Where contraception is available and affordable, abortion should rarely be necessary; when it is necessary, however, it should be accessible and safe. Abortion rates in the European Region have declined between 2000 and 2013 from 431 to 234 abortions per 1000 live births. However, up to 20% of all deaths during pregnancy in several countries are due to unsafe abortion. In some countries, there are more abortions than births. The countries of central and eastern Europe are estimated to have the highest abortion rates in the world.