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Elizabeth Renstrom for TIME

About half of all abortions that take place around the world are considered unsafe, a new report reveals.

Every year, an estimated 55.7 million abortions are performed worldwide. Among those, 25.5 million are not considered safe, according to a new report published in the journal The Lancet. Researchers from the World Health Organization (WHO) and Guttmacher Institute looked at abortions performed worldwide and classified the procedures as as safe, less safe and least safe, based on what methods were used and whether a trained provider was involved.

They found that 55% of abortions performed worldwide were considered safe, which meant that the abortions used a method that was recommended by the WHO, including medical abortion, vacuum aspiration or dilatation and evacuation, and that the abortion was provided and supported by someone who is trained in the procedure.

Among the unsafe abortions, nearly 31% were classified by the study authors as less safe. This meant that while the abortion was done by a trained provider, they may have used an outdated method. It also meant that the abortion may have been done with a currently advised method, but without the oversight of a professional.

Slightly more than 14% of abortions performed worldwide were classified as the least safe, which meant they were provided by someone who was untrained and used unsafe methods like sharp curettage.

“It’s sad that there are so many unsafe abortions, when actually the science and technology for making safe abortion assessable is very simple,” said study author Dr. Bela Ganatra, a scientist at the Department of Reproductive Health and Research at the WHO. “It’s something that can be provided at primary care level.”

The countries with the highest rates of unsafe abortions were also the countries that had the most restrictive laws regarding abortion. In the countries where abortion is legal and available, 87% of abortions were deemed safe. In countries where abortion is banned or only allowed to protect a woman’s health, only 25% of abortions were deemed safe.

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Regions with the most unsafe abortions were Africa and Latin America. However, the study authors note that abortions in Latin America were more likely to be classified as “less safe” rather than “least safe,” possibly because of the increased use there of misoprostol, a medication for abortion, rather than traditional unsafe procedures.

Ganatra says that having access to abortion is just one part of meeting women’s reproductive health needs. Contraception and sex education are also important, she says, but arguments to ban abortions or increase restrictions to the procedure are not helpful.

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“We found that [abortion] was no more common or less common based on the laws in each country, but we did see an association between the types of abortion laws and safety of abortions,” says Ganatra.

The report authors say that in order to address the high numbers of unsafe abortions around the world, more efforts are needed to ensure that unsafe methods are replaced with up-to-date methods, and more monitoring is needed to address gaps in care.

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