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. 2018 Jun;62(6):729-736.
doi: 10.1016/j.jadohealth.2017.12.015. Epub 2018 Mar 14.

Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia

Elizabeth Sully  1 , Yohannes Dibaba  2 , Tamara Fetters  2 , Nakeisha Blades  3 , Akinrinola Bankole  3
Affiliations

Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia

Elizabeth Sully et al. J Adolesc Health. 2018 Jun.

Abstract

Purpose: The 2005 expansion of the Ethiopian abortion law provided minors access to legal abortions, yet little is known about abortion among adolescents. This paper estimates the incidence of legal and clandestine abortions and the severity of abortion-related complications among adolescent and nonadolescent women in Ethiopia in 2014.

Methods: This paper uses data from three surveys: a Health Facility Survey (n = 822) to collect data on legal abortions and postabortion complications, a Health Professionals Survey (n = 82) to estimate the share of clandestine abortions that resulted in treated complications, and a Prospective Data Survey (n = 5,604) to collect data on abortion care clients. An age-specific variant of the Abortion Incidence Complications Method was used to estimate abortions by age-group.

Results: Adolescents have the lowest abortion rate among all women below age 35 (19.6 per 1,000 women). After adjusting for lower levels of sexual activity among adolescents however, we find that adolescents have the highest abortion rate among all age-groups. Adolescents also have the highest proportion (64%) of legal abortions compared with other age-groups. We find no differences in the severity of abortion-related complications between adolescent and nonadolescent women.

Conclusions: We find no evidence that adolescents are more likely than older women to have clandestine abortions. However, the higher abortion and pregnancy rates among sexually active adolescents suggest that they face barriers in access to and use of contraceptive services. Further work is needed to address the persistence of clandestine abortions among adolescents in a context where safe and legal abortion is available.

Keywords: Abortion, clandestine; Abortion, complications; Abortion, induced; Abortion, legal; Adolescent; Family planning; Unintended pregnancy.

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Conflict of interest statement

Conflicts of Interest:The authors do not have financial relationships with any organizations that might have an interest in the submitted work. They have no other relationships or activities that could influence or appear to have influenced the submitted work.

Figures

Figure 1.
Figure 1.
Methodology for estimating legal and clandestine abortions by age-group.
Figure 2.
Figure 2.
Abortion rate and ratio by age-group in Ethiopia in 2014 (abortion rate constructed for all women, for ever-sexually active women, and for women sexually active in the past 12 months). Source: HFS, PDS and HPS (See Figure 1 and Appendix A).
Figure 3.
Figure 3.
Legal and clandestine abortion rates and the percentage of legal abortions by age-group, Ethiopia 2014. Source: HFS, PDS and HPS (See Figure 1 and Appendix A). Notes: Calculated among all reproductive age women 15–49 years.
Figure 4.
Figure 4.
Pregnancies by intention status and outcome, Ethiopia 2014. Source: Abortions estimated using HFS, PDS and HPS data (See Figure 1 and Appendix A). Births by intention status estimated from the 2014 Ethiopian Mini DHS [26] and Central Statistical Agency[25]. Miscarriages estimated as 20% of all live births and 10% of abortions [32]. Notes: Calculated among all reproductive age women 15–49 years.
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References

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