OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil.METHODS Ecological study based on records of hospital admissions of women due to abortion in
Brazil between 1996 and 2012, obtained from the Hospital Information System of the
Ministry of Health. We estimated the number of unsafe abortions stratified by place of
residence, using indirect estimate techniques. The following indicators were calculated:
ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of
childbearing age. We analyzed temporal trends through polynomial regression and spatial
distribution using municipalities as the unit of analysis.RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were
recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country,
with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0
abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live
births). Unsafe abortion presented a declining trend at national level (R2:
94.0%, p < 0.001), with unequal patterns between regions. There was a significant
reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001),
Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2:
64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an
increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial
analysis identified the presence of clusters of municipalities with high values for
unsafe abortion, located mainly in states of the North, Northeast and Southeast
Regions.CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional
differences, mainly concentrated in the socioeconomically disadvantaged regions of the
country. Qualification of attention to women’s health, especially to reproductive
aspects and attention to pre- and post-abortion processes, are necessary and urgent
strategies to be implemented in the country.