The human cost of unsafe abortions
In the two decades from 1965 to 1985, maternal mortality fell sharply across Europe.
1965年至1985年的二十年间，整个欧洲的孕产妇死亡率急剧下降。
Rates in my own country, the United Kingdom, fell by more than two-thirds.
我自己的国家英国的利率下降了三分之二以上。
Romania was the exception.
罗马尼亚是个例外。
Its rates increased by almost 150%.
其比率增加了近 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.
到 20 世纪 80 年代末，罗马尼亚妇女的死亡率比其他东欧国家高出几倍，比西欧国家高出十倍，如下图所示。
Why were Romanian women dying at much higher rates than in neighboring countries?
为什么罗马尼亚妇女的死亡率比邻国高得多？
To understand this, we need to go back three decades.
要理解这一点，我们需要追溯到三十年前。
In 1957, Romania legalized abortion.
1957年，罗马尼亚将堕胎合法化。
Surgical procedures became readily available, affordable, and relatively safe.
外科手术变得容易获得、负担得起且相对安全。
1 At the same time, there was very little access to contraception, which made unintended pregnancies extremely common.
1 同时，避孕措施很少，这使得意外怀孕极为常见。
As a result, many women relied on abortion to control their fertility.
因此，许多女性依靠堕胎来控制生育能力。
By the mid-1960s, more than a million abortions were performed each year, four times the number of babies born.
到 20 世纪 60 年代中期，每年有超过一百万例堕胎，是出生婴儿数量的四倍。
2
2
You can see the impact of this in the next chart.
您可以在下一张图表中看到其影响。
In the decade from 1957 to the late 1960s, births fell by around 40%.
从 1957 年到 20 世纪 60 年代末的十年间，出生率下降了约 40%。
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3
But things changed when Nicolae Ceaușescu became president in 1965.
但 1965 年尼古拉·齐奥塞斯库 (Nicolae Ceauşescu) 就任总统后，情况发生了变化。
Worried about declining births in Romania, Ceaușescu implemented “Decree 770”, which put tight restrictions on abortions and contraception.
由于担心罗马尼亚出生率下降，齐奥塞斯库实施了“770号法令”，对堕胎和避孕进行了严格限制。
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.
禁止堕胎，但年龄超过 45 岁、至少有四个孩子（后来增加到五个）、面临危及生命的并发症或曾是强奸受害者的妇女除外。
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4
The impact of these restrictions was dramatic.
这些限制的影响是巨大的。
Births nearly doubled from 1966 to 1967.
1966 年至 1967 年间，出生人数几乎翻了一番。
Fertility rates increased from less than 2 births per woman to more than 3.5, as you can see in the chart below.
生育率从每名女性生育不到 2 次增加到超过 3.5 次，如下图所示。
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.
最终，随着夫妇们找到其他方法来管理生育，生育率再次下降，但花了几十年的时间才回落到禁令前的水平。
So Ceaușescu’s plan to boost population growth worked.
因此齐奥塞斯库促进人口增长的计划奏效了。
But making abortion illegal for most women meant that many turned to more dangerous alternatives.
但对大多数女性来说，堕胎非法意味着许多人转向更危险的替代方案。
We know abortions continued because women and those who performed them were imprisoned or heavily fined when caught.
我们知道堕胎现象仍在继续，因为妇女和堕胎者一旦被发现就会被监禁或被处以巨额罚款。
Records suggest that many of these people were not medically trained.
记录显示，其中许多人没有接受过医学培训。
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5
These procedures often relied on non-sterile metal instruments, improvised tools, or toxic substances to induce a miscarriage.
这些手术通常依赖非无菌金属器械、简易工具或有毒物质来诱导流产。
As a result, many women suffered from severe internal bleeding, perforation of the uterus, or life-threatening conditions caused by infections.
结果，许多妇女遭受严重内出血、子宫穿孔或感染引起的危及生命的情况。
Because these procedures were illegal, women often delayed seeking medical help when complications arose, turning treatable problems into fatal ones.
由于这些手术是非法的，女性在出现并发症时往往会推迟寻求医疗帮助，从而将可治疗的问题变成致命的问题。
As you can see in the chart below, maternal mortality rates in Romania increased substantially in the decades following the abortion ban.
如下图所示，堕胎禁令实施后的几十年里，罗马尼亚的孕产妇死亡率大幅上升。
This reflects the expansion of illegal abortion methods and practitioners, and partly explains why births gradually fell over the same period.
这反映了非法堕胎方法和从业人员的扩张，并部分解释了同期出生率逐渐下降的原因。
A growing fraction of maternal deaths were caused by unsafe abortion; by the 1980s, these deaths accounted for more than 80% of the total.
越来越多的孕产妇死亡是由不安全堕胎造成的；到了20世纪80年代，这些死亡人数已占总数的80%以上。
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6
In 1989, Ceaușescu was overthrown, and just as quickly as abortion was criminalized, restrictions were lifted again.
1989 年，齐奥塞斯库被推翻，随着堕胎被定为犯罪，限制也再次取消。
Maternal deaths declined as abortions moved from illegal methods to regulated ones.
随着堕胎从非法方法转向受监管方法，孕产妇死亡率下降。
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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.
在限制堕胎的两年半里，估计约有 10,000 名罗马尼亚妇女死于不安全堕胎。
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8
We send two regular newsletters so you can stay up to date on our work and receive curated highlights from across Our World in Data.
我们定期发送两份时事通讯，以便您及时了解我们的工作并接收来自“我们的数据世界”的精选亮点。
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.
罗马尼亚突然的政策变化创造了一个罕见的自然实验：当堕胎合法时，孕产妇死亡率很低；当堕胎合法时，孕产妇死亡率很低。当它被禁止时，他们崛起；当它被禁止时，他们崛起；当它再次合法化时，他们就倒下了。
If we want to draw lessons from Romania’s history, we need to keep in mind that its situation was unusual.
如果我们想从罗马尼亚的历史中吸取教训，我们需要记住它的情况是不寻常的。
No country today has anywhere close to the abortion rates that Romania had in the early 1960s.
如今，没有哪个国家的堕胎率能接近 20 世纪 60 年代初罗马尼亚的堕胎率。
I estimate that around 20% of women of reproductive age in Romania were having an abortion each year at that time.
我估计当时罗马尼亚每年约有 20% 的育龄妇女进行堕胎。
9 Globally, the country with the highest rate today is less than half that of Romania in the 1960s.
9 从全球来看，目前比率最高的国家还不到 20 世纪 60 年代罗马尼亚的一半。
10 Most countries in Europe and North America have rates closer to 1%.
10 欧洲和北美大多数国家的税率接近 1%。
11 Romania was an extreme case, and we shouldn’t expect changes today to have such dramatic consequences.
11 罗马尼亚是一个极端的例子，我们不应该指望今天的变化会产生如此戏剧性的后果。
But the mechanism still applies.
但该机制仍然适用。
It is estimated that around 40% of women in the world live in countries where abortion is either completely illegal or severely restricted.
据估计，世界上大约 40% 的妇女生活在堕胎完全非法或受到严格限制的国家。
Yet abortion rates are still higher in these places than they are in Western Europe and many other places where abortion is legal.
然而，这些地方的堕胎率仍然高于西欧和许多其他堕胎合法的地方。
Where abortions are illegal, most take place in unsafe and unsanitary conditions.
在堕胎非法的地方，大多数堕胎都是在不安全和不卫生的条件下进行的。
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.
在受到严格限制的国家，四分之三的堕胎估计是不安全的，而北美、北欧和西欧的这一比例远低于 10%。
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12
How does this affect the health risks for women?
这对女性的健康风险有何影响？
Safe abortions have very low mortality rates, typically below 1 death per 100,000 abortions.
安全堕胎的死亡率非常低，通常每 10 万例堕胎就有 1 人死亡。
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.
13 在大多数堕胎都不安全的地区，死亡率可能高出数百倍；在西非和中非，大约二百分之一的堕胎会导致妇女死亡。
14
14
Estimates suggest that unsafe abortions account for 8% of maternal deaths globally.
据估计，全球孕产妇死亡中 8% 是由不安全堕胎造成的。
15 This means that an estimated 23,000 women die every year.
15 这意味着每年估计有 23,000 名妇女死亡。
16 Romania learned about the consequences of unsafe abortion at an enormous cost.
16 罗马尼亚付出了巨大代价，了解到不安全堕胎的后果。
In many parts of the world, that lesson continues.
在世界许多地方，这一教训仍在继续。
Many thanks to Max Roser and Edouard Mathieu for editorial feedback and comments on this article.
非常感谢 Max Roser 和 Edouard Mathieu 对本文的编辑反馈和评论。
Maternal mortality was much more common in the past.
过去，孕产妇死亡率更为常见。
It is much lower today, but global inequalities are still large.
今天要低得多，但全球不平等仍然很大。
What could be more tragic than a mother losing her life in the moment that she is giving birth to her newborn?
还有什么比母亲在生下新生儿的那一刻失去生命更悲惨的事情呢？
Why are mothers dying and what can be done to prevent these deaths?
为什么母亲会死亡？可以采取哪些措施来预防这些死亡？
Maternal mortality rates appear to have risen in the last 20 years in the US.
过去 20 年来，美国的孕产妇死亡率似乎有所上升。
But this reflects a change in measurement rather than an actual rise in mortality.
但这反映了衡量标准的变化，而不是死亡率的实际上升。
Teitelbaum, M.
泰特尔鲍姆，M.
S.
S。
(1972).
（1972）。
Fertility effects of the abolition of legal abortion in Romania.
罗马尼亚废除合法堕胎对生育率的影响。
Population Studies.
人口研究。
Horga, M., Gerdts, C., & Potts, M.
Horga, M.、Gerdts, C. 和 Potts, M.
(2013).
（2013）。
The remarkable story of Romanian women's struggle to manage their fertility.
罗马尼亚妇女努力控制生育的非凡故事。
Journal of Family Planning and Reproductive Health Care.
计划生育和生殖保健杂志。
By the mid-1960s, births had fallen to around 260,000 per year.
到 20 世纪 60 年代中期，每年的出生人数已降至 26 万左右。
The policy initially had an age threshold of 45 years, which was later lowered to 40 years, then raised again to 45.
该政策最初的年龄门槛为45岁，后来降低到40岁，然后再次提高到45岁。
The government became deeply involved in women's and families' reproductive decisions in other ways, too.
政府还以其他方式深入参与妇女和家庭的生育决策。
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.
职业女性必须每月进行一次妇科检查；如果他们未能参加，他们将失去获得医疗保健、养老金和社会支持的权利。
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.
如果一对已婚夫妇在两年内没有孩子——并且没有任何医疗原因阻止他们这样做——他们就必须缴纳额外的税。
Hord, C., David, H.
霍德，C.，大卫，H.
P., Donnay, F., & Wolf, M.
P.、唐奈 F. 和沃尔夫 M.
(1991).
（1991）。
Reproductive health in Romania: reversing the Ceausescu legacy.
罗马尼亚的生殖健康：扭转齐奥塞斯库的遗产。
Studies in family planning .
计划生育研究。
Hord, C., David, H.
霍德，C.，大卫，H.
P., Donnay, F., & Wolf, M.
P.、唐奈 F. 和沃尔夫 M.
(1991).
（1991）。
Reproductive health in Romania: reversing the Ceausescu legacy.
罗马尼亚的生殖健康：扭转齐奥塞斯库的遗产。
Studies in Family Planning.
计划生育研究。
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.
如果不是堕胎合法化后一年内堕胎诊所人满为患，死亡人数的下降可能会更大。
The demand from women was high, and medical support was limited; abortion clinics had either been severely restricted or closed completely.
女性需求高，医疗支持有限；堕胎诊所要么受到严格限制，要么完全关闭。
I’ve seen this figure cited in several places, but failed to find a solid original reference.
我在好几个地方都看到过这个数字，但未能找到可靠的原始参考资料。
However, based on my own calculations, this seems reasonable as an estimate.
然而，根据我自己的计算，这个估计似乎是合理的。
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.
根据本文前面的图表，在限制堕胎期间，堕胎死亡率平均约为每 10 万活产 80 至 120 人。
Earlier in the period, it was around 30, and by the end, it had reached over 140.
前期是30左右，到年底已经达到140多了。
An average of 100 deaths per 100,000 live births seems like a reasonable estimate.
每 100,000 名活产婴儿中平均有 100 人死亡似乎是一个合理的估计。
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 .
根据1966年至1989年（限制时期）的出生人数，除以10万，再乘以100（每10万出生的堕胎死亡人数），我计算出这24年期间的死亡人数约为9,500人。
Approximately 10,000 deaths, therefore, seems like a reasonable estimate.
因此，大约 10,000 人死亡似乎是一个合理的估计。
I’ve based this on the number of girls and women aged 15 to 49 years (often described as the “reproductive age”).
我根据 15 岁至 49 岁（通常被称为“生育年龄”）的女孩和妇女的数量得出这一结论。
In 1965, there were around 4.9 million Romanian women in this age bracket.
1965年，这个年龄段的罗马尼亚女性约有490万。
Some women could have multiple abortions in a given year, so this 20% figure is a simplification assuming that women only had one.
有些女性可能在一年内进行过多次堕胎，因此这个 20% 的数字是假设女性只进行过一次堕胎的简化结果。
At those rates, the average woman would have had four abortions in her lifetime.
按照这个比例，普通女性一生中会经历四次堕胎。
Horga, M., Gerdts, C., & Potts, M.
Horga, M.、Gerdts, C. 和 Potts, M.
(2013).
（2013）。
The remarkable story of Romanian women's struggle to manage their fertility.
罗马尼亚妇女努力控制生育的非凡故事。
Journal of Family Planning and Reproductive Health Care.
计划生育和生殖保健杂志。
The study by Bearak et al.
Bearak 等人的研究。
(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.
(2022) 估计，格鲁吉亚的堕胎率是世界上最高的，每年每 1,000 名 15 至 49 岁女性就有 80 例堕胎。
Bearak, J.
比拉克，J.
M., Popinchalk, A., Beavin, C., Ganatra, B., Moller, A.
M.、Popinchalk, A.、Beavin, C.、Ganatra, B.、Moller, A.
B., Tunçalp, Ö., & Alkema, L.
B.、Tunçalp, Ö. 和 Alkema, L.
(2022).
（2022）。
Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019.
各国意外怀孕和堕胎发生率的估计：2015-2019 年水平的全球比较分析。
BMJ Global Health.
《BMJ 全球健康》。
This study is based on data from the period 2010 to 2014, so it’s a bit outdated.
这项研究基于2010年至2014年期间的数据，因此有点过时了。
However, I could not find a more recent global study of this question.
然而，我找不到关于这个问题的更新的全球研究。
Ganatra, B., Gerdts, C., Rossier, C., Johnson, B.
Ganatra, B.、Gerdts, C.、Rossier, C.、Johnson, B.
R., Tunçalp, Ö., Assifi, A., ...
R.、通萨尔普、Ö.、阿西菲、A.、...
& Alkema, L.
&阿尔克玛，L.
(2017).
（2017）。
Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model.
2010-14 年全球、区域和次区域堕胎安全分类：贝叶斯分层模型的估计。
The Lancet.
柳叶刀。
In countries like the United States, there are around 0.5 deaths per 100,000.
在美国等国家，每 10 万人中约有 0.5 人死亡。
Steenland, M.
斯廷兰，M.
W., Mercon, K., Brown, B.
W.，默康，K.，布朗，B.
P., & Thoma, M.
P.，＆托马，M.
E.
E.
(2026).
（2026）。
Pregnancy-and Abortion-Related Mortality in the US, 2018-2021.
2018-2021 年美国怀孕和堕胎相关死亡率。
JAMA Network Open.
JAMA 网络开放。
Estimates are that case fatality rates are between 450 and 500 per 100,000 abortions.
据估计，每 10 万例堕胎就有 450 至 500 例堕胎死亡。
Ganatra, B., Gerdts, C., Rossier, C., Johnson, B.
Ganatra, B.、Gerdts, C.、Rossier, C.、Johnson, B.
R., Tunçalp, Ö., Assifi, A., ...
R.、通萨尔普、Ö.、阿西菲、A.、...
& Alkema, L.
&阿尔克玛，L.
(2017).
（2017）。
Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model.
2010-14 年全球、区域和次区域堕胎安全分类：贝叶斯分层模型的估计。
The Lancet.
柳叶刀。
Cresswell, J.
克雷斯韦尔，J.
A., Alexander, M., Chong, M.
A.，亚历山大，M.，冲，M.
Y., Link, H.
Y.、林克、H.
M., Pejchinovska, M., Gazeley, U., ...
M.、Pejchinovska、M.、Gazeley、U.、...
& Say, L.
＆萨伊，L.
(2025).
（2025）。
Global and regional causes of maternal deaths 2009–20: a WHO systematic analysis.
2009-20 年全球和区域孕产妇死亡原因：世卫组织系统分析。
The Lancet Global Health.
柳叶刀全球健康。
Some earlier figures from the 2010s suggested that abortions were responsible for as much as 13% of maternal deaths globally.
2010 年代的一些早期数据表明，全球孕产妇死亡人数中有 13% 是由堕胎造成的。
World Health Organization (2011).
世界卫生组织（2011）。
Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008.
不安全堕胎：2008 年全球和区域不安全堕胎发生率及相关死亡率的估计。
In 2023, there were 286,000 maternal deaths globally.
2023年，全球孕产妇死亡人数为28.6万人。
8% of this figure is 23,000.
这个数字的8%是23,000。
Our articles and data visualizations rely on work from many different people and organizations.
我们的文章和数据可视化依赖于许多不同的人和组织的工作。
When citing this article, please also cite the underlying data sources.
引用本文时，请同时注明底层数据来源。
This article can be cited as:
这篇文章可以引用为：
We are a live site and we keep our work maintained.
我们是一个活跃的网站，我们会保持我们的工作。
So our articles are often changed, including the data.
所以我们的文章经常改，包括数据。
You can browse previous versions of this work here.
您可以在此处浏览此作品的先前版本。