Is abortion risky? Can women easily die?
No. Abortion is safer than childbirth. In the US, 0.6 out of 100,000 abortions result in death while 13 out of 100,000 live births result in death. In Malaysia, the corresponding figures are 27 and 33. (In 2002, the Malaysian Ministry of Health reported 9 out of 33,759 induced abortions resulted in deaths nationwide, based on hospital admissions.) The major risk is that of infection deriving from unsafe abortion procedures.

Does unsafe abortion automatically mean maternal mortality?
Not automatically, but if the abortion results in infection which remains untreated, this can lead to sepsis and death.

Some 68,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer long-term health complications. Unsafe abortion is thus a pressing issue, particularly in developing nations, where most unsafe abortions (97%) occur (Haddad, Lisa B., and Nawal M. Nour. 2009. “Unsafe Abortion: Unnecessary Maternal Mortality.” Review of Obstetrics and Gynecology 2(2): 122–126.)

In each state, is it well known where abortion clinics are and is the quality good?
It depends. In every large city, there are at least a couple of clinics that perform abortions that people have heard about through the local grapevine. The local FRHAM clinic usually has a list of clinics with which to make referrals for women who request these services. These clinics are considered safe. Based on the population of Malaysian cities, it is estimated that there are at least 240 clinics nationwide offering abortion services, but not all have been vetted for quality of service or safety. RRAAM is in the process of developing a provider network of quality clinics.

What is the typical profile of women who seek abortions?
At one local clinic that has been studied, the vast majority are usually between 25-35 years of age and they are usually women who already have had a few children and have completed their families, or have pregnancies sooner than expected and wish to space their births.

Women terminate these pregnancies for a variety of reasons. They most frequently mention having an abortion because they are not ready to care for a child (or another child), financial constraints, concern for or responsibility to others (especially concerns related to caring for other children), desire to avoid single parenthood, relationship problems, and feeling too young or immature to raise a child. Some pregnancies are terminated because they are a consequence of rape or incest.

Is there factual data on pregnancies by rape or incest?
No. Actual reported rape cases numbered 3626 in 2009 and have been rising annually. Reported incest cases numbered 385 in 2009.  There is no record of pregnancies by rape or incest. The one stop crisis centers in public hospitals are set up more to facilitate forensic investigations than to help rape survivors. They do not record data on pregnancies by rape or incest.

Emergency contraception could prevent up to 90 percent of the 25,000 pregnancies resulting from rape in the United States each year, according to studies published in 1998 in The Lancet and 2000 in the American Journal of Preventive Medicine. At least 9,000 abortions each year stem from pregnancies resulting from rape, according to the New York-based Guttmacher Institute. Many abortion funds report that high levels of women seeking abortion (up to 11 percent) are pregnant as a result of rape or incest, according to the Boston-based National Network of Abortion Funds (Ginty, Molly. 2005. “Some Hospitals Withhold Plan B After Rape.” Women’s ENews).

What is the estimation of abortion rates in Malaysia?
The following computation of the estimate of the abortion rate was originally submitted with the article but was removed during the editorial process. A computation of an estimate for the total number of annual abortions which did not appear in the original submission has been added here.

The abortion ratio refers to the number of abortions per 100 known pregnancies.
The abortion rate or incidence of abortion refers to the number of abortions per 1,000 women aged 15-44.

Given the following known statistics:
a) abortions per 100 live births (estimated) = 17 (Tey 2008);
b) number of Malaysian women aged 15-44 (2008) = 6,157,000 (WHO 2008);
c) Malaysia’s 2008 birth rate = 22.44 / 1000 persons in the population (Index Mundi 2008); and
d) total population of Malaysia in July 2008 (estimated) = 25,274,132 (US CIA 2008);

it is possible to compute a ballpark figure for the abortion rate in Malaysia as follows:
i) The abortion ratio, assuming that all known pregnancies resulted in live births, was estimated at 17.
ii) The total number of births in 2008 was:
(25,274,132 / 1000) x 22.44 = 567,152 births (rounded up).
iii) The number of births per 1,000 women, assuming they are aged 15-44, would be:
(1000 / 6157000) x 567,152 = 92.11.
iv) The estimated Malaysian abortion rate in 2008 was therefore:
(17 / 100) x 92.11 = 15.6.
v) And, finally, the annual number of abortions in Malaysia (2008) was:
(17 / 100) x 567152 = 96, 416 (rounded up); or 15.6 / 92.11 x 567152 = 96,054.

As a point of reference, the abortion rate for Southeast Asia is 16 (Singh et al 2009).