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. 2025 May 21;25(1):732.
doi: 10.1186/s12913-025-12896-2.

Voluntary termination of pregnancy in the context of decriminalized safe abortion: a longitudinal study on the availability, coverage, and utilization of services during 2016-2021 in Nampula province, northern Mozambique

Gilda Gondola Sitefane  1 , Birgitta Essén  2 , Osvaldo Loquiha  3 , Khátia Munguambe  4 , Esmeralda Mariano  5 , William Ugarte  2 , Pia Axemo  2
Affiliations

Voluntary termination of pregnancy in the context of decriminalized safe abortion: a longitudinal study on the availability, coverage, and utilization of services during 2016-2021 in Nampula province, northern Mozambique

Gilda Gondola Sitefane et al. BMC Health Serv Res. .

Abstract

Background: Reducing maternal deaths is a critical public health concern. The Sustainable Development Goals (SDGs) aim to reduce maternal mortality globally to less than 70/100,000 live births by 2030. Mozambique has one of the highest maternal mortality rates in the world, at 233/100,000 live births. Of all maternal deaths, 11% are attributed to abortion. Mozambique decriminalized abortion in 2014 under certain conditions and approved clinical guidelines for service provision in 2016, aiming to reduce maternal deaths from unsafe abortion. This study assesses the availability, coverage, and utilization of facility-based voluntary termination of pregnancy (VTP) during the period 2016-2021 in Nampula province, northern Mozambique.

Methods: A descriptive quantitative study was performed, using secondary data analysis extracted from the national health monitoring information system (SIS-MA). Trends in the availability and utilization of VTP services were calculated from 2016 to 2021. The results were analysed while considering the geospatial distribution, coverage, and level of care of health facilities providing such services.

Results: Utilization of VTP services significantly increased by 77% (p < 0.001) and complications related to unsafe abortion decreased by 23.5% (p = 0.018) during 2016-2021.

Conclusions: Despite the significant improvement in service availability and utilization, the geographic distribution and population coverage of public health facilities providing services remains uneven and limited to semi-urban and urban areas, leaving unsafe abortion as the only option for women in rural areas. Despite these challenges, the results of this study reinforce scientific evidence that decriminalization of VTP and expansion of services may significantly improve access to and utilization of facility-based VTP, holding great potential for decreasing unsafe abortion-related complications and deaths.

Keywords: Availability; Coverage; Decriminalization; Distribution; Mozambique; Nampula; Utilization; Voluntary termination of pregnancy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Scientific Committee and the Institutional Bioethics Committee for Health at the Maputo Faculty of Medicine (CIBS FM/HCM), (# CIBSFM&HCM/122/2019). It received administrative authorization from the cabinet of the Minister of Health. The Scientific Committee of Uppsala University reviewed and approved the protocol. Consent for publication: All authors reviewed and approved this manuscript version to be submitted and published at BMC Health Services Research. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trends in admissions for abortion in Nampula, 2016–2021
Fig. 2
Fig. 2
Trends in abortion-related complications in Nampula, 2016–2021
Fig. 3
Fig. 3
Admissions for abortion by level of care in Nampula, 2016–2021
Fig. 4
Fig. 4
Population coverage of WRA by health facilities with VTP services, per district, 2021
See this image and copyright information in PMC

References

    1. World Health Organization. Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2008. 6th ed. Geneva: World Health Organization; 2011.
    1. United Nations. Transforming our world: the 2030 agenda for sustainable development. A/RES/70/1. 2015.
    1. World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, world bank group and the united nations population division. Geneva: World Health Organization; 2019.
    1. National Institute of Statistics and Ministry of Health. Demographic and health [Portuguese]nquiry 1997 [Portuguese]. Maputo: Government of Mozambique; 1998.
    1. National Institute of Statistics and Ministry of Health. Demographic and health [Portuguese]nquiry 2003 [Portuguese]. Maputo: Government of Mozambique; 2005.

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