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      Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

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      Author(s): 1 , 2 , , 3
      Publication date (Electronic):
      Journal: Reproductive Health
      Publisher: BioMed Central

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          Abstract

          Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform.

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          Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries.

          Susheela Singh (2006)
          Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries. The WHO estimates that one in eight pregnancy-related deaths result from unsafe abortions. The social stigma and legal restrictions associated with abortion in many countries means that data on the magnitude of this problem are scarce; this article estimates the rate and numbers of hospital admissions resulting from unsafe abortions in developing countries to help quantify the problem. National estimates of abortion-related hospital admissions in women aged 15-44 years were compiled for 13 developing countries: Africa (Egypt, Nigeria, and Uganda), Asia (Bangladesh, Pakistan, and the Philippines), and Latin America and the Caribbean (Brazil, Chile, Colombia, Dominican Republic, Guatemala, Mexico, and Peru). These data were combined with supplementary data from five countries in sub-Saharan Africa (Burkina Faso, Ghana, Kenya, Nigeria, and South Africa) to give estimates for the three world regions. The annual hospitalisation rate varies from a low of about 3 per 1000 women in Bangladesh to a high of about 15 per 1000 in Egypt and Uganda. Nigeria, Pakistan, and the Philippines have rates of 4-7 per 1000, and two countries in Latin America with recent data have rates of almost 9 per 1000. In the developing world as a whole, an estimated five million women are admitted to hospital for treatment of complications from induced abortions each year. This equates to an average rate of 5.7 per 1000 women per year in all developing regions, excluding China. By comparison, in developed countries complications from abortion procedures or hospitalisation are rare. These results help quantify the magnitude of the adverse health effects of unsafe abortion in developing countries and highlight the need for improved access to post-abortion care. The provision of abortion services is changing to include the drug misoprostol and this could reduce the severity of abortion complications and the number of women who are hospitalised. Researchers will need to monitor these changes to provide countries with up-to-date information on illness and death from unsafe abortion. Improved contraceptive services are necessary to prevent unintended pregnancy. However, increasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, and remains a high priority for developing countries.
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            Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study.

            S. Saha, Roslin Botlero, Carine Ronsmans … (2007)
            Research on the effectiveness of strategies to reduce maternal mortality is scarce. We aimed to assess the contribution of intervention strategies, such as skilled attendance at birth, to the recorded reduction in maternal mortality in Matlab, Bangladesh. We examined and compared trends in maternal mortality in two adjacent areas over 30 years, by separate analyses of causes of death, underlying sociodemographic determinants, and areas and time periods in which interventions differed. We analysed survey data that was routinely collected between 1976 and 2005 for about 200 000 inhabitants of Matlab, in Bangladesh, in adjacent areas served by either the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) or by the government. We used logistic regression to assess time trends in maternal mortality. We separately analysed deaths due to direct obstetric causes, abortion-related causes, and other causes. Maternal mortality fell by 68% in the ICDDR,B service area and by 54% in the government service area over 30 years. Maternal mortality remained stable between 1976 and 1989 (crude annual OR 1.00 [0.98-1.01]) but decreased substantially after 1989 (OR 0.95 [0.93-0.97]). The speed of decline was faster after the skilled-attendance strategy was introduced in the ICDDR,B service area in 1990 (p=0.09). Abortion-related mortality fell sharply from 1990 onwards (OR 0.91 [0.86-0.95]). Educational differentials for mortality were substantial; the OR for more than 8 years of schooling compared with no schooling was 0.30 (0.21-0.44) for maternal mortality and 0.09 (0.02-0.37) for abortion mortality. The fall in maternal mortality over 30 years occurred despite a low uptake of skilled attendance at birth. Part of the decline was due to a fall in abortion-related deaths and better access to emergency obstetric care; midwives might also have contributed by facilitating access to emergency care. Investment in midwives, emergency obstetric care, and safe pregnancy termination by manual vacuum aspiration have clearly been important. However, additional policies, such as those that bring about expansion of female education, better financial access for the poor, and poverty reduction, are essential to sustain the successes achieved to date.
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              Caring for Women with Abortion Complications in Ethiopia: National Estimates and Future Implications

              Hailemichael Gebreselassie, Tamara Fetters, Susheela Singh … (2010)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Reprod Health
                Title: Reproductive Health
                Publisher: BioMed Central
                ISSN (Electronic): 1742-4755
                Publication date Collection: 2011
                Publication date (Electronic): 22 December 2011
                Volume: 8
                Page: 39
                Affiliations
                [1 ]Vice President, Research and Evaluation Unit, Ipas, P.O. Box 5027, Chapel Hill, NC 27514 USA
                [2 ]Senior Associate, Research and Evaluation Unit, Ipas, P.O. Box 5027, Chapel Hill, NC 27514 USA
                [3 ]Independent Consultant, Research and Evaluation Unit, Ipas, P.O. Box 5027, Chapel Hill, NC 27514 USA
                Article
                Publisher ID: 1742-4755-8-39
                DOI: 10.1186/1742-4755-8-39
                PMC ID: 3287245
                PubMed ID: 22192901
                SO-VID: c5aebf4e-ea26-4b83-a85e-450b151f34a3
                Copyright © Copyright ©2011 Benson et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 August 2011
                Date accepted : 22 December 2011
                Categories
                Subject: Review

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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