Termination of pregnancy in Curaçao: need for improvement of sexual and reproductive healthcare

Abstract

Background: In Curaçao Termination of Pregnancy (TOP) is still forbidden by law, although a policy of tolerance has been stipulated since 1999. This paper is about the prevalence of TOP and about its health complications. These data on TOP are officially unknown but are suspected to be rather high.

Methods: One year registration of illegal performed termination of pregnancy cases by all general physicians (GPs) practicing TOP in Curaçao. The registration included patient characteristics according to the model of the National Abortion Registration in The Netherlands, adjusted to the local Curaçao situation. Socio demographic characteristics, number of previous pregnancies and TOPs, pregnancy duration, contraception methods and reason for failure were registered. The comparative part of the research compares TOP rates of Curaçao with those of Antillean women in the Netherlands. The gynaecologists in the referral hospital registered complications requiring hospital admission after TOP.

Results: All GPs performing TOP participated and the majority registered extensively. The total number of registered TOP was 1126. 666 of the 1126 were registered using the local adjusted Abortion Registration Model. With 30.000 women aged between 15 and 45 living in Curaçao, the TOP rate was at least 38 (per 1000 in that age category), comparable to rates for Antillean women in the Netherlands. Mean age was 26.9 years. Nearly half (47%) had one or more TOPs before; the majority (53%) was less than 7 weeks pregnant and two third (67%) had one or more children. Two third of the women did not use contraception (63%). For those using contraception, main reason for failure was inconsistent use (50%). There were 14 hospital admissions due to complications of TOP.

Conclusion: The number of TOP is high in Curaçao and comparable to (first generation) Antillean women living abroad in the Netherlands. Most unintended pregnancies originated from no or inconsistent use of reliable contraception. Improvement of sex education is necessary in order to bring down the number of TOP, as well as realizing accessible and affordable contraception, including sterilization. The number of complications around TOPs was equal to other countries where TOP is illegal.