Academic journal article International Perspectives on Sexual and Reproductive Health

Documenting the Individual- and Household-Level Cost of Unsafe Abortion in Uganda

Academic journal article International Perspectives on Sexual and Reproductive Health

Documenting the Individual- and Household-Level Cost of Unsafe Abortion in Uganda

Article excerpt

CONTEXT: Although Uganda has a restrictive abortion law, illegal abortions performed under dangerous conditions are common. Data are lacking, however, on the economic impact of postabortion complications on women and their households.

METHODS: Data from a 2011-2012 survey of 1,338 women who received postabortion care at 27 Ugandan health facilities were used to assess the economic consequences of unsafe abortion and subsequent treatment. Information was obtained on treatment costs and on the impact of abortion complications on children in the household, on the productivity of the respondent and other household members, and on changes in their economic circumstances.

RESULTS: Most women reported that their unsafe abortion had had one or more adverse effects, including loss of productivity (73%), negative consequences for their children (60%) and deterioration in economic circumstances (34%). Women who had spent one or more nights in a facility receiving postabortion care were more likely than those who had not needed an overnight stay to experience these three consequences (odds ratios, 1.6-2.8), and women who had incurred higher postabortion care expenses were more likely than those with lower expenses to report deterioration in economic circumstances (1.6). Wealthier women were less likely than the poorest women to report that their children had suffered negative consequences (0.4-0.5).

CONCLUSIONS: The impact of complications of unsafe abortion and the expense of treating them are substantial for Ugandan women and their households. Strategies to reduce the number of unsafe procedures, such as by expanding access to contraceptives to prevent unintended pregnancies, are urgently needed.

International Perspectives on Sexual and Reproductive Health, 2013, 39(4):174-184, doi: 10.1363/3917413

Induced abortion is common in Uganda. In 2003, the estimated rate was 54 abortions per 1,000 women aged 15-49; (1) although the rate may have changed somewhat since then, it is nonetheless likely among the highest in the world. (2) Uganda's abortion laws and policies are overall very restrictive, but contain inconsistencies that make it difficult for the medical community and women themselves to understand what is permitted (see Appendix A). As a result, almost all abortions are clandestine, and a large proportion are performed under dangerous conditions. (3) As a result, unsafe abortion is one of the leading causes of maternal morbidity and mortality in the country. A study carried out in 1993 in three Kampala hospitals found that one in live maternal deaths were attributable to unsafe abortion; (4) more recently, a 2010 government document estimated that unsafe abortion is the cause of 8% of maternal deaths. (5) In 2011, Uganda had a maternal mortality ratio of 438 maternal deaths per 100,000 live births--well above the average of 240 per 100,000 among all developing countries--and unsafe abortion is likely an important contributor to these deaths. (6), (7)

Uganda also has a very high unmet need for contraception. The 2011 Uganda Demographic and Health Survey found that 34% of married women and 35% of sexually active unmarried women had an unmet need for contraception.' This high level of unmet need leads to a high incidence of unintended pregnancy; the rate of such pregnancies was 141 per 1,000 women aged 15-49 in 2003. (1) Because of Uganda's restrictive abortion law, many women with unintended pregnancies seek clandestine, unsafe abortions to meet their fertility goals.

One of the consequences of unsafe abortion was documented by a nationally representative survey of health facilities, the results of which suggest that almost 85,000 women in Uganda were treated for complications of unsafe abortions in 2003.1 Furthermore, this estimate represents only a portion of the number of women with such complications, as many others do not obtain care at health facilities. The most frequent complications of unsafe abortion are incomplete abortion and hemorrhage; less common but more severe complications include trauma (such as punctures or tearing of the uterus) and sepsis. …

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