential abortion levels stem from variation in the level of unintended pregnancies and in the likelihood that women with unintended pregnancies obtain abortions.ObjectivesTo examine the characteristics of women obtaining induced abortions in LMICs.MethodsWe use data from official statistics, population-based surveys, and abortion patient surveys to examine variation in the percentage distribution of abortions and abortion rates by age at abortion, marital status, parity, wealth, education, and residence. We analyze data from five countries in Africa, 13 in Asia, eight in Europe, and two in Latin America and the Caribbean (LAC).ResultsWomen across all sociodemographic subgroups obtain abortions. In most countries, women aged 20–29 obtained the highest proportion of abortions, and while adolescents obtained a substantial fraction of abortions, they do not make up a disproportionate share. Region-specific patterns were observed in the distribution of abortions by parity. In many countries, a higher fraction of abortions occurred among women of high socioeconomic status, as measured by wealth status, educational attainment, and urban residence. Due to limited data on marital status, it is unknown whether married or unmarried women make up a larger share of abortions.ConclusionsThese findings help to identify subgroups of women with disproportionate levels of abortion, and can inform policies and programs to reduce the incidence of unintended pregnancies; and in LMICs that have restrictive abortion laws, these findings can also inform policies to minimize the consequences of unsafe abortion and motivate liberalization of abortion laws. Program planners, policymakers, and advocates can use this information to improve access to safe abortion services, postabortion care, and contraceptive services.

BackgroundIn the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion.ObjectivesOur study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa.MethodsWe applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility.ResultsIn 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15–49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15–49.ConclusionsIncreasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.

* Countries that set age 18 as the legal minimum age of marriage but permit exceptions under the law (e.g., with parental or judicial consent) were not considered to have laws banning child marriage. Since the publication of these data, five countries (Bangladesh, Gambia, Kenya, Malawi, Tanzania) have passed legislation modifying their legal minimum age of marriage. The current statistic reflects these recent changes.