Incidence of induced abortion in Malawi, 2015

Abstract

BackgroundIn Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates.MethodsWe conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology.ResultsWe estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures.ConclusionsThe estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi.

Effects of refresher training on the use of manual vacuum aspiration in the treatment of incomplete abortions: a quasi-experimental study in Malawi

“…7–9 Even though induced abortion is only legal to save a woman’s life, 7 it is estimated that around 140 000 induced abortions were performed in 2015. 10 Given this restrictive abortion law, most of them were likely clandestine and contributed to the high maternal mortality. There are ongoing discussions on how to modify the law; however, no change has been made so far.…”

Estimating Abortion Incidence: Assessment of a Widely Used Indirect Method

“…Sources Health Professional Surveys, in each country, based on opinions of key informants. See Bankole et al (2015), Basinga et al (2012), Keogh et al (2015), Mohamed et al (2015), Moore et al (2016), Polis et al (2017), Prada et al (2016), Puri et al (2016), Sathar et al (2014), Sedgh et al (2011Sedgh et al ( , 2015 and Singh et al (2017) Country treated for complications with official statistics or with results from other data collection approaches such as a Prospective Morbidity Survey (PMS); comparison of a multiplier based on the HPS with multipliers from population-based surveys; and AICM estimates of abortion incidence with estimates obtained through different methodologies, such as the secret ballot or sealed envelope approach.…”

“…More recently, researchers improved the approach by using estimates of the confidence interval around the number of women treated for abortion complications, which was feasible given the representative sample design used by HFS surveys. Examples include: Bangladesh , Pakistan (Sathar et al 2014), Malawi (Polis et al 2017) and Ethiopia . The HPS survey is based on a purposive sample of respondents, and until recently, a statistical approach for estimating confidence intervals around the multiplier had not yet been developed.…”

The duty to make abortion law transparent: A Malawi case study

“…Of these women, 15 000 needed uterine evacuation procedures requiring the government to spend an estimated US$314 000 in total . A follow‐up study in 2015 established that 141 000 women induced abortion, giving an abortion rate of 38 per 1000 women of reproductive age . 53 600 women were treated for complications in 2015, thereby significantly increasing the cost of care since 2009.…”

“…3 A follow-up study in 2015 established that 141 000 women induced abortion, giving an abortion rate of 38 per 1000 women of reproductive age. 4 53 600 women were treated for complications in 2015, thereby significantly increasing the cost of care since 2009. Abortion-related complications contribute to up to 18% of the maternal mortality ratio in Malawi.…”