INDIA – Unsafe abortion and abortion-related death among 1.8 million women in India

Iby Ryo Yokoe, Rachel Rowe, Saswati Sanyal Choudhury, Anjali Rani, Farzana Zahir, Manisha Nair

BMJ Global Health, 2019 May;4(3) DOI: (Open access)

Abstract [adjusted odds ratios omitted, text added from main article]

Introduction: Unsafe abortion is a preventable cause of maternal mortality. While studies report high number of abortions in India, the population-level rates of unsafe abortion and their risk factors are not well understood. Our objective was to analyse the rates of and risk factors for unsafe abortion and abortion-related maternal death in India.

Methods: We conducted a secondary analysis of data from 1,876,462 pregnant women aged 15–58 years from nine states in the Indian Annual Health Survey (2010–2013). We calculated the rate of unsafe abortion and abortion-related mortality with 95% confident interval. Multivariable logistic regression models examined the associations of socio-demographic characteristics, health seeking behaviours and family planning with unsafe abortion and abortion-related mortality.

Results: There were 89,447 abortions among 1,876,462 pregnant women in 2007–2011 (4.8%). Of these, 58,266 were classified as unsafe (67.1%, range 45.1%–78.3%). There were 253 abortion-related maternal deaths (0.3%) which did not vary appreciably across the states. Factors associated with unsafe abortions were different from those associated with abortion-related mortality. Factors associated with unsafe abortion were: maternal age 20–24 years, illiteracy, rural residence, Muslim religion, Schedule caste social group, poorest asset quintile, antenatal care, no surviving children, all surviving children being female, use of family planning methods. Factors associated with abortion-related deaths were: maternal age 15–19, rural residence, Schedule tribe social group.

Conclusion: Despite abortion being legal, the high estimated prevalence of unsafe abortion demonstrates a major public health problem in India. Socio-economic vulnerability and inadequate access to healthcare services combine to leave large numbers of women at risk of unsafe abortion and abortion-related death. There was a disproportionately higher risk of unsafe abortion among the vulnerable and disadvantaged populations in India. Young women aged 15–19 years were at the highest risk of dying from an abortion-related complication.

PHOTO: by Poulomi Basu for US National Public Radio, 31 December 2014