Academic journal article International Perspectives on Sexual and Reproductive Health

The Incidence of Induced Abortion in Malawi

Academic journal article International Perspectives on Sexual and Reproductive Health

The Incidence of Induced Abortion in Malawi

Article excerpt

CONTEXT: Abortion is legally restricted in Malawi, and no data are available on the incidence of the procedure.

METHODS: The Abortion Incidence Complications Methodology was used to estimate levels of induced abortion in Malawi in 2009. Data on provision of postabortion care were collected from 166 public, nongovernmental and private health facilities, and estimates of the likelihood that women who have abortions experience complications and seek care were obtained from 56 key informants. Data from these surveys and from the 2010 Malawi Demographic and Health Survey were used to calculate abortion rates and ratios, and rates of pregnancy and unintended pregnancy.

RESULTS: Approximately 18,700 women in Malawi were treated in health facilities for complications of induced abortion in 2009. An estimated 67,300 induced abortions were performed, equivalent to a rate of 23 abortions per 1,000 women aged 15-44 and an abortion ratio of 12 per 100 live births. The abortion rate was higher in the North (35 per 1,000) than in the Central region or the South (20-23 per 1,000). The unintended pregnancy rate in 2010 was 139 per 1,000 women aged 15-44, and an estimated 52% of all pregnancies were unintended.

CONCLUSIONS: Unsafe abortion is common in Malawi. Interventions are needed to help women and couples avoid unwanted pregnancy, reduce the need for unsafe abortion and decrease maternal mortality.

International Perspectives on Sexual and Reproductive Health, 2013, 39(2):88-96, doi:10.1363/3908813

Unsafe abortion is a public health concern for many developing countries. The World Health Organization has estimated that 21.6 million unsafe abortions and 47,000 abortion-related deaths occurred globally in 2008. (1) The vast majority (98%) of unsafe abortions take place in developing regions. The risk of death from unsafe abortion is highest in Sub-Saharan Africa, where an estimated 520 deaths occur per 100,000 unsafe abortion procedures, compared with about 30 per 100,000 in the developed world. (1)

Unsafe abortion is one of the major factors contributing to high levels of maternal mortality (pregnancy-related deaths). (2) Sub-Saharan Africa has the highest maternal mortality ratio in the world--an estimated 640 deaths per 100,000 live births in 2008, of which 14% were due to abortion complications. (1), (3) According to the 2010 Malawi Demographic and Health Survey (DHS), the average maternal mortality ratio during the seven-year period before the survey was 675 deaths per 100,000 live births (range, 570-780). (4) Although a comparison of maternal mortality ratios for 2004 and 2010 (984 and 675, respectively) shows a substantial decline, the rate of maternal deaths remains very high in Malawi. (3), (5) A study at a large facility in Malawi indicated that 24% of maternal deaths in 1999 were attributable to postabortion complications. (6)

Studies have shown that banning or severely restricting abortion does not reduce abortion rates, but instead affects the safety of the procedure. in regions where most women live under restrictive abortion laws, the estimated abortion incidence is higher than it is in regions comprising countries with liberal abortion laws. (1), (7) In countries with restrictive laws, not only do some women die from unsafe abortion, but many others suffer long-term health consequences, including chronic pain and sterility. (8)

In Malawi, abortion is legal only when performed to save a pregnant woman's life. (9) Despite this restrictive law, a study by the Family Planning Association of Malawi revealed that women in Malawi seek abortion for a variety of reasons, including poverty, unplanned pregnancy, coercion, shame and fear of being forced out of school. (10) In a 2004 study of Malawian adolescents, more than one-third of 15-19-year-olds and about one-fifth of 12-14-year-olds reported having one or more close friends who had tried to end a pregnancy. …

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