The epidemiology of incomplete abortion in South Africa. National Incomplete Abortion Reference Group

Abstract

Objective: To describe the epidemiology of incomplete abortion (spontaneous miscarriage and illegally induced) in South Africa.

Design: Multicentre, prospective, descriptive study.

Setting: Fifty-six public hospitals in nine provinces (a stratified, random sample of all hospitals treating gynaecological emergencies).

Patients: All women of gestation under 22 weeks who presented with incomplete abortion during the 2-week study period.

Main outcome measures: Incidence of, morbidity associated with and mortality from incomplete abortion.

Main results: An estimated 44686 (95% CI 35633-53709) women per year were admitted to South Africa's public hospitals with incomplete abortion. An estimated 425 (95% CI 78-735) women die in public hospitals from complications of abortion. Fifteen per cent (95% CI 13-18) of patients have severe morbidity while a further 19% (95% CI 16-22) have moderate morbidity, as assessed by categories designed for the study which largely reflect infection. There were marked inter-provincial differences and inter-age group differences in trimester of presentation and proportion of patients with appreciable morbidity.

Conclusions: Incomplete abortions and, in particular, unsafe abortions are an important cause of mortality and morbidity in South Africa. The methods used in this study underestimate the true incidence for reasons that are discussed. A high priority should be given to the prevention of unsafe abortion.