Elena Prada

The incidence of induced abortion in Uganda.

CONTEXT Although Ugandas law permits induced abortion only to save a womans life, many women obtain abortions, often under unhygienic conditions. Small-scale studies suggest that unsafe abortion is an important health problem in Uganda, but no national quantitative studies of abortion exist. METHODS A nationally representative survey of 313 health facilities that treat women who have postabortion complications and a survey of 53 professionals who are knowledgeable about the conditions of abortion provision in Uganda were conducted in 2003. Indirect estimation techniques were applied to the data to calculate the number of induced abortions performed annually. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and its four major regions. Data on contraceptive use and unmet need were obtained from Demographic and Health Surveys. RESULTS Each year, an estimated 297,000 induced abortions are performed in Uganda, and nearly 85,000 women are treated for complications. Abortions occur at a rate of 54 per 1,000 women aged 15-49 and account for one in five pregnancies. The abortion rate is higher than average in the Central region (62 per 1,000 women), the countrys most urban and economically developed region. It is also very high in the Northern region (70 per 1,000). Nationally, about half of pregnancies are unintended; 51% of married women aged 15-49 and 12% of their unmarried counterparts have an unmet need for effective contraceptives. CONCLUSIONS Unsafe abortion exacts a heavy toll on women in Uganda. To reduce unplanned pregnancy and unsafe abortion, and to improve womens health, increased access to contraceptive services is needed for all women.

Induced abortion and unintended pregnancy in Guatemala.

CONTEXT Although Guatemalan law permits induced abortion only to save a womans life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist. METHODS Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions. RESULTS Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15-49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29-30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women. CONCLUSIONS Unsafe abortion has a significant impact on womens health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.

Induced abortion in Colombia: new estimates and change between 1989 and 2008.

CONTEXT Although abortion was made legal in Colombia under selected circumstances in 2006, no national studies have examined whether the incidence of the procedure has changed since the previous estimate in 1989. METHODS Data on the number of women treated for abortion complications were obtained from a nationally representative survey of 300 public and private health facilities, and estimates of the likelihood that women obtaining abortions experience complications and receive treatment at a facility were obtained from a survey of 102 knowledgeable professionals. Indirect estimation techniques were used to calculate national and regional abortion measures for 2008, which were compared with previously published 1989 estimates. Numbers and rates of unintended pregnancy were also calculated. RESULTS In 2008, an estimated 93,300 women were treated for induced abortion complications in public and private health facilities. An estimated 400,400 induced abortions were performed, which translates to a rate of 39 per 1,000 women aged 15-44, a slight increase from 1989 (36 per 1,000). Rates varied widely across regions, from 66 in Bogotá to 18 in Oriental. Despite the new abortion law, only 322 legal abortions were performed in 2008. Between 1989 and 2008, the proportion of pregnancies ending in induced abortion increased from 22% to 29%, and the proportion of pregnancies that were unintended rose from 52% to 67%. CONCLUSION Improvements in provision of and access to contraceptive and legal abortion services are needed to meet the increased demand among women and couples to prevent unintended pregnancy and unsafe abortion.

Health consequences of unsafe abortion in Colombia, 1989–2008

The number of Colombian women hospitalized for the treatment of induced abortion complications increased from 57 679 in 1989 to 93 336 in 2008; the hospitalization rate also rose: from 7.2 to 9.1 cases per 1000 women aged 15–44 years. Factors that likely underlie the increase include improved access to postabortion care (although 1 in 5 women still do not obtain the care they need) and the growing role of misoprostol, often used incorrectly and to some extent replacing the use of surgical abortion by doctors. Efforts are evidently needed to improve access to safe abortion and effective contraception.

The cost of postabortion care and legal abortion in Colombia.

CONTEXT Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. METHODS The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. RESULTS The median direct cost of treating a woman with abortion complications ranged from

Incidence of Induced Abortion in Uganda 2013: New Estimates Since 2003.

44 to

Abortion and Postabortion Care in Guatemala: A Report from Health Care Professionals and Health Facilities

141 (in U.S. dollars), representing an annual direct cost to the health system of about

Reducing unintended pregnancy and unsafe abortion in Uganda.

14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians,

Ensuring a healthier tomorrow in Central America: Protecting the sexual and reproductive health of todays youth.

213 and

Maternal Near-Miss Due to Unsafe Abortion and Associated Short-Term Health and Socio-Economic Consequences in Nigeria

189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower (