Estimating abortion incidence among adolescents and differences in postabortion care by age: a cross-sectional study of postabortion care patients in Uganda

Abstract

Objectives:To provide the first estimate of adolescents’ abortion incidence in Uganda and to assess differences in the abortion experiences and morbidities of adolescent and nonadolescent postabortion care (PAC) patients.Study design:We used the age-specific Abortion Incidence Complications Method, drawing from three surveys conducted in Uganda in 2013: a nationally representative Health Facilities Survey (n=418), a Health Professionals Survey (n=147) and a Prospective Morbidity Survey of PAC patients (n=2169). Multivariable logistic and Cox proportional hazard models were used to compare adolescent and nonadolescent PAC patients on dimensions including pregnancy intention, gestational age, abortion safety, delays to care, severity of complications and receipt of postabortion family planning. We included an interaction term between adolescents and marital status to assess heterogeneity among adolescents.Results:Adolescent women have the lowest abortion rate among women less than 35 years of age (28.4 abortions per 1000 women 15–19) but the highest rate among recently sexually active women (76.1 abortions per 1000 women 15–19). We do not find that adolescents face greater disadvantages in their abortion care experiences as compared to older women. However, unmarried PAC patients, both adolescent and nonadolescent, have higher odds of experiencing severe complications than nonadolescent married women.Conclusions:The high abortion rate among sexually active adolescents highlights the critical need to improve adolescent family planning in Uganda. Interventions to prevent unintended pregnancy and to reduce unsafe abortion may be particularly important for unmarried adolescents. Rather than treating adolescents as a homogenous group, we need to understand how marriage and other social factors shape reproductive health outcomes.Implications:This paper provides the first estimate of the adolescent abortion rate in Uganda. Studies of adolescent abortion and reproductive health must account for sexual activity and marital status. Further, interventions to address unintended pregnancy and unsafe abortion among unmarried women of all ages in Africa should be a priority.

Abortion among adolescents in Africa: A review of practices, consequences, and control strategies

“…In 2018, the Southern African region registered the highest abortion rate at 24%, followed by Northern Africa, Eastern Africa, Central Africa, and Western Africa at 23%, 14%, 13%, and 12%, respectively . However, in all regions, adolescents who are sexually active are more vulnerable than women older than 20 years of age with respect to their experiences and needs for and access to safe abortion care . First, they have a higher risk of unintended pregnancy and are unable to recognize it early compared to older women.…”

“…Additional factors include gender inequality, an unmet need for contraceptive use, sexual education, high cost, and restrictive abortion laws . The issue of stigma is a serious issue, as highlighted by many other studies …”

“…Another study conducted in Uganda indicated that 46% of adolescents had ever had sex, and 80% were not married. Because pregnancy carries different socio‐cultural implications for unmarried adolescents than married women generally, those who unintentionally become pregnant may resort to unsafe methods of inducing abortion . Adolescents generally suffer a greater impact because they are vulnerable, have inadequate sexual and reproductive health information, and are unable to make firm choices .…”

“…Abortions induced by oneself or by traditional healers, result in complications, with infections in 81.8% of women and haemorrhage in 68.2% of women, and in some instances, the process results in incomplete abortion . There are higher odds of such complications among unmarried adolescents and non‐adolescents than among married women in both categories . Adolescents, especially students, are aware of safe abortion services but may not use them due to costs and associated stigma .…”

“…Nonetheless, in Asia and Europe, older women procure abortion mainly to limit or space births . Adolescents from African countries may particularly pursue abortions because of probable consequences such as stigmatization . It is often procured through clandestine measures and in unhygienic hidden places, offered by untrained practitioners .…”