Abortion Rates Vary Significantly

The abortion rate in Uganda, 39, is three times greater than in GB, 13.
The abortion rate in Kampala, 77, is twice the national average.

There is one complication for every 2.4 abortions in Uganda, a rate which is 262 times higher than in England and Wales.

If you work in sexual and reproductive health and rights, SRHR, and/or have an interest in maternal health, then you probably review the abortion rate data for your country of interest. Last month Guttmacher published a new report which highlights the ongoing disparities in abortion rates and in access to safe abortion services across the globe.

A key headline from Guttmacher outlined how abortion rates have remained steady across developing regions while declining in developed regions. In the latter, the average abortion rate, the annual number of abortions per 1,000 women aged 15-45, dropped from 46 in the years 1990-94, to 27 in the years 2010-14; in developing regions the movement was from 39 to 36. These are averages, and most are estimates rather than based on actual clients’ data.

In England, the doctor responsible for the abortion client must notify the Chief Medical Officer by completion and submission of the Abortion notification form, HSA4. The average abortion rate is derived from data on these forms, and so it is reliable for planning purposes.

In many countries, such as Uganda, the abortion rate is estimated using the Abortion Incidence Complications Method (AICM), which is explained in a research paper by Prada E et al “Incidence of Induced Abortion in Uganda, 2013: New Estimates Since 2003” published here on PLOS One. Researchers also examine patterns of hospitalisation due to abortion-related complications, a key indicator of morbidity resulting from unsafe abortion.

Going beyond the headlines and global averages we see that the abortion rate estimated by Guttmacher for Uganda is 39, three times greater than the rate in GB, 13 (this is noted as 16 for England and Wales in the latest Department of Health Report on abortion statistics in England and Wales for 2016). There are many reasons for this significant difference, and in a recent post I noted five actions that are necessary to address the disparities:

  • Allow women and adolescents self-determination;
  • Make effective contraception easily accessible;
  • Change restrictive legislation;
  • Remove price barriers;
  • Train and equip willing Health Service Providers.

During 2016 in England and Wales there were a total of 190,406 abortions, and only 294 reported complications, which is a very low rate of about one complication in every 630 abortions. The latest annual data for Uganda, 2013, show a total of 314,304 abortions, from which an estimated 128,682 women were treated for complications. This is a staggeringly high rate of one complication in every 2.4 abortions, 262 times higher than in England and Wales, which demonstrates the very significant detrimental impact of unsafe abortions on women’s’ health.

Going even further into these Uganda data we find that the estimated abortion rates vary widely across the country, and eg in Kampala the rate is twice the national average. It is also worth noting the variance between the low and high AICM estimates, the bars shown in this graph.

Uganda Abortion Rate

We need to be aware of these regional differences when planning and, of course, also take account of the total estimated numbers in each, as shown here for 2013.

Uganda Abortion Numbers

About Kevin Duffy

Interim Management and Consulting - Global Healthcare Development. Kevin has over ten years of senior management experience in the delivery of healthcare services in Africa and South Asia. His current focus is on the strategic development of policy, guidance, and tools to help healthcare organisations achieve sustainable impact – balancing the need to become financially sustainable, with the mission of ensuring equitable access to affordable healthcare services.
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