Percent of deaths related to unsafe abortion
The proportion of maternal mortality that can be attributed to unsafe abortion. Unsafe abortion is defined by WHO as a procedure meant to terminate an unintended pregnancy that is performed by individuals without the necessary skills, or in an environment that does not conform to the minimum medical standards, or both.
This indicator is calculated as:
(Total number of deaths related to unsafe abortion/ Total number of maternal deaths) x 100
Because of the social and political sensitivity surrounding induced abortion, it is very difficult to conduct high-quality research to measure its incidence. Consequently, there are large evidence gaps in the documentation of abortion incidence and abortion-related morbidity. The 2010 document, “Methodologies for Estimating Abortion Incidence and Abortion-Related Morbidity: A Review” by the Guttmacher Institute is a useful resource for calculating this indicator.
Country-specific maternal mortality data, best-guess incidence of unsafe abortion
The number of maternal deaths due to unsafe abortions is usually estimated from community reports or hospital data of abortion deaths as a percentage of all maternal deaths. For some countries national reproductive age mortality surveys and/or official reporting provide data.
National community studies or reporting are assumed to provide the best estimate available and are used without adjustments. For a small number of countries for which no information is available, an assumption is made that they have the same percentage of abortion-related maternal mortality as other countries in the region, or as other countries having similar abortion laws, total fertility rate, contraceptive use, and percentage hospital deliveries, and data can be extrapolated from national or sub-national abortion data using the regional and global estimation process.
Evaluations of available data for a country consider a wide range of abortion research to make appropriate assumptions and adjust as needed to approximate the most probable magnitude of unsafe abortions for a given country.
This indicator measures to what extent unsafe abortion contributes to national estimates of maternal mortality. Unsafe abortion is one of the five major causes of maternal mortality and accounts for 13% of maternal deaths globally but up to 50% in sub-Saharan Africa (Rogo 2004). It accounts for 70,000 maternal deaths each year and causes a further 5 million women to suffer temporary or permanent disability. (Shah I and Ahman E 2009). Yet unsafe abortion is the most easily preventable and treatable cause of maternal death and disability (Rogo 2004). The determinants of unsafe abortion include restrictive abortion legislation, poor social support, lack of female empowerment, inadequate contraceptive services and poor health-service infrastructure.
Unsafe abortions occur primarily in the developing world. In many less developed countries, access to appropriate services at the primary level, a functioning referral system, and the inclusion of quality postabortion care with essential counseling and contraception remains poor or nonexistent (Fawcus SR 2008). Even when such care is available, distance, cost and the stigma often associated with abortion can discourage women from seeking treatment. Because of these barriers, poor women are the most likely to experience complications from unsafe abortion. The Millennium Development Goal to improve maternal health is unlikely to be achieved without addressing unsafe abortion and associated mortality and morbidity.
In countries where induced abortion is restricted and inaccessible, or even where abortion is legal but difficult to obtain, little information is available on abortion incidence and practices. Whether legal or illegal, induced abortion is generally stigmatized and frequently censured by religious teaching. Because of the difficulty of quantifying and classifying abortion in such circumstances, its occurrence tends to be unreported or under-reported. Surveys show that under-reporting occurs even where abortion is legal and, when taking place in clandestine circumstances, it may not be reported at all or declared a spontaneous abortion (miscarriage).
Abortion statistics are therefore notoriously incomplete, and it is recognized that in countries where induced abortion is restricted or illegal, its magnitude can only be estimated indirectly and with great difficulty. Estimates will have to be adjusted for mis- and under-reporting, as data available from community studies and hospital data will only show the “tip of the iceberg”. The adjustments will largely depend on the methods used for abortion, and on assumptions of its relative incidence in rural and urban areas. Estimates of the incidence of unsafe abortion and resulting maternal mortality have a degree of uncertainty. They should be considered only as best estimates relying on the information currently available.
Singh S, Remez L and Tartaglione A,eds., Methodologies for Estimating Abortion Incidence and Abortion-Related Morbidity: A Review, New York: Guttmacher Institute; and Paris: International Union for the Scientific Study of Population, 2010.
Shah I. and Ahman E. “Unsafe abortion: global and regional incidence, trends, consequences, and challenges,” Journal of Obstetrics and Gynaecology Canada (12) 2009: 1149-58.
Fawcus S.R. “Maternal mortality and unsafe abortion,” Best Practice and Research. Clinical Obstetrics and Gynaecology (3) 2008: 533-48.
Guttmacher Institute. Abortion Worldwide: A Decade of Uneven Progress, 2009.
Rogo K.O. “Unsafe abortion and maternal mortality: is Africa prepared to face the reality?” East African Medical Journal February 2004: 61-62.