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. 2018 Oct 24;13(10):e0205239.
doi: 10.1371/journal.pone.0205239. eCollection 2018.

Abortion in Zimbabwe: A national study of the incidence of induced abortion, unintended pregnancy and post-abortion care in 2016

Elizabeth A Sully  1 , Mugove Gerald Madziyire  2 , Taylor Riley  1 , Ann M Moore  1 , Marjorie Crowell  1 , Margaret Tambudzai Nyandoro  3 , Bernard Madzima  3 , Tsungai Chipato  2
Affiliations

Abortion in Zimbabwe: A national study of the incidence of induced abortion, unintended pregnancy and post-abortion care in 2016

Elizabeth A Sully et al. PLoS One. .

Erratum in

Abstract

Background: Zimbabwe has the highest contraceptive prevalence rate in sub-Saharan Africa, but also one of the highest maternal mortality ratios in the world. Little is known, however, about the incidence of abortion and post-abortion care (PAC) in Zimbabwe. Access to legal abortion is rare, and limited to circumstances of rape, incest, fetal impairment, or to save the woman's life.

Objectives: This paper estimates a) the national provision of PAC, b) the first-ever national incidence of induced abortion in Zimbabwe, and c) the proportion of pregnancies that are unintended.

Methods: We use the Abortion Incidence Complications Method (AICM), which indirectly estimates the incidence of induced abortion by obtaining a national estimate of PAC cases, and then estimates what proportion of all induced abortions in the country would result in women receiving PAC. Three national surveys were conducted in 2016: a census of health facilities with PAC capacity (n = 227), a prospective survey of women seeking abortion-related care in a nationally-representative sample of those facilities (n = 127 facilities), and a purposive sample of experts knowledgeable about abortion in Zimbabwe (n = 118). The estimate of induced abortion, along with census and Demographic Health Survey data was used to estimate unintended pregnancy.

Results: There were an estimated 25,245 PAC patients treated in Zimbabwe in 2016, but there were critical gaps in their care, including stock-outs of essential PAC medicines at half of facilities. Approximately 66,847 induced abortions (uncertainty interval (UI): 54,000-86,171) occurred in Zimbabwe in 2016, which translates to a national rate of 17.8 (UI: 14.4-22.9) abortions per 1,000 women 15-49. Overall, 40% of pregnancies were unintended in 2016, and one-quarter of all unintended pregnancies ended in abortion.

Conclusion: Zimbabwe has one of the lowest abortion rates in sub-Saharan Africa, likely due to high rates of contraceptive use. There are gaps in the health care system affecting the provision of quality PAC, potentially due to the prolonged economic crisis. These findings can inform and improve policies and programs addressing unsafe abortion and PAC in Zimbabwe.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Abortion Incidence Complications Methodology (AICM), with adjustments made for Zimbabwe.
a Abortion methods include surgical methods, misoprostol, and other methods of abortion. b Sub-groups include rural poor women, rural non-poor women, urban poor women, urban non-poor women.
Fig 2
Fig 2. Breakdown of induced abortions by complication and treatment status, nationally and by subgroup, Zimbabwe 2016.
See this image and copyright information in PMC

References

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    1. Zimbabwe Termination of Pregnancy Act [Chapter 15:10] [Internet]. 1977. Available: http://www.parlzim.gov.zw/acts-list/termination-of-pregnancy-act-15-10
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