In the first nationally representative study of the incidence of abortion and the provision of postabortion care in Tanzania, researchers found that clandestine abortion is common and is a major contributor to maternal death and injury. The study, conducted by researchers at the U.S.-based Guttmacher Institute and Tanzania’s National Institute for Medical Research and Muhimbili University of Health and Allied Sciences, found that an estimated 405,000 abortions were performed in the country in 2013, the vast majority of which were clandestine procedures that put women’s well-being at risk. Because of an abortion law that is both highly restrictive and ambiguous, Tanzanian women generally seek clandestine abortions that are unsafe.

The researchers, who conducted surveys of health facilities and health professionals and reviewed population and fertility data, estimate that 66,600 women received postabortion care in health facilities for complications resulting from unsafe abortions in 2013. However, almost 100,000 women who experienced complications did not receive the medical attention they needed. These findings, the researchers hope, will help inform Tanzania’s ongoing efforts to decrease its maternal mortality ratios, which remain among the highest in the world.

 

"Recognizing that unsafe abortion is a leading cause of maternal death, the Tanzanian government has expanded the availability of postabortion care over the past decade, but significant gaps still exist and most women do not receive the care they need," said Sarah C. Keogh, senior research scientist at the Guttmacher Institute and the study’s lead author. "This study identifies many of those gaps and will inform strategies to ensure that every Tanzanian woman who needs it can access lifesaving postabortion care."

Tanzania’s national abortion rate—36 per 1,000 women of reproductive age—is similar to that in other East African countries. However, within Tanzania, abortion rates vary considerably by zone. The highest abortion rates are found in the Lake zone (51 per 1,000) and Southern Highlands (47 per 1,000), and the lowest rate is found in Zanzibar (11 per 1,000). These disparate abortion rates are associated primarily with differences in rates of contraceptive use and unintended pregnancy, and in the likelihood of women resorting to abortion in the event of an unintended pregnancy.

"In addition to postabortion care services, Tanzanian women need better access to a full range of contraceptive methods and family planning counseling so they can make informed decisions," said Godfather Kimaro, research scientist with Tanzania’s National Institute for Medical Research, who worked on the study. "In 2013, Tanzanian women had just over one million unintended pregnancies, 39% of which ended in abortion. Addressing the unmet need for contraception will reduce the unintended pregnancy rate and thereby the need for abortion and the deaths and injuries that often follow unsafe procedures."

The researchers recommend strengthening efforts to ensure universal access to postabortion care, which is currently unevenly available across zones. They suggest investments in making postabortion care available at all levels of the health care system, including training midlevel providers and adequately supplying health facilities with the necessary drugs and equipment. They also emphasize the importance of including the provision of contraceptive services as a routine part of postabortion care and urge that every woman treated for an abortion complication receive comprehensive contraceptive counseling and supplies. Finally, they recommend that the ambiguity in Tanzania’s abortion law be clarified to ensure that women can obtain safe and legal procedures to the full extent allowed. The researchers hope that the findings of this study will help inform policies and programs that will create more effective services and ultimately will improve the maternal and reproductive health outcomes of all Tanzanian women.

"Incidence of Induced Abortion and Post-Abortion Care in Tanzania" by Sarah C. Keogh of the Guttmacher Institute et al. is available online in PLoS ONE.

This study was made possible by grants from the Dutch Ministry of Foreign Affairs, the UK Government and the Norwegian Agency for Development Cooperation. The findings and conclusions contained within do not necessarily reflect the positions and policies of the donors.