Induced Abortion and Unintended Pregnancy in Guatemala

Article excerpt

CONTEXT: Although Guatemalan law permits induced abortion only to save a woman's 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 women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.

International Family Planning Perspectives, 2006,32(3):136-145

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Unsafe abortion is a leading cause of reproductive morbidity and mortality in countries where abortion is illegal or severely restricted, as is the case in Guatemala. (a) In these settings, abortion is a clandestine event that is poorly documented and difficult to study. Little empirical research on abortion has been conducted in Guatemala, and no national-level data on abortion incidence are available. As a result, there is limited public awareness of the issue of unsafe abortion, its consequences for women's health or its impact on the health care system.

In Guatemala, abortion is against the law except to save a woman's life. (1) Nonetheless, the little evidence that is available suggests that induced abortion is common. Much of this evidence is based on women hospitalized for treatment of abortion complications. However, Ministry of Health reports of the number of women treated for abortion complications in all hospitals are acknowledged to be undercounts. (2) A large-scale surveillance initiative, part of the Postabortion Care Program of the Epidemiological Research Center in Sexual and Reproductive Health (CIESAR), reported that 13,928 incomplete abortions were treated in 22 public hospitals between July 2003 and December 2004. (3) Other hospital-based studies further support the conclusion that induced abortion is common. One study of abortion patients treated in six hospitals between August 1993 and July 1994 found that about 50% were likely to have had induced abortions (4), a 1995 Ministry of Health study found that 76% of abortion patients in seven hospitals had had a previous abortion. (5) Treatment of abortion complications results in substantial costs to hospitals: In a study conducted over five months in 2000 at a Coatepeque hospital, 30% of the maternity budget and 10% of the total hospital budget were spent treating abortion complications. (6)

According to a recent government study on maternal mortality, abortion is the third most important cause of maternal deaths. (7) A four-year surveillance program carried out in the Guatemala City metropolitan area found that between 1993 and 1996, 110 of 435 maternal deaths were due to infection, and 34 of these were related to induced or spontaneous abortion. …