Frequency, risk factors, and complications of induced abortion in ten districts of Madagascar: results from a cross-sectional household survey

Abstract

Background: Madagascar has restrictive abortion laws with no explicit exception to preserve the woman's life. This study aimed to estimate the incidence of abortion in the country and examine the methods, consequences, and risk factors of these abortions. Methods: We interviewed 3179 women between September 2015 and April 2016. Women were selected from rural and urban areas of ten districts via a multistage, stratified cluster sampling survey and asked about any induced abortions within the previous 10 years. Analyses used survey weighted estimation procedures. Quasi-Poisson regression was used to estimate the incidence rate of abortions. Logistic regression models with random effects to account for the clustered sampling design were used to estimate the risk of abortion complications by abortion method, provider, and month of pregnancy, and to describe risk factors of induced abortion. Results: For 2005-2016, we estimated an incidence rate of 18.2 abortions (95% CI 14.4-23.0) per 1000 person-years among sexually active women (aged 18-49 at the time of interview). Applying a multiplier of two as used by the World Health Organization for abortion surveys suggests a true rate of 36.4 per 1000 person-year of exposure. The majority of abortions involved invasive methods such as manual or sharp curettage or insertion of objects into the genital tract. Signs of potential infection followed 29.1% (21.8-37.7%) of abortions. However, the odds of potential infection and of seeking care after abortion did not differ significantly between women who used misoprostol alone and those who used other methods. The odds of experiencing abortion were significantly higher among women who had ever used contraceptive methods compared to those who had not. However, the proportion of women with a history of abortion was significantly lower in rural districts where contraception was available from community health workers than where it was not.

Prognostic Factors of Time to First Abortion After Sexual Debut Among Fragile State Congolese Women: A Survival Analysis

“…Furthermore, women from higher households wealth quintiles, educated, those who had ever used anything or tried to delay or avoid getting pregnant, had their rst birth before age 20 years and having higher total lifetime number of sex partners had higher risk of abortion among Congolese women. Although, there was no previous study identi ed anywhere in the world that examined the prognostic factors of time to rst abortion, however, these ndings are comparable with the results from previous studies that examined the factors associated with history of abortion (9,11,(21)(22)(23). Women of higher socioeconomic status will usually weigh the options on whether to keep a pregnancy or not, as such could have higher risk of rst abortion.…”

“…The factors examined in this study are based on previous studies related to abortion and presented in Table 1 below (9,11,(21)(22)(23). Total number of men that a women had sexual relationship with (1-2, 3-4, 5+) * For the calculation household wealth status, household assets such as ownership of television, radio, bicycle possessed by the household and housing quality such as type of oor, wall and roof were taken into consideration.…”

Prognostic factors of time to first abortion after sexual debut among fragile State Congolese women: a survival analysis

“…Furthermore, women from higher households wealth quintiles, educated, those who had ever used anything or tried to delay or avoid getting pregnant, had their rst birth before age 20 years and having higher total lifetime number of sex partners had higher risk of abortion among Congolese women. Although, there was no previous study identi ed anywhere in the world that examined the prognostic factors of time to rst abortion, however, these ndings are comparable with the results from previous studies that examined the factors associated with history of abortion (9,11,(29)(30)(31). Women of higher socioeconomic status will usually weigh the options on whether to keep a pregnancy or not, as such could have higher risk of rst abortion.…”

Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar

“…[4] A 2016 study in 10 districts found that 11% of sexually active women aged 18-49 had had at least one induced abortion in the previous 10 years; 27.7% of these women sought care for complications after the abortion, indicating that the abortions were unsafe. [16] In 2007, several UN agencies raised the issue of decriminalisation of abortion; this recommendation engendered significant backlash from the Catholic Church and the President. [18] The MOH proposed articles permitting abortion to save a woman's life to a 2017 law on reproductive health and family planning, but these articles were removed during debate.…”