Abortion is legal in South Africa, but over half of abortions remain unsafe there. Evidence suggests women who are (Black) African, of lower socioeconomic status, living with HIV, or residents of Gauteng, KwaZulu-Natal, or Limpopo provinces are disproportionately vulnerable to morbidity or mortality from unsafe abortion. Negative attitudes toward abortion have been documented in purposively sampled studies, yet it remains unclear what attitudes exist nationally or whether they differ across sociodemographic groups, with implications for inequities in service accessibility and health. In the current study, we analysed nationally representative data from 2013 to estimate the prevalence of negative abortion attitudes in South Africa and to identify racial, socioeconomic and geographic differences. More respondents felt abortion was ‘always wrong’ in the case of family poverty (75.4%) as compared to foetal anomaly (55%), and over half of respondents felt abortion was ‘always wrong’ in both cases (52.5%). Using binary logistic regression models, we found significantly higher odds of negative abortion attitudes among non-Xhosa African and Coloured respondents (compared to Xhosa respondents), those with primary education or less, and residents of Gauteng and Limpopo (compared to Western Cape). We contextualise and discuss these findings using a human rights-based approach to health.
While prosecutions of women who have had an illegal abortion are rare in Cameroon, women who have a legitimate claim to a legal abortion, e.g. following rape, can rarely take advantage of it. This is because the law in Cameroon is Not applied, either when it is violated or when it is indicated. This paper examines the histories of four young women who became pregnant and had an abortion in the Anglophone region of the Cameroon Grassfields. Three of them became pregnant following rape or sexual coercion, in one case by the girl's priest, in the second case by her employer's son, and in the third case by a stranger. The fourth young woman, who sold sex for survival money and food, had two abortions while in prison for committing infanticide following a failed attempt to abort an earlier pregnancy. The four young women were interviewed as part of a qualitative, hospital-based study among 65 women who had had abortions in 1996-97. The women's affecting personal histories illuminate the reality of living under a restrictive abortion law, the troubling conditions in which they have to manage their lives, and the harsh circumstances in which they become pregnant and seek (but may not find) a safe abortion.
Unsafe abortion in Kenya is a leading cause of maternal morbidity and mortality. In October 2012, we sought to understand the methods married women aged 24–49 and young, unmarried women aged ≤ 20 used to induce abortion, the providers they utilized and the social, economic and cultural norms that influenced women’s access to safe abortion services in Bungoma and Trans Nzoia counties in western Kenya. We conducted five focus groups with young women and five with married women in rural and urban communities in each county. We trained local facilitators to conduct the focus groups in Swahili or English. All focus groups were audiotaped, transcribed, translated, computerized, and coded for analysis. Abortion outside public health facilities was mentioned frequently. Because of the need for secrecy to avoid condemnation, uncertainty about the law, and perceived higher cost of safer abortion methods, women sought unsafe abortions from community midwives, drug sellers and/or untrained providers at lower cost. Many groups believed that abortion was safer at higher gestational ages, but that there was no such thing as a safe abortion method. Our aim was to inform the design of a community-based intervention on safe abortion for women. Barriers to seeking safe services such as high cost, perceived illegality, and fear of insults and abuse at public facilities among both age groups must be addressed.
In Mozambique, since 1985, induced abortion services up to 12 weeks of pregnancy are performed in the interest of protecting women's health. We asked whether any women were being adversely affected by the 12-week limit. A retrospective record review of all 1,734 pregnant women requesting termination of pregnancy in five public hospitals in Maputo in 2005-2006 revealed that it tended to be those who were younger and poorer, with lower levels of education, literacy and formal employment who were coming for abortions after 12 weeks. Countries such as Mozambique that endeavor to enhance equality, equity and social justice must consider the detrimental effect of narrow gestational limits on its most vulnerable citizens and include second trimester abortions. We believe the 12-week restriction works against efforts to reduce maternal deaths due to unsafe abortion in the country.
In Cameroon, induced abortion is permitted when a woman’s life is at risk, to preserve her physical and mental health and on the grounds of rape or incest. Objectives: The aim of this study was to determine the prevalence, reasons and complications of voluntary induced abortion among women attending the obstetrics and gynecology services in an urban area, Yaoundé and in a rural area, Wum in Cameroon. Methods: We carried out a cross sectional study, with 509 women recruited between August 1, 2011 and December 31, 2011 in three health facilities in Cameroon. We appreciated the frequency, complications and reasons for Voluntary induced abortions. Results: The prevalence of voluntary induced abortion was 26.3% (134/509) globally; 25.6% (65/254) in urban area and 27.1% (69/255) in rural area. One hundred and eleven (83%) cases of induced abortions were carried out in a health structure and 23 (17%) cases in private homes. Medical doctors and nurses were the most frequent abortion providers in both urban (84.7%) as well as rural setting (77.2%). The three main reasons for induced abortion were to pursue their studies (34.3%), not yet married (22.6%) and fear of parents (13.9%). Complications were reported by 20% (27/134) of respondents who had carried out voluntary induced abortion. Excessive bleeding was the most reported complication (70.4%). Conclusion: Despite its illegality in Cameroon, the prevalence of voluntary induced abortion was high in this study.
This paper offers an analysis of women's performance of unsafe abortion in rural Ghana despite significant cultural sanctions that forbid the practice. Findings demonstrate how women in the study balance sanctions inherent in traditional belief structures against their own immediate physical and social best interests. In rural Ghana, a woman's body is Not always her own to do with as she would wish. It is also a social body, which is embedded in multiple sets of relationships and subject to social regulation. Traditional authority over a woman's body belongs Not only to the community elders in the immediate physical environment of the village but also extends beyond time and space to immaterial ancestral persons who watch over the actions and behaviours of those on earth. Authority resides also with Mawu, the Ewe God, who is offended by the practice of abortion. Data from this study reveal that the performance of unsafe abortion in this Ewe community is a desperate act in which the women must Not only risk their physical lives, but must also step outside the boundaries of ideological cultural conformity to traditional values and carry the risk of their actions even into life after death.
"OBJECTIVES: Maternal mortality in Sierra Leone is one of the highest in the world and complications from unsafe abortion are one of the leading causes. This article reports the results of a 2012 study to assess the impact and costs of treatment of abortion complications on the country’s public health system, and estimate the costs of a shift to safe, legal abortion. METHODS: Records of post-abortion care (PAC) cases treated in 19 public hospitals in 2011 were reviewed to estimate the number of cases and clinical severity of presenting complications. Personnel time and amounts of supplies and medications to treat PAC cases were estimated by a panel of 16 experienced health care providers and applied to cost information from Ministry of Health records and international sources. The cost of safe abortion services was based on a team of experienced abortion provider estimates of time and supplies needed to provide first trimester induced abortion services. RESULTS: Deaths from unsafe abortion made up 10% of maternal mortality with a high abortion case-fatality rate of 1.73%. An estimated 3,379 women were treated for abortion complications in the hospitals, 21% of whom presented with clinically-moderate or severe complications. The proportion of cases with clinically moderate or severe complications was 32% at rural secondary facilities, compared to 18% at urban secondary facilities. The mean per-PAC-case cost overall was USD 68. Sierra Leone Government spends an estimated USD 231,000 annually to treat women with abortion complications in public hospitals. This cost could be reduced by an estimated 53% with a shift to safe induced abortion service provision. CONCLUSION: Unsafe abortion creates an undue treatment and economic burden on the health system of Sierra Leone. A shift to safe, legal abortion would dramatically reduce the current costs of PAC."
BACKGROUND: Complications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya. METHODS: A nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women's socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses. RESULTS: Over three quarters of abortions clients presented with moderate or severe complications. About 65 % of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7-48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3-7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79). CONCLUSION: Moderate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed. Factors such as delay in seeking care, interference with pregnancy, and unwanted pregnancies are important determinants of complication severity and fortunately these are amenable to targeted interventions.
Despite the availability of safe and highly effective methods of abortion, unsafe abortions continue to be widespread, nearly all in developing countries. The latest estimates from the World Health Organization put the figure at 21.6 million unsafe abortions worldwide in 2008, up from 19.7 million in 2003, a rise due almost entirely to the increasing number of women of reproductive age globally. No substantial decline was found in the unsafe abortion rate globally or by major region; the unsafe abortion rate of 14 per 1,000 women aged 15-44 years globally remained the same from 2003 to 2008. Modest reductions in unsafe abortion rates were found in 2008 as compared to 2003 in most sub-regions, however. The upward changes in rates in Middle Africa, Western Asia and Central America were due to better coverage and more reliable information in 2008 than in 2003. Eastern and Middle Africa showed the highest rates of unsafe abortion among all sub-regions. Some 47,000 women per year are estimated to lose their lives from the complications of unsafe abortion, almost all of which could have been prevented through better access to sexuality education, fertility awareness, contraception and especially safe abortion services.
Each year, nearly 22 million women worldwide have an unsafe abortion, almost all of which occur in developing countries. This paper estimates the incidence and rates of unsafe abortion by five-year age groups among women aged 15-44 years in developing country regions in 2008. Forty-one per cent of unsafe abortions in developing regions are among young women aged 15-24 years, 15% among those aged 15-19 years and 26% among those aged 20-24 years. Among the 3.2 million unsafe abortions in young women 15-19 years old, almost 50% are in the Africa region. 22% of all unsafe abortions in Africa compared to 11% of those in Asia (excluding Eastern Asia) and 16% of those in Latin America and the Caribbean are among adolescents aged 15-19 years. The number of adolescent women globally is approaching 300 million. Adolescents suffer the most from the negative consequences of unsafe abortion. Efforts are urgently needed to provide contraceptive information and services to adolescents, who have a high unmet need for family planning, and to women of all ages, with interventions tailored by age group. Efforts to make abortion safe in developing countries are also urgently needed.