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

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.

Estimating abortion incidence among adolescents and differences in postabortion care by age: a cross-sectional study of postabortion care patients in Uganda

“…To estimate the incidence of abortion among adolescent women, we used an age-specific variant of the Abortion Incidence Complications Method [ 28 ]. We indirectly estimated abortion incidence through the use of three surveys conducted in Uganda in 2013: a nationally representative Health Facilities Survey (HFS) that provided data on the number of postabortion complications cases ( n =418); a Health Professionals Survey (HPS) of purposively selected, knowledgeable key informants used to assess the proportion of all abortions resulting in treated complications ( n =147); and a Prospective Morbidity Survey (PMS) which collected data on PAC patients obtaining services from a nationally representative sample of health facilities ( n =2169).…”

“…The Abortion Incidence Complications Method assumes that only women with late miscarriages (13–22 weeks) will go to a facility for PAC. In order to estimate the risk of late miscarriage by age, we drew on clinical data from Harlap et al [ 35 ] to construct age-specific life tables, which are available in an appendix to Sully et al [ 28 ]. As not all late miscarriages will result in facility-based care, we assumed that the proportion of women receiving care for late miscarriages in a facility is equal to the proportion that gives birth in a facility.…”

“…Recent analyses of national data from the Republic of Congo, Ethiopia, Gabon and Ghana found that abortions do not occur disproportionately among adolescents [ 27 ]. In addition, many adolescents are not sexually active, meaning that abortion rates may underrepresent abortion among at-risk adolescents; a recent analysis in Ethiopia, for example, found sexually active adolescents to have the highest abortion rate among all age groups [ 28 ]. Further, a national study of PAC patients in Malawi found adolescents to have similar abortion complications and gestational ages as nonadolescents [ 23 ].…”

Post-Abortion Family Planning Utilization and Associated Factors Among Women Seeking Abortion Service: Cross-Sectional Study

“…In addtiotion, from the unintended pregnancies occured between 2015 and 2019 years, 61% of them ended in abortion [8]. Out of worldwide induced, abortion half of them were unsafe abortion, contributing about 13% of all maternal deaths [7, 9,10].…”

Pregnancy History and Associated Factors Among Hawassa University Regular Undergraduate Female Students, Southern Ethiopia

“…Many of these abortions take place in legally restrictive settings [13,[15][16][17]. In Ethiopian students having unintended pregnancy is about 32.4% [18]; more likely ends with abortion complications [19].…”