Estimating the costs of induced abortion in Uganda: A model-based analysis

Babigumira, Joseph B.; Stergachis, Andy; Veenstra, David L.; Gardner, Jacqueline S.; Ngonzi, Joseph; Mukasa-Kivunike, Peter; Garrison, Louis P.

doi:10.1186/1471-2458-11-904

Cited by 25 publications

(31 citation statements)

References 25 publications

(33 reference statements)

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“…11 Using Monte Carlo methods, a Ugandan study estimated that the average woman pays US$62 per abortion in direct costs, including those for any postabortion care. 14 However, very few studies have looked at the social and economic impact of unsafe abortion on women and their households. A study in Cambodia examined the number of days lost from a woman's normal routine, as well as the wages lost by the woman and her family members because of need for postabortion care and continuing morbidity from the abortion.…”

mentioning

confidence: 99%

Documenting the Individual- and Household-Level Cost of Unsafe Abortion in Uganda

Sundaram¹,

Vlassoff²,

Mugisha³

et al. 2013

IPSRH

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Induced abortion is common in Uganda. In 2003, the estimated rate was 54 abortions per 1,000 women aged 15-49; 1 although the rate may have changed somewhat since then, it is nonetheless likely among the highest in the world. 2 Uganda's abortion laws and policies are overall very restrictive, but contain inconsistencies that make it difficult for the medical community and women themselves to understand what is permitted (see Appendix A). As a result, almost all abortions are clandestine, and a large proportion are performed under dangerous conditions. 3As a result, unsafe abortion is one of the leading causes of maternal morbidity and mortality in the country. A study carried out in 1993 in three Kampala hospitals found that one in five maternal deaths were attributable to unsafe abortion; 4 more recently, a 2010 government document estimated that unsafe abortion is the cause of 8% of maternal deaths. 5 In 2011, Uganda had a maternal mortality ratio of 438 maternal deaths per 100,000 live births-well above the average of 240 per 100,000 among all developing countries-and unsafe abortion is likely an important contributor to these deaths. 6,7 Uganda also has a very high unmet need for contraception. The 2011 Uganda Demographic and Health Survey found that 34% of married women and 35% of sexually active unmarried women had an unmet need for contraception. 6 This high level of unmet need leads to a high incidence of unintended pregnancy; the rate of such pregnancies was 141 per 1,000 women aged 15-49 in 2003. 1 Because of Uganda's restrictive abortion law, many women with unintended pregnancies seek clandestine, unsafe abortions to meet their fertility goals. One of the consequences of unsafe abortion was documented by a nationally representative survey of health facilities, the results of which suggest that almost 85,000 women in Uganda were treated for complications of unsafe abortions in 2003.1 Furthermore, this estimate represents only a portion of the number of women with such complications, as many others do not obtain care at health facilities. The most frequent complications of unsafe abortion are incomplete abortion and hemorrhage; less common but more severe complications include trauma (such as punctures or tearing of the uterus) and sepsis. In addition, some women experience long-term health problems, including chronic pain, pelvic inflammatory disease and infertility. 8,9 Health complications resulting from unsafe abortion clearly constitute a serious burden for both women and the health care system. Less well understood, however, is the social and finan-

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confidence: 99%

Documenting the Individual- and Household-Level Cost of Unsafe Abortion in Uganda

Sundaram¹,

Vlassoff²,

Mugisha³

et al. 2013

IPSRH

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“…This baseline analysis of health-related quality of life and social support utilizes data from a prospective cohort study to evaluate the impact of abortion complications on health and economic outcomes of women in Uganda [2,10]. Between December 2009 and October 2010, we enrolled women at discharge who had been admitted to the Obstetric and Gynecology unit for treatment of complications resulting from induced abortions.…”

Section: Methodsmentioning

confidence: 99%

“…Recent studies in Uganda have documented the substantial economic costs associated with unsafe abortions and resulting complications. Babigumira et al [2], using a decision-analytic model to represent the consequences of an induced abortion, estimated an annual per-patient societal cost of $171, translating into $64 million in costs per year for the country. In an empirical analysis, Vlassoff et al [3] found that the annual cost of treating abortion complications was approximately $131 per case and $13.9 million per year in Uganda, and an estimated $20.8 million per year that would be needed to satisfy all demand for management of abortion complications in the country.…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life and social support among women treated for abortion complications in western Uganda

Levine

Jenny

Ngonzi

et al. 2013

Health and Quality of Life Outcomes

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BackgroundWhile the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found no reports of their impact on Health-Related Quality of Life (HRQoL), nor the role of social support in moderating such outcomes. In this study, we performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda.MethodsWe interviewed women who were discharged after treatment for abortion complications and, as a comparison, women visiting a regional referral hospital for routine obstetric care. We administered the EuroQol instrument and the Social Support Questionnaire Short-Form, and collected demographic and socioeconomic data. We performed descriptive analyses using t-tests, Wilcoxon rank-sum tests and chi-square tests, and multivariable linear regressions with interaction effects to examine the associations between abortion complications, EQ-5D utility scores and social support.ResultsOur study included 139 women (70 with abortion complications, and 69 receiving routine obstetric care). In four out of the 5 dimensions of the EQ-5D, a larger proportion of women with abortion complications reported “some or severe” problems than women receiving routine obstetric care (self-care: 42% v 24%, p=0.033; usual activities: 49% v 16%, p<0.001; pain/discomfort: 68% v 25%, p<0.001; and anxiety/depression: 60% v 22%, p<0.001). After adjusting for age, social support, wealth tertile, employment status, marital status, and HIV status, women with abortion complications had a 0.12 (95% CI: 0.07, 0.18, p < 0.001) lower mean EQ-5D utility score than those receiving routine obstetric care. An analysis of the modifying effect of social support showed that a one-unit higher average number of people providing social support was associated with larger mean difference in EQ-5D utility score when comparing the two groups, while a one unit higher average satisfaction score with social support was associated with smaller mean differences in EQ-5D utility score.ConclusionsOur study suggests that abortion complications are associated with diminished HRQoL and the magnitude of the association depends on social support. However, the mediating role of social support in a setting of social and legal proscriptions to induced abortion is complex.

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“…Mothers who unintentionally become pregnant opt for unsafe abortions due to the insufficiency and inaccessibility of safe abortion services, restrictive laws, high costs, and diligent objections by health care providers who observe the professional ethic of do not harm and due to insufficient knowledge of eligibility for safe abortion care . Nonetheless, in Asia and Europe, older women procure abortion mainly to limit or space births .…”

Section: Introductionmentioning

confidence: 99%

“…Adolescents from African countries may particularly pursue abortions because of probable consequences such as stigmatization . It is often procured through clandestine measures and in unhygienic hidden places, offered by untrained practitioners . These abortions are generally unsafe, accounting for 21% of the maternal deaths that occur annually, making it an issue of public health importance in the region.…”

Section: Introductionmentioning

confidence: 99%

Abortion among adolescents in Africa: A review of practices, consequences, and control strategies

Atuhaire

2019

Health Planning & Management

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Summary Background Developing countries register 98% of unsafe abortion annually, 41% of which occur among women aged between 15 and 25 years. Additionally, 70% of hospitalizations due to unsafe abortion are among girls below 20 years of age. Purpose This study unveils abortion practices in Africa, its consequences, and control strategies among adolescents. Methods Online databases that provided relevant information on the topic were searched. A Google Scholar search yielded 623 000 results, PubMed yielded 1134 results, African Journals Online yielded 110 results, and PsycINFO yielded eight results. A total of 25 studies published from 2000 to 2018 that met the Critical Appraisal Skills Programme (CASP) standard were thematically reviewed. Findings These studies indicated that abortion is a neglected problem in health care in developing countries, and yet decreasingly safe abortion practices dominate those settings. Adolescents who have unintended pregnancies may resort to unsafe abortion practices due to socio‐economic factors and the cultural implications of being pregnant before marriage and the legal status of abortion. Adolescents clandestinely use self‐prescribed drugs or beverages, insert sharps in the genitals, and most often consult traditional service providers. Abortion results in morbidities such as sepsis, severe anaemia, disabilities, and, in some instances, infertility and death. Such events can be controlled by the widening availability of and accessibility to contraceptives among adolescents, advocacy, and comprehensive sexuality education and counselling. Conclusion Adolescents are more likely to use clandestine methods of abortion whose consequences are devastating, lifelong, or even fatal. Awareness and utilization of youth‐friendly services would minimize the problem.

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Estimating the costs of induced abortion in Uganda: A model-based analysis

Cited by 25 publications

References 25 publications

Documenting the Individual- and Household-Level Cost of Unsafe Abortion in Uganda

Documenting the Individual- and Household-Level Cost of Unsafe Abortion in Uganda

Health-related quality of life and social support among women treated for abortion complications in western Uganda

Abortion among adolescents in Africa: A review of practices, consequences, and control strategies

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