Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia

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Abstract

Purpose:

The 2005 expansion of the Ethiopian abortion law provided minors access to legal abortions, yet little is known about abortion among adolescents. This paper estimates the incidence of legal and clandestine abortions and the severity of abortion-related complications among adolescent and nonadolescent women in Ethiopia in 2014.

Methods:

This paper uses data from three surveys: a Health Facility Survey (n = 822) to collect data on legal abortions and postabortion complications, a Health Professionals Survey (n = 82) to estimate the share of clandestine abortions that resulted in treated complications, and a Prospective Data Survey (n = 5,604) to collect data on abortion care clients. An age-specific variant of the Abortion Incidence Complications Method was used to estimate abortions by age-group.

Results:

Adolescents have the lowest abortion rate among all women below age 35 (19.6 per 1,000 women). After adjusting for lower levels of sexual activity among adolescents however, we find that adolescents have the highest abortion rate among all age-groups. Adolescents also have the highest proportion (64%) of legal abortions compared with other age-groups. We find no differences in the severity of abortion-related complications between adolescent and nonadolescent women.

Conclusions:

We find no evidence that adolescents are more likely than older women to have clandestine abortions. However, the higher abortion and pregnancy rates among sexually active adolescents suggest that they face barriers in access to and use of contraceptive services. Further work is needed to address the persistence of clandestine abortions among adolescents in a context where safe and legal abortion is available.

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Most cited references 23

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Maternal age and fetal loss: population based register linkage study.

A M Nybo Andersen, J Wohlfahrt, P Christens … (2000)

To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. Prospective register linkage study. All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion leading to admission to hospital, induced abortion, ectopic pregnancy, or hydatidiform mole) in Denmark from 1978 to 1992; a total of 634 272 women and 1 221 546 pregnancy outcomes. Age related risk of fetal loss, ectopic pregnancy, and stillbirth, and age related risk of spontaneous abortion stratified according to parity and previous spontaneous abortions. Overall, 13.5% of the pregnancies intended to be carried to term ended with fetal loss. At age 42 years, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20-24 years and 74.7% in those aged 45 years or more. High maternal age was a significant risk factor for spontaneous abortion irrespective of the number of previous miscarriages, parity, or calendar period. The risk of an ectopic pregnancy and stillbirth also increased with increasing maternal age. Fetal loss is high in women in their late 30s or older, irrespective of reproductive history. This should be taken into consideration in pregnancy planning and counselling.

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The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008

Moore, Gebrehiwot, Fetters … (2016)

CONTEXT In 2005, Ethiopia’s parliament amended the penal code to expand the circumstances in which abortion is legal. Although the country has expanded access to abortion and postabortion care, the last estimates of abortion incidence date from 2008. METHODS Data were collected in 2014 from a nationally representative sample of 822 facilities that provide abortion or postabortion care, and from 82 key informants knowledgeable about abortion services in Ethiopia. The Abortion Incidence Complications Methodology and the Prospective Morbidity Methodology were used to estimate the incidence of abortion in Ethiopia and assess trends since 2008. RESULTS An estimated 620,300 induced abortions were performed in Ethiopia in 2014. The annual abortion rate was 28 per 1,000 women aged 15–49, an increase from 22 per 1,000 in 2008, and was highest in urban regions (Addis Ababa, Dire Dawa and Harari). Between 2008 and 2014, the proportion of abortions occurring in facilities rose from 27% to 53%, and the number of such abortions increased substantially; nonetheless, an estimated 294,100 abortions occurred outside of health facilities in 2014. The number of women receiving treatment for complications from induced abortion nearly doubled between 2008 and 2014, from 52,600 to 103,600. Thirty-eight percent of pregnancies were unintended in 2014, a slight decline from 42% in 2008. CONCLUSIONS Although the increases in the number of women obtaining legal abortions and postabortion care are consistent with improvements in women’s access to health care, a substantial number of abortions continue to occur outside of health facilities, a reality that must be addressed.

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Increased maternal age and the risk of fetal death.

R H Usher, J Schmittdiel, Janet McLean … (1995)

Although the fetal death rate has declined over the past 30 years among women of all ages, it is unknown whether particular characteristics of the mother, such as age, still affect the risk of fetal death. We undertook a study to determine whether older age, having a first child (nulliparity), or other characteristics of the mother are risk factors for fetal death. We used data from the McGill Obstetrical Neonatal Database to evaluate risk factors for fetal death among all deliveries at the Royal Victoria Hospital in Montreal (n = 94,346) from 1961 through 1993. Data were available for two time periods (1961 through 1974 and 1978 through 1993); data for 1975 through 1977 have not been entered into the data base and were therefore not included. Using logistic regression, we estimated the effect of specific maternal characteristics and complications of pregnancy on the risk of fetal death. The fetal death rate decreased significantly from 11.5 per 1000 total births (including live births and stillbirths) in the 1960s to 3.2 per 1000 in 1990 through 1993 (P < 0.001). Between these periods, the average maternal age at delivery increased from 27 to 30 years (P < 0.001), and the frequency of the diagnosis of diabetes and hypertension during pregnancy increased fivefold (P < 0.001). Nevertheless, after we controlled for these and other maternal characteristics, women 35 years of age or older continued to have a significantly higher rate of fetal death than their younger counterparts (odds ratio for women 35 to 39 years of age as compared with women < 30 years of age, 1.9; 95 percent confidence interval, 1.3 to 2.7; for those 40 or older, 2.4; 95 percent confidence interval, 1.3 to 4.5). Changes in maternal health and obstetrical practice have resulted in a 70 percent decline in the rate of fetal death among pregnant women of all ages since the 1960s. Advancing maternal age, however, continues to be a risk factor for fetal death.

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Author and article information

Journal

Journal ID (nlm-journal-id): 9102136

Journal ID (pubmed-jr-id): 1030

Journal ID (nlm-ta): J Adolesc Health

Journal ID (iso-abbrev): J Adolesc Health

Title: The Journal of adolescent health : official publication of the Society for Adolescent Medicine

ISSN (Print): 1054-139X

ISSN (Electronic): 1879-1972

Publication date Nihms-submitted: 29 July 2018

Publication date (Electronic): 14 March 2018

Publication date (Print): June 2018

Publication date PMC-release: 01 October 2018

Volume: 62

Issue: 6

Pages: 729-736

Affiliations

[a ]Guttmacher Institute, New York, New York

[b ]Ipas, Chapel Hill, North Carolina

Author notes

[* ]Address correspondence to: Elizabeth Sully, Ph.D., Guttmacher Institute, 125 Maiden Lane, New York, NY 10038. esully@ 123456guttmacher.org (E. Sully).

[1]

Present Address/Affiliation: African Population and Health Research Center, Manga Close, P.O. Box 10787-00100, Nairobi, Kenya.

Article

Manuscript ID: NIHMS982773

DOI: 10.1016/j.jadohealth.2017.12.015

PMC ID: 6166408

PubMed ID: 29550154

SO-VID: 076bdf06-9c07-4400-bd63-191d5cf40442

License:

This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia

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Tobacco Prevention & Cessation

Most cited references 23

Maternal age and fetal loss: population based register linkage study.

The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008

Increased maternal age and the risk of fetal death.

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