Illegal Abortion: An Attempt to Assess its Cost to the Health Services and its Incidence in the Community

Abstract

This article describes a study designed to test a method for assessing the cost to the health services of illegally induced abortion and the feasibility of estimating the incidence of induced abortion by a field interviewing approach. The participating centers included three hospitals in Ankara, Turkey; three hospitals in Ibadan, Nigeria; one hospital in Caracas and one in Valencia, Venezuela; and two hospitals in Kuala Lumpur, Malaysia. Hospitalized abortion cases were classified as induced or spontaneous or as "probably induced," "possibly induced," or "unknown" according to a classification scheme comprising certain medical criteria. The sociodemographic characteristics of induced and spontaneous abortion cases were subjected to discriminant function analysis and the discriminating variables best characterizing the induced versus the spontaneous abortion groups were identified for each center. On the basis of this analysis, the "probably" and "possibly" induced and "unknown" categories were further classified as induced or spontaneous abortion, with stated probabilities. Thus an overall estimate is made of the proportion of all hospitalized abortions that can be considered illegally induced outside the hospital. Selected results on costs of induced and spontaneous abortion are shown. The method further tested the feasibility of obtaining valid survey data on abortion from the communities studied by re-interviewing the women hospitalized for induced and spontaneous abortion six months later in their homes. This exercise showed a degree of under-reporting of abortion that varied widely among centers, even among women who had admitted illegal induction at the time of hospitalization. The feasibility of estimating the incidence of illegal abortion by field studies is discussed in the light of these findings.

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

“…Therefore, in this study, all women being treated for pregnancy loss were interviewed, and information from both the patient and the provider were used to determine the likelihood that the woman's abortion had been induced. We used an algorithm, developed by the World Health Organization (WHO), 19 that classifies women into four mutually exclusive groups: those who certainly had had an induced abor-*Consent was obtained by a provider who was not involved in the patient's care. †Of the 729 women we attempted to interview at follow-up, we classified 35% as certainly having had an induced abortion, 47% as probably or possibly having had such an abortion and the remaining 18% as having had a spontaneous abortions.…”

Caring for Women with Abortion Complications in Ethiopia: National Estimates and Future Implications

“…The methodology, which was developed by a WHO task force, has been adapted and used to measure the severity of abortion-related complications in countries as diverse as South Africa, Cambodia and Kenya. 8,[19][20][21][22][23] For this study, we reviewed data collection instruments from Kenya and Cambodia and revised them on the basis of input obtained from a panel of experts and investigators.…”

“…The symptom severity index used in this research was initially developed as a tool to distinguish miscarriages from unsafely induced abortions. 21 Self-reports of induction attempts, moderate and severe morbidity, and abortion complications in the second trimester of pregnancy are infrequent among women who have had a miscarriage, but they are strongly associated with attempted unsafe abortion.…”

Management of incomplete abortion in South African public hospitals

“…The management of incomplete abortions drains resources in these already underresourced countries 2 , more so when unnecessary technology is used. In South Africa, the legislation has changed from restrictive laws to legislation that allows for legal termination of pregnancy on request up to 13 weeks of gestation and for a number of conditions including socio-economic conditions to the end of the 20th week of gestation.…”