A new study by researchers at the U.S.-based Guttmacher Institute and Uganda’s Makerere University documents, for the first time, abortion rates and the severity of abortion-related complications among Ugandan adolescents aged 15–19. The study, published in Contraception, found that an estimated 57,000 abortions took place among Ugandan adolescents in 2013. The researchers also found that adolescents seeking postabortion care for complications resulting from an unsafe abortion or miscarriage did not face greater disadvantages in their abortion care experiences, compared with women older than 20. However, among those seeking postabortion care, unmarried women, including unmarried adolescents, were more likely than married women to experience severe complications.
Although Ugandan law allows abortion to save a woman’s life and national guidelines permit abortion under additional circumstances—including in cases of fetal anomaly, rape and incest, and if the woman is HIV-positive—safe and legal abortion is difficult to obtain. As a result, many women resort to unsafe abortion, which accounts for more than 10% of all maternal deaths in Uganda. An estimated 314,300 abortions occurred in Uganda in 2013 among all age-groups, and more than 93,000 women were hospitalized for complications from unsafe abortion.
Researchers found no differences between adolescents and older women seeking postabortion care in terms of their experiences with certain aspects of service provision: Adolescents were no more likely than older women to be past their first trimester of pregnancy, to report delays in seeking postabortion care or to have experienced severe complications.
"These findings challenge the perception that adolescents as a group fare worse than older populations when it comes to abortion-related care," says Elizabeth Sully, senior research scientist at the Guttmacher Institute and the study’s lead author. "Still, sexual and reproductive health services tailored to adolescents’ unique needs remain vital."
As of 2013, the adolescent abortion rate was lower than that among all women of reproductive age (28 per 1,000 women aged 15–19 vs. 39 per 1,000 women aged 15–49). Among women who were recently sexually active, however, adolescents had the highest abortion rate (76 vs. 56, respectively). Adolescents are less likely to be sexually active than older women, but they often face more barriers to obtaining high-quality contraceptive services.
"We need to better understand how marital status and other social factors influence adolescents’ sexual and reproductive health experiences," says Lynn Atuyambe, a researcher at Makerere University and one of the study’s authors. "More-effective strategies for addressing these inequities are critically needed."
The researchers underscore the need to provide adolescents with comprehensive sexuality education and family planning that is both age-appropriate and medically accurate. They recommend further research to understand how marriage and other factors, rather than age alone, may shape sexual and reproductive health experiences and outcomes. This information can be used to ensure that sexual and reproductive health programs meet the diverse needs of all adolescents.
"Estimating abortion incidence among adolescents and differences in postabortion care by age: a cross-sectional study of postabortion care patients in Uganda" by Elizabeth Sully, et al., is available online in Contraception.
