Unsafe Abortion: 7 Million Women Treated Globally Each Year

Beth Skwarecki

August 19, 2015

Complications from unsafe abortion resulted in treatment at a hospital or other health facility for an estimated 7 million women worldwide in 2012, or 6.9 of every 1000 women aged 15 to 44 years. That rate rises to 7.4 when excluding countries in which abortion is legal and widely accessible.

The estimates, derived from both health systems data and a nonsystematic review of published studies, come from 26 countries and were published online August 19 in BJOG.

The number of women receiving treatment after unsafe abortions has increased since 2005, when 5 million women were estimated to require health facility treatment. Since then, medical abortions with misoprostol have replaced riskier methods, but the drug is often used incorrectly. Expanded access to healthcare may have increased the proportion of women with complications who were able to access care.

Treatment rates varied from 2.4 per 1000 reproductive-age women in Brazil to 14.6 per 1000 in Pakistan. In Africa, Kenya, Malawi, and Uganda had the highest rates, at 13.4, 10.2, and 11.8, respectively, whereas Ethiopia and Mauritius had very low rates at, 3.2 and 3.9. In Latin America, the Dominican Republic had the highest rate, at 10.3, and Brazil the lowest, at 2.4.

Most of the published studies asked senior health facility staff to estimate the number of women seeking care for complications after the end of a pregnancy, including both abortion and miscarriage. The researchers then estimated the number of miscarriages based on known rates of miscarriage at different ages of gestation, and the assumption that women are more likely to need postmiscarriage care when the miscarriage occurs after 12 weeks. In those cases, the proportion of women who obtain health facility care was assumed to be the same as the proportion of mothers who deliver in a health facility instead of at home. For a handful of African countries in which health facility delivery rates were especially low, investigators assumed that women are more likely to seek care for miscarriage than for birth.

Ten countries had data on abortion complication rates (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, codes O00 - O08) available from health systems for the years 2009 to 2013. Some of the codes could apply to complications not associated with abortion, such as O02 for other abnormal products of conception, so the investigators adjusted these numbers according to previously published data on how often such complications occur biologically.

"Treatment rates are a function of both the underlying levels of morbidity associated with unsafe [termination of pregnancy], and access to postabortion care at health facilities.... Nevertheless, treatment rates are a useful measure of the load borne by health systems in the developing world from complications caused by unsafe [termination of pregnancy]," write the authors.

On the basis of previous estimates, the authors write, only 60% of women with complications seek care in health facilities, so the number of women experiencing complications may be substantially larger than indicated by the calculations from this study. The mortality rate from unsafe abortion also has fallen in recent years, suggesting that although more women seem to be experiencing complications, fewer of them are severe.

The authors have disclosed no relevant financial relationships.

BJOG. Published online August 19, 2015. Full text

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