Severity and Cost of Unsafe Abortion Complications Treated in Nigerian Hospitals

By Henshaw, Stanley K.; Adewole, Isaac et al. | International Family Planning Perspectives, March 2008 | Go to article overview

Severity and Cost of Unsafe Abortion Complications Treated in Nigerian Hospitals


Henshaw, Stanley K., Adewole, Isaac, Singh, Susheela, Bankole, Akinrinola, Oye-Adeniran, Boniface, Rubina, Hussain, International Family Planning Perspectives


CONTEXT: Each year, thousands of Nigerian women have unintended pregnancies that end in illegal abortion. Many such procedures occur under unsafe conditions, contributing to maternal morbidity and mortality.

METHODS: In a 2002-2003 survey of women and their providers in 33 hospitals in eight states across Nigeria, 2,093 patients were identified as being treated for complications of abortion or miscarriage or seeking an abortion. Women's abortion experiences and the health consequences and associated costs were examined through bivariate analysis. Multivariate analysis was used to examine the characteristics of women by type of pregnancy loss and to compare characteristics among three groups of women who had induced abortions in differing circumstances.

RESULTS: Among women admitted for abortion-related reasons, 36% had attempted to end the pregnancy before coming to the hospital (including 24% with and 12% without serious complications), 33% obtained an induced abortion at the facility (not withstanding the country's restrictive law) without having made a prior abortion attempt and 32% were treated for complications from a miscarriage. Of women with serious complications, 24% had sepsis, 21% pelvic infection and 11% instrumental injury; 22% required blood transfusion and 10% needed abdominal surgery. The women in this group were poorer and later in gestation than those who sought abortions directly from hospitals. They paid more for treatment (about 13,900 naira) than those who went directly to the hospital for an abortion (3,800 naira) or those treated for miscarriage (5,100 naira).

CONCLUSIONS: Policy and program interventions are needed to improve access to contraceptive services and postabortion care in order to reduce abortion-related morbidity and mortality.

International Family Planning Perspectives, 2008, 34(1):40-50

Abortion is legally restricted in most African countries, and in Nigeria it is permitted only to save the life of a pregnant woman. Nevertheless, the practice is common: According to an estimate based on a 1996 national survey of physicians and hospitals in Nigeria, 610,000 abortions occurred in a one-year period, a rate of about 25 abortions per 1,000 women of childbearing age (15-44 years). (1) This study also found that 27% of physicians in private practice performed abortions despite the legal restrictions.

A majority of the abortions in Nigeria take place under unsafe conditions and constitute a major source of maternal morbidity and mortality. A study based on the 1996 survey of physicians and hospitals estimated that 142,000 women were treated for complications of abortion each year, and experts believe that unsafe abortion accounts for at least 13% and possibly 30-40% of maternal deaths.(1-3) However, a substantial proportion of women having an abortion in Nigeria seek the procedure from a physician, often in a private clinic or hospital. Research in the mid-1990s, based on a nationally representative sample of facilities, estimated that 27% of women receiving abortion care were seeking an. abortion, 47% needed treatment for complications of an abortion attempt and 26% were treated for complications of a spontaneous abortion. (1) The present study provides new and comprehensive information from personal interviews of women with all types of pregnancy loss, and also obtains medical information from their providers.

Unsafe abortion is not only a significant cause of morbidity and mortality among women, but also an economic drain on the health care system. As in many other countries in the region, a high proportion of gynecological admissions to hospitals result from complications of unsafe induced abortion. Providing postabortion care to these women involves huge costs and thus diminishes the health care system's capacity to provide other needed services. (4) Reducing the burden of unsafe abortion on women, their families, health care providers and the fragile health care system presents an important policy challenge to Nigeria and similar developing countries. …

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