September 2012 Special Supplement to the International Journal of Gynecology and Obstetrics

August 28, 2012

Complications due to unsafe abortion contribute substantially to maternal injury and death, and most of these complications occur in the developing world. The unsafe abortion rate in developing countries, which declined for a period leading up to 2003, has since remained stagnant at 16 abortions per 1,000 women aged 15–44. Given this high rate of risky procedures, developing countries account for 98% of all unsafe abortions.

To help bring together the most recent research on the consequences of unsafe abortion, the International Journal of Gynecology and Obstetrics published a special supplement to their September 2012 issue, edited by Susheela Singh, vice president for research at the Guttmacher Institute, and members of the International Union for the Scientific Study of Population panel on abortion research. The supplement examines morbidity and mortality; costs to health systems, women and families; and the social consequences of unsafe abortion.

Here’s what you can find in this special supplement to the International Journal of Gynecology and Obstetrics:

In Colombia, wider misoprostol use and better access to health care lead to an increased number of women receiving treatment for abortion complications

Between 1992 and 2008, there were large increases in Colombian women’s use of misoprostol to induce abortion. This has reduced the health risks previously associated with clandestine abortion procedures, such as those performed by traditional midwives. By 2009, half of women who obtained an abortion in Colombia used misoprostol, according to "Health Consequences of Unsafe Abortion in Colombia 1989–2008," a new study by independent consultant Elena Prada; Susheela Singh, Guttmacher Institute; and Cristina Villarreal, Fundación Oriéntame. Furthermore, because of impressive gains in general health care coverage among Colombian women between 1992 and 2008, the proportion of women in need of postabortion care who did not receive required medical attention fell from 46% to 21%. The researchers, who analyzed data from a nationally representative survey of health facilities and a selected group of health professionals, found that although poor rural women were less likely than other groups to use misoprostol, they experienced a likely net improvement in safety.

However, over the same time period, the proportion of women experiencing abortion complications increased from 29% to 33%, and the rate of hospitalization for the treatment of abortion complications rose by 26%—two trends that are due, in part, to an increase in ineffective and incorrect misoprostol use. The authors emphasize that health care providers, pharmacists and pregnant women themselves need better information on the correct use of the drug. They also argue in favor of devoting special attention to poor and rural women, who are the most likely to develop complications and the least likely to receive treatment.

In Brazil, abortion-related complications declined significantly between 1992 and 2009

The number of women treated for abortion complications in Brazil declined by 41% between 1992 and 2009, from 282,000 to 165,000. Over the same time period, the rate of women treated for abortion-related complications declined by 57%, from 7.1 to 3.1 per 1,000 women aged 15–44, according to "Trends in Hospitalization for Abortion Complications and the Potential Impact of Misoprostol Use: The Case of Brazil," by Susheela Singh, Guttmacher Institute; Mario Monteiro, Institute of Social Medicine, Brazil; and Jacques Levin, DATASUS, Ministry of Health, Brazil. The decline was greater in the treatment of serious complications than in the treatment of those that were less serious (69% vs. 52%). The authors, who analyzed hospital admissions data from the Ministry of Health’s national health statistics system, found that abortion treatment rates varied by region and by women’s economic status.

The authors suggest several possible reasons for overall declines in treatment for abortion-related complications, including increased use and availability of misoprostol; improved access to health care services; and a dramatic improvement in the country’s economic conditions.

In Ethiopia, improved contraceptive services would save lives and reduce expenditures for postabortion care

Every dollar spent on family planning services in Ethiopia could save six dollars in postabortion care services, according to "The Health Systems Cost of Postabortion Care in Ethiopia," by Michael Vlassoff, of the Guttmacher Institute, et al. The study, which provides the first comprehensive national estimates of health care costs associated with postabortion care in Ethiopia, found the direct costs of treating postabortion complications in 2008 stood at $7.6 million, an average of $36 per patient. Including indirect costs, such as capital and overhead, which were not investigated in the study, would bring the national total to at least $11.5 million. In addition, women themselves pay more than 75% of the total cost of treatment, a much higher proportion than they pay for other reproductive health services. The authors relied on interviews with key informants from a national sample of health facilities who provided estimates of costs to the health system of providing postabortion care.

The study is part of a larger investigation of the incidence of abortion in Ethiopia, which found that 382,000 abortions occurred in Ethiopia in 2008, and that the vast majority of these procedures were likely unsafe. An estimated 220,000 women—58% of those who had had an abortion—experienced complications that required medical treatment. However, approximately 170,000 of these women—44% of abortion patients who had experienced complications—did not receive the medical care they required, indicating a large need for increased postabortion care.

About 1.7 million unintended pregnancies occur every year in Ethiopia, largely due to unmet need for contraception. The authors recommend that public health interventions aimed at improving the provision of family planning services and preventing unplanned pregnancy would decrease abortion levels and reduce overall health care costs.

The following articles also appear in this special supplement to the International Journal of Gynecology and Obstetrics: