The global cost of unsafe termination of pregnancyPublished on 08/20/15
Seven million women a year in the developing world are treated in healthcare facilities for complications following unsafe termination of pregnancy, finds a study published BJOG.
Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. Unsafe termination of pregnancy accounts for 8 – 15% of maternal deaths and remains one of the leading causes of maternal mortality worldwide. However, these figures do not take into account the number of women who are surviving but need hospital treatment.
This study, conducted by the Guttmacher Institute in the US, used data from official health statistics and scientific studies from 26 countries in the developing world to calculate the number of women attending hospital for treatment following an unsafe termination of pregnancy. Data were adjusted to take into account women receiving treatment in the private sector and to exclude those who needed treatment after miscarriage.
Results found that the highest rate of treatment after unsafe termination of pregnancy was in Pakistan, with rates of 14.6 per 1000 women aged between 15 and 44. The lowest treatment rate was found in Brazil with 2.4 per 1000 women.
The results indicate that the regional rate is highest in Asia (excluding Eastern Asia) at 8.2 per 1000 women (4.6 million women per year), driven largely by high rates in South-Central Asia. It is followed by Africa, with an average regional rate of 6.7 (around 1.6 million women per year), and Latin America and the Caribbean, with a regional rate of 5.3 (757 000 women per year).
In addition to the health burden for women, treatment for complications from unsafe termination of pregnancy also results in substantial costs to both women, their families and healthcare systems. An estimated $232 million is spent each year by healthcare systems on post-abortion care in the developing world.
Dr Susheela Singh from the Guttmacher Institute and lead author of the study, said:
“We already know that around 22 million unsafe abortions take place each year, resulting in the death of at least 22,000 women. Our study provides further evidence about the number of women who suffer injury as a result of complications due to unsafe abortion, often leading to chronic disability. These statistics represent only part of the problem as they do not include women who need care but do not visit health facilities.
“The provision of better reproductive healthcare, including access to family planning services, contraception and safe abortion where the law allows, would have significant economic benefits as well as improving the health and wellbeing of women and their families.”
John Thorp, Deputy Editor-in-Chief of BJOG, said:
“This study demonstrates the importance of understanding the scope of the global problem in providing appropriate emergency care and counselling for these women, and in providing better reproductive healthcare to reduce unsafe termination of pregnancy.”
 WHO: http://www.who.int/mediacentre/factsheets/fs348/en/
 Guttmacher Institute: https://www.guttmacher.org/pubs/AddingItUp2014.pdf
In this paper, a termination of pregnancy is defined as a procedure for terminating an unwanted pregnancy before independent viability, typically defined as before 22 weeks; this procedure is referred to as unsafe if it is carried out ‘by persons lacking the necessary skills or in an environment lacking minimal medical standards or both. The authors use the term postabortion or abortion complications to refer to complications arising from either an unsafe TOP or miscarriage; postabortion care is the treatment of these complications at either a public or private health facility.
Full paper: Susheela Singh, Isaac Maddow-Zimet. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: A review of evidence from 26 countries. BJOG: An International Journal of Obstetrics and Gynaecology (BJOG) 2015; DOI: 10.1111/1471-0528.13552