Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion
by Mariana Romero, Rodolfo Gomez Ponce de Leon, Luiz Francisco Baccaro, Berenise Carroli, Hedieh Mehrtash, and 16 others
BMJ Global Health 2021;6(8) (Open access) DOI: 10.1136/bmjgh-2021-005618
Introduction – Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women’s experiences with abortion care in selected countries of the Americas region.
Methods – This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women’s characteristics, including socio-demographics, obstetric history, clinical information, management procedures and, using an Audio Computer-Assisted Self-Interviewing (ACASI) survey, the experience of abortion care. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical, mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.
Results – We collected data on 7,983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.
Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, vacuum aspiration being the most common one (5007/7437, 67.4%).
Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity.
Conclusions – This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women’s experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.
What is already known?
- Globally, the Latin America and Caribbean (LAC) region has the most legally restrictive abortion laws and policies.
- Complications as a result of abortions account for 9.9% (8.1–13) of maternal deaths in the LAC region.
- Estimates of post-abortion complications indicate that the LAC has lower complication rates than Asia and Africa, with a regional rate of 5.3 per 1000 women aged 15–44 years (around 757 000 women per year) reflecting a decrease from previous estimates (7.7 in 2005).
What are the new findings?
- This is one of the few global studies to provide data on abortion-related complications, collecting data across 70 health facilities in six LAC countries using a standardised tool.
- This study provides insights on the burden and management of abortion-related complications in health facilities in LAC region, using a hierarchal severity gradient, according to sociodemographic, obstetric and clinical characteristics.
- Although most women in our study were classified as having mild or moderate complications, the proportion of women with potentially life-threatening complications and with severe maternal outcomes (including death) is still high.
What do the new findings imply?
- The prevalence of these severe complications varies across countries illustrating that abortion continues to be a major public health and policy challenge to address in the LAC region.
- Future research in the region should focus on measurement of abortion-related complications using the standardised methodology proposed in this study to document the severity of abortion-related complications in the region.