Induced abortion in sub-Saharan Africa: what we do and do not know

Abstract

The first step in addressing the growing public health problem of abortion in sub-Saharan Africa is to gain a better understanding of the problem and its complexities. Abortion behavior is inextricably connected with issues of women's roles and opportunities, and until the various dimensions of abortion behavior and its socioeconomic context are understood, governments will have difficulty addressing the problem effectively. In addition, abortion needs to be studied within the broader framework of reproductive health. In a continent where fertility is highly valued and infertility prevalent, the interaction between abortion, practice of contraception, and fears of infertility must be fully understood if we are to have any hope of reducing the numbers of unwanted pregnancies and the morbidity and mortality caused by induced abortion.

PIP: This paper reviews the literature on abortion in subSahara Africa, identifies the gaps in existing knowledge, and makes recommendations for future research and action. African policymakers and health authorities are expressing concern over the numbers of clandestine abortions they see and the resulting morbidity and mortality associated with these proceedures. Abortion-related deaths are a major cause of maternity mortality in Africa, and the treatment of incomplete and septic abortions is severely taxing the scarce health resources of governments throughout the region. Yet the existing literature only hints at the magnitude and urgency of the problem and provides very little information on its nature or social epidemiology. Throughout subSaharan Africa, abortion is highly restricted. Only 7 countries permit abortion for reasons other than those directly threatening a woman's life, and in only 1 country, Zambia, is it legal or social or socioeconomic grounds. Even where the laws are liberal, the availability of services is so poor and the requirement for an elective procedure so great that most abotions continue to be clandestine. For example, at the University Teaching Hospital in Zambia, for every 1 abortion that is performed legally, 9 incomplete abortions are being treated. 3 categories of research are required: 1) epidemiological and community-based studies that estimate the prevalence of abortion and identify the groups of women resorting to abortion; 2) in-depth surveys and qualitative research to elucidate the social and cultural context of induced abortion; and 3) operations research to improve access to safe abortion and contraceptive services.