Clandestine induced abortion: prevalence,incidence and risk factors among women in a Latin American country

Background

Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country.

Methods

We conducted a large population-based survey of women aged 18–29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure.

Results

Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%– 12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%– 14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%– 3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07– 1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84– 0.91), geographic region (highlands: OR 1.56, 95% CI 1.23– 1.97; jungle: OR 1.81, 95% CI 1.41– 2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68– 0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23– 2.09; ≥ 3 partners: OR 2.79, 95% CI 2.12– 3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01– 1.72; ≥ 2 partners: OR 1.54, 95% CI 1.14– 2.02). Overall, 49.0% (95% CI 47.6%– 50.3%) of the women who reported being currently sexually active were not using contraception.

Interpretation

The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.In most developing countries, induced abortion is legal only if the pregnancy threatens the health or life of the mother. Many women, therefore, seek clandestine abortions, which are too often unsafe and place the woman at risk of complications and death.¹Forty percent of women live in countries where abortion is legally restricted.² In 2003, an estimated 55% of induced abortions in developing countries were unsafe, and 97% of all unsafe abortions were in developing countries.³ Induced abortion is highly restricted in most countries in Latin America and the Caribbean.¹ According to the World Health Organization (WHO), the region of Latin America and the Caribbean has the same estimated incidence of clandestine induced abortions as Africa (3% per year among women aged 15–44 years).⁴ It also has the highest proportion of maternal death from unsafe abortion (12%).⁵ Women who have complications from clandestine abortions may not seek medical help for fear of being reported to legal authorities by health care workers.^6,7Elimination of unsafe abortions is a key component of sexual and reproductive health care.⁸ There is a public health need to determine more accurately the burden of, and risk factors for, clandestine induced abortion in different countries. Because of data limitations, the WHO reports only regional estimates.⁴ The lack of official records and underreporting by those involved make this task difficult, requiring that estimates calculated by different methods be compared.Rates of clandestine induced abortion are estimated with the use of either direct methods, such as population-based surveys and surveys of providers of illegal abortions, or indirect methods, such as the application of multipliers to recorded rates of hospital admission or death attributed to induced abortions.^4,9We performed a large, representative, population-based survey to determine the prevalence and incidence of, and risk factors for, induced abortion in an urban population of a Latin American country where access to abortion services is legally restricted.